Researching special populations: retention of Latino gay and bisexual men and transgender persons in longitudinal health research

Factors associated with the retention of travestis and transgender women living with HIV in a peer navigation intervention in São Paulo, Brazil

Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome ("retention at nine months", regardless of contact at three months, defined by the "full completion of the final questionnaire"), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.

The perceived social rejection of sexual minorities: Substance use and unprotected sexual intercourse

INTRODUCTION

This study presents associations between the perceived social rejection of sexual minorities and tobacco, alcohol and cannabis consumption and unprotected sexual intercourse in the capital of Greece, Athens. This is the first Greek study to evaluate the concept of the minority stress theory on sexual minorities' substance use and unprotected sexual intercourse. In addition, this is among the first international studies to examine whether periods of adverse economic conditions are associated with sexual minorities' substance use and unprotected sexual intercourse.

METHODS

Two-panel datasets covering the periods 2013-2014 and 2018-2019 were used to determine the perceived social rejection, that is, whether sexual minorities have been rejected by friends, treated unfairly in educational and/or workplace environments, treated negatively in social situations and received poor health and public services due to their sexuality.

RESULTS

The estimates indicate that perceived social rejection is associated with the increased consumption of tobacco (by 9.1%, P < 0.01), alcohol (by 7.1%, P < 0.01) and cannabis (by 12.5%, P < 0.01), as well as unprotected sexual intercourse (by 6.5%, P < 0.01). In the first three cases, the magnitude of the associations is stronger for men than women and there is increased cannabis consumption during periods of deteriorated economic conditions (by 5.5%, P < 0.01).

DISCUSSION AND CONCLUSIONS

In the European Union, reducing stigma, substance use, risky sexual behaviours and health inequalities for sexual minorities is a goal of public health. If minority stress is correlated with substance use and risky sexual behaviours leading to detrimental physical/mental health outcomes then prevention and support interventions should be designed.

Youth Characteristics Associated With Sexual Violence Perpetration Among Transgender Boys and Girls, Cisgender Boys and Girls, and Nonbinary Youth

IMPORTANCE

Gender minority adults experience higher rates of sexual violence (SV) than cisgender adults. How this disparity extends to youths, including perpetration rates, is unknown.

OBJECTIVE

To compare rates of experience and perpetration of SV by gender identity and investigate characteristics associated with odds of perpetration within gender identity categories.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used baseline data from a national online longitudinal survey collected in 2018 to 2020. Eligible participants were youths ages 14 to 16 years who read English and had internet access. Data were analyzed in November 2021 and March 2022.

EXPOSURES

Youth characteristics included stressors associated with being marginalized (eg, internalized transphobia), general stressors (eg, trauma not associated with experiencing SV), other marginalized statuses (eg, identifying as a girl), factors associated with protection (eg, social support), environmental characteristics (eg, community violence exposure), and risk factors associated with SV (eg, consumption of violent pornography).

MAIN OUTCOMES AND MEASURES

Self-reported rates of experiencing and perpetrating SV, defined as sexual assault, rape, attempted rape, and coercive sex, among cisgender, transgender, and nonbinary youths.

RESULTS

Among 4193 youths in the sample (mean [SD] age, 14.8 [0.7] years), 3282 participants (78.3%) were cisgender, 329 participants (7.9%) were transgender, and 582 participants (13.9%) were nonbinary. The odds of SV perpetration were not statistically significantly different for transgender boys and girls (odds ratio [OR], 0.90; 95% CI, 0.57-1.41; P = .64) or nonbinary youths (OR, 0.78; 95% CI, 0.54-1.12; P = .18) compared with cisgender boys and girls. By contrast, transgender boys and girls (OR, 2.31; 95% CI, 1.83-2.91; P < .001) and nonbinary youths (OR, 2.37; 95% CI, 1.98-2.83; P < .001) were more than 2-fold as likely as cisgender boys and girls to report experiencing SV. Aggressive behavior was associated with higher odds of SV perpetration for transgender boys and girls (adjusted OR [aOR], 1.87; 95% CI, 0.75-4.65; P = .18) and nonbinary youths (aOR, 1.61; 95% CI, 0.78-3.32; P = .20). Indications of hostile masculinity were associated with higher odds of SV perpetration among cisgender youths (ie, positive attitudes for boys to engage in rape behaviors: aOR per unit increase in score, 1.15; 95% CI, 1.07-1.25; P < .001; sexual dominance: aOR per unit increase in score, 1.03; 95% CI, 1.01-1.04; P < .001) but not among transgender or nonbinary youths.

CONCLUSION AND RELEVANCE

These findings may suggest an important foundation for the development of inclusive, research-based SV prevention programs and methods for incorporating gender identity effectively into SV research.

Interventions for Hispanic/Latino gay, bisexual, and men who have sex with men: Critical appraisal

OBJECTIVE

Some interventions have been developed and tested to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and men who have sex with men (MSM). The purpose of this paper is to critically appraise published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM.

DESIGN/SAMPLE/MEASUREMENT

A critical appraisal of published interventions designed to reduce high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM was conducted. Using guidelines established by the Johns Hopkins Nursing Evidence-Based Practice Rating Scale published research articles were categorized and evaluated using these guidelines.

RESULTS

The critical appraisal identified nine intervention studies that met all inclusion criteria. The critical appraisal of these interventions highlighted strengths and weaknesses of these interventions which should be considered when developing future interventions to decrease high risk sexual practices among Hispanic/Latino gay, bisexual, and MSM.

CONCLUSION

While several interventions have been created to specifically address HIV infection among Hispanic/Latino gay, bisexual, and MSM, these interventions were varied. Suggestions for future intervention development to decrease high risk sexual behaviors among Hispanic/Latino gay, bisexual, and MSM based on the findings of the critical appraisal of the literature are included.

Reasons Lesbian and Bisexual Adolescent Girls Have or Might Have Sex with Females or Males: Implications for Discordance between Sexual Identity and Behaviors and for Prevention of Pregnancy and STIs

We examined reasons lesbian and bisexual adolescent girls have sex or, if sexually inexperienced, might have sex with girls or boys, and the role of internalized homonegativity in these relations and among lesbians. Girls were recruited online and classified as lesbian (n = 129) or bisexual (n = 193); the classification was validated. Love and pleasure were common reasons for having sex with girls, although more lesbian girls (LG) than bisexual girls (BG) endorsed love. BG, relative to LG, had sex with girls because they were curious or wanted to verify their sexual identity. Love and pleasure were motives for having sex with boys for BG. They were common reasons for potentially having sex with either sex among sexually inexperienced girls, but both were more likely for BG than LG for sex with boys. Internalized homonegativity did not mediate the relation between sexual identity and reasons for sex, but LG just with male partners were more homonegative than LG just with female partners. The findings indicate that LG and BG should not be combined into a single group, provide insights into the discordance between sexual identity and behaviors, and have implications for reducing risk for pregnancy and sexually transmitted infections among sexual minority girls.

Effects of victimization on mental health and substance use trajectories in young sexual minority men

Young sexual minority men (YSMM) experience more victimization and are at higher risk for mental health and substance use problems compared with heterosexual youth. We attempt to understand change over time in the experience of these constructs among YSMM. Data were taken from a diverse community-based sample of YSMM (N = 450, baseline mean age 18.93) surveyed every 6 months for 2.5 years. Multilevel modeling was used to model within-person change in victimization, internalizing symptoms, externalizing symptoms, alcohol frequency, marijuana use, and illicit drug use. We tested the indirect effect of concurrent and time-lagged victimization on the association between age and mental health and substance use. Victimization, internalizing symptoms, and externalizing symptoms decreased over time. Concurrent victimization was associated with higher internalizing symptoms, externalizing symptoms, alcohol use, marijuana use, and illicit drug use. Analysis of indirect effects suggested that the association between victimization and mental health and substance use outcomes decreased as participants transitioned from adolescence into adulthood. This study found that the reduction in victimization that YSMM experience as they grow older is associated with a reduction in negative mental health and substance use outcomes. Prevention efforts to limit victimization exposure may reduce health disparities for YSMM.

Individual and Network Factors Associated With Racial Disparities in HIV Among Young Men Who Have Sex With Men: Results From the RADAR Cohort Study

BACKGROUND

Individual sexual risk behaviors have failed to explain the observed racial disparity in HIV acquisition. To increase understanding of potential drivers in disparities, we assessed differences across individual, network, and social determinants.

METHODS

Data come from RADAR (N = 1015), a longitudinal cohort study of multilevel HIV-risk factors among young men who have sex with men (YMSM) aged 16-29 years in Chicago, IL. Data collection includes biological specimens; network data, including detailed information about social, sexual, and drug-use networks; and psychosocial characteristics of YMSM.

RESULTS

Compared to white YMSM (24.8%) and Hispanic YMSM (30.0%), black YMSM (33.9%) had a higher prevalence of both HIV (32%; P < 0.001) and rectal sexually transmitted infections (26.5%; P = 0.011) with no observed differences in pre-exposure prophylaxis use. Black YMSM reported lower rates of sexual risk behaviors and more lifetime HIV tests (P < 0.001) compared with all other YMSM; however, they were also significantly less likely to achieve viral suppression (P = 0.01). Black YMSM reported the highest rate of cannabis use (P = 0.03) as well as greater levels of stigma (P < 0.001), victimization (P = 0.04), trauma (P < 0.001), and childhood sexual abuse (P < 0.001). White YMSM reported higher rates of depression (P < 0.001) and alcohol use (P < 0.001). In network analyses, significant differences existed across network characteristics with black YMSM having the lowest transitivity (P = 0.002), the highest density (P < 0.001), and the highest homophily (P < 0.001).

CONCLUSIONS

Black YMSM do not report higher rates of HIV-risk behaviors, but social and network determinants are aligned toward increased HIV risk. These results suggest that network interventions and those addressing social determinants may help reduce disparities.

Barriers and recruitment strategies for precarious status migrants in Montreal, Canada

BACKGROUND

Precarious status migrants are a group of persons who are vulnerable, heterogeneous, and often suspicious of research teams. They are underrepresented in population-based research projects, and strategies to recruit them are described exclusively in terms of a single cultural group. We analyzed the recruitment strategies implemented during a research project aimed at understanding precarious status migrants' health status and healthcare access in Montreal, Canada. The research sample consisted of 854 persons recruited from a variety of ethnocultural communities between June 2016 and September 2017. This article analyzes the strategies implemented by the research team to respond to the challenges of that recruitment, and assess the effectiveness of those strategies. Based on the results, we share the lessons learned with a view to increasing precarious status migrants' representation in research.

METHOD

A mixed sequential design was used to combine qualitative data gathered from members of the research team at a reflexive workshop (n = 16) and in individual interviews (n = 15) with qualitative and quantitative data collected using the conceptual mapping method (n = 10).

RESULTS

The research team encountered challenges in implementing the strategies, related to the identification of the target population, the establishment of community partnerships, and suspicion on the part of the individuals approached. The combination of a venue-based sampling method, a communications strategy, and the snowball sampling method was key to the recruitment. Linking people with resources that could help them was useful in obtaining their effective and non-instrumental participation in the study. Creating a diverse and multicultural team helped build trust with participants. However, the strategy of matching the ethnocultural identity of the interviewer with that of the respondent was not systematically effective.

CONCLUSION

The interviewers' experience and their understanding of the issue are important factors to take into consideration in future research. More over, the development of a community resource guide tailored to the needs of participants should be major components of any research project targeting migrants. Finally, strategies should be implemented as the result of a continuous reflexive process among all members of the research team.

Evaluation of supplemental samples in longitudinal research with non-normal missing data

Missing data is a commonly encountered problem in longitudinal research. Methodological articles provide advice on ways to handle missing data at the analysis stage, however, there is less guidance for researchers who wish to use supplemental samples (i.e., the addition of new participants to the original sample after missing data appear at the second or later measurement occasions) to handle attrition. The purpose of this study is to evaluate the effects of using supplemental samples when analyzing longitudinal data that are non-normally distributed. We distinguish between two supplemental approaches: a refreshment approach where researchers select additional participants using the same criteria as the initial participants (i.e., random selection from the population of interest) and a replacement approach where researchers identify auxiliary variables that explain missingness and select new participants based on those attributes. Overall, simulation results suggest that the addition of refreshment samples, but not replacement samples, is an effective way to respond to attrition in longitudinal research. Indeed, use of refreshment samples may reduce bias of parameter estimates and increase efficiency and statistical power, whereas use of replacement samples results in biased parameter estimates. Our findings may be utilized by researchers considering using supplemental samples and provide guidance for selecting an appropriate supplemental sample approach.

The colours and contours of compassion: A systematic review of the perspectives of compassion among ethnically diverse patients and healthcare providers

OBJECTIVE

To identify and describe the perspectives, experiences, importance, and impact of compassionate care among ethnically diverse population groups.

METHODS

A systematic search of peer-reviewed research focused on compassionate care in ethnically diverse populations published between 1946 and 2017 was conducted.

RESULTS

A total of 2296 abstracts were retrieved, out of which 23 articles met the inclusion criteria. Synthesis of the literature identified the perspectives, facilitators and barriers of compassion in healthcare within ethnic groups. Compassion was described as being comprised of healthcare provider (HCP) virtues (honesty, kindness, helpful, non-judgment) and actions (smile, touch, care, support, flexibility) aimed at relieving the suffering of patients. The importance and impact of providing compassion to ethnically diverse patients was also identified which included overcoming cultural differences, alleviating distress at end-of-life, promoting patient dignity and improving patient care. This review also identified the need for more contextual studies directly exploring the topic of compassion from the perspectives of individuals within diverse ethnic groups, rather than superimposing a pre-defined, enculturated and researcher-based definition of compassion.

CONCLUSIONS

This review synthesizes the current evidence related to perceptions of compassion in healthcare among diverse ethnic groups and the role that compassion can play in bridging ethno-cultural differences and associated challenges, along with identifying gaps in literature related to compassionate care within diverse ethnic groups. Establishing an evidence base grounded in the direct accounts of members of diverse ethnic communities can enhance culturally sensitive compassionate care and improve compassion related health outcomes among diverse ethnic groups.

Trajectories of Internalized Heterosexism among Young Men Who have Sex with Men

Minority stress, or the unique stressors encountered by sexual minorities, has a significant impact on the mental health and well-being of this population. One minority stressor, internalized heterosexism, refers to incorporating stigma against sexual minorities into one's self-concept as a product of social bias. This minority stressor has been consistently related to worse mental health in sexual minorities. We evaluated experiences of internalized heterosexism longitudinally, over 24 months, in a sample of 450 young men who have sex with men (YMSM; age range = 16-20 years old at baseline). Latent class growth analyses revealed three classes: individuals with low-decreasing internalized heterosexism (57.1%), medium-stable internalized heterosexism (37.3%), and high-stable internalized heterosexism (5.6%). Multinomial logistic regression analyses revealed that some racial/ethnic minorities, non-gay identified individuals (i.e., bisexual/other), and individuals with less femininity and greater masculinity were significantly more likely to be in the medium- and high-stable internalized heterosexism classes. Higher victimization, as well as lower gay/bisexual community involvement, peer support, and outness predicted membership in the medium-stable internalized heterosexism class (relative to the low-decreasing class). Further, higher past 6-month victimization and lower outness were also predictive of high-stable internalized heterosexism class membership (relative to the low-decreasing class). These findings reveal that there is not a single trajectory of internalized heterosexism-the degree to which it changes differs across men and depends on demographic characteristics and interpersonal experiences. Furthermore, the results indicate interpersonal targets for future work aimed at promoting positive identity development and decreased internalized heterosexism for sexual minority youth.

Measuring stigma affecting sex workers (SW) and men who have sex with men (MSM): A systematic review

Background

Stigma involves discrediting a person or group based on a perceived attribute, behaviour or reputation associated with them. Sex workers (SW) and men who have sex with men (MSM) are key populations who are often at increased risk for the acquisition and transmission of HIV and who are affected by stigma that can negatively impact their health and well-being. Although stigma was included as an indicator in the US National HIV/AIDS Strategic Plan and there have been consultations focused on adding a stigma indicator within PEPFAR and the Global Fund in relation to potentiating HIV risks among key populations, there remains limited consensus on the appropriate measurement of SW- or MSM-associated stigma. Consequently, this systematic review summarizes studies using quantitative, qualitative, or mixed methods approaches to measure stigma affecting sex workers and men who have sex with men.

Methods and findings

This systematic review included English, French, and Spanish peer-reviewed research of any study design measuring SW- or MSM-associated stigma. Articles were published from January 1, 2004 to March 26, 2014 in PsycINFO, PubMed, EMBASE, CINAHL Plus, Global Health, and World Health Organization Global Health Library Regional Indexes.

Of the 541 articles reviewed, the majority measured stigma toward MSM (over 97%), were conducted in North America, used quantitative methods, and focused on internalized stigma.

Conclusions

With the inclusion of addressing stigma in several domestic and international HIV strategies, there is a need to ensure the use of validated metrics for stigma. The field to date has completed limited measurement of stigma affecting sex workers, and limited measurement of stigma affecting MSM outside of higher income settings. Moving forward requires a concerted effort integrating validated metrics of stigma into health-related surveys and programs for key populations.

Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte

OBJECTIVE

The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men.

METHODS

The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994–1999, 2000–2005, and 2006–2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model.

RESULTS

A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994–1999), 11.80 (2000–2005), and 9.00 (2006–2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21–30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex.

CONCLUSIONS

A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

Internalized Homophobia and Perceived Stigma: A Validation Study of Stigma Measures in a Sample of Young Men who Have Sex with Men

Young men who have sex with men (YMSM) experience minority stressors that impact their mental health, substance use, and sexual risk behaviors. Internalized homophobia (IH) and perceived stigma represent two of these minority stressors, and there has been limited research empirically validating measures of these constructs. We validated measures of IH and perceived stigma with a sample of 450 YMSM (mean age=18.9) and a sample of 370 YMSM (mean age=22.9). Results from exploratory and confirmatory factor analyses supported modifications to the IH and perceived stigma scales, ultimately revealing a three factor and one factor structure, respectively. Convergent and discriminant validity were examined utilizing correlations between IH, perceived stigma, and other variables related to minority stress (e.g., victimization). We evaluated predictive validity by examining relations with mental health, substance use, and risky sexual behaviors measured 12-months from baseline. There were mixed findings for IH, with subscales varying in their relations to mental health, drinking, and sexual risk variables. Perceived stigma was not related to mental health or substance use, but was associated with greater prevalence of STIs. Findings supported the use of these modified scales with YMSM and highlight the need for further measurement studies.

Prospective Effects of a Syndemic on HIV and STI Incidence and Risk Behaviors in a Cohort of Young Men Who Have Sex with Men

Young men who have sex with men continue to be highly affected by HIV. To improve understanding of the role that multiple co-occurring health issues (i.e., syndemics) play in HIV acquisition, sophisticated modeling methods are needed. The purpose of this study was to use structural equation modeling to understand the structure of the syndemic and to test its longitudinal association with condomless anal sex. Data are from a longitudinal study of 450 YMSM. A primary syndemic component comprised of substance use, violence, and internalizing mental health factors significantly predicted the number of condomless anal sex partners in the full sample. Analyses exploring associations by race/ethnicity found a significant association among White YMSM, but not among Black or Latino YMSM. Higher-order factor modeling suggests these psychosocial factors form a syndemic in all racial/ethnic groups, but the syndemic, as conceptualized here, may be less relevant to racial/ethnic minority YMSM.

The Impact of Victimization and Neuroticism on Mental Health in Young Men who have Sex with Men: Internalized Homophobia as an Underlying Mechanism

Sexual minorities experience greater mental health issues compared to heterosexuals due to minority stressors. This study focused on the impact of victimization and neuroticism on mental health in young men who have sex with men (YMSM), and the mediating role of internalized homophobia (IH). IH refers to when a sexual minority person internalizes social bias and develops a negative view of themselves, which is a likely process through which victimization and neuroticism impact mental health. Data were collected over three time points across 12 months, with 450 YMSM (mean age = 18.9) and an 80.7% retention rate. Two mediation analyses with bias-corrected bootstrapping using 1000 samples were conducted, controlling for age, race, and sexual orientation. Results revealed that victimization [F (9, 440) = 4.83, p < .001, R² = .09] and neuroticism [F (9, 440) = 12.23, p < .001, R² = .20] had a significant indirect effect on mental health via increased levels of IH. These findings show how external experiences of stigma and personality level characteristics may impact YMSM in terms of their sense of self. Furthermore, these results support addressing social conditions that marginalize YMSM in order to promote better mental health through decreasing IH.

Validation of the Sexual Orientation Microaggression Inventory in Two Diverse Samples of LGBTQ Youth

Critical race theory asserts that microaggressions, or low-level, covert acts of aggression, are commonplace in the lives of people of color. These theorists also assert a taxonomy of microaggressions, which includes "microassaults," "microinsults," and "microinvalidations". The theory of microaggressions has been adopted by researchers of LGBTQ communities. This study investigated the three-factor taxonomy as it relates to a diverse sample of LGBTQ youth using the newly developed Sexual Orientation Microaggression Inventory (SOMI). Exploratory factor analysis was used to determine the number of factors that exist in SOMI in a sample of 206 LGBTQ-identifying youth. Follow up confirmatory factor analyses were conducted in order to compare single-factor, unrestricted four-factor, second-order, and bi-factor models in a separate sample of 363 young men who have sex with men. The best fitting model was used to predict victimization, depressive symptoms, and depression diagnosis in order to test validity. The best fitting model was a bi-factor model utilizing 19 of the original 26 items with a general factor and four specific factors representing anti-gay attitudes ("microinsults"), denial of homosexuality, heterosexism ("microinvalidations"), and societal disapproval ("microassaults"). Reliability analyses found that the majority of reliable variance was accounted for by the general factor. The general factor was a significant predictor of victimization and depressive symptoms, as well as unrelated to social desirability, suggesting convergent, criterion-related, and discriminant validity. SOMI emerged as a scale with evidence of validity for assessing exposure to microaggressions in a diverse sample of LGBTQ youth.

The role of substance use motives in the associations between minority stressors and substance use problems among young men who have sex with men

Young men who have sex with men (YMSM) report higher rates of substance use than their heterosexual peers and minority stress has been posited as a risk factor for substance use. The associations between specific types of minority stress and substance use have been inconsistent throughout the literature and few studies have examined mechanisms underlying these associations. Drawing on minority stress theory and the motivational model of alcohol use, we propose that one mechanism underlying these associations may be people's motivations for using substances, including using substances to cope with negative emotions and to enhance pleasure. The goals of the current study were: (1) to examine the associations among minority stressors, substance use motives, and substance use problems; and (2) to examine substance use motives as mediators of the associations between minority stressors and substance use problems. Baseline self-report data were used from a cohort of 370 YMSM enrolled in a larger study of substance use and sexual behavior. Results indicated that using marijuana to cope mediated the association between victimization and marijuana use problems. Using other drugs to cope mediated the associations between victimization and drug use problems and between internalized stigma and drug use problems. Drinking to cope and to enhance pleasure mediated the association between internalized stigma and alcohol use problems. In sum, substance use motives, especially using substances to cope, act as mechanisms through which certain types of minority stress influence substance use problems among YMSM.

Challenges and strategies for cohort retention and data collection in an indigenous population: Australian Aboriginal Birth Cohort

BACKGROUND

Longitudinal prospective birth cohort studies are pivotal to identifying fundamental causes and determinants of disease and health over the life course. There is limited information about the challenges, retention, and collection strategies in the study of Indigenous populations. The aim is to describe the follow-up rates of an Australian Aboriginal Birth Cohort study and how they were achieved.

METHODS

Participants were 686 babies enrolled between January 1987 and March 1990, born to a mother recorded in the Delivery Suite Register of the Royal Darwin Hospital (RDH) as a self-identified Aboriginal. The majority of the participants (70%) resided in Northern Territory within rural, remote and very remote Aboriginal communities that maintain traditional connections to their land and culture. The Aboriginal communities are within a sparsely populated (0.2 people/ km2) area of approximately 900,000 km² (347 sq miles), with poor communication and transport infrastructures. Follow-ups collecting biomedical and lifestyle data directly from participants in over 40 locations were conducted at 11.4 years (Wave-2) and 18.2 years (Wave-3), with Wave-4 follow-up currently underway.

RESULTS

Follow-ups at 11 and 18 years of age successfully examined 86% and 72% of living participants respectively. Strategies addressing logistic, cultural and ethical challenges are documented.

CONCLUSIONS

Satisfactory follow-up rates of a prospective longitudinal Indigenous birth cohort with traditional characteristics are possible while maintaining scientific rigor in a challenging setting. Approaches included flexibility, respect, and transparent communication along with the adoption of culturally sensitive behaviours. This work should inform and assist researchers undertaking or planning similar studies in Indigenous and developing populations.

Representativeness of an HIV cohort of the sites from which it is recruiting: results from the Ontario HIV Treatment Network (OHTN) cohort study

Background

Participation bias is a well-known phenomenon in epidemiologic research, where individuals consenting to research studies differ from individuals who are not able or willing to participate. These dissimilarities may limit the generalizability of results of research studies. Quantification of the participation bias is essential for the interpretation of research findings.

Methods

The Ontario HIV Treatment Network Cohort Study (OCS) is an ongoing open cohort study of HIV positive individuals receiving care at one of 11 sites in Ontario. OCS participants from 4 sites were compared to non-participants (those who declined or were not approached) at those sites with regard to gender, age, HIV risk factor, CD4 count and viral load (VL). Generalized logit regression models were used to identify predictors of declining to participate or not being approached to participate.

Results

Compared to participants (P) in the OCS, individuals who declined to participate (D) and those who were not approached (NA) were slightly younger (D:45, NA:44 vs P:46), less likely to be male (D: 71%, NA:75% vs P:88%), less likely to be Caucasian (D:41%, NA:57% vs P:72%) and less likely to be Canadian-born (D: 39%, NA: 52% vs P: 69%). Patients who were not approached to participate were less likely to have VL < 50 copies/mL than other patients (D: 75%, NA: 62%, P: 74%) and had lower CD4 counts than OCS participants (D: 450 cells/mm³, NA: 420 cells/mm³, P: 480 cells/mm³).

Conclusions

Significant demographic and clinical differences were found between OCS participants and non-participants. Extrapolation of research findings to other populations should be undertaken cautiously.

Recalled sexual experiences in childhood with older partners: a study of Brazilian men who have sex with men and male-to-female transgender persons

This study assessed the prevalence of recalled childhood sexual experiences with an older partner among men who have sex with men (MSM) and/or male-to-female transgender persons recruited in Campinas, Brazil. It also analyzed associations between such recalled experiences and sexual risk behavior in adulthood. Participants recruited using respondent driven sampling completed a self-administered, computer-based questionnaire, and underwent HIV testing. For data analysis, raw scores were weighted based on participants' reported network size. Of 575 participants (85% men and 15% transgender), 32% reported childhood sexual experiences with an older partner. Mean age at first experience was 9 years, partners being, on average, 19 years old, and mostly men. Most frequent behaviors were partners exposing their genitals, mutual fondling, child masturbating partner, child performing oral sex on partner, and child being anally penetrated. Only 29% of the participants who had had such childhood sexual experiences considered it abuse; 57% reported liking, 29% being indifferent and only 14% not liking the sexual experience at the time it happened. Transgender participants were significantly more likely to report such experiences and, compared with men, had less negative feelings about the experience at the time of the interview. No significant associations were found between sexual experiences in childhood and unprotected receptive or insertive anal intercourse in adulthood. Results highlight the importance of assessing participants' perception of abuse, regardless of researchers' pre-determined criteria to identify abuse. MSM and transgender people may experience childhood sexual experiences with older partners differently from other populations (e.g., heterosexuals), particularly in countries with different cultural norms concerning sexuality than those prevalent in Europe and the U.S.

Recruitment and retention strategies for minority or poor clinical research participants: lessons from the Healthy Aging in Neighborhoods of Diversity across the Life Span study

Purpose of the study: Investigating health disparities requires studies designed to recruit and retain racially and socioeconomically diverse cohorts. It is critical to address the barriers that disproportionately affect participation in clinical research by minorities and the socioeconomically disadvantaged. This study sought to identify and rectify these barriers to recruit and retain a biracial (African American and non-Hispanic White) and socioeconomically diverse cohort for a longitudinal study. Design and Method: The Healthy Aging in Neighborhoods of Diversity across the Life Span study is a 20-year longitudinal examination of how race and socioeconomic status influence the development of age-related health disparities. One goal was to create a multifactorial recruitment and retention strategy. The recruitment paradigm targeted known barriers and identified those unique to the study's urban environment. The retention paradigm mirrored the recruitment plan but was based on specifically developed approaches. Results: This cohort recruitment required attention to developing community partnerships, designing the research study to meet the study hypotheses and to provide benefit to participants, providing a safe community-based site for the research and creating didactics to develop staff cultural proficiency. These efforts facilitated study implementation and enhanced recruitment resulting in accrual of a biracial and socioeconomically diverse cohort of 3,722 participants. Implications: Recruiting and retaining minority or poor research participants is challenging but possible. The essential facets include clear communication of the research hypothesis, focus on providing a direct benefit for participants, and selection of a hypothesis that is directly relevant to the community studied

A systematic review of the effect of retention methods in population-based cohort studies

Background

Longitudinal studies are of aetiological and public health relevance but can be undermined by attrition. The aim of this paper was to identify effective retention strategies to increase participation in population-based cohort studies.

Methods

Systematic review of the literature to identify prospective population-based cohort studies with health outcomes in which retention strategies had been evaluated.

Results

Twenty-eight studies published up to January 2011 were included. Eleven of which were randomized controlled trials of retention strategies (RCT). Fifty-seven percent of the studies were postal, 21% in-person, 14% telephone and 7% had mixed data collection methods. A total of 45 different retention strategies were used, categorised as 1) incentives, 2) reminder methods, repeat visits or repeat questionnaires, alternative modes of data collection or 3) other methods. Incentives were associated with an increase in retention rates, which improved with greater incentive value. Whether cash was the most effective incentive was not clear from studies that compared cash and gifts of similar value. The average increase in retention rate was 12% for reminder letters, 5% for reminder calls and 12% for repeat questionnaires. Ten studies used alternative data collection methods, mainly as a last resort. All postal studies offered telephone interviews to non-responders, which increased retention rates by 3%. Studies that used face-to-face interviews increased their retention rates by 24% by offering alternative locations and modes of data collection.

Conclusions

Incentives boosted retention rates in prospective cohort studies. Other methods appeared to have a beneficial effect but there was a general lack of a systematic approach to their evaluation.