Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.     

The Rate and Characteristics of Suicide Attempters in the Native Hawaiian Adolescent Population

Native Hawaiian high school students, N = 1779, were surveyed for symptoms of psycho-pathology and suicide attempts in the previous 6 months. Seventy-seven (4.3%) of the students reported making a suicide attempt. There were no significant differences in prevalence rates for males and females. Depression, anxiety, aggression, substance abuse symptoms, and low family support, but not peer support, were significantly correlated with suicide attempts. On logistic regression, depression, substance abuse, and family support independently predicted attempts. The lack of gender difference may indicate a cultural characteristic of the Hawaiian population that differentiates it from mainstream American populations but likens it to the Native American population.     

Effects of communication apprehension,familiarity of partner,and topic on selected “women's language” features

In keeping with Lakoff's (1975) notion that the use of women's language (WL) conveys uncertainty on the part of the speaker, the influence of communication apprehension, familiarity of partner, and topic on the use of selected WL forms was investigated. In dyadic conversation with a female friend or stranger, 71 female university students, who had completed the Personal Report of Communication Apprehension—Long, discussed a familiar or an unfamiliar topic. Multiple-regression analyses revealed that (1) communication apprehension was positively related to the use of question intonation, (2) familiarity of topic and partner were negatively related to the use of hedges, and (3) familiarity of topic was positively related to the use of intensifiers. There were no intercorrelations of the linguistic forms. These results challenge the notion that WL forms actually cohere to form a kind of language and suggest that the influence of social and psychological variables on the use of WL is much more complex and multifaceted than Lakoff believed.This article is based on portions of an Honour's thesis completed by the second author, and was presented at the Annual Convention of the Canadian Psychological Association held in Ottawa, Ontario, June 1990.     

Components of analogical reasoning in a mildly head injured population

This study sought to investigate the effects of mild head injury on a particular type of cognitive ability, verbal analogical reasoning. The performance of 19 individuals with head injuries was compared to a group of 30 control subjects matched for age, education, and gender on 100 verbal analogies. Solution times and error rates were modeled. Unstandardized regression weights for individual subjects were correlated with subjects’ performance on a number of standardized ability tests. Results showed that compared to the control subjects, the head injured subjects: (a) were significantly slower to solve the analogies, and were particularly slow to perform certain processes: encoding/inference and comparison; (b) tended to show greater variability in performance; and (c) had data that had a poorer componential model fit. The data suggest that analogical reasoning is affected by a head injury, and that certain information processes may be responsible for performance deficits.     

Gender and Sex-Role Influences on Children''s Self-Esteem

This study examined direct and moderating influences of gender and sex-role orientations on children's general self-esteem. Moderating influences of these variables on the prediction of self-esteem were examined with respect to two sets of competence beliefs regarding school achievement: perceived capacities and perceived strategies for doing well in school. One hundred nineteen fourth-, fifth-, and sixth-grade children were assessed using the Perceived Competence Scale for Children (Harter, 1982), the Multidimensional Measure of Children's Perceptions of Control (Connell, 1985), and the Children's Personal Attributes Questionnaire (Hall & Halberstadt, 1980). Correlational and hierarchical multiple regression analyses indicated that upper elementary schoolchildren's general self-esteem is (a) marginally related to biological gender, with boys showing a slight advantage; (b) significantly related to masculinity and androgyny; and (c) predicted more strongly by perceived capacities to do schoolwork in girls than in boys, and by perceived (lack of) strategies for academic success in nontraditionally sex-typed children than in traditionally sex-typed children. Of the two nontraditionally sex-typed groups, androgynous children were found to have more positive school competence beliefs than were undifferentiated children.     

Psychosocial characteristics of preschool siblings of handicapped and nonhandicapped children

This project examined psychosocial characteristics of 24 preschool-aged siblings of handicapped children in relation to a control group of 22 siblings of nonhandicapped children. Subjects were matched on family size and income, sibling age, birth order, sex, age spacing, and marital status of their parents. Results indicated no statistically significant differences between groups of children on measures of perceived self-competence and acceptance, understanding of developmental disabilities, empathy, and child care responsibility. Significant group differences were found where brothers of handicapped children were rated by their mothers as being more depressed and aggressive than brothers of nonhandicapped control children. Sisters of handicapped children were rated by mothers as being more aggressive than sisters of nonhandicapped children. Sisters of handicapped children and brothers of nonhandicapped children had significantly fewer privileges and more restrictions on their home activities than other groups. Results are discussed in relation to previous research on older silbings of handicapped children and the general literature on family stress and childhood disability and disease. The importance of examining sibling functioning via multiple measures of child behavior is stressed.The authors are grateful to the children and families who participated in the project. The assistance of Dr. Ricardo Barrera, Christine DiBlasio, Lisa Kaye, Paola Bellabarba, Jeanne Logozzo, Donna Motley, Jennifer Harter, and Tina Meisell is also gratefully acknowleged. This project was funded by Grant Number G008300345 from the U.S. Department of Education.