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.     

A model of stage of change to recommend colonoscopy among urban primary care physicians.

Theory is little used in the prediction of physician cancer screening stage of change. Structural equation modeling was used to evaluate the theoretical predictors of stage of change to recommend colonoscopy among 235 urban physicians. Constructs from the theory of planned behavior, social-cognitive theory, and the transtheoretical model were systematically tested. As predicted, contextual factors, such as the physicians' ages, their race-ethnicities, patient race-ethnicity, and office-related barriers to preventive care were associated with stage of change through self-efficacy, normative beliefs, and negative behavioral beliefs. The findings demonstrate the relevance of these models to studying the behavior of physicians and support the development of interventions that are tailored to normative beliefs and specific physician cognitions for colonoscopy recommendation.     

A BLACK FEMINIST MODEL OF RAPE MYTH ACCEPTANCE

A Black feminist model was used to investigate rape myth acceptance between African American antirape activists and a comparison group of nonactivists using Cross's (1991) racial identity model and Downing and Roush's (1985) feminist identity model. As predicted, activists rejected rape myths more than nonactivists; the earlier stages of both models were associated with rape myth acceptance; the later stages were associated with rape myth rejection; and activists evidenced more sociopolitical maturity (race and gender consciousness) than nonactivists. The findings suggest that researchers may need to investigate to what degree rape myth acceptance serves an overarching system of social domination where racism and sexism overlap.     

Neurological soft signs and school achievement: The mediating effects of sustained attention

A group of 115 black male adolescents drawn from a clinically unselected birth cohort, half of whom were known to have had neurological soft signs at age 7, were examined at age 17 to determine the relation between soft signs and performance on standard tests of school achievement and sustained attention. Three signs measured at age 17-dysgraphesthesia, difficulties with rapid alternating movements (dysdiadochokinesis), and motor slowness—were related to lower concurrent and past IQ and to impaired performance on laboratory and paper-and-pencil measures of sustained attention. The relation between signs and the attentional measures remained significant after IQ was statistically controlled. The three age 17 soft signs as well as age 7 signs were related to impaired performance on standardized tests (age 17) of school achievement. Most of the relation between signs and school achievement could be accounted for by the variance signs shared with sustained attention. One sign, mirror movements, was unrelated to all other attentional and cognitive measures.The study was supported by center grant MH 306906 and research training grant 5 T32 MH 13043-13 from the National Institute of Mental Health, as well as by the City College and the City University Computing Centers. We thank Lillian Belmont and two reviewers for their critical comments on an earlier version of the paper. We dedicate this paper to the memory of Joseph Barmack.     

The influence of alcohol and loud music on analytic and holistic processing

The influence of alcohol and loud music on analytic versus holistic processing was examined in classification, concept learning, and embedded figures tasks. In the classification task, loud music reduced analytic responding by individuals who had consumed alcohol and increased analytic responding by individuals who had received placebo drinks. Alcohol also decreased the speed with which individuals were able to generate analytic responses in the classification task and decreased analytic performance on the embedded figures test. Alcohol slowed the rate of learning in the concept-learning task but did not lead to less analytic responding in that task. The results are consistent with the idea that alcohol slows the rate of information processing, particularly in tasks requiring visual analysis of stimuli.     

The effect of knowledge of reversibility on the reversibility of ambiguous figures

The role of knowledge of the reversibility of reversible figures was tested in four experiments. Two ambiguous figures, the vase-face figure and a depth-reversing pyramid-hallway figure were shown to high school students. In the Uninformed condition, subjects were not told that the figures were reversible. A sampling procedure was used in which subjects reported what they perceived at 5-sec intervals. Viewing durations of up to 3 min were used, and approximately half of all subjects did not reverse at all during the uninformed condition, whereas virtually all subjects reversed quickly and frequently once they knew that the figures were reversible. These results are not consistent with neural fatigue models of perceptual reversal.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

Alcohol use and depression among African-American and Caucasian adolescents

The purpose of this study was to determine differences in reported alcohol use and depressive symptomatology among a sample of 524 African-American and Caucasian adolescents. Of specific interest was determining if ethnicity, gender, and age predicted severity of scores obtained on the Reynolds Adolescent Depression Scale (RADS) and Adolescent Drinking Index (ADI). Extreme groups were formed using upper (> 75%) and lower (< 25%) quartiles. Three other groups were formed using each instrument's normatively derived cutoff scores: depressed only (RADS > 77), heavy drinking (ADI > 16) and mixed (RADS > 77, ADI > 16). Several results were obtained. First, Caucasians obtained significantly higher scores on the ADI than African-Americans, although no differences were obtained for the RADS. Females scored higher on the RADS but lower on the ADI than males. In terms of extreme scores, females were less likely to belong to the severe depression group, while older adolescents in general and African-Americans in particular had a greater probability of belonging to the heavy-drinking group. Finally, using RADS and ADI cutoff scores, females were less likely than males to belong to the depression only group as were African-Americans. Older adolescents, in general, and African-Americans in particular had a greater probability of belonging to the mixed group than did their counterparts.     

Salient worries of at-risk youth: needs assessment using the things I worry about scale

At-risk students in the southern United States were surveyed using the Things I Worry About Scale. From their responses, 13 categories were ranked from most salient to least salient. The rank order obtained in the present study was compared to that obtained with a normative group of youths in Northern Ireland. The two rank orders were found to be significantly correlated. The relatedness of the rank orderings of the two seemingly disparate samples suggests the universality of the Things I Worry About Scale. The merits of using the scale as part of a comprehensive needs assessment are discussed.