ICare data: religious preferences

All --
Here are some data from ICare re: the religious attitudes and behavior of our participants.  I have not looked at this real closely, but I am struck by the large % of men who express strong religious affiliation.  


I am working with Jessica Lapinski on a paper re: christian religion and gay identity in a mostly white sample - it may be interesting to look at religion and well being / health / risk in this group.

Any takers?


DjM

bre11 Religious preference or faith
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	1 Christian	150	65.5	65.5	65.5
	3 Muslim, Islamic, Moorish	2	.9	.9	66.4
	4 None	24	10.5	10.5	76.9
	5 No preference	22	9.6	9.6	86.5
	6 Other	31	13.5	13.5	100.0
	Total	229	100.0	100.0

 

 

brec1 Religious preference or faith - christian
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	1 Apostolic/Holiness/Pentecostal	16	7.0	10.7	10.7
	2 Baptist	82	35.8	55.0	65.8
	3 Catholic	5	2.2	3.4	69.1
	5 Jehovah's Witness	3	1.3	2.0	71.1
	6 Lutheran	1	.4	.7	71.8
	7 Methodist	2	.9	1.3	73.2
	10 Non-Denominational	25	10.9	16.8	89.9
	11 Presbyterian	1	.4	.7	90.6
	12 Protestant	4	1.7	2.7	93.3
	13 Seventh Day Adventist	1	.4	.7	94.0
	14 Other	9	3.9	6.0	100.0
	Total	149	65.1	100.0
Missing	98 Refuse to Answer	1	.4
	99	79	34.5
	Total	80	34.9
Total		229	100.0

 

 

bre2 How often did you go to religious services?
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	0 Never	47	20.5	20.5	20.5
	1 Once or twice a year	50	21.8	21.8	42.4
	2 Every month or so	36	15.7	15.7	58.1
	3 Once or twice a month	33	14.4	14.4	72.5
	4 Every week	44	19.2	19.2	91.7
	5 More than once a week	19	8.3	8.3	100.0
	Total	229	100.0	100.0

 

 

bre3 How often do you pray?
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	0 Never	21	9.2	9.2	9.2
	1 Once or twice a year	11	4.8	4.8	14.0
	2 Every month or so	19	8.3	8.3	22.3
	3 Once or twice a month	15	6.6	6.6	28.8
	4 Every week	11	4.8	4.8	33.6
	5 More than once a week	40	17.5	17.5	51.1
	6 Everyday	112	48.9	48.9	100.0
	Total	229	100.0	100.0

 

 

bre5 How important is spirituality or religion in your life?
		Frequency	Percent	Valid Percent	Cumulative Percent
Valid	1 Not important at all	11	4.8	4.8	4.8
	2 Somewhat important	46	20.1	20.1	24.9
	3 Very important	78	34.1	34.1	59.0
	4 Extremely important	94	41.0	41.0	100.0
	Total	229	100.0	100.0

 

MSM counseling research issues: Special Issue of Jr. Coun. Psy

The Journal of Counseling Psychology has a 2009 special issue addressing GLBT issues in mental health and mental health research. Take a look for some good papers overviewing GLBT research generally, sampling issues, definitions & assessment of gay identity, minority stress, etc.
Journal of Counseling Psychology, Volume 56, Issue 1, 2009.

"Project Natal" can help get kids moving?

Microsoft is working on a a sensor that tracks a person's full body movements. So far it is called "Project Natal" and will work with the Xbox 360.

The Wii system has shown promise in health applications (USA Today Article), and so has Dance Dance Revolution (New York Times Article). Project Natal promises to have a larger application than these two platforms because the games will no longer require a controller and will allow the user a greater range of motion.

So far there is not a release date, but it was demoed on Late Night with Jimmy Fallon in Jun. Click here to see the demo.




From Microsoft:
Compatible with any Xbox 360 system, the "Project Natal" sensor is the world's first to combine an RGB camera, depth sensor, multi-array microphone and custom processor running proprietary software all in one device. Unlike 2-D cameras and controllers, "Project Natal" tracks your full body movement in 3-D, while responding to commands, directions and even a shift of emotion in your voice.

In addition, unlike other devices, the "Project Natal" sensor is not light-dependent. It can recognize you just by looking at your face, and it doesn't just react to key words but understands what you're saying. Call a play in a football game, and players will actually respond.

Are your social networks making you fat? Lab discussion readings

A recent NYT Sunday Magazine cover story summarizes the work of Nicholas Christakis and James Fowler on the Framingham data.  The find social network changes to predict obesity, smoking and happiness over 20 years, with specific network features accounting for different outcome behaviors.

I have the NYT article and the journal articles on my Health web site, at http://www.uic.edu/classes/psych/Health/. Look at the article of the week for the NYT piece, and at Week 1 readings for the journal articles.

Comment at will, & read for Wednesday.
On Wednesday we will also begin discussing potential grant applications.

Mainstream Media Health Article of the Week

Rx versus XXX: androgen deficiency is the newest way for Boomers to delay (deny?) getting old. Rather than viewing a little slowing down, less sex drive, a little extra around the waist as natural signs of aging, middle aged (ha!) men are convincing themselves they are in "andropause". Andropause, of course, being a medical problem, can be "cured" with (what else...) a drug: testosterone. But is 'T' any better than, say, a little porn for revving the androgens? Click the title for an article.

Army to offer mental health prevention

Just as congress and, seemingly, every conservative pundit on the planet are up in arms over the prospect of systematic, government-sponsored, proactive or preventive health programming, the Army has quietly moved on its own. Click here or the title for a recent NYT piece describing the plan by the U.S. Army to enroll literally every soldier, family member, and civilian employee in a basic anxiety/depression, aggression and suicidality prevention program. (Enter "army mental health" in the NYT search field to get a host of articles on mental health issues in the military).

The program will be put on by Seligman's group at Penn, using basic CBT reframing and "self-talk" -type procedures. It also appears to be a train-the-trainer delivery model, wherein Sargents and similar level personnel will deliver the actual trainings. This piece is interesting both from a simple peer-delivery perspective, and in terms of facilitating buy-in by the very strata of Army personnel who are stereotyped as least amenable to "touchy-feely" interventions. There also appears to be a major research component, consisting of standard scales administered in a pre- post- design.

Mental health issues in the Army have reached "critical mass" for some time, so they are simply impossible to ignore no matter how stigmatized that entire discourse is in military culture. Vietnam might also have been such a period. However, with the draft soldiers were not required to do the multiple tours that have been so debilitating for Iraq vets: Veterans of Vietnam fell apart after they left the service, not during.

Were other areas of government - and conservatives in general - only as willing to read the data and act on it. Charles Kruthhamer recently had a column denigrating the prospect of preventive care in Obama's health plan, Fox News conservatives have convinced much of the population (even those who lack health care!) that government-run health care could not be other than a disaster, and mental health care continues to be a luxury for a substantial majority of even the insured population.

The military has shown this sort of courage before. The Army was one of the first areas of government to decree racial integration, which was reviled by conservatives at the time as an "experiment" that would certainly fail and was no business of the military anyway. The VA system is one of the first (and largest?) health systems in the U.S. to completely computerize their records, far, far ahead of the private sector. And where are some of the clearest and most credible calls for integrating gays into the military? By military brass. The same civilian conservative politicians who decry health care reform as "socialist" and leading to "death panels" are also the most aggressive homophobes on gays in the military.

I have not found any journal articles on the program, nor seen any actual materials - if any of you come across some please pass along.

Comments?

DjM

Withdrawal increasing as STI/pregnancy prevention?

A recent blog post on XX, a women's -oriented web magazine (here) describes data showing that younger women are increasingly using withdrawal rather than condoms for contraception and STI prevention. Apparently there are some data suggesting that withdrawal is almost as effective as condoms in preventing pregnancy, and is strongly preferred, sensation-wise. Of course many STIs are not well prevented by withdrawal.

Is this a variation on the "safer sex burnout" that has been obvious among MSM - particularly younger MSM - for a number of years? Or does it represent a lessening of completely casual sex and an increasing trust in male partners (who, after all, have to do the pulling...). It would be interesting to see data on the social and sexual contexts within which women make a decision to insist on a condom or trust her partner to pull out at the critical time.

If accurate, this trend flies in the face of research and public health efforts to develop more women-controlled contraception and STI prevention devices. Of course by "women-controlled" is meant not just the technology - such as recent major efforts toward microbicides - but the context within which the women is empowered to make key sexual decisions.

Are younger women as tired of condoms as gay men have become and backsliding to an earlier health perspective, or are they now in enough sexual control that they can tell their male partner to pull out on time and fully expect him to actually do so?

Thoughts on this?

(I know the paper posting mechanism is still bad, but the "comments" link works fine).

DjM

An Excellent Adherence overview: Does health behavior theory "do" anything?

While looking for something else I came across this World Health Organization publication from 2003. It summarizes adherence literature on a variety of chronic diseases, including HIV/AIDS. One of the addenda has a very good review of Health Behavior theories.

The post title (or here) links to the publication.

A key issue in the overview is whether health behavior theory has been fruitfully applied to actual intervention or support programs for people with chronic diseases. The authors bemoan the relative lack of theory in program design, and the almost complete lack of theory-testing per se., but do conclude that health systems must be more attuned to behavioral theory.

However, from my read it is not clear that current health behavior theory & research is actually good for much other than describing - rather than changing - health behaviors. In the actual trenches social learning theory and simple information + skills provision seems out front; more complex theories of perceived vulnerability, stages of change, attitude models and the like all seem like fluff when thinking about actual health systems in an international context.

One interesting trend I noted in this review and another, very similar recent one is how "cognitive" our HB theories are. Lots of belief formation, attitudes, vulnerability judgments, efficacy expectations, but not much emphasis on motivation (Deci & Ryan are not even cited in these reviews). The strong cognitive bias in HB theories seems to assume that people are already motivated, and just need direction or self-efficacy.

As we keep finding out, when dealing with a public rather than clinical population motivation simply cannot be assumed. This is particularly the case for maintenance rather than initiation of behavior change.

The obvious path is the transition from extrinsic to intrinsic motivation that David F. is addressing in his paper. "How to motivate people" is really the core question: all the attitude and self-perception theories really just dance around this issue.

Self-determination theory is silent on how this happens, although Motivational Interviewing approaches do address it directly. It seems as though Carver's hierarchical perspective on values and goals may be relevant here: everyone (?) is intrinsically motivated to be healthy, but few are intrinsically motivated to actually get on a treadmill. The lower-level, more concrete behaviors that actually contribute to health are often extrinsically motivated, despite intrinsic motivation for the outcome.

The distinction between behaviors and outcomes is similar to what Eric is addressing in his dissertation in terms of high v. low levels of action identification. People must want not just to be healthier, but to actually exercise, eat dark green veggies, etc.

David F's paper, in process, will be addressing the transition from extrinsic to intrinsic motivation, for general and domain-specific self-schema (that is, larger values and actual behaviors). I would like us all to participate in that and make it more of a lab paper so we can collate more of our thoughts on these important topics.

David will send around a draft shortly. Everyone take a look at this overview and put on your thinking caps.

DjM

Rape and HIV in South Africa

The title links to a Globe & Mail overview of a very disturbing recent report about sexual assault in South Africa. The original report is here.

Some 27% of randomly sampled men report at least one rape lifetime, and almost 5% report a rape within the past year. Many - but certainly not all - rapes were within a relationship.

Some 3% of men reported an MSM rape, and 10% of respondents reported that they themselves had been victim of an MSM rape.

The authors describe this phenomenon in terms of a culture of violence and sexual entitlement among South African men, as well as in terms of potentially abusive personal histories among men who rape.

As usual, HIV infection co-occurs with those who are most risky, seemingly a universal problem:

...men who are physically violent towards women are twice as likely to be HIV-positive. They are also more likely to pay for sex and to not use condoms.

Any woman raped by a man over the age of 25 has a one in four chance of her attacker being HIV-positive.

There is also a methodological note: they used PDAs and in the field to collect the data anonymously, which seems to have worked in lessening social desirability responding (!). They also used finger-sticks to create dry samples to test for HIV, which they analyzed later (leaving the men anonymous but not informing them of their HIV status).

A dramatic example of the hard barrier culture can represent.

Can Moral identity tell us about cognitive escape and health risk?

…affirming a moral identity leads people to feel licensed to act immorally. However, when moral identity is threatened, moral behavior is a means to regain some lost self-worth.

Sachdeva, S., Iliev, R., & Medin, D. L. (2009). Sinning Saints and Saintly Sinners: The Paradox of Moral Self-Regulation. [Article]. Psychological Science, 20(4), 523-528. Link here

In our quest to understand why people behave badly we have examined several theoretical frames, most of which concern "personality" or "drive" -like constructs. So, a few weeks ago I posted a paper on self-control versus impulsive "systems" (that we never got to discuss in lab). That "dual-systems" paper takes adopts a quasi-drive model, to suggest that overt behavior represents a compromise between two incompatible motivations. The relative strength of self-control versus impulse drives controls how well we self-regulate our sexual, dietary or other appetites.

Similarly, the "self-regulation as a muscle" view has it that self-regulatory action is a limited resource that literally gets fatigued as it is expended. In this view we self-regulate as much as we are able – since we really do want to be healthy and regulated – but at some point we just get tired.

Moving away from drive or capacity models toward a more cognitive view invokes an escape perspective. This may better characterize our participants' struggles in resisting unsafe sex, drug use, or other highly tempting behaviors. Here the conflict is not so much between regulatory versus impulse drives, but between our self-perception as a healthy / good / in-control person, versus our temptation to do those bad things that we really desire.

This view may articulate with older cognitive consistency models from social psychology. These views – best articulated in Leon Festinger's theory of cognitive dissonance – assume that we want to have a positive self-perception, and that to do so we must view our behaviors as being consistent with our values. If I both value smartness and think I am smart, but see myself doing something patently stupid, I may blame that behavior on someone else (I was talked into it!!) so as to maintain my positive self-perception. Similarly B.B. King's excuse for cheating: "…honey, you know it don't count if I was high." ("How Blues can you get").

Sachdeva et al. (2009) present an interesting variation on this theme in terms of moral behavior. When participants are primed to think of themselves in positive, moral terms, they are less likely to actually show moral behavior (contribute to a charity, recycle) than if they have no prime. Alternately, those primed with a threat to their self-worth end up showing more altruistic behavior.

The common denominator is that people have a sort of "set point" for self-worth. If they are given a "surplus" of self-worth (by being asked to recall a string of positive self-descriptions) they have self-worth to burn, and are therefore licensed to be self-centered for a while. In contrast, if their self-worth is threatened they are in deficit. They can restore the balance by doing something nice to prove to themselves that they are good after all.

This reflects a common problem noted in the environmental behavior literature. People will engage in some trivial environmental behavior – buying a carbon offset – and use it to rationalize a larger environmental sin (unnecessary flights, driving instead of walking, etc.) The person's self-worth (or even sense of moral superiority) remains intact by doing a little good to offset a larger bad.

Is this a variation on cognitive escape? How much to people rationalize their problem behaviors not by literally escaping (e.g., via drug use, sensation seeking, etc.), but by maintaining their self-worth via this "offsetting" or "licensing" behavior.

If I have been "good" for a week can I get high and have unsafe sex on Saturday? Have I "earned" that, despite my knowledge that such rationalizations are medical nonsense? Does this only apply if my "moral set point" is relatively high? – what if I just view myself as a loser?

This view may lend itself to intervention applications. We assume that one antidote to escape motivation is self-awareness – getting people to actually see what they are doing when they, e.g., use drugs to escape or regulate affect. Might behavioral interventions also include explicit cognitive dissonance exercises?

Thoughts?

Chiago AIDS surveillance data bleak: Young AAMSM

All --

CDPH HIV/AIDS surveillance data to be released soon shows a bleak picture for the MSM community generally, and younger African-American men specifically. To quote:

A first-of-its-kind study looking at HIV infection rates found that half of gay men in Chicago who have HIV did not know they were infected, and two-thirds of infected black men were unaware. In addition, infection rates for black men were more than twice the rates for whites and Hispanics.

An overview of the findings is in the Chi-Town News here. These data are very similar to those published by the CDC a number of years ago - and even look worse than some of the national data. In particular, 50% of all HIV+ gay men being "HIV unaware" is shocking; those were the figures for the most at-risk men in previous years!!

One implication of these findings is that the men we studied in MIX are unusual. Only 8% of them had not been tested recently, suggesting that very high risk, drug-using men actually are getting their results. It may be a more moderate risk, less conspicuous group who are not getting tested but are risky enough to get infected. Of course these men - who may assume themselves to be HIV-negative - may be the core intervention target.

This really calls for us to get the clinical data from MIX to see how many ostensibly HIV-negative men were actually infected.

All the more reason for us to get funded for YMCA!

Comments?

DjM

Oxytocin Selectively Facilitates Recognition of Positive Sex and Relationship Words

All --

Follow the link (title and here) to a brief report on the effect of Oxytocin [OT] on sexually related stimuli.
OT is usually assessed in serum as a result of, e.g., social supportive interventions. It typically increases as one feels "close" to another, and serves to enhance social bonds. These guys are inducing OT exogenously - via a nasal spray (!?) - and showing increases in the cognitive "availability" of sexual and relationship concepts.

Besides its obvious commercial potential, this raises some interesting conceptual issues. Their outcome is reaction time in a word recognition task, so it is far from the sexual trenches. It is interesting nonetheless. The key is that their experimental paradigm may allow for examining changes in sexual decisions within-person.

Does a measurable increase in OT disrupt one's good intentions by shifting the threshold for perceiving an otherwise neutral (or even negative / "risky") stimulus as sexual and positive? Sort of a neurochemical beer goggles.

Or, less crudely, and using some of Eric's framework, does OT shift one's action identification in a sexual context from the concrete (hanging out, maybe having sex...) to the abstract (pair-bonding, establishing human closeness, closely "relating"). As Eric has argued, higher-order action identifications may be hazardous to your health: you may sacrifice (concrete) individual protective motives on the alter of some abstract notion of "really being close tonight".

Do we, in our preventive interventions, inculcate beliefs and intentions that are learned in a "low-OT" state that, in a state-dependent learning -like fashion, fail to control behavior when one's brain state shifts? Perhaps a signal-detection paradigm may provide a way to examine the effect of temporary changes in OT level on high versus low risk mens' shifting thresholds for recognizing risk.

Are there individual - or within-individual - differences in the precursors of OT that we could conceptualize, assess and modify?

How do neurotransmitters such as OT map onto avoidant or "escape" coping with health risks? To the use of alcohol or drugs in potentially risky contexts? Brian Mustanski has found that the search for positive affect may be more important to risk than seeking relief from negative affect.

Your thoughts, esteemed colleagues? Kyle, you are the new experimental guy - what do you think?

DjM