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.     

Further explorations in empowerment theory: An empirical analysis of psychological empowerment

Developed empowerment theory and replicated previous research on citizen participation and perceived control. Few investigators have designed studies that specifically test empowerment theory. This research further extends a theoretical model of psychological empowerment that includes intrapersonal, interactional, and behavioral components, by studying a large randomly selected urban and suburban community sample and examining race differences. Results suggest that one underlying dimension that combines different measures of perceived control may be interpreted as the intrapersonal component of psychological empowerment, because it distinguishes groups defined by their level of participation in community organizations and activities (behavioral component). The association found between the intrapersonal and behavioral components is consistent with empowerment theory. Interaction effects between race groups and participation suggest that participation may be more strongly associated with the intrapersonal component of psychological empowerment for African Americans than for white individuals. Implications for empowerment theory and intervention design are discussed. The authors express appreciation to Steven Rosenstone who was the Principal Investigator for the Detroit Area Study from which the data for our study is based. We also thank Deborah A. Salem and the anonymous reviewers for their thoughtful comments on earlier drafts of this paper.     

Orientation-contingent color aftereffects mediated by subjective transparent structures

We examined whether the orientation-contingent color aftereffect (the McCollough effect) could be mediated by subjective horizontal and vertical structure induced by the perception of transparency. In our experiments, red vertical bars and green horizontal bars were alternated as an adapting stimulus. After adaptation, subjects (n=6) were asked to adjust the green and red saturation of a test pattern until they obtained a neutral gray. Horizontal and vertical stripes were combined in the test pattern in three different ways: (1) overlapping with a luminance combination that gave rise to a perception of transparent overlays of horizontal and vertical stripes (valid transparency condition), (2) overlapping with luminance combinations that did not induce a perception of transparency (invalid transparency condition) and that appeased more as a patchwork of checks, and (3) presented in adjacent, nonoverlapping areas. Our results showed that the McCollough effect was significantly greater in the valid transparency condition than in the invalid transparency conditions. The effect in the valid transparency condition was nevertheless less strong than was the effect seen with the standard test stimulus made up of nonoverlapping vertical and horizontal stripes, Our results suggest that the McCollough effect can be mediated by the subjective spatial organization (inner representation of vertical and horizontal stripes) that accompanies the perception of transparency in our stimulus.     

Electronic language: A study of word processing by emotionally disturbed children and adolescents in residential treatment

The word-processing language use of a small group of severely emotionally disturbed children and adolescents was compared with their handwritten productions. A content analysis based on a total sample of 4,112 words was performed to explore the thematic and structrual language differences between the two writing modes. The findings indicate that the computer-mediated writing tended to improve some aspects of thematic expression, while the handwritten mode was preferable for certain structural characteristics.     

Measurement and structure of pathological gambling behavior

The serious effects of pathological gambling on both gamblers and their families warrants research on the disorder. This study aimed at identifying components of pathological gambling with the goal of developing methods for early detection and preventive strategies. A factor analysis of behaviors hypothesized to relate to pathological gambling resulted in a multidimensional model of the disorder. Eight factors were identified, including distinct neurotic, psychopathic, and impulsive components, and used in a comparative analysis of 83 admitted compulsive gamblers and 61 nongamblers. Five of the factors differentiated the two groups even when sex, age, and education were controlled. Implications of these findings are discussed.     

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.