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Ascha M, Sasson DC, Sood R, Cornelius JW, Schauer JM, Runge A, Muldoon AL, Gangopadhyay N, Simons L, Chen D, Corcoran JF, Jordan SW. Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults. JAMA Pediatr 2022; 176:1115-1122. [PMID: 36156703 PMCID: PMC9513704 DOI: 10.1001/jamapediatrics.2022.3424] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/08/2022] [Indexed: 12/15/2022]
Abstract
Importance Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be performed to treat chest dysphoria. Objective To determine whether top surgery improves chest dysphoria, gender congruence, and body image in TGNB DFAB AYA. Design, Setting, and Participants This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and 3 months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy. Exposures Patients in the surgical cohort underwent gender-affirming mastectomy; surgical technique was at the discretion of the surgeon. Main Outcomes and Measures Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Secondary outcomes included the Transgender Congruence Scale (TCS) and Body Image Scale (BIS). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. Inverse probability of treatment weighting (IPTW) was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with the following covariates: baseline outcome score, age, gender identity, race, ethnicity, insurance type, body mass index, testosterone use duration, chest binding, and parental support. Results Overall, 81 patients were enrolled (mean [SD] age, 18.6 [2.7] years); 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal. IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores. Conclusions and Relevance Top surgery in TGNB DFAB AYA is associated with low complication rates. Top surgery is associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.
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Affiliation(s)
- Mona Ascha
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel C. Sasson
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachita Sood
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jeremy W. Cornelius
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jacob M. Schauer
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adariane Runge
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Abigail L. Muldoon
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Noopur Gangopadhyay
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Lisa Simons
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Julia F. Corcoran
- Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois at Chicago, Chicago
| | - Sumanas W. Jordan
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Garofalo R, Adetunji A, Kuhns LM, Omigbodun O, Johnson AK, Kuti K, Awolude OA, Berzins B, Janulis P, Okonkwor O, Oladeji B, Muldoon AL, Amoo OP, Atunde H, Kapogiannis B, Taiwo BO. Evaluation of the iCARE Nigeria Pilot Intervention Using Social Media and Peer Navigation to Promote HIV Testing and Linkage to Care Among High-Risk Young Men: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e220148. [PMID: 35191969 PMCID: PMC8864509 DOI: 10.1001/jamanetworkopen.2022.0148] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Nigeria has the fourth-largest HIV epidemic globally, yet high levels of social stigma inhibit HIV testing among Nigerian youths and young men who have sex with men (MSM). OBJECTIVE To report pilot data from iCARE Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents), a combination intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk youths and young men (hereinafter referred to as young men), including predominantly young MSM. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled study assessed an organizational and community-level 12-month, preintervention-postintervention pilot trial of a combination intervention designed to increase HIV testing uptake, increase the rate of identified seropositive cases, and improve linkage to care among young men, including MSM, using social media outreach and peer navigation. Data were collected from June 1, 2019, to May 30, 2020. Participants were young men aged 15 to 24 years in the city of Ibadan, Nigeria, and surrounding areas. Frequencies and percentages were examined, and a Fisher exact test was used to evaluate outcomes compared with historical surveillance data. Linkage to care was defined as 2 clinic visits, including HIV confirmation, within 2 months of a positive rapid test result. INTERVENTION Four peer navigators conducted social media outreach promoting sexual health and guiding individuals to HIV counseling and rapid testing in clinical, community, or home-based settings. MAIN OUTCOMES AND MEASURES Primary outcomes included the number of young men tested for HIV at university-based iCARE catchment clinics or by iCARE peer navigators in the community, the postintervention HIV seroprevalence of these groups, and linkage to care of participants diagnosed with HIV infection. RESULTS A total of 339 participants underwent testing for HIV (mean [SD] age, 21.7 [1.9] years), with 283 (83.5%) referred through social media. The main referral sources for social media were WhatsApp (124 [43.8%]), Facebook (101 [35.7%]), and Grindr (57 [20.1%]). Regarding testing location, participants chose home (134 [39.5%]), community-based (202 [59.6%]), or clinic (3 [0.9%]) settings. Eighty-six participants reported no prior HIV testing. Thirty-six participants (10.6%) were confirmed as HIV seropositive; among those, 18 (50.0%) reported negative test results within the past year, and 31 (86.1%) were linked to care. In two 6-month follow-up periods, the intervention increased HIV testing by 42% and 31%, respectively, and seroprevalence increased compared with historical trends with odds ratios of 3.37 (95% CI, 1.43-8.02; P = .002) and 2.74 (95% CI, 1.10-7.11; P = .02), respectively. CONCLUSIONS AND RELEVANCE These findings suggest that use of iCARE Nigeria was associated with increased HIV testing and linkage to care in a high-risk, difficult-to-reach population, making it a promising combination intervention for young MSM. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN94590823.
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Affiliation(s)
- Robert Garofalo
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Adedotun Adetunji
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Lisa M. Kuhns
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Olayinka Omigbodun
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Nigeria
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Amy K. Johnson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Kehinde Kuti
- Department of Family Medicine, University College Hospital, Ibadan, Nigeria
| | - Olutosin A. Awolude
- Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Baiba Berzins
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Ogochukwu Okonkwor
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
| | - Bibilola Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abigail L. Muldoon
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Oluwaseun P. Amoo
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hannah Atunde
- Infectious Disease Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Babafemi O. Taiwo
- Division of Infectious Diseases and Center for Global Health, Northwestern University, Chicago, Illinois
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Chen D, Lash B, Kim E, Hidalgo MA, Muldoon AL, Liu E, Jensen J, Grabert R, Chan YM, Garofalo R, Tishelman A. A Comparison of Demographic and Psychosocial Characteristics Between Transgender Youth Enrolling Versus Not Enrolling in a Multisite Study. Transgend Health 2021; 6:229-234. [PMID: 34414280 DOI: 10.1089/trgh.2020.0060] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To characterize demographics, psychosocial functioning, and gender-related experiences in transgender youth enrolling versus declining participation in a multisite research study. Methods: Clinical data were abstracted from patient charts at two study sites. Continuous variables were compared using t-tests, and categorical variables were compared using χ 2 tests based on study enrollment status. Results: Few significant differences were observed between enrolled and nonenrolled youth. None of these differences (i.e., designated sex at birth/gender identity; parent-reported separation anxiety; and youth-reported attention deficit/hyperactivity disorder) was replicated across sites. Conclusion: Trans Youth Care findings are likely generalizable to transgender youth initiating hormone treatment at pediatric academic centers.
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Affiliation(s)
- Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Pritzker Department of Child & Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Brenna Lash
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ellie Kim
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Marco A Hidalgo
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Abigail L Muldoon
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Enju Liu
- Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer Jensen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ren Grabert
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Yee-Ming Chan
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Tishelman
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
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Kuhns LM, Carlino B, Greeley K, Muldoon AL, Karnik N, Thompson H, Garofalo R, Rahmandar M. A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice. Subst Abuse Treat Prev Policy 2020; 15:36. [PMID: 32450882 PMCID: PMC7249384 DOI: 10.1186/s13011-020-00276-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/06/2020] [Indexed: 12/03/2022]
Abstract
Background Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice. Methods We abstracted a random sample of 127 records of patients aged 12–17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors. Results Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models. Conclusions Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment. Clinical trial registration not applicable.
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Affiliation(s)
- Lisa M Kuhns
- The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA. .,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Brookley Carlino
- The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Katie Greeley
- The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA
| | - Abigail L Muldoon
- The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA
| | - Niranjan Karnik
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, USA
| | - Hale Thompson
- Department of Psychiatry & Behavioral Sciences, Rush Medical College, Rush University, Chicago, IL, USA
| | - Robert Garofalo
- The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Maria Rahmandar
- The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.,Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Kolbuck VD, Muldoon AL, Rychlik K, Hidalgo MA, Chen D. Psychological Functioning, Parenting Stress, and Parental Support among Clinic-Referred Prepubertal Gender Expansive Children. Clin Pract Pediatr Psychol 2019; 7:254-266. [PMID: 33312836 DOI: 10.1037/cpp0000293] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/08/2022]
Abstract
Objective The purpose of this study is to describe psychological functioning, parenting stress, and parental support of gender expansiveness in prepubertal gender expansive children presenting to a specialized pediatric gender clinic and examine relations between parenting factors and child psychological functioning. Methods Standard-of-care questionnaires were completed by parents of all children presenting for services. Data from prepubertal children (i.e., Tanner stage 1 of pubertal development) seen between August 2013 and April 2018 were extracted from patient charts. Results Data were analyzed from 71 youth ages three to 11, including 20% (n=14) ages five and younger. Fourteen percent of the sample (n=10) met diagnostic cutoff criteria for Generalized Anxiety Disorder and 20% (n=14) for Oppositional Defiant Disorder. Caregivers reported varying levels of support of their child's gender expansiveness (female caregivers: M=78.85, SD=8.68, range=56-90; male caregivers: M=77.32, SD=10.37, range=53-90), and only 3% (n=2) of caregivers endorsed parenting stress levels in the high range. Parenting stress significantly predicted higher symptom counts across all eight diagnoses. Unexpectedly, higher levels of parental support predicted more symptoms of Major Depressive Disorder and Dysthymia. Parenting stress was a significant moderator of relations between gender-nonconformity and ADHD Hyperactive-Impulsive Type and Conduct Disorder symptoms-higher levels of gender nonconformity was associated with higher symptom counts at moderate and high levels of parenting stress (but not at low levels of parenting stress). Conclusions Clinical interventions aimed at reducing parenting stress among caregivers of gender expansive children may have a positive effect on children's psychological functioning.
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Affiliation(s)
- Victoria D Kolbuck
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
| | - Abigail L Muldoon
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
| | - Karen Rychlik
- Biostatistics Research Core, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, IL USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Marco A Hidalgo
- Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Diane Chen
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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Muldoon AL, Kuhns LM, Supple J, Jacobson KC, Garofalo R. A Web-Based Study of Dog Ownership and Depression Among People Living With HIV. JMIR Ment Health 2017; 4:e53. [PMID: 29117933 PMCID: PMC5700404 DOI: 10.2196/mental.8180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 06/09/2017] [Revised: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) are approximately twice as likely to be depressed compared with HIV-negative individuals. Depression is consistently associated with low antiretroviral therapy (ART) adherence, an important step within the HIV care continuum related to HIV disease progression and overall health. One factor that may have positive psychosocial benefits and promote ART adherence is dog ownership. Research indicates that dog ownership is associated with lower depression, and initial evidence suggests its positive impact on psychosocial outcomes for PLHIV. OBJECTIVE The aim of our study was to expand the existing research by examining the relationship between current dog ownership and depression for a sample of PLHIV while controlling for demographic characteristics and other potential confounders. METHODS Participants aged 18 years or older and who self-reported an HIV diagnosis were recruited via social media into When Dogs Heal, a cross-sectional Web-based survey to collect data among adult PLHIV. The research visit was conducted via a Web-based survey, and there was no in-person interaction with the participant. Primary outcome measures included demographic questions (age, race, ethnicity, gender, and sexual orientation), pet ownership (type of pet owned and current dog ownership), depression (Center for Epidemiologic Studies Depression Scale, 10 items), and resilience (Resilience Research Centre Adult Resilience Measure, 28 items). RESULTS A total of 252 participants were enrolled into the study in January 2016, with a final analytic sample of 199 participants. Mean age was 49 years, 86.4% (172/199) of participants were male, and 80.4% (160/199) were white. Current dog ownership was prevalent among the sample (68.3%, 136/199). Bivariate analysis indicated that there was no significant relationship between depression and demographic characteristics (age, race, ethnicity, gender, and sexual orientation), with P>.05. The multivariate logistic regression, including age, race, ethnicity, gender, resilience, and current dog ownership, was significant, with P<.001. Of the 6 predictor variables, only 2 were statistically significant: dog ownership and resilience. Noncurrent dog owners had 3 times higher odds of depression in comparison with current dog owners: odds ratio 3.01; 95% CI 1.54-6.21. CONCLUSIONS Growing evidence suggests that dog ownership reduces the likelihood of depression and, therefore, may confer long-term health benefits on PLHIV. Future studies should explore whether dog-specific interventions are a feasible and efficacious intervention to improve outcomes among PLHIV.
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Affiliation(s)
- Abigail L Muldoon
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Julie Supple
- Test Positive Aware Network, Chicago, IL, United States
| | - Kristen C Jacobson
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Kuhns LM, Hotton AL, Garofalo R, Muldoon AL, Jaffe K, Bouris A, Voisin D, Schneider J. An Index of Multiple Psychosocial, Syndemic Conditions Is Associated with Antiretroviral Medication Adherence Among HIV-Positive Youth. AIDS Patient Care STDS 2016; 30:185-92. [PMID: 27028184 DOI: 10.1089/apc.2015.0328] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medication adherence among HIV-infected individuals is critical to limit disease progression and onward transmission. Evidence indicates that among youth living with HIV (YLH), adherence is suboptimal and related to co-morbid psychosocial conditions. Cross-sectional data from 212 YLH, ages 16-29, collected between 2011-2014 in Chicago were analyzed to assess the relationship of multiple psychosocial conditions (e.g., depressive symptoms, anxiety symptoms, moderate/heavy marijuana use, moderate/heavy alcohol use, HIV-related stigma) to ART adherence (i.e., a "syndemic.") Adherence was regressed on an index of increasing numbers of psychosocial conditions, controlling for demographic and treatment factors as well as enrollment site. The mean age of participants was 24, 89% were male, 87% black, and 91% behaviorally infected. Psychosocial conditions were prevalent, including 38% and 34% with high depressive and anxiety symptoms, respectively, 54% and 25% with a moderate/high level of marijuana and alcohol use, respectively, and 46% reporting high HIV-related stigma. In regression analysis, the likelihood of ART adherence decreased with the number of syndemic conditions (linear dose response, p = 0.02) as did the odds of viral load suppression (p = 0.008). Interventions to address these conditions in concert with biomedical treatment as prevention for YLH are needed.
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Affiliation(s)
- Lisa M. Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Anna L. Hotton
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois
| | - Rob Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Abigail L. Muldoon
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Kaitlyn Jaffe
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Alida Bouris
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
- School of Social Service Administration, University of Chicago, Chicago, Illinois
- STI/HIV Intervention Network, University of Chicago, Chicago, Illinois
| | - Dexter Voisin
- School of Social Service Administration, University of Chicago, Chicago, Illinois
- STI/HIV Intervention Network, University of Chicago, Chicago, Illinois
| | - John Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
- STI/HIV Intervention Network, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
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Garofalo R, Kuhns LM, Hidalgo M, Gayles T, Kwon S, Muldoon AL, Mustanski B. Impact of religiosity on the sexual risk behaviors of young men who have sex with men. J Sex Res 2014; 52:590-598. [PMID: 25072796 PMCID: PMC4425613 DOI: 10.1080/00224499.2014.910290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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] [Indexed: 06/03/2023]
Abstract
Young men who have sex with men (YMSM), particularly Black YMSM, bear a disproportionate burden of new human immunodeficiency virus (HIV) infections in the United States. Several studies support the positive and protective role of religion in health and the prevention of morbidity and mortality. However, little empirical research has been conducted looking at religion with the context of YMSM and HIV prevention. We examined the impact of religious attendance and faithfulness on sexual risk among a community-based sample of 450 YMSM in Chicago ages 16 to 20. Participants were mostly racial/ethnic minorities, that is, Black (53.4%) and Latino (19.9%). Multivariate logistic regression indicated that faithfulness in combination with frequent formal religious attendance was associated with a decrease in reported number of unprotected anal sex acts, including unprotected receptive anal sex with male partners. These association trends were also found for the Black YMSM in our sample, suggesting that religious involvement and faithfulness is a potential protective factor for the acquisition of HIV among this high-risk population.
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Affiliation(s)
- Robert Garofalo
- a Department of Pediatrics, Feinberg School of Medicine , Northwestern University
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