The long-term outcome of a personal network-oriented HIV prevention intervention for injection drug users: The SAFE study

Social influence processes have been found to affect numerous drug and health-related behaviors. We postulated that by using a network-oriented intervention it may be possible to capitalize on social influence processes to reduce human immunodeficiency virus (HIV) risk behaviors. The present study used an experimental study design for delivering a psychoeducational acquired immunodeficiency syndrome (AIDS) preventive intervention to injection drug sharing networks. Participants were recruited from the ALIVE study, an epidemiological study in Baltimore. In the present paper we examine the self-reported behavioral outcomes of 117 injection drug users 18 months after the baseline interview. HIV seronegative experimental participants reported significantly less frequent needle sharing and less injecting of heroin and cocaine than controls. In multiple logistic regression models of HIV seronegative participants, there was a significant negative association between assignment to the experimental group and the HIV-related behaviors of needle sharing and sharing of cookers in the prior 6 months; controls were 2.8 times more likely than experimentals to report needle sharing and were 2.7 times more likely to report sharing cookers. The results of this 18-month follow-up suggest that among injection drug users network-oriented interventions may be a promising approach to HIV prevention.     

Neighborhood and Housing Disorder,Parenting, and Youth Adjustment in Low-Income Urban Families

Using two waves of data, this study examined relations among neighborhood and housing disorder, parents’ psychological distress, parenting behaviors, and subsequent youth adjustment in a low‐income, multiethnic sample of families with children aged 6–16. Results supported the hypothesized indirect relation between disorder and youth outcomes via parenting processes. Higher levels of neighborhood and housing disorder were associated with higher levels of parents’ psychological distress, which was in turn related to more frequent use of harsh and inconsistent discipline strategies and lower parental warmth. More frequent use of harsh and inconsistent discipline was associated with higher levels of youth internalizing and externalizing behaviors 3 years later. Housing disorder contributed more strongly to parents’ psychological distress than neighborhood disorder, whereas neighborhood disorder contributed more strongly to youth externalizing behaviors compared to housing disorder. Multiple‐group analyses showed that the patterns of relations were similar for younger and older children, and for girls and boys.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.     

Identifying Perceived Neighborhood Stressors Across Diverse Communities in New York City

There is growing interest in the role of psychosocial stress in health disparities. Identifying which social stressors are most important to community residents is critical for accurately incorporating stressor exposures into health research. Using a community‐academic partnered approach, we designed a multi‐community study across the five boroughs of New York City to characterize resident perceptions of key neighborhood stressors. We conducted 14 community focus groups; two to three in each borough, with one adolescent group and one Spanish‐speaking group per borough. We then used systematic content analysis and participant ranking data to describe prominent neighborhood stressors and identify dominant themes. Three inter‐related themes regarding the social and structural sources of stressful experiences were most commonly identified across neighborhoods: (1) physical disorder and perceived neglect, (2) harassment by police and perceived safety and (3) gentrification and racial discrimination. Our findings suggest that multiple sources of distress, including social, political, physical and economic factors, should be considered when investigating health effects of community stressor exposures and psychological distress. Community expertise is essential for comprehensively characterizing the range of neighborhood stressors that may be implicated in psychosocial exposure pathways.     

The Effects of Social Capital and Neighborhood Characteristics on Intimate Partner Violence: A Consideration of Social Resources and Risks

Intimate partner violence (IPV) is a growing public health problem, and gaps exist in knowledge with respect to appropriate prevention and treatment strategies. A growing body of research evidence suggests that beyond individual factors (e.g., socio‐economic status, psychological processes, substance abuse problems), neighborhood characteristics, such as neighborhood economic disadvantage, high crime rates, high unemployment and social disorder, are associated with increased risk for IPV. However, existing research in this area has focused primarily on risk factors inherent in neighborhoods, and has failed to adequately examine resources within social networks and neighborhoods that may buffer or prevent the occurrence of IPV. This study examines the effects of neighborhood characteristics, such as economic disadvantage and disorder, and individual and neighborhood resources, such as social capital, on IPV among a representative sample of 2412 residents of Toronto, Ontario, Canada. Using a population based sample of 2412 randomly selected Toronto adults with comprehensive neighborhood level data on a broad set of characteristics, we conducted multi‐level modeling to examine the effects of individual‐ and neighborhood‐level effects on IPV outcomes. We also examined protective factors through a comprehensive operationalization of the concept of social capital, involving neighborhood collective efficacy, community group participation, social network structure and social support. Findings show that residents who were involved in one or more community groups in the last 12 months and had high perceived neighborhood problems were more likely to have experienced physical IPV. Residents who had high perceived social support and low perceived neighborhood problems were less likely to experience non‐physical IPV. These relationships did not differ by neighborhood income or gender. Findings suggest interesting contextual effects of social capital on IPV. Consistent with previous research, higher levels of perceived neighborhood problems can reflect disadvantaged environments that are more challenged in promoting health and regulating disorder, and can create stressors in which IPV is more likely to occur. Such analyses will be helpful to further understanding of the complex, multi‐level pathways related to IPV and to inform the development of effective programs and policies with which to address and prevent this serious public health issue.     

Mental Health, Social Environment and Sexual Risk Behaviors of Adolescent Service Users: A Gender Comparison

We examined individual mental health problems (depression, conduct disorder, and substance abuse) and social environment (family, peer, and neighborhood) factors associated with the sexual risk behaviors of male and female adolescents. Interviews with 778 adolescents, aged 14 to 18, showed that both mental health problems and social environment were related to adolescents' involvement in sexual risk behaviors. Conduct disorder symptoms, substance abuse or dependence symptoms, and the interaction between peer misbehavior and neighborhood problems were significantly associated with risky sexual behaviors. Peer misbehavior was a particularly strong factor related to sexual risk behaviors for youths who lived in neighborhoods with multiple problems. The only gender differences were found in age, with older males more likely to report engaging in high risk sexual behaviors. This study suggests the utility of multidimensional intervention strategies to deal with various adolescent problem behaviors, including risky sexual behaviors, within the context of their social environment.     

Stress processes in HIV-positive African American mothers: moderating effects of drug abuse history

This study examined the mechanism by which stressors, dissatisfaction with family, perceived control, social support, and coping were related to psychological distress in a sample of HIV-positive African American mothers. Additional analyses explored whether women who had a history of a drug abuse or dependence diagnosis differed either on levels of the study variables or the model pathways. The results indicated that HIV-positive African American mothers who had higher levels of stressors perceived their stressors as a whole to be less controllable. Coping resources, available social support and perceived control, were positively associated with active coping and negatively associated with psychological distress. Avoidant coping was the most important predictor of psychological distress. Furthermore, the effect of avoidant coping on psychological distress was stronger for mothers with a history of drug diagnosis. The implications of these findings for targeting interventions are discussed.     

居住流动性对心理行为的影响

居住流动性,指某时期个体搬迁的次数或某区域居民搬迁的比率。本文从居住流动性引起社会环境变化入手,综述其心理影响。对儿童/青少年,搬迁中断了成长所需的关键社会环境,影响自我调节、认知能力、情感与群体行为等。对成年人,搬迁使社会环境陌生化、所属群体变换频繁,影响心理健康、人际交往、自我概念和群体认同等。随后,就成年前、后研究的关系、居住流动性对利己行为的影响及国内居住流动性研究的未来方向进行了讨论。     

Psychosocial correlates of emotional distress and risk behavior in african-american women at risk for hiv infection

We examined a model of stress and coping in 749 African-American women at risk for HIV infection. Women in the sample were either homeless, intravenous drug users (IVDUs) sexual partners of IVDUs, or prostitutes. A model was hypothesized based on stress and coping theory and research. Antecedents studied were personal resources, specifically self-esteem and available support. Mediators were threat appraisal and coping efforts. Outcomes studied were emotional distress and HIV risk behaviors. Structural equation modeling techniques were used to test hypothesized pathways between these variables. Forty-five percent of the variance in emotional distress in these women was explained by the model with self-esteem and avoidant coping the strongest predictors. Ten percent of the variance in risk behavior was explained by the model with emotional distress the strongest predictor. Direct and indirect pathways predicting risk behavior and distress are discussed. Implications of results for intervention and theory building are considered.     

A New Approach to Reducing Disorder and Improving Well-Being

ABSTRACT— Psychological science has usually approached the treatment of disorder through research on individual combinations of risk and protective factors (including life experiences, thinking styles, behaviors, social relationships and genes) and the application of interventions that focus on improvements in the individual. However, we can do better than this. Not only should we be aiming to enhance well-being rather than merely reducing disorder, but we should also be doing so for the majority of people rather than the few who have a disorder. In this article, I focus on the mental health spectrum and make the case for a broad population-based approach. I argue that a very small shift in the population mean of the underlying symptoms or risk factors can do more to enhance well-being and reduce disorder than would any amount of intervention with individuals who need help. Examples from research on alcohol abuse and psychological distress are presented to illustrate the value of a population-based approach.     

Social Cohesion and Self-Rated Health: The Moderating Effect of Neighborhood Physical Disorder

Using data from the Los Angeles Family and Neighborhood Survey and its companion datasets, we examined how neighborhood disorder, perceived danger and both individually perceived and contextually measured neighborhood social cohesion are associated with self-rated health. Results indicate that neighborhood disorder is negatively associated with health and the relationship is explained by perceived cohesion and danger, which are both also significant predictors of health. Further, individually perceived cohesion emerges as a more important explanation of self-rated health than neighborhood-level social cohesion. Finally, neighborhood disorder and perceived cohesion interact to influence health, such that cohesion is especially beneficial when residents live in neighborhoods characterized by low to moderate disorder; once disorder is at high levels, cohesion no longer offers protection against poor health. We interpret our findings as they relate to prior research on neighborhoods, psychosocial processes, and health, and discuss their implications for intervention efforts that address disorder in urban communities.     

Predictors of needle-sharing behavior among IDUs entering treatment

Abstract

Public funded treatment intake data from 3905 injection drug users were analyzed to identify correlates of reported needle sharing. Respondents included all first admissions to treatment from July 1, 1988 to June 30, 1989 in the city and county of San Francisco. More previous experience in drug treatment predicted lower rates of needle sharing (OR = 0.85, 95% C.I.= 0.79 - 0.92). Young age, cocaine use and white or Hispanic ethnicity predicted higher rates of needle sharing. The finding that drug treatment reduces the frequency of needle sharing in this population has important policy implications; these data support the role of treatment availability in reducing the spread of HIV among injection drug users.     

Social Relations,Coping, and Psychological Distress Among Persons With HIV/AIDS1

The interrelationships among social support, coping style, and psychological distress were examined using longitudinal data from a sample of 212 persons with HIV/AIDS. Structural equation modeling analyses showed significant indirect effects on psychological distress for avoidant coping, feeling loved and understood, satisfaction with support, rejection by family members, discrimination because of HIV status, and number of AIDS symptoms. The inclusion of negative social interactions in the model is an important extension of the stress‐support literature. Feeling loved and understood mediated the relationship between social support and coping style choice. Results highlight the multidimensional nature of the processes that shape psychological outcomes in HIV disease. and suggest several potential points of intervention, including social‐support efforts that increase the sense that one matters to others, and interventions to assist patients to move from avoidant to active coping strategies.     

Childhood Abuse Types and Physical Health at the Age of 24: Testing Health Risk Behaviors and Psychological Distress as Mediators

This study examines whether adult psychological distress and health risk behaviors mediate the relationship between childhood abuse and physical health in adulthood. A randomly selected population-based sample, with oversampling to include a one-third subgroup of former child protection cases, completed a structured interview. Questions pertained to childhood exposure to abuse, adult psychological distress, physical health, and health risk behaviors. Previous research using this sample had identified three abuse typologies: emotional abuse, sexual abuse, and polyvictimization (physical abuse, emotional abuse, and neglect). All three typologies were significantly associated with poorer self-reported physical health. Psychological distress and health risk behaviors partially mediated the relationship between nonabuse, sexual abuse, polyvictimization, and physical health, and fully mediated the relationship between emotional abuse and physical health. The results of this study indicate that health risk behaviors and symptoms of psychological distress could contribute to some of the long-lasting consequences of childhood abuse on adult physical health.     

Psychosocial adjustment along the HIV disease continuum

Abstract

Evidence suggests that certain indices of stage of HIV disease are determinants of psychological distress, although information is lacking on how disease stage impacts on multiple domains of adjustment. The present study aimed: (1) to explore differences among clinical stages of HIV on measures of psychosocial adjustment, and (2) to explore the relationship between indices of psychosocial adjustment to HIV and self-report measures of physical health. Ninety six HIV-infected persons and 33 HIV seronegative comparison group participants were interviewed and completed self-administered scales. Participants were divided into four groups (the independent variable): a comparison group and three HIV groups, representing the three clinical indices of illness stage (asymptomatic, early symptomatic and AIDS). Three subjective health indices included number of HIV-related symptoms, global health rating, and T4 count. The dependent variables included 5 psychosocial adjustment measures. Results indicated that social and instrumental domains of adjustment were significantly associated with both clinical stage and all 3 subjective health indices. Levels of psychological distress were associated with number of physical symptoms and global health rating, but were unrelated to clinical stage and T4 count. Emotional and existential concerns were unrelated to all indices of illness stage.     

Substance Use and Health and Safety among Homeless Youth

This study examines how substance use is associated with the health and safety of homeless youth using cross-sectional, self-report data from 285 homeless adolescents. Path models were used to examine concurrent relationships between youth’s substance use and multiple aspects of their health and safety, including measures of psychological distress, housing risk and instability, and medical problems. Substance use was examined with both global (i.e., a composite of days of use across various drugs and alcohol) and specific (i.e., rates of use of specific drugs, injection drug use) measures. After controlling for demographic and historical variables, number of days of use was significantly related to psychological distress, whereas injection drug use was significantly related to housing risk. Examination of specific drugs revealed relationships between psychological distress and the use of alcohol, cocaine, and amphetamines, and a specific relationship between housing risk and the use of heroin. None of the measures of substance use was significantly related to youth’s medical problems. Implications for interventions with homeless adolescents are discussed.     

Membership in a Devalued Social Group and Emotional Well-Being: Developing a Model of Personal Self-Esteem,Collective Self-Esteem,and Group Socialization

We proposed and tested a theoretical model that links membership in a devalued social group to emotional health. People who identify with devalued social groups (e.g., ethnic minorities, gay men/lesbians, bisexuals, women) may be at increased risk for distress via 3 different pathways. First, some members of devalued groups may internalize negative stereotypes about their group, which negatively impact personal self-esteem. Second, being devalued simply on the basis of one's group membership could lead to emotional distress independent of one's own personal self-esteem. Third, some members of devalued groups may be socialized to develop attitudes and behaviors that increase their risk for emotional distress. Data were collected from a sample of White, middle-to-upper-class undergraduate women and men with respect to personal self-esteem, collective self-esteem on the basis of their gender group, attitudes and behaviors associated with female socialization, and emotional distress. Results supported the direct effect of each pathway in predicting concurrent depression and partially supported the prediction of concurrent anxiety. Each pathway fully accounted for women's greater levels of depression relative to men's. Implications for the study of devalued groups are discussed.     

Interaction Effects of Neighborhood Disadvantage and Individual Social Support on Frequency of Alcohol Use in Youth Living with HIV

Youth living with HIV (YLH) experience multiple disease‐related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual‐ and neighborhood‐level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood‐specific data were compiled from the 2010 U.S. Census Bureau and matched with individual‐level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non‐Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross‐level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.     

Psychological investigation of genital herpes recurrence: prospective assessment and cognitive-behavioral intervention for a chronic physical disorder

Previous studies suggest that anxiety and/or depressed mood are associated with recurrence of genital herpes lesions. The present study sought to extend the assessment of factors associated with genital herpes and to investigate the impact of psychological therapy on features of the disorder. Sixteen genital herpes patients received 5 weeks of either structured discussion or cognitive restructuring (CR) therapy in a group format. Measures of attitude about herpes, global coping, distress, loneliness, health locus of control, and recurrence frequency were administered at pretreatment, posttreatment, and 3 months follow-up. Patients also made daily reports during the 5 weeks of treatment from which information was extracted regarding their herpes symptoms, dysphoria, anxiety, and ongoing coping process. Therapy did not produce the expected reductions in reported distress or loneliness. The CR procedure, however, was associated with reduced frequency of lesion recurrence at follow-up. Avoidant coping was associated with lower recurrence rates, and loneliness scores were associated with higher recurrence rates. Prospective data indicated that recurrences were preceded by elevated anxiety that was independent of prodromal symptoms. These results provide support for the general proposals that psychological factors influence health status and that psychological intervention may reduce disease recurrence.