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Sheinfil AZ, Firkey M, Bucci V, Gjoka M, Woolf-King SE. A Mixed-Methods Approach to Develop a Combined Model of U.S. College Student Alcohol-Associated Condomless Sex. Arch Sex Behav 2024; 53:1499-1518. [PMID: 38429569 DOI: 10.1007/s10508-024-02826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.
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Affiliation(s)
- Alan Z Sheinfil
- Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Houston, TX, 77021, USA.
- Department of Veterans Affairs, South Central Mental Illness Research Education Clinical Center, Houston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Veronica Bucci
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Mikaela Gjoka
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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2
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McBride H, Jhawar N, Boucicaut L, Bearden CE, Kates WR, Woolf-King SE, Antshel KM. Mental health, coping, and protective factors in mothers of children with 22q11.2 deletion syndrome. Am J Med Genet B Neuropsychiatr Genet 2024:e32973. [PMID: 38409998 DOI: 10.1002/ajmg.b.32973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/29/2023] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
Compared to the large body of maternal mental health research for other pediatric disorders, we know far less about the experience of mothers of children with 22q11DS. This study investigates the coping methods, protective factors, and mental health of this population. These findings might lead to better support for 22q11DS maternal mental health. An international sample of 71 mothers (M = 40.5 years) of children with 22q11DS (M = 9.2 years) was recruited and completed an online survey assessing maternal mental health (symptoms of depression, anxiety, traumatic stress, general stress, and alcohol consumption), coping methods, and mental health protective factors (social support, dyadic adjustment, parenting competence). Maternal ratings of child mental health symptoms were also obtained. Mothers' self-report revealed a high percentage who screened positive for elevated levels of general stress (69%), hazardous alcohol consumption (30.9%), traumatic stress (33.8%), anxiety (26.8%), and depression (26.8%). After controlling for demographic variables and child mental health symptoms, maternal self-reported maladaptive coping methods were positively associated with maternal symptoms of depression, anxiety, stress, and traumatic stress. Reducing maladaptive coping methods may be a promising intervention for improving mental health in mothers of children with 22q11DS.
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Affiliation(s)
- Haley McBride
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Nandini Jhawar
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Laurie Boucicaut
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
- Department of Psychology, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Wendy R Kates
- Department of Psychiatry and Behavioral Sciences, SUNY-Upstate Medical University, Syracuse, New York, USA
| | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- Department of Psychiatry and Behavioral Sciences, SUNY-Upstate Medical University, Syracuse, New York, USA
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Firkey MK, Tully LK, Schiros AM, Antshel KM, Woolf-King SE. Sexual Assault, Mental Health, and Alcohol Use in College Women: The Role of Resilience and Campus Belonging. J Interpers Violence 2023; 38:7990-8015. [PMID: 36757066 DOI: 10.1177/08862605231153884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Understanding the mental health outcomes of sexual assault among college women is a public health priority. Although research has identified risk factors for the development of mental health problems following an assault, few studies have utilized a strengths-based approach to identify personal and social resources that may mediate the sexual assault-mental health link. Prior studies allude to the role of resilience and perceived campus belonging in explaining the relationship between sexual assault and mental health. This study represents the first application of the stress process model using a large sample of college women to examine (a) the association between sexual assault and mental health (i.e., psychological distress, suicidality, self-harm) and alcohol use problems and (b) the role of resilience and perceived campus belonging as partial mediators of these associations. Data were collected as part of the Spring 2021 American College Health Association National College Health Assessment (ACHA-NCHA; n = 31,328, Mean age = 20.26, SD = 1.64, 58.8% White), a cross-sectional, online survey that samples college students from 143 self-selected United States colleges. To test our primary hypothesis, a structural regression model was conducted, which included a latent sexual assault predictor, manifest resilience and campus belonging mediators, a latent mental health outcome, and a manifest alcohol use problems outcome. Mental health and alcohol use problems were positively associated with sexual assault and negatively associated with resilience and campus belonging. Resilience partially mediated the association between sexual assault and mental health. Campus belonging partially mediated the association between sexual assault, mental health, and alcohol use problems. This model explained 23.2% of the variance in mental health and 5.9% of the variance in alcohol use. Resilience and campus belonging may represent modifiable factors that can be targeted in trauma-focused interventions in efforts to improve victimized college women's mental health.
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Firkey MK, Tully LK, Bucci VM, Walsh ME, Maisto SA, Hahn JA, Bendinskas KG, Gump BB, Woolf-King SE. Feasibility of remote self-collection of dried blood spots, hair, and nails among people with HIV with hazardous alcohol use. Alcohol Clin Exp Res (Hoboken) 2023; 47:986-995. [PMID: 36949025 PMCID: PMC10360030 DOI: 10.1111/acer.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The use of biomarkers in behavioral HIV research can help to address limitations of self-reported data. The COVID-19 pandemic forced many researchers to transition from standard in-person data collection to remote data collection. We present data on the feasibility of remote self-collection of dried blood spots (DBS), hair, and nails for the objective assessment of alcohol use, antiretroviral therapy adherence, and stress in a sample of people with HIV (PWH) who are hazardous drinkers. METHODS Standardized operating procedures for remote self-collection of DBS, hair, and nails were developed for an ongoing pilot study of a transdiagnostic alcohol intervention for PWH. Prior to each study appointment, participants were mailed a kit containing materials for self-collection, instructions, a video link demonstrating the collection process, and a prepaid envelope for returning samples. RESULTS A total of 133 remote study visits were completed. For DBS and nail collection at baseline, 87.5% and 83.3% of samples, respectively, were received by the research laboratory, of which 100% of samples were processed. Although hair samples were intended to be analyzed, most of the samples (77.7%) were insufficient or the scalp end of the hair was not marked. We, therefore, decided that hair collection was not feasible in the framework of this study. CONCLUSION An increase in remote self-collection of biospecimens may significantly advance the field of HIV-related research, permitting the collection of specimens without resource-intensive laboratory personnel and facilities. Further research is needed on the factors that impeded participants' ability to complete remote biospecimen collection.
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Affiliation(s)
| | - Lyric K. Tully
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - McKenna E. Walsh
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - Judith A. Hahn
- University of California, San Francisco, Department of Medicine, San Francisco, California
| | | | - Brooks B. Gump
- Syracuse University, Department of Public Health, Syracuse, New York
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Hahn JA, Fatch R, Emenyonu NI, Sanyu N, Katusiime A, Levine B, John Boscardin W, Chander G, Hutton H, Camlin CS, Woolf-King SE, Muyindike WR. Effect of two counseling interventions on self-reported alcohol consumption, alcohol biomarker phosphatidylethanol (PEth), and viral suppression among persons living with HIV (PWH) with unhealthy alcohol use in Uganda: A randomized controlled trial. Drug Alcohol Depend 2023; 244:109783. [PMID: 36706675 PMCID: PMC10437504 DOI: 10.1016/j.drugalcdep.2023.109783] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To test the efficacy of two interventions to reduce alcohol use and increase viral suppression compared to a control in persons with HIV (PWH). METHODS In a three-arm (1:1:1) randomized controlled trial (N = 269), we compared in-person counselling (45-70 minutes, two sessions over three months) with interim monthly booster phone calls (live call arm) or twice-weekly automated booster sessions (technology arm) to a brief advice control arm. We enrolled PWH self-reporting unhealthy alcohol use (Alcohol Use Disorders Identification Test - Consumption, prior three months, women ≥3, men ≥4). Primary outcomes were number of self-reported drinking days (NDD) in the prior 21 and biomarker phosphatidylethanol (PEth) at six and nine months and viral suppression (<40 copies/mL) at nine months; we adjusted for sex and baseline outcomes. RESULTS At baseline, mean 21-day NDDs were 9.4 (95 % CI: 9.1-9.8), mean PEth was 407.8 ng/mL (95 % CI: 340.7-474.8), and 89.2 % were virally suppressed. At follow-up, there were significant reductions in mean NDDs for the live call versus control arm (3.5, 95 % CI:2.1-4.9, p < 0.001) and for the technology versus control arm (3.6, 95 % CI: 2.2-5.1, p < 0.001). The mean PEth differences compared to the control arm were not significant, i.e. 36.4 ng/mL (95 % CI: -117.5 to 190.3, p = 0.643) for the live call and -30.9 ng/mL (95 % CI: -194.8 to 132.9, p = 0.711) for the technology arm. Nine-month viral suppression compared to the control was similar in the live call and in the technology arm. CONCLUSION Intervention effects were found on self-reported NDD but not PEth or viral suppression, suggesting no treatment effect. (NCT #03928418).
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Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, CA, USA.
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Naomi Sanyu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Anita Katusiime
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Barry Levine
- Department of Computer Science, San Francisco State University, San Francisco, CA, USA
| | - W John Boscardin
- Department of Medicine, University of California, San Francisco, CA, USA
| | | | - Heidi Hutton
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | | | - Winnie R Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Firkey MK, Sheinfil AZ, Woolf-King SE. Substance use, sexual behavior, and general well-being of U.S. college students during the COVID-19 pandemic: A brief report. J Am Coll Health 2022; 70:2270-2275. [PMID: 33577419 DOI: 10.1080/07448481.2020.1869750] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/04/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
This study gathered preliminary data on the impact of the U.S. response to the COVID-19 pandemic on the substance use, sexual behavior, and general well-being of U.S. college students. Participants from colleges across the U.S. (N = 212; 50.5% female; M age = 22.09) completed an online survey between May 20th and July 5th, 2020 about COVID-19-related behavior change. Most students reported a decrease in quality of life (71.7%), an increase in levels of anxiety (63.7%), and problems with basic resource needs (53.8%). Reports of alcohol consumption increased for 26.9% of students and 15.1% reported an increase in cannabis use. Most students (57.5%) reported a decrease in sexual activity, yet access to, and use of, condoms generally remained unchanged. As universities resume residential instruction, existing prevention and intervention services will need to be adapted to address the mental and behavioral health needs of college students during the era of COVID-19.
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Affiliation(s)
- Madison K Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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7
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Sheinfil AZ, Foley JD, Moskal D, Dalton MR, Firkey M, Ramos J, Maisto SA, Woolf-King SE. Daily Associations Between Alcohol Consumption and Antiretroviral Therapy (ART) Adherence Among HIV-Positive Men Who Have Sex With Men. AIDS Behav 2022; 26:3153-3163. [PMID: 35362912 PMCID: PMC9474713 DOI: 10.1007/s10461-022-03657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 01/02/2023]
Abstract
Alcohol consumption is one of the strongest predictors of suboptimal adherence to antiretroviral therapy (ART), however, there is little research that has investigated both within- and between-person associations of alcohol consumption and ART adherence at the event-level. In this secondary data-analysis, (N = 22) HIV-positive MSM prospectively reported daily alcohol consumption and ART adherence for 42-days. Multilevel models demonstrated (1) days in which participants reported consuming any alcohol was associated with 2.48 increased odds of ART non-adherence, compared to days in which participants reported no alcohol consumption, and (2) there was a non-significant trend indicating days in which participants reported consuming greater than their own average levels of alcohol was associated with increased odds of ART non-adherence. Findings highlight the importance of combining intervention efforts that address alcohol consumption and suboptimal ART adherence, and indicate a need for future research to investigate the mechanisms by which alcohol influences ART adherence.
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Affiliation(s)
- Alan Z Sheinfil
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA.
| | - Jacklyn D Foley
- Behavioral Medicine Program, Massachusetts General Hospital, Boston, USA
| | - Dezarie Moskal
- VA Center for Integrated Healthcare, VA WNY Healthcare System, New York, USA
| | - Michelle R Dalton
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
| | - Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244, Syracuse, NY, USA
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8
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Rohacek AM, Firkey MK, Woolf-King SE, Antshel KM. Moderation of Risks to Sexual Health by Substance Use in College Students With ADHD. J Clin Psychiatry 2022; 83. [PMID: 35771970 DOI: 10.4088/jcp.21m14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: Poor sexual health is a public health concern for college students and individuals with attention-deficit/hyperactivity disorder (ADHD), yet limited information is available on the sexual health of college students with ADHD. Here, the sexual health of college students with and without ADHD was described and moderators of risk to sexual health were identified. Methods: A secondary data analysis of the National College Health Assessment III (Fall 2019, Spring 2020, and Fall 2020 administrations) was conducted using a sample of sexually active undergraduate students (N = 36,236). Logistic regressions were used to compare sexual behaviors and health outcomes of college students with and without self-reported ADHD and test for interactions between ADHD and substance use-related moderators of risk to sexual health (ie, alcohol use, binge drinking, and cannabis use). Results: Compared to non-ADHD peers, college students with ADHD reported more past-year sexual partners (adjusted odds ratio [aOR] = 1.27; P < .01), lower rates of condom use (aOR = 0.77; P < .001), and higher rates of condomless sex while drinking (aOR = 1.52; P < .001). College students with ADHD reported more sexually transmitted infection diagnoses (aOR = 1.29; P < .01), a greater number of unplanned pregnancies (aOR = 1.72; P < .001), and more emergency contraception use (aOR = 1.19; P < .001). Alcohol use, binge drinking, and cannabis use moderated the relationship between ADHD and sexual health. Conclusions: College students with ADHD represent a vulnerable population for poor sexual health and are differentially impacted by substance use. Indicated sexual health prevention strategies and treatment for college students with ADHD are warranted.
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Affiliation(s)
- Ashley M Rohacek
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Madison K Firkey
- Department of Psychology, Syracuse University, Syracuse, New York
| | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, New York.,Corresponding author: Kevin M. Antshel, PhD, Department of Psychology, 430 Huntington Hall, Syracuse University, Syracuse, NY 13244
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Woolf-King SE, Firkey M, Foley JD, Bricker J, Hahn JA, Asiago-Reddy E, Wikier J, Moskal D, Sheinfil AZ, Ramos J, Maisto SA. Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers. AIDS Behav 2022; 26:3029-3044. [PMID: 35303190 PMCID: PMC8931450 DOI: 10.1007/s10461-022-03649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.
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Woolf-King SE, Sheinfil AZ, Ramos J, Foley JD, Moskal D, Firkey M, Kellen D, Maisto SA. A conceptual model of alcohol use and adherence to antiretroviral therapy: systematic review and theoretical implications for mechanisms of action. Health Psychol Rev 2022; 16:104-133. [PMID: 32757813 PMCID: PMC8972079 DOI: 10.1080/17437199.2020.1806722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Alcohol consumption is one of the most prevalent correlates of antiretroviral therapy (ART) adherence, yet causal processes underlying this association remain largely unexplored. The goal of this systematic review was to develop a conceptual model that describes the causal effect of alcohol consumption on ART nonadherence. We reviewed 230 studies that examined the association between alcohol consumption and ART adherence with three primary aims: (1) to replicate and extend previous reviews of the literature, (2) to summarize and critique study designs capable of answering questions about temporal overlap and (3) to summarize potential mechanisms of action. A model of alcohol-associated ART nonadherence was proposed to guide future work, integrating general theories of ART adherence and theory on the psychological and behavioral effects of alcohol intoxication. The conceptual model describes two mechanistic processes-prospective memory impairment and interactive toxicity beliefs/avoidance behaviors-involved in alcohol-associated intentional and unintentional nonadherence, respectively. This model can be used to guide future research on the causal processes involved in the frequently observed correlation between alcohol consumption and adherence.
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Affiliation(s)
| | - Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - David Kellen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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Leddy AM, Hahn JA, Getahun M, Emenyonu NI, Woolf-King SE, Sanyu N, Katusiime A, Fatch R, Chander G, Hutton HE, Muyindike WR, Camlin CS. Cultural Adaptation of an Intervention to Reduce Hazardous Alcohol Use Among People Living with HIV in Southwestern Uganda. AIDS Behav 2021; 25:237-250. [PMID: 33590322 DOI: 10.1007/s10461-021-03186-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 02/08/2023]
Abstract
Hazardous drinking by persons living with HIV (PLHIV) is a well-established determinant of sub-optimal HIV care and treatment outcomes. Despite this, to date, few interventions have sought to reduce hazardous drinking among PLHIV in sub-Saharan Africa (SSA). We describe an iterative cultural adaptation of an evidence-based multi-session alcohol reduction intervention for PLHIV in southwestern Uganda. The adaptation process included identifying core, theoretically informed, intervention elements, and conducting focus group discussions and cognitive interviews with community members, HIV clinic staff and patients to modify key intervention characteristics for cultural relevance and saliency. Adaptation of evidence-based alcohol reduction interventions can be strengthened by the inclusion of the target population and key stakeholders in shaping the content, while retaining fidelity to core intervention elements.
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12
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Simmons EM, Firkey MK, Sheinfil AZ, Ramos JM, Woolf-King SE. The Association Between Financial Resources Strain and Self-Reported Antiretroviral Therapy (ART) Adherence among HIV-Positive Men Who Have Sex with Men. J Health Care Poor Underserved 2021; 32:2222-2232. [PMID: 34803071 DOI: 10.1353/hpu.2021.0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to assess the relationship between financial resources strain and self-reported ART adherence among men who have sex with men (MSM) who are living with HIV. Secondary data analyses were conducted with a sample of HIV-positive MSM (N = 77) who participated in a daily diary study on substance use and sexual behavior. Logistic regression was used to model the odds of self-reported ART adherence associated with financial resources strain. The adjusted model revealed a significant association between financial resources strain and self-reported ART adherence such that financially strained participants were 78.4% less likely to have "excellent" self-reported adherence ability compared with non-financially strained participants (aOR = .216, 95% CI [.063, .749], p = .016). Financial resources strain may negatively influence ART adherence. Future research should consider objectively measuring ART adherence. Health care providers might consider assessing patients' financial situation to identify those at-risk for nonadherence.
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13
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Sheinfil AZ, Woolf-King SE. Effects of affective arousal on risky sexual decision-making in US emerging adult college students. Psychology & Sexuality 2021. [DOI: 10.1080/19419899.2021.1950202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alan Z Sheinfil
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Sarah E. Woolf-King
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- University of California, San Francisco, Department of Medicine, Center for AIDS Prevention Studies, San Francisco, California, USA
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14
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Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Foley JD, Firkey M, Sheinfil A, Ramos J, Woolf-King SE, Vanable PA. Framed Messages to Increase Condom Use Frequency Among Individuals Taking Daily Antiretroviral Medication for Pre-exposure Prophylaxis. Arch Sex Behav 2021; 50:1755-1769. [PMID: 34105056 DOI: 10.1007/s10508-021-02045-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 06/12/2023]
Abstract
PrEP delivery and routine care provide a unique opportunity to promote sexually transmitted infection (STI) prevention by both increasing STI testing frequency and creating a space for affirmative and effective safer sex counseling. This study was a feasibility and acceptability pilot of an adapted framed message intervention to increase condom use frequency with PrEP. In the formative phase, two focus groups with PrEP users (N = 7) provided feedback on a provisional loss-framed message intervention and identified potential study barriers. In the pilot trial, the adapted loss-framed message intervention was compared to a gain-framed message intervention and enhanced skills condition in a sample of PrEP users (N = 29). In terms of intervention feasibility, 58% of approached PrEP users completed the eligibility screen; 79% of those eligible enrolled in the study and 66% of enrolled participants completed the three-month follow-up. In terms of intervention acceptability, participants found the informational messages, regardless of assignment, to be moderately interesting (M = 6.24, SD = 2.97) and useful (M = 7.07, SD = 3.00), and very easy to understand (M = 9.50, SD = 0.97) on Likert-type scales ranging from 1 to 10. In terms of intervention effects, there was a small effect of the gain-framed intervention (b = .58, SE = .93, CI = -1.33, 2.48, Cohen's d = .26) on HIV/STI risk transmission. There was a small-medium effect of both the loss- (b = 2.00, SE = .90, CI = .15, 3.85, Cohen's d = 1.46) and gain-framed (b = 2.24, SE = .93, CI = .34, 4.15, Cohen's d = 1.65) interventions on condom use motivation. Finally, there was a medium-large effect of both the loss- (b = .97, SE = 1.33, CI = -1.88, 3.82, Cohen's d = .54) and gain-framed intervention (b = 1.97, SE = 1.33, CI = -.88, 4.82, Cohen's d = .87) on condom use frequency. Further refinement and testing, in a larger -scale trial with higher ecological validity than this initial pilot intervention, is warranted.
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Affiliation(s)
- Jacklyn D Foley
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA.
- Department of Psychology, Syracuse University, Syracuse, NY, USA.
| | - Madison Firkey
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | | | - Peter A Vanable
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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16
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Foley JD, Sheinfil A, Woolf-King SE, Fatch R, Emenyonu NI, Muyindike WR, Kekibiina A, Ngabirano C, Samet JH, Cheng DM, Hahn JA. Assessing the interaction between depressive symptoms and alcohol use prior to antiretroviral therapy on viral suppression among people living with HIV in Rural Uganda. AIDS Care 2020; 32:1251-1257. [PMID: 32482097 DOI: 10.1080/09540121.2020.1770671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although there is evidence of individual associations between depressive symptoms and hazardous alcohol use with suboptimal antiretroviral therapy (ART) adherence among people living with HIV (PLWH), few studies have established how the two risk factors may interact to predict viral suppression. We conducted secondary data analyses with two cohorts of Ugandan PLWH (N = 657) to investigate the hypothesized interaction between depressive symptoms (Center for Epidemiological Studies Depression Scale) and hazardous alcohol use (Alcohol Use Disorder Identification Test -Consumption and/or Phosphatidylethanol biomarker) prior to ART initiation with viral suppression (<550 copies/ml). We were unable to detect an interaction between depressive symptoms and hazardous alcohol use prior to ART initiation with viral suppression in the first two years (M = 19.9 months) after ART initiation (p = 0.75). There was also no evidence of a main effect association for depressive symptoms (Adjusted Odds Ratio [AOR] = 0.88, 95% Confidence Interval [CI]: 0.50, 1.55) or hazardous alcohol use (AOR = 1.37, 95% CI: 0.80, 2.33). PLWH with depressive symptoms and/or hazardous alcohol use appear to exhibit similar levels of viral suppression as others in care; further work is needed to determine effects on HIV testing and treatment engagement.
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Affiliation(s)
- Jacklyn D Foley
- Department of Psychology, Syracuse University, Syracuse University, Syracuse, NY, USA.,Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Alan Sheinfil
- Department of Psychology, Syracuse University, Syracuse University, Syracuse, NY, USA
| | - Sarah E Woolf-King
- Department of Psychology, Syracuse University, Syracuse University, Syracuse, NY, USA
| | - Robin Fatch
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Allen Kekibiina
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - Judith A Hahn
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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17
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Adong J, Fatch R, Emenyonu NI, Cheng DM, Muyindike WR, Ngabirano C, Kekibiina A, Woolf-King SE, Samet JH, Hahn JA. Social Desirability Bias Impacts Self-Reported Alcohol Use Among Persons With HIV in Uganda. Alcohol Clin Exp Res 2019; 43:2591-2598. [PMID: 31610017 DOI: 10.1111/acer.14218] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Self-report is widely used to assess alcohol use in research and clinical practice, but may be subject to social desirability bias. We aimed to determine if social desirability impacts self-reported alcohol use. METHODS Among 751 human immunodeficiency virus (HIV)-infected patients from a clinic in southwestern Uganda, we measured social desirability using the Marlowe-Crowne Social Desirability Scale (SDS) Short Form C, self-reported alcohol use (prior 3 months) Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and phosphatidylethanol (PEth), a biomarker of prior 3 weeks' drinking. We conducted multiple regression analyses to assess the relationship between SDS score (low, medium, and high levels) and (i) any self-reported recent alcohol use, among those who were PEth-positive (≥8 ng/ml), and (ii) continuous AUDIT-C score, among those reporting any recent alcohol use. We controlled for PEth level, age, gender, education, economic assets, marital status, religion, spirituality/religiosity, social support, and study cohort. RESULTS Of 751 participants, 59% were women; the median age was 31 years (interquartile range [IQR]: 26 to 39). Median SDS score was 9 (IQR: 4 to 10). Two-thirds (62%) self-reported any recent alcohol use; median AUDIT-C was 1 (IQR: 0 to 4). Among those who were PEth-positive (57%), 13% reported no recent alcohol use. Those with the highest SDS tertile had decreased odds of reporting any recent alcohol use compared to the lowest tertile, but the association did not reach statistical significance in multivariable analyses (adjusted odds ratio 0.55 [95% confidence interval (CI): 0.25, 1.23]). Among participants self-reporting recent alcohol use, SDS level was negatively associated with AUDIT-C scores (adjusted β: -0.70 [95% CI: -1.19, -0.21] for medium vs. low SDS and -1.42 [95% CI: -2.05, -0.78] for high vs. low SDS). CONCLUSIONS While use of objective measures (e.g., alcohol biomarkers) is desirable for measuring alcohol use, SDS scores may be used to adjust self-reported drinking levels by participants' level of social desirability in HIV research studies.
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Affiliation(s)
- Julian Adong
- From the, Mbarara University of Science and Technology, (JA, WRM, CN, AK), Mbarara, Uganda
| | - Robin Fatch
- Department of Medicine, (RF, NIE, JAH), University of California, San Francisco, San Francisco, California
| | - Nneka I Emenyonu
- Department of Medicine, (RF, NIE, JAH), University of California, San Francisco, San Francisco, California
| | - Debbie M Cheng
- School of Public Health, (DMC, JHS), Boston University, Boston, Massachusetts
| | - Winnie R Muyindike
- From the, Mbarara University of Science and Technology, (JA, WRM, CN, AK), Mbarara, Uganda.,Mbarara Regional Referral Hospital, (WRM), Mbarara, Uganda
| | - Christine Ngabirano
- From the, Mbarara University of Science and Technology, (JA, WRM, CN, AK), Mbarara, Uganda
| | - Allen Kekibiina
- From the, Mbarara University of Science and Technology, (JA, WRM, CN, AK), Mbarara, Uganda
| | - Sarah E Woolf-King
- Department of Psychology, (SEW-K), Syracuse University, New York, New York
| | - Jeffrey H Samet
- School of Public Health, (DMC, JHS), Boston University, Boston, Massachusetts.,School of Medicine, (JHS), Boston University, Boston, Massachusetts
| | - Judith A Hahn
- Department of Medicine, (RF, NIE, JAH), University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, (JAH), University of California, San Francisco, San Francisco, California
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18
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Sheinfil AZ, Foley JD, Ramos J, Antshel KM, Woolf-King SE. Psychotherapeutic depression interventions adapted for sexual and gender minority youth: A systematic review of an emerging literature. Journal of Gay & Lesbian Mental Health 2019. [DOI: 10.1080/19359705.2019.1622616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alan Z. Sheinfil
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Jacklyn D. Foley
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Jeremy Ramos
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Kevin M. Antshel
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Sarah E. Woolf-King
- Department of Psychology, Syracuse University, Syracuse, New York, USA
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
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Abstract
OBJECTIVE The HIV literature has largely ignored the importance of alcohol use in the quality of intimate relationships in sub-Saharan Africa (SSA), despite evidence of alcohol's role in relational behaviors that increase risk for HIV infection and other harms. The present study explored the association of alcohol use with relationship functioning among heterosexual couples from rural South Africa. METHOD Dyadic analyses were conducted with 443 sexually active, heterosexual, South African couples (886 individuals) to examine the association between male partners' alcohol use (abstinent, nonhazardous, and hazardous), and male and female partners' reports of relationship intimacy, trust, mutually constructive communication, demand/withdraw communication, and satisfaction. Five structural equation models were fit using male partner alcohol use as a predictor of male and female reports of relationship quality. RESULTS Women with a hazardous-drinking male partner (compared to an abstainer) reported significantly higher levels of intimacy (p <.05) and significantly more demand/withdraw communication (p <.001); men who were hazardous drinkers reported significantly less trust in their relationship compared to men who were abstainers (p < .01). CONCLUSIONS Hazardous alcohol use among South African couples is positively correlated with women's relationship intimacy and maladaptive communication patterns, yet negatively correlated with men's perceived trust.
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Affiliation(s)
- Sarah E Woolf-King
- a Department of Psychology , Syracuse University , Syracuse , New York , USA.,b Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , California , USA
| | - Amy A Conroy
- b Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , California , USA
| | - Katherine Fritz
- c International Center for Research on Women , Washington , District of Columbia , USA
| | - Mallory O Johnson
- b Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , California , USA
| | - Victoria Hosegood
- d Department of Social Statistics and Demography , University of Southampton , Southampton , UK.,e Africa Health Research Institute , KwaZulu-Natal , South Africa
| | - Heidi van Rooyen
- f Human Sciences Research Council , Sweetwaters , South Africa.,g School of Clinical Medicine, Faculty of Health Sciences , University of Witwatersrand , Johannesburg , South Africa
| | - Lynae Darbes
- b Center for AIDS Prevention Studies , University of California, San Francisco , San Francisco , California , USA.,h Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing , University of Michigan , Ann Arbor , Michigan , USA
| | - Nuala McGrath
- i Academic Unit of Primary Care and Population Sciences and Department of Social Statistics and Demography , University of Southampton , Southampton , UK.,j Africa Health Research Institute, School of Nursing & Public Health , University of KwaZulu-Natal , KwaZulu-Natal , South Africa.,k Research Department of Epidemiology & Public Health , University College London , London , UK
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20
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Woolf-King SE, Sheinfil AZ, Babowich JD, Siedle-Khan B, Loitsch A, Maisto SA. Acceptance and Commitment Therapy (ACT) for HIV-infected Hazardous Drinkers: A Qualitative Study of Acceptability. Alcohol Treat Q 2018; 37:342-358. [PMID: 31564766 PMCID: PMC6764523 DOI: 10.1080/07347324.2018.1539630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Alcohol use is a significant problem in HIV care, and clinical trials of alcohol interventions for people living with HIV infection (PLWH) have produced mixed results. The purpose of this qualitative study was to collect preliminary data on the practical feasibility and acceptability of Acceptance and Commitment Therapy (ACT) as a treatment for PLWH who are hazardous drinkers. A total of 25 PLWH participated in individual interviews. Four major themes emerged from the thematic analysis: (I) Perceived Appropriateness for PLWH and People who use Alcohol and/or other Substances, (II) General Satisfaction and Dissatisfaction, (III) Positive and Negative Effects on Participants and (IV) Facilitators and Barriers to Implementing ACT Intervention Strategies.
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Affiliation(s)
- Sarah E. Woolf-King
- Syracuse University, Department of Psychology, Syracuse, New York
- University of California, San Francisco, Department of Medicine, Center for AIDS Prevention Studies, San Francisco, California
| | - Alan Z Sheinfil
- Syracuse University, Department of Psychology, Syracuse, New York
| | | | - Bob Siedle-Khan
- University of California, San Francisco, Department of Medicine, Center for AIDS Prevention Studies, San Francisco, California
| | - Amanda Loitsch
- Syracuse University, Department of Psychology, Syracuse, New York
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21
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Babowitch JD, Sheinfil AZ, Woolf-King SE, Vanable PA, Sweeney SM. Correction to: Association of Depressive Symptoms with Lapses in Antiretroviral Medication Adherence Among People Living with HIV: A Test of an Indirect Pathway. AIDS Behav 2018; 22:3175. [PMID: 29855974 DOI: 10.1007/s10461-018-2158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The original version of this article unfortunately contained a mistake in Fig. 1. The figure was incorrectly presented with the results of an additional path model for forgotten antiretroviral therapy (ART) doses that was dropped from the primary analyses.
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Affiliation(s)
- Jacklyn D Babowitch
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224‑2340, USA.
| | - Alan Z Sheinfil
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224‑2340, USA
| | - Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224‑2340, USA
| | - Peter A Vanable
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224‑2340, USA
| | - Shannon M Sweeney
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13224‑2340, USA
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22
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Woolf-King SE, Fatch R, Cheng DM, Muyindike W, Ngabirano C, Kekibiina A, Emenyonu N, Hahn JA. Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study. Arch Sex Behav 2018; 47:1937-1948. [PMID: 29327090 PMCID: PMC6041192 DOI: 10.1007/s10508-017-1131-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 11/18/2017] [Accepted: 11/30/2017] [Indexed: 06/07/2023]
Abstract
While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Debbie M Cheng
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, USA
| | - Winnie Muyindike
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Allen Kekibiina
- Mbarara University of Science and Technology Grants Office, Mbarara, Uganda
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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23
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Woolf-King SE, Arnold E, Weiss S, Teitel D. "There's no acknowledgement of what this does to people": A qualitative exploration of mental health among parents of children with critical congenital heart defects. J Clin Nurs 2018; 27:2785-2794. [PMID: 29345005 DOI: 10.1111/jocn.14275] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore the psychological impact of parenting a child with a critical congenital heart defect and the feasibility and acceptability of integrating psychological services into paediatric cardiology care. BACKGROUND Children with critical congenital heart defect are at an increased risk for long-term behavioural, social and emotional difficulties. Data suggest that this risk is partially attributable to parental mental health, which is a stronger predictor of long-term behavioural problems in congenital heart defect children than disease-specific and surgical factors. Parental stress and mental health are thus important intervention targets, especially among high-risk families. DESIGN This article presents data from a qualitative study with 25 congenital heart defect parents (n = 15) and providers (n = 10). METHODS Using thematic analysis, semi-structured in-depth interviews were transcribed and coded by the first and second author to identify major themes and subthemes. RESULTS Results of the interviews were organised into four major themes: (i) the psychological impact of parenting a child with critical congenital heart defect, (ii) factors that influence the psychological impact of parenting a child with critical congenital heart defect, (iii) how and when to psychologically support congenital heart defect parents and (iv) feasibility and acceptability of integrating psychological support into congenital heart defect care. Providers and parents endorsed the integration of mental health treatment into routine congenital heart defect care and identified several practical issues related to feasibility (e.g., funding and space) that should be considered prior to implementation. CONCLUSIONS Parents of children with critical congenital heart defect need access to mental health services, and integrating these services into routine paediatric cardiology care is a novel and practical way for parents to receive the treatment they need. RELEVANCE TO CLINICAL PRACTICE Suggestions for how the field of paediatric cardiology could begin to integrate mental health services into congenital heart defect treatment are provided.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY, USA.,Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Emily Arnold
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sandra Weiss
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - David Teitel
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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24
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Woolf-King SE, Muyindike W, Hobbs MM, Kusasira A, Fatch R, Emenyonu N, Johnson MO, Hahn JA. Vaginal Prostate Specific Antigen (PSA) Is a Useful Biomarker of Semen Exposure Among HIV-Infected Ugandan Women. AIDS Behav 2017; 21:2141-2146. [PMID: 27224979 DOI: 10.1007/s10461-016-1433-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The practical feasibility of using prostate specific antigen (PSA) as a biomarker of semen exposure was examined among HIV-infected Ugandan women. Vaginal fluids were obtained with self-collected swabs and a qualitative rapid test (ABAcard®p30) was used to detect PSA. Trained laboratory technicians processed samples on-site and positive PSA tests were compared to self-reported unprotected vaginal sex (UVS) in the last 48 h. A total of 77 women submitted 126 samples for PSA testing at up to three study visits. Of these samples, 31 % (n = 39/126) were PSA positive, and 64 % (n = 25/39) of the positive PSA samples were accompanied by self-report of no UVS at the study visit the PSA was collected. There were no reported difficulties with specimen collection, storage, or processing. These findings provide preliminary data on high levels of misreported UVS among HIV-infected Ugandan women using practically feasible methods for PSA collection and processing.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Winnie Muyindike
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Marcia M Hobbs
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adrine Kusasira
- Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mallory O Johnson
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
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25
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Abstract
Background Parents of children with critical congenital heart defects (PCCHDs) may be at high risk for mental health morbidity; however, the literature is not well characterized. Given that compromised parental mental health can lead to long‐term cognitive, health‐related, and behavioral problems in children, a systematic review of this literature could provide informed recommendations for continued research and enhance the care of families of children living with critical congenital heart defects. Methods and Results We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines that resulted in 30 studies on the mental health of PCCHDs. The literature revealed that PCCHDs are at an elevated risk for psychological problems, particularly in the immediate weeks and months following cardiac surgery. Up to 30% of PCCHDs have symptoms consistent with a diagnosis of posttraumatic stress disorder, with over 80% presenting with clinically significant symptoms of trauma; 25% to 50% of PCCHDs reported clinically elevated symptoms of depression and/or anxiety, and 30% to 80% reported experiencing severe psychological distress. There was high variability in measurements used to assess study outcomes, methodological quality, and sociocultural composition of the parents included in the studies. Conclusions There is an urgent need for additional research on the severity, course, persistence, and moderators of these mental health problems over time, and for the development and testing of screening approaches and interventions that can be feasibly delivered in the context of ongoing pediatric cardiac care.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY .,Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Alexandra Anger
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA.,Department of Pediatrics, Pediatric Heart Center, University of California, San Francisco, San Francisco, CA
| | - Emily A Arnold
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sandra J Weiss
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA
| | - David Teitel
- Department of Pediatrics, Pediatric Heart Center, University of California, San Francisco, San Francisco, CA
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Woolf-King SE, Fatch R, Emenyonu N, Muyindike W, Carrico AW, Maisto SA, Hahn JA. Development and validation of the East Africa Alcohol Expectancy Scale (AFEXS). J Stud Alcohol Drugs 2016; 76:336-43. [PMID: 25785809 DOI: 10.15288/jsad.2015.76.336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to develop and validate the East Africa Alcohol Expectancy Scale (AFEXS), a measure of alcohol expectancies for use with HIV-positive adults in East Africa. METHOD The study was conducted in several phases. The first involved development of the scale and an exploratory factor analysis (EFA) with a total of 209 HIV-positive, Ugandan men (n = 120) and women (n = 89). The second phase involved a confirmatory factor analysis (CFA) as well as validity analyses with a second, demographically similar, sample of 181 HIV-positive Ugandan men (n = 109) and women (n = 72). All participants were recruited from two ongoing cohort studies taking place at an HIV clinic in rural southwestern Uganda. RESULTS The EFA resulted in a 13-item, three-factor scale that explained 67% of the variance and showed excellent internal consistency (α = .89). The CFA showed good model fit with a final 11-item scale, χ(2)(41) = 68.60, p = .004; comparative fit index = .97; root mean square error of approximation = .06, 90% CI [.03, .09], that again showed excellent internal consistency and yielded the following three factors: sex-related (α = .94), release of inhibition (α = .61), and negative expectancies (α = .73). CONCLUSIONS The AFEXS is the first psychometrically validated alcohol expectancy scale available for use in Africa. The extent to which the AFEXS can be used with other populations and with adults from countries outside of East Africa requires ongoing validation.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Nneka Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Winnie Muyindike
- School of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Adam W Carrico
- Department of Medicine, University of California, San Francisco, San Francisco, California, Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, New York
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Woolf-King SE, Maisto SA. The effects of alcohol, relationship power, and partner type on perceived difficulty implementing condom use among African American adults: an experimental study. Arch Sex Behav 2015; 44:571-81. [PMID: 25277692 PMCID: PMC4359030 DOI: 10.1007/s10508-014-0362-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/09/2014] [Accepted: 06/14/2014] [Indexed: 06/03/2023]
Abstract
African American adults are disproportionately affected by HIV in the United States, underscoring the need for additional research on barriers to condom use. Guided by the theory of gender and power, this experimental study used a series of vignettes to test causal hypotheses regarding the influence of event-level alcohol use (present and absent), partner type (serious and casual), and relationship power (low and equal) on perceived difficulty implementing condom use. A total of 299 (151 women and 148 men) heterosexual African American adults indicated how "difficult" it would be to use a condom after reading 8 hypothetical sexual encounters, presented in a random order. A 2 × 2 × 2 × 2 repeated measures analysis of covariance with one between subjects factor (gender) and one covariate (condom use self-efficacy) was used to estimate the effects of these variables on an index of perceived difficulty. The women in the study reported significantly higher ratings of difficulty implementing condom use in vignettes characterized by low relationship power (p < .001) and presence of alcohol use (p < .001); the manipulated independent variables did not produce any main effects for men. Both men and women's ratings of perceived difficulty decreased as condom use self-efficacy increased (p < .001). This is the first study to use an experimental methodology to test hypotheses about barriers to condom use among a community-based sample of African American adults. These data can be used to enhance existing HIV prevention interventions.
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Affiliation(s)
- Sarah E Woolf-King
- Center for AIDS Prevention Studies, Department of Medicine, University of California, 50 Beale Street, Suite 1300, San Francisco, CA, 94105, USA,
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Carrico AW, Woolf-King SE, Neilands TB, Dilworth SE, Johnson MO. Stimulant use and HIV disease management among men in same-sex relationships. Drug Alcohol Depend 2014; 139:174-7. [PMID: 24726318 PMCID: PMC4048569 DOI: 10.1016/j.drugalcdep.2014.03.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/18/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research conducted to date has focused primarily on identifying individual-level, psychological determinants of stimulant use and HIV disease management. The present cross-sectional study examined relationship factors as correlates of stimulant use and HIV disease management among men who have sex with men (MSM). METHODS In total, 266 male couples completed a baseline assessment for a cohort study examining the role of relationship factors in HIV treatment. A computer-based assessment of relationship factors, self-reported alcohol and substance use, and self-reported anti-retroviral therapy (ART) adherence was administered. All HIV-positive participants also provided a blood sample to measure viral load. RESULTS After controlling for demographic characteristics and relationship factors, men in a primary relationship with a stimulant-using partner had more than six-fold greater odds of reporting any stimulant use in the past three months. Among HIV-positive participants on ART (n=371), having a stimulant-using partner was independently associated with 67% lower odds of reporting perfect 30-day ART adherence and more than two-fold greater odds of displaying a detectable HIV viral load. In contrast, more partner-level alcohol use was independently associated with greater odds of reporting perfect 3-day ART adherence and lower odds of displaying a detectable HIV viral load. CONCLUSIONS Partner-level stimulant use is an important risk factor for individual-level stimulant use and difficulties with HIV disease management among MSM. To optimize the effectiveness of HIV treatment as prevention, clinical research is needed to develop couples-based interventions targeting stimulant use as a potential driver of detectable HIV viral load.
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Affiliation(s)
- Adam W Carrico
- University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States.
| | - Sarah E Woolf-King
- University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States
| | - Torsten B Neilands
- University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States
| | - Samantha E Dilworth
- University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States
| | - Mallory O Johnson
- University of California, San Francisco, School of Nursing, United States; University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), United States; University of California, San Francisco, School of Pharmacy, United States
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Woolf-King SE, Neilands TB, Dilworth SE, Carrico AW, Johnson MO. Alcohol use and HIV disease management: the impact of individual and partner-level alcohol use among HIV-positive men who have sex with men. AIDS Care 2013; 26:702-8. [PMID: 24215238 DOI: 10.1080/09540121.2013.855302] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Alcohol use among HIV-positive (HIV+) individuals is associated with decreased adherence to antiretroviral therapy (ART) and consequently poorer HIV treatment outcomes. This study examined the independent association of individual and partner-level alcohol use with HIV disease management among men who have sex with men (MSM) in primary partnerships. In total, 356 HIV+ MSM and their male primary partners completed a baseline visit for a longitudinal study examining the role of couple-level factors in HIV treatment. The Alcohol Use Disorders Identification Test (AUDIT) was administered to assess the individual and the partner-level alcohol use. Primary outcome variables included self-reported ART adherence, ART adherence self-efficacy, and HIV viral load. Results demonstrated that abstainers, compared to hazardous drinkers, had higher self-efficacy to integrate and persevere in HIV treatment and a lower odds of having a detectable viral load. Participants with a partner-abstainer, versus a partner-hazardous drinker, had less self-efficacy to persevere in HIV treatment, a lower odds of 100% three-day adherence and a higher viral load. Together, these findings suggest that assessment and treatment of both the patient's and the patient's primary partner's pattern of alcohol consumption is warranted when attempting to optimize HIV care among MSM.
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Affiliation(s)
- Sarah E Woolf-King
- a Department of Medicine, Center for AIDS Prevention Studies , University of California, San Francisco (UCSF) , San Francisco , CA , USA
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Woolf-King SE, Rice TM, Truong HHM, Woods WJ, Jerome RC, Carrico AW. Substance use and HIV risk behavior among men who have sex with men: the role of sexual compulsivity. J Urban Health 2013; 90:948-52. [PMID: 23974946 PMCID: PMC3795185 DOI: 10.1007/s11524-013-9820-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationship between substance use, sexual compulsivity and sexual risk behavior was assessed with a probability-based sample of men who have sex with men (MSM). Stimulant, poppers, erectile dysfunction medication (EDM), alcohol use, and sexual compulsivity were independently associated with higher odds of engaging in any serodiscordant unprotected anal intercourse (SDUAI). The association of sexual compulsivity with SDUAI was moderated by poppers and EDM use. Behavioral interventions are needed to optimize biomedical prevention of HIV among substance using MSM.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale St., Suite 1300, San Francisco, CA, 94105, USA,
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Maisto SA, Palfai T, Vanable PA, Heath J, Woolf-King SE. The effects of alcohol and sexual arousal on determinants of sexual risk in men who have sex with men. Arch Sex Behav 2012; 41:971-86. [PMID: 22009480 PMCID: PMC3745008 DOI: 10.1007/s10508-011-9846-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 07/18/2011] [Accepted: 07/31/2011] [Indexed: 05/10/2023]
Abstract
Primary prevention efforts aimed at sexual risk behaviors are critical. This experiment was designed to investigate the effects of alcohol intoxication and sexual arousal, as well as person variables of alcohol sex expectancies and attitudes toward condom use, on hypothesized determinants of sexual risk behaviors among men who have sex with men (MSM). The participants were 117 MSM aged 21-50 years who were randomly assigned to one of six separate experimental conditions created by the combination of beverage administration (water control, placebo or alcohol designed to raise blood alcohol level to .07%) and sexual arousal (low or high, manipulated by participants' viewing non-erotic or mildly erotic film clips). Participants attended two experimental sessions. The first session included completing questionnaires about beliefs about alcohol's effects on sex and attitudes toward condoms' effect on sexual pleasure. The second session involved the beverage condition and arousal manipulations. Following these, participants viewed and responded to two interactive videos depicting high sexual risk scenarios. Participants also completed the CARE, a measure of risk perceptions. The dependent variables were behavioral skills, intentions to have unsafe sex, and "risk exposure," derived from responses to the videos. The results of both planned and exploratory analyses showed general support for the hypothesized enhancement of alcohol's effects on sexual risk by both sexual arousal and expectancies. Also as predicted, condom attitudes showed direct relationships to risk exposure and intentions. Implications of the findings for models of alcohol's effects on sexual risk and for the development of HIV prevention interventions were discussed.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, Syracuse, NY 13244, USA.
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Abstract
Alcohol consumption adds fuel to the HIV epidemic in sub-Saharan Africa (SSA). SSA has the highest prevalence of HIV infection and heavy episodic drinking in the world. Alcohol consumption is associated with behaviors such as unprotected sex and poor medication adherence, and biological factors such as increased susceptibility to infection, comorbid conditions, and infectiousness, which may synergistically increase HIV acquisition and onward transmission. Few interventions to decrease alcohol consumption and alcohol-related sexual risk behaviors have been developed or implemented in SSA, and few HIV or health policies or services in SSA address alcohol consumption. Structural interventions, such as regulating the availability, price, and advertising of alcohol, are challenging to implement due to the preponderance of homemade alcohol and beverage industry resistance. This article reviews the current knowledge on how alcohol impacts the HIV epidemic in SSA, summarizes current interventions and policies, and identifies areas for increased research and development.
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Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, USA.
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Woolf-King SE, Maisto SA. Alcohol use and high-risk sexual behavior in Sub-Saharan Africa: a narrative review. Arch Sex Behav 2011; 40:17-42. [PMID: 19705274 DOI: 10.1007/s10508-009-9516-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 06/16/2009] [Accepted: 06/16/2009] [Indexed: 05/09/2023]
Abstract
Sub-Saharan Africa (SSA) contains 10% of the world's population and 60% of all people living with AIDS. Consequently, research investigating risk factors associated with HIV acquisition is a public health priority and one such risk factor is alcohol consumption. This article is a review of empirical studies on the association of alcohol and high-risk sexual behavior in SSA, with a focus on measurable outcomes generated from quantitative data. A critique of the literature is provided, with attention to methodological concerns. Empirically based theoretical orientations were used to interpret the reviewed research and to stimulate discussion about how to improve the state of the current literature. Based on this discussion, a model of alcohol and high-risk sexual behavior in an African context is proposed in order to integrate the existing literature and highlight areas in need of continued research.
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Woolf-King SE, Maisto S, Carey M, Vanable P. Selection of film clips and development of a video for the investigation of sexual decision making among men who have sex with men. J Sex Res 2010; 47:589-97. [PMID: 19760530 PMCID: PMC3734861 DOI: 10.1080/00224490903216748] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Experimental research on sexual decision making is limited, despite the public health importance of such work. We describe formative work conducted in advance of an experimental study designed to evaluate the effects of alcohol intoxication and sexual arousal on risky sexual decision making among men who have sex with men. In Study 1, we describe the procedures for selecting and validating erotic film clips (to be used for the experimental manipulation of arousal). In Study 2, we describe the tailoring of two interactive role-play videos to be used to measure risk perception and communication skills in an analog risky sex situation. Together, these studies illustrate a method for creating experimental stimuli to investigate sexual decision making in a laboratory setting. Research using this approach will support experimental research that affords a stronger basis for drawing causal inferences regarding sexual decision making.
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Affiliation(s)
- Sarah E Woolf-King
- Department of Psychology, Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244–2340, USA.
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