Annals of Behavioral Medicine最新文献

Background: As part of a study to test the feasibility and acceptability of the Finding Respect and Ending Stigma around HIV (FRESH) intervention to reduce stigmas and improve HIV viral suppression, our team collected qualitative data from men who have sex with men (MSM) with HIV, transgender women with HIV, and HIV healthcare providers for their perspectives on different stigmas in Dominican Republic healthcare settings.

Purpose: We aimed to develop an understanding of the causes, consequences, and domains of stigma among sexual and gender minorities with HIV in Dominican Republic HIV clinics.

Methods: Data collection occurred in Santo Domingo and Santiago (2020-2021) and included four focus groups with MSM with HIV (n = 26), in-depth interviews with transgender women with HIV (n = 14), and in-depth interviews with HIV healthcare providers (n = 16). All data collection occurred in person and was audio recorded. Standardized guides were used for focus groups and in-depth interviews. Using a deductive process, 2 research associates thematically coded data in the NVivo software.

Results: On average, focus groups were 81 minutes, provider in-depth interviews were 24 minutes, and transgender women in-depth interviews were 32 minutes. We identified 4 key themes that mapped to 4 domains of stigma affecting MSM and transgender women with HIV: migrant stigma, religious stigma, sexual and gender minorities (SGM) stigma, and HIV stigma. All participant types noted the persistence of stigma and discrimination in healthcare settings in the Dominican Republic. The consequences of these stigmas were reported as being significant, including attempted suicide.

Conclusions: Interventions to reduce stigma experienced by SGM populations with HIV should address structural barriers, including inner and outer contexts of HIV care provision and cultural norms and values that propagate stigma. Findings offer insights about which stigmas could be targeted in future studies and how to potentially address stigma to improve population health in the Dominican Republic.

Background: Depression co-occurs with diabetes at twice the rate, relative to the general population without diabetes but it is unknown whether depression is longitudinally associated with diabetes control in the general population.

Purpose: To characterize the longitudinal association between depressive symptoms and joint achievement of glycemic, blood pressure (BP), and cholesterol control (ABC control) among middle-aged and older adults (≥50 years) with diabetes in United States.

Methods: Data of the nationally representative Health and Retirement Study 2006-2017 were pooled across study waves conducted every 2 years. Center for Epidemiological Studies Depression (CES-D8) scale was used to assess baseline depressive symptoms (≥3 points). Joint ABC control 4 years later was ascertained using HbA1c (<7.0% [53 mmol/mol] if <65 years, <7.5% [58 mmol/mol] if ≥65 years or <8.0% [64 mmol/mol] with comorbidities), BP (systolic < 140 and diastolic < 90 mm Hg), and non-HDL cholesterol (<130 mg/dL). Survey-weighted modified Poisson regressions were used to study the association (risk ratios [RR]) of depressive symptoms with ABC control.

Results: The study sample consisted of 3 332 observations from 2 531 individuals (mean age: 64.4 years [SD: 8.8], 55.4% women). Depressive symptoms were neither associated with the achievement of joint ABC control (RR: 0.91 [95% CI, 0.76-1.09]) nor achievement of glycemic, BP or cholesterol control after adjusting for covariates. Findings were consistent across various subgroups defined by age, gender, baseline ABC control, medication use, and duration of diabetes.

Conclusions: Baseline depressive symptoms do not compromise future diabetes management. Care models should focus on both conditions independently to potentially improve overall health.

Background: Cardiovascular health (CVH) disparities have been documented among sexual minority adults, yet prior research has focused on individual CVH metrics. We sought to examine sexual identity differences in CVH using the American Heart Association's composite measure of ideal CVH, which provides a more comprehensive assessment of future CVD risk.

Methods: Data from the All of Us Research Program were analyzed. Sexual identity was categorized as heterosexual, gay/lesbian, bisexual, or other. Individual CVH health metrics and cumulative ideal CVH (range 0-100) were assessed. We ran sex-stratified multiple linear regression models to estimate differences across individual CVH metrics and cumulative ideal CVH between sexual minority and heterosexual adults. We also explored differences in CVH across racial/ethnic and age groups.

Results: The sample included 11 047 cisgender adults with a mean age of 61.1 years (± 13.85); 80% were non-Hispanic White. Lesbian women, gay men, and bisexual women reported greater nicotine exposure than their heterosexual counterparts. Compared to heterosexual men, gay men (B [95% CI] = -8.95 [-14.50, -3.39]) had worse physical activity scores. Gay men also had better body mass index scores than heterosexual men (B [95% CI] = 3.21 [0.09, 6.33]). Bisexual women and men had lower cumulative ideal CVH scores than heterosexual adults. Exploratory analyses revealed several differences in individual CVH metrics and cumulative ideal CVH across racial/ethnic and age groups.

Conclusions: Clinical interventions to improve the CVH of bisexual adults are needed. Findings can inform the design of interventions that are tailored for specific subgroups of sexual minority adults.

Background: Preliminary data indicate that smoking cessation offered in a rolling group format is feasible and effective.

Purpose: The current study evaluated the implementation and outcomes of the remote Courage to Quit-Rolling Virtual (CTQ-RV) smoking group treatment compared to its precursor in-person format (Courage to Quit-Rolling, CTQ-R).

Methods: Virtual materials for CTQ-RV were adapted from in-person evidence-based programming, thus content in both groups was similar but delivered via videoconference or in-person. We used an interrupted time series design to examine feasibility by comparing attendance, monthly enrollment, and program completion between those who attended CTQ-R (July 2018-March 2020) versus CTQ-RV (April 2020-December 2022).

Results: There were 611 patients enrolled in tobacco cessation (N = 221 CTQ-R, N = 390 CTQ-RV). The average age was 59.4 years and most patients reported Black/African American race (81%) and female sex (69.5%). CTQ-RV proved feasible relative to CTQ-R, with higher rates of attendance (5.5 vs. 2.7 sessions, respectively), program completion (39.4% vs. 19%) and increased enrollment across each year (from 44.6 sessions per month in CTQ-R vs. 72.3 in CTQ-RV). CTQ-RV patients requested nicotine replacement therapy (NRT) at substantially higher rates (81.4%) than CTQ-R members (42.1%). Self-reported smoking abstinence at final session was higher in CTQ-RV compared with CTQ-R (33.3% vs. 15.7%). Within CTQ-RV, more than half (57%) of patients attended by video format, with outreach improving rates of video attendance each year.

Conclusions: Results show that a transition to virtual rolling enrollment smoking group treatment is feasible and can augment treatment outcomes, such as engagement, NRT use, and self-reported cessation.

Many middle-aged to older adults do not engage in regular exercise at all, despite its importance for healthy aging. Extensive research grounded in behavioral and social science theories has identified numerous determinants of exercise. However, few studies used an exposure-wide approach, a data-driven exploratory method particularly useful for identifying novel determinants.

Methods: We used data from 13 771 participants in the Health and Retirement Study, a diverse, national panel study of adults aged >50 years in the United States, to evaluate 62 candidate determinants of exercise participation. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. We used Poisson regression with robust error variance to individually regress exercise in the outcome wave (t2: 2014/2016) on baseline candidate predictors (at t1: 2010/2012) controlling for all covariates in the previous wave (t0: 2006/2008).

Results: Some physical health conditions (eg, physical functioning limitations and lung disease), psychological factors (eg, health mastery, purpose in life, and positive affect), and social factors (eg, helping others, religious service attendance, and volunteering) were robustly associated with increased subsequent exercise. Among factors related to psychological distress, perceived constraints stood out as a factor in reducing exercise.

Conclusions: We identified potentially novel exercise determinants, such as helping friends/neighbors/relatives, religious attendance, and volunteering, that have not been captured using a theory-driven approach. Future studies validating these findings experimentally in midlife and older adults are needed.

Background: Medically unexplained, persistent physical symptoms and syndromes are commonly seen in primary care. These are debilitating for patients and difficult to treat, causing frustration for patients and providers.

Purpose: This study investigates how well US military veterans with multiple persistent physical symptoms (PPS), called Gulf War illness (GWI), agree with their healthcare providers about their illness. This agreement, called perceived concordance, is hypothesized to influence veterans' satisfaction with care, adherence to care plans, and disability levels.

Methods: Participants were 230 veterans with GWI deployed to the 1990-1991 Gulf War who were recruited from Veteran Affairs primary care and War Related Illness and Injury Study Centers (WRIISCs). Veterans' GWI perceptions and perceived concordance with their providers regarding GWI were assessed at a medical visit. Veterans' self-reported satisfaction with care, adherence to care plans, and disability levels were measured at 1 week, 1 month, and 6 months post-baseline.

Results: Bivariate correlations indicated that veterans' GWI-related illness perceptions were related to veterans' satisfaction with care and reports of functional disability. Beyond these effects, veterans' perceived concordance with the provider regarding GWI was positively associated with satisfaction over time (e.g., fixed-effect estimate = 0.36, P < .001 for 1-week follow-up) and adherence to care plans (fixed-effect estimate averaged across all timepoints = 0.03, P = .03) but was unrelated to reported disability.

Conclusions: Veterans' perceived concordance with their providers about GWI seems to be important for patient satisfaction and adherence to care plans. More research with longer-term follow-up is needed to understand how perceived concordance might influence disability levels and the outcome of care plans.

Background: Chronic pain inequities follow a social power-driven gradient of health, whereby those with less social advantage experience chronic pain more often. Feeling socially supported may reduce the burden of chronic pain.

Purpose: To take an intersectional approach to understand inequities in chronic pain in the United States, by testing whether living at different intersections of sexual orientation and gender shape chronic pain through differences in experiences of social and emotional support.

Methods: We compared chronic pain frequency and availability of social support at intersections of sexual orientation and gender in the 2021 National Health Interview Study using an analytic intercategorical intersectional approach using a 3-way decomposition approach to mediation.

Results: Pairwise comparisons highlighted inequities in chronic pain among sexual minority women (i.e., women who identified as "something else," gay/lesbian, or bisexual) and bisexual men compared to all other identities (i.e., straight and questioning men and women, and men who identified as "something else"). Inequities were most salient for bisexual men and women, especially bisexual women. A theoretical intervention to increase available social support to that of straight women, who reported the greatest availability of social support, would decrease chronic pain frequency for all sexual minority people except for gay/lesbian women. Inequities, while attenuated, would persist among bisexual men and women after a theoretical intervention.

Conclusions: Social position shapes chronic pain inequities in sexual minority people in the United States through differences in available social and emotional support. Results highlight bisexual men as an understudied group in chronic pain research.

Background: Repetitive stress is at the nexus of acute and chronic stress, and there is limited knowledge about how physiological and emotional responses change with repeated exposure.

Purpose: We examined stress-related biomarkers and emotional responses to repeated social stressors, and we tested behavioral moderators.

Methods: In Study 1, 42 adults completed the Trier Social Stress Test (TSST) twice, 4 months apart. Serum inflammatory cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), blood pressure, pulse, salivary cortisol, and state-level anxiety were measured surrounding the stressor. In Study 2, 84 married individuals completed two 20-minute discussions of contentious topics in the marriage, 1 month apart. Serum IL-6, TNF-α, blood pressure, pulse, salivary cortisol, and state affect were collected surrounding the conflict. Trained experimenters rated positive and negative behavior during the conflict.

Results: In the repetitive Trier paradigm, participants reported less anxiety (Ps = .048) and had higher anticipatory IL-6 responses (P = .014) at Visit 2, compared to Visit 1. In the repetitive marital conflict paradigm, participants had lower positive affect (P = .0004), as well as systolic blood pressure (SBP) (P = .009), diastolic blood pressure (P = .0003), and pulse (P = .027) habituation at the second visit. Objectively rated negative conflict behavior interacted with visit to predict TNF-α (P = .025) and SBP (P = .037) responses. Positive conflict behavior did not moderate outcomes (Ps > .06).

Conclusions: Stress-sensitive systems can habituate or sensitize to even nontraumatic, repetitive social stressors. Patterns of habituation or sensitization may vary by time between repetition, type of social stressor, stress-sensitive system, and participant behavior.

Background: Depression affects 33% of women with type 2 diabetes (T2D) and leads to increased risks of premature mortality. Fluctuation and variation of depressive presentations can hinder clinical identification.

Purpose: We aimed to identify and examine subgroups characterized by distinct depressive symptom trajectories among women with T2D.

Methods: This retrospective analysis leveraged the Women's Interagency HIV Study data to identify depressive symptom trajectories based on the Center for Epidemiological Studies Depression scores (2014-2019) among women with and without HIV. Descriptive statistics characterized sample demographics (eg, age, race, income), clinical indices (eg, hemoglobin A1C [HbA1c], BMI, HIV status), and psychosocial experiences (eg, discrimination, social support, anxiety, pain). We used growth mixture modeling to identify groups defined by distinct depressive symptom trajectories and parametric and non-parametric tests to examine demographic, clinical, and psychosocial differences across subgroups.

Results: Among the 630 women included, the mean age was 50.4 (SD = 8.3) years, 72.4% identified as Black and non-Hispanic, and 68.2% were living with HIV. Five subgroups were identified and distinguished by severity and symptom type. Participants with lower incomes (P = .01), lower employment (P < .0001), lower social support (P = .0001), and experiences of discrimination (P < .0001) showed greater membership in threshold, moderate, and severe depressive subgroups. Subgroup membership was not associated with metabolic indices (BMI, HbA1c) or HIV status. Anxiety, pain, and loneliness (all P = .0001) were worse in subgroups with higher depressive symptoms.

Conclusions: Among women with T2D, depressive symptom trajectories differ across clinical and social contexts. This study advances precision by delineating subgroups within a broad clinical category.