Monday, October 26, 2009

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.

Wednesday, September 23, 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.

Tuesday, September 22, 2009

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.

Thursday, September 10, 2009

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.

Friday, August 21, 2009

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

Tuesday, August 11, 2009

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

Thursday, July 2, 2009

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

Thursday, June 18, 2009

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.

Friday, June 5, 2009

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?

Tuesday, June 2, 2009

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

Thursday, May 21, 2009

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

Tuesday, May 5, 2009

Self-control v. impulses: get ready for summer!

Here is a paper I would like to chat about during lab on Friday:

Hofmann, W., Friese, M., & Strack, F. (2009). Impulse and Self-Control From a Dual-Systems Perspective. Perspectives on Psychological Science, 4(2), 162-176.

Get it here.

We will also briefly talk about Natalie's stuff, and how we can get the blog to be more useful.

DjM

Brief validated adherence measure

Next time we get funded (!): a brief, validated adherence measure from UCSD.

Mathews, W., Barker, E., Winter, E., Ballard, C., Colwell, B., & May, S. (2008). Predictive validity of a brief antiretroviral adherence index: Retrospective cohort analysis under conditions of repetitive administration. AIDS Research and Therapy, 5(1), 20.

http://www.aidsrestherapy.com/content/5/1/20


DjM


Monday, April 20, 2009

CSA and EXPLORE

Childhood Sexual Abuse Is Highly Associated With HIV Risk-Taking Behavior and Infection Among MSM in the EXPLORE Study.

Mimiaga MJ, Noonan E, Donnell D, Safren SA, Koenen KC, Gortmaker S, O╩╝cleirigh C, Chesney MA, Coates TJ, Koblin BA, Mayer KH.

Departments of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA; …

BACKGROUND: Previous studies have found high rates of childhood sexual abuse (CSA) among US men who have sex with men (MSM). CSA history has been associated with a variety of negative effects later in life including behaviors that place MSM at greater risk for HIV acquisition and transmission. The present analysis is the first to examine the longitudinal association between CSA and HIV infection, unprotected anal sex, and serodiscordant unprotected anal sex, as well as mediators of these relationships among a large sample of HIV-uninfected MSM. METHODS: The EXPLORE Study was a behavioral intervention trial conducted in 6 US cities over 48 months with HIV infection as the primary efficacy outcome. Behavioral assessments were done every 6 months via confidential computerized assessments. Longitudinal regression models were constructed, adjusting for randomization arm, geographical location of study site, age at enrollment, education, and race/ethnicity. RESULTS: Of the 4295 participants enrolled, 39.7% had a history of CSA. Participants with a history of CSA [adjusted hazards ratio = 1.30, 95% confidence interval (CI): 1.02 to 1.69] were at increased risk for HIV infection over study follow-up. A significant association was seen between history of CSA and unprotected anal sex (adjusted odds ratio = 1.24, 95% CI: 1.12 to 1.36) and serodiscordant unprotected anal sex (adjusted odds ratio = 1.30, 95% CI: 1.18 to 1.43). Among participants reporting CSA, the EXPLORE intervention had no effect in reducing HIV infection rates. Participants reporting CSA were significantly more likely to have symptoms of depression and use nonprescription drugs. CONCLUSIONS: A predictive relationship between a history of CSA and subsequent HIV infection was observed among this large sample of HIV-uninfected MSM. Findings indicate that HIV-uninfected MSM with CSA histories are at greater risk for HIV infection, report higher rates of HIV sexual risk behavior, and may derive less benefit from prevention programs. Future HIV prevention interventions should address the specific mental health concerns of MSM with a history of CSA.

Monday, March 30, 2009

Annual review of Clinical Psychology Links:


Preface by Editors

Annual Review of Clinical Psychology; Volume 5


------------------------------------------------------------------------
Construct Validity: Advances in Theory and Methodology

Milton E. Strauss and Gregory T. Smith
Annual Review of Clinical Psychology; Volume 5, Page 1 - 25


------------------------------------------------------------------------
Item Response Theory and Clinical Measurement

Steven P. Reise and Niels G. Waller
Annual Review of Clinical Psychology; Volume 5, Page 27 - 48


------------------------------------------------------------------------
Methodological Issues in Molecular Genetic Studies of Mental Disorders

Carrie E. Bearden, Anna J. Jasinska, and Nelson B. Freimer
Annual Review of Clinical Psychology; Volume 5, Page 49 - 69


------------------------------------------------------------------------
Statistical Methods for Risk-Outcome Research: Being Sensitive to
Longitudinal Structure

David A. Cole and Scott E. Maxwell
Annual Review of Clinical Psychology; Volume 5, Page 71 - 96


------------------------------------------------------------------------
Psychological Treatment of Anxiety: The Evolution of Behavior Therapy
and Cognitive Behavior Therapy

S. Rachman
Annual Review of Clinical Psychology; Volume 5, Page 97 - 119


------------------------------------------------------------------------
Computer-Aided Psychological Treatments: Evolving Issues

Isaac Marks and Kate Cavanagh
Annual Review of Clinical Psychology; Volume 5, Page 121 - 141


------------------------------------------------------------------------
The Past, Present, and Future of HIV Prevention: Integrating Behavioral,
Biomedical, and Structural Intervention Strategies for the Next
Generation of HIV Prevention

Mary Jane Rotheram-Borus, Dallas Swendeman, and Gary Chovnick
Annual Review of Clinical Psychology; Volume 5, Page 143 - 167


------------------------------------------------------------------------
Evolving Prosocial and Sustainable Neighborhoods and Communities

Anthony Biglan and Erika Hinds
Annual Review of Clinical Psychology; Volume 5, Page 169 - 196


------------------------------------------------------------------------
Five-Factor Model of Personality Disorder: A Proposal for DSM-V

Thomas A. Widiger and Stephanie N. Mullins-Sweatt
Annual Review of Clinical Psychology; Volume 5, Page 197 - 220


------------------------------------------------------------------------
Differentiating the Mood and Anxiety Disorders: A Quadripartite Model

David Watson
Annual Review of Clinical Psychology; Volume 5, Page 221 - 247


------------------------------------------------------------------------
When Doors of Perception Close: Bottom-up Models of Disrupted Cognition
in Schizophrenia

Daniel C. Javitt
Annual Review of Clinical Psychology; Volume 5, Page 249 - 275


------------------------------------------------------------------------
The Treatment of Borderline Personality Disorder: Implications of
Research on Diagnosis, Etiology, and Outcome

Joel Paris
Annual Review of Clinical Psychology; Volume 5, Page 277 - 290


------------------------------------------------------------------------
Development and Etiology of Disruptive and Delinquent Behavior

Rolf Loeber, Jeffrey D. Burke, and Dustin A. Pardini
Annual Review of Clinical Psychology; Volume 5, Page 291 - 310


------------------------------------------------------------------------
Anxiety Disorders During Childhood and Adolescence: Origins and
Treatment

Ronald M. Rapee, Carolyn A. Schniering, and Jennifer L. Hudson
Annual Review of Clinical Psychology; Volume 5, Page 311 - 341


------------------------------------------------------------------------
APOE-4 Genotype and Neurophysiological Vulnerability to Alzheimer's and
Cognitive Aging

Susan Bookheimer and Alison Burggren
Annual Review of Clinical Psychology; Volume 5, Page 343 - 362


------------------------------------------------------------------------
Depression in Older Adults

Amy Fiske, Julie Loebach Wetherell, and Margaret Gatz
Annual Review of Clinical Psychology; Volume 5, Page 363 - 389


------------------------------------------------------------------------
Pedophilia

Michael C. Seto
Annual Review of Clinical Psychology; Volume 5, Page 391 - 407


------------------------------------------------------------------------
Treatment of Smokers with Co-Occurring Disorders: Emphasis on
Integration in Mental Health and Addiction Treatment Settings

Sharon M. Hall and Judith J. Prochaska
Annual Review of Clinical Psychology; Volume 5, Page 409 - 431


------------------------------------------------------------------------
Environmental Influences on Tobacco Use: Evidence from Societal and
Community Influences on Tobacco Use and Dependence

K. Michael Cummings, Geoffrey T. Fong, and Ron Borland
Annual Review of Clinical Psychology; Volume 5, Page 433 - 458


------------------------------------------------------------------------
Adolescent Development and Juvenile Justice

Laurence Steinberg
Annual Review of Clinical Psychology; Volume 5, Page 459 - 485


------------------------------------------------------------------------

Monday, March 23, 2009

GLBTs & Poverty

Thanks to Steve for Chicago AIDS report - Chicago is consistent with the national picture on the status of minorities and HIV. We still have to schedule Nanette B. from the city to talk to the lab about the CDC/city surveillance work.

On another note: the "affluent gay" myth is, in fact, empirically a myth. See a good report by the Williams Institute (a GLBT research outfit) on this topic at: http://www.law.ucla.edu/williamsinstitute/pdf/LGBPovertyReport.pdf

-DjM

Chicago AIDS Survival Characteristics, 1993-2001

Hi All:

Here is an abstract to a review of AIDS survival rates amongst different demographic groups in Chicago, published by authors from the Department of Public Health in Chicago. Primary conclusion that we may use for future grant writing/study proposals: Blacks and Hispanics with AIDS are at a higher risk for death than Whites with AIDS.

Steve

Demographic Characteristics and Survival With AIDS: Health Disparities in Chicago, 1993–2001

Girma Woldemichael, ScD, Demian Christiansen, DSc, Sandra Thomas, MD and Nanette Benbow, MAS

At the time of the study, the authors were with the Department of Public Health, Chicago, IL.

Correspondence: Requests for reprints should be sent to G. Woldemichael, Epidemiology Program, Department of Public Health, DePaul Center, Rm 2136, 333 S State St, Chicago, IL 60604 (e-mail:woldemichael_girma@cdph.org).

Objectives. We examined correlations between survival and race/ethnicity, age, and gender among persons who died from AIDS-related causes.

Methods. We estimated survival among 11 022 persons at 12, 36, and 60 months after diagnosis with AIDS in 1993 through 2001 and reported through 2003 to the Chicago Department of Public Health. We estimated hazard ratios (HRs) by demographic and risk characteristics.

Results. All demographic groups had higher 5-year survival rates after the introduction of highly active retroviral therapy (1996–2001) than before (1993–1995). The HR for non-Hispanic Blacks to Whites was 1.18 in 1993 to 1995 and 1.51 (P < .01) in 1996 to 2001. The HR for persons 50 years or older to those younger than 30 years was 1.63 in 1993–1995 and 2.28 (P < .01) in 1996–2001. The female-to-male HR was 0.90 in 1993–1995 and 1.20 (P < .02) in 1996–2001.

Conclusions. The risk of death was higher for non-Hispanic Blacks and Hispanics than for non-Hispanic Whites. Interventions are needed to increase early access to care for disadvantaged groups.


Thursday, March 19, 2009

Various, plus New review paper on Prevention for Positives

Here (thanks to Steve) is the link to a new review re: TAP-like interventions:
http://www.sciencedirect.com/science/article/B7MDD-4VTWN5N-8/2/4004fb30e870a0e3d9290dc273d4f88c

Let me know if the link does not work - this should go right to the journal.

No lab Friday, 3/20.

I am trying to get to a point where we can post papers for mutual review on this site, but no luck quite yet. Any insights would be VERY helpful.

DjM

Tuesday, March 10, 2009

Black MSM Intervention Article

Hi All:

Here is a preview of an article from the new AIDS & Behavior. The full article isn't yet available (or at least I can't find it), but this gives us something on efficacious interventions for Black MSM.

http://www.springerlink.com/content/vt720u28613rrx07/

Take care,

Steve

Tuesday, February 17, 2009

Medical Advocates MSM Homepage

Hi All:

This link gives access to many articles we may find relevant to our research or helpful for our grant proposal.

http://www.medadvocates.org/marg/msm/main.html

Enjoy!

Steve

Wednesday, February 11, 2009

Behavioral economics and health behavior

Today's thought topic –

Behavioral Economics is flourishing as a discipline, addressing the same problems we face in health behavior of HIV prevention: short-term versus long-term thinking. In Econ jargon it is "present self" versus "future self", the latter being more abstract and difficult to focus on.

Following is a piece in today's NYT – the other is a piece by Sunstein (who we cited in the internet paper) about "nudges" toward pro-social behavior.

http://www.nytimes.com/2009/02/11/business/economy/11leonhardt.html?scp=1&sq=behavioral%20economics&st=cse


 

http://www.nytimes.com/2009/02/08/business/08nudge.html?scp=3&sq=behavioral%20economics&st=cse

Blacks and HIV Rates

Hi All:

I found this ref today. We might use some stats from it in our grant proposal. Also, after following some links from this article, I found this:

Chapter 5: Research Related to Specific Populations (PDF, 46 pages) PDF document

This is a list of NIH objectives regarding HIV research for the 2009. In the Racial and Ethnic Populations section, there is a more specific list of goals relating to HIV research on these groups. Many of the goals we discussed with this grant are those that the NIH has proclaimed as important in HIV-research.

HIV Disproportionately Affecting Blacks in U.S., Fauci Says

Excerpts below- full text at

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=56856

HIV/AIDS is disproportionately affecting blacks in the U.S., with almost half of all new infections occurring in the population, Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, said recently, Reuters reports. According to Fauci's statement, which was released to mark National Black HIV/AIDS Awareness Day on Saturday, blacks comprise 12% of the U.S. population but account for almost 50% of all people living with HIV in the country. Fauci pointed to the majority black city of Washington, D.C., where one in 20 residents is living with HIV -- about the same proportion of people in sub-Saharan Africa. Fauci's statement is available online at http://www3.niaid.nih.gov/about/directors/news/BAAID_09.htm

Tuesday, February 10, 2009

HIV adherence overview

Fairly recent overview of predictors of HIV medication adherence:

Ammassari, A., Trotta, M. P., Murri, R., Castelli, F., Narciso, P., Noto, P., et al. (2002). Correlates and predictors of adherence to highly active antiretroviral therapy: Overview of published literature. JAIDS-Journal Of Acquired Immune Deficiency Syndromes 31(Suppl. 3), S123-S127.

Covers mostly demographic variables, but exhaustive.

Wednesday, February 4, 2009

Lab topics for this week:

Lab topics for this week:

1. The CDC grant
2. Two interesting articles from Health Psych. today. Both deal with affect and health behavior.

Lawton R, Conner M, McEachan R. Desire or Reason: Predicting Health Behaviors From Affective and Cognitive Attitudes. Health Psychology. Jan 2009;28(1):56-65. Link


...affective attitude was a significantly more powerful predictor of behavior than cognitive attitude for 9 behaviors. Also, affective attitude had a direct effect on behavior that was not fully mediated by intention for 9 behaviors... ...The findings underscore the importance of affect in the performance of health-related behaviors and suggest that interventions could usefully target the affective consequences of engaging in these behaviors.

Safren SA, O'Cleirigh C, Tan JY, et al. A Randomized Controlled Trial of Cognitive Behavioral Therapy for Adherence and Depression (CBT-AD) in HIV-Infected Individuals. Health Psychology. Jan 2009;28(1):1-10.
Link

...those who received CBT-AD evidenced significantly greater improvements in medication adherence and depression relative to the comparison group. Those who were originally assigned to the comparison group who chose to cross over to CBT-AD showed similar improvements in both depression and adherence outcomes. Treatment gains for those in the intervention group were generally maintained at 6-and 12-month follow-up assessments. By the end of the follow-up period, those originally assigned CBT-AD demonstrated improvements in plasma HIV RNA concentrations ...


This is really an important finding, using a very sophisticated design - the roll-over condition helps both with statistical power and study ethics.

Saturday, January 31, 2009

Social norms and behavior change: a new (to us...) variable to consider

This is not strictly health, but the Saturday NYT had an interesting piece on Chialdini's work on persuasion and social norms, in this case with regards to energy conservation. The basic finding is that providing descriptive norms is double edged: if you tell people their neighbors use X amount of energy, which is lower than they use, you will get pro-social changes toward that lower norm. However, if your neighbors use more than you do you may actually relax your behavior.

From the abstract of the article cited in the NYT piece (link to it Here):

Abstract: It is widely recognized that communications that activate social norms can be effective in producing societally beneficial conduct. Not so well recognized are the circumstances under which normative information can backfire to produce the opposite of what a communicator intends. There is an understandable but misguided, tendency to try to mobilize action against a problem by depicting it as regrettably frequent. Information campaigns emphasize that alcohol and drug use is intolerably high, that adolescent suicide rates are alarming, and-most relevant to this article-that rampant polluters are spoiling the environment. Although these claims may be both true and well intentioned, the campaigns' creators have missed something critically important: Within the statement "Many people are doing this undesirable thing" lurks the powerful and undercutting normative message "Many people are doing this." Only by aligning descriptive norms (what people typically do) with injunctive norms (what people typically approve or disapprove) can one optimize the power of normative appeals. Communicators who fail to recognize the distinction between these two types of norms imperil their persuasive efforts.

This has pretty obvious implications for the messages we send about safer sex and drug use.

It is also relevant to the sustainability issue, which I am recently getting involved in.

Comments? Intervention implications?

DjM

Thursday, January 29, 2009

Health & HIV prevention blog

Here is a new concept (actually an old one, we tried this once before)...:
Since we have been exchanging e-mail notes about health & HIV topics and are working on various papers, let's try to frame this as a blog.

My thought is to use this both for the lab, and for the Health course as I teach it. We may also try to include others who may be interested, whether faculty or students.

We'll see if I have the energy to keep this going, but for now let's at least give it a go.

I see this as a venue to post interesting popular press pieces, links to interesting papers, materials or discussion for lab meetings, etc. I would also like to incorporate a "Wiki" to this, which will let us all collaboratively work on papers.

First item - I will post the CDC RFA for the African-American MSM project, and will put the sero-sorting paper in a wiki if I can figure out how to.

Let me know what you all think.

DjM