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.     

Referential communication abilities of learning-disabled, language-learning-disabled, and normal school-age children

Past research in referential communication has indicated normally developing children show developmental progression in ability to communicate a specific referent to a listener. In one paradigm subjects were given lists of word-pairs in which one member of each pair was designated as the referent. It was shown that communicating about referents found in word-pairs associated in some way was more difficult than communicating about referents in dissimilar word-pairs. The present study extended this methodology to learning-disabled children. Learning-disabled, language-learning-disabled, and normally achieving children were asked to communicate about 30 pictured referents on three different tasks. On Tasks 1 and 2 each subject was asked to give a clue for the referent that would distinguish it from the other picture. Stimuli for Task 1 were 30 pairs of pictures that were related in some way and the stimuli for Task 2 were 30 pairs of unrelated pictures. Task 3 required the subjects to evaluate the adequacy of the examiner's clues for Task 1 stimuli. The disabled subjects were matched to the normally achieving subjects on the basis of receptive vocabulary age. Few differences were noted among the groups' performances on these referential communication tasks. Implications include the importance of vocabulary and concept development to referential communication.     

Affect, personality, and social activity.

These studies examined relations between social activity and state and trait measures of Positive and Negative Affect. In Study 1 Ss completed scales relevant to 3-factor models of personality and a weekly mood and social activity questionnaire for 13 weeks. In Study 2 Ss completed measures of the 5-factor model of personality and a daily mood and social activity survey for 6-7 weeks. In within- and between-Ss analyses, socializing correlated significantly with state measures of Positive Affect and with trait measures of Extraversion/Positive Emotionality. These relations were relatively general across various types of positive affect and social events; however, specific types of social events also were differentially related to affect. In contrast, social activity had no consistent association with measures of Negative Affect or the other personality dimensions. The results support a temperamental view of Extraversion.     

Consistency of use of phonological processes by a sample of educable mentally impaired children.

A group of 10 educable mentally impaired children (M age = 10 yr., 4 mo.) were assessed for use of phonological process under three speaking conditions: production of single words, imitated sentences, and connected speech samples. Only the process of gliding showed significant differences in use among conditions. Results generally indicated that any of those three speaking conditions were viable for eliciting use of phonological processes by such subjects. Results are also discussed in terms of individual differences.     

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.