Pilot Randomized Controlled Trial of Game Plan for PrEP: A Brief, Web and Text Message Intervention to Help Sexual Minority Men Adhere to PrEP and Reduce Their Alcohol Use.

Suboptimal adherence to oral PrEP medications, particularly among younger sexual minority men (SMM), continues to be a key barrier to achieving more substantial declines in new HIV infections. Although variety of interventions, including web and text-message-based applications, have successfully addressed PrEP adherence, very few have addressed the potential influence of alcohol. This pilot study explored whether the Game Plan for PrEP, a brief, web-based and text messaging intervention, helped promote PrEP persistence and adherence and reduced condomless sex and alcohol use. Seventy-three heavy-drinking SMM on PrEP were recruited online from states with Ending the HIV Epidemic jurisdictions and randomly assigned 1:1 to receive either the Game Plan for PrEP intervention or an attention-matched control. We collected online surveys assessing primary outcomes at one, three, and six months post-enrollment. As secondary outcomes, we also collected dried blood spot samples at baseline, three, and six months to analyze for biomarkers of PrEP and alcohol use. Our results showed that the odds of stopping PrEP or experiencing a clinically meaningful lapse in PrEP adherence (≥ 4 consecutive missed doses) were not different across the two conditions. We also did not find evidence of any differences in condomless sex or drinking outcomes across conditions, although participants in both conditions reported drinking less often over time. These findings were consistent across both self-reported outcomes and biomarkers. Overall, we did not find evidence that our brief, web and text messaging intervention encouraged more optimal PrEP coverage or moderate their alcohol use.

ReACH2Gether: Iterative Development of a Couples-Based Intervention to Reduce Alcohol use Among Sexual Minority Men Living with HIV and Their Partners.

Unhealthy alcohol use, which encompasses heavy episodic drinking to alcohol use disorder, has been identified as a modifiable barrier to optimal HIV care continuum outcomes. Despite the demonstrated efficacy of couples-based interventions for addressing unhealthy alcohol use, there are no existing couples-based alcohol interventions designed specifically for people living with HIV. This study presents the development and refinement of a three-session couples-based motivational intervention (ReACH2Gether) to address unhealthy alcohol use among a sample of 17 sexual minority men living with HIV and their partners living in the United States. To increase potential population reach, the intervention was delivered entirely remotely. Throughout an original and a modified version, results indicated that the ReACH2Gether intervention was acceptable and there were no reports of intimate partner violence or adverse events. Session engagement and retention were high. In pre-post-test analyses, the ReACH2Gether intervention showed trends in reducing Alcohol Use Disorder Identification Test scores and increasing relationship-promoting dynamics, such as positive support behaviors and goal congruence around alcohol use. Results support the need for continued work to evaluate the ReACH2Gether intervention.

RESUMEN: El consumo no saludable de alcohol, que abarca episodios intensos de consumo hasta llegar a causar trastornos de alcohol, se ha identificado como una barrera modificable para los resultados óptimos continuos de la atención del VIH. A pesar de la eficacia demostrada de las intervenciones basadas en parejas para abordar el consumo no saludable de alcohol, no existen intervenciones de alcohol basadas en parejas diseñadas específicamente para personas que viven con el VIH. Este estudio presenta el desarrollo y perfeccionamiento de una intervención motivacional basada en parejas de tres sesiones (ReACH2Gether) para abordar el consumo no saludable de alcohol entre una muestra de 17 hombres de minorías sexuales que viven con el VIH y sus parejas que viven en los Estados Unidos. Para aumentar el alcance de la población potencial, la intervención se realizó de forma totalmente remota. A lo largo de una versión original y modificada, los resultados indicaron que la intervención ReACH2Gether era aceptable y no hubo informes de violencia de pareja o eventos adversos. El compromiso y la retención de la sesión fueron altos. En los análisis previos y posteriores a la prueba, la intervención ReACH2Gether mostró tendencias en la reducción de las puntuaciones de la prueba de identificación del trastorno por consumo de alcohol y en el aumento de las dinámicas que promueven las relaciones, como comportamientos de apoya positivas y congruencia de objetivos en torno al consumo alcohol. Los resultados respaldan la necesidad de un trabajo continuo para evaluar la intervención ReACH2Gether.

The Impact of the COVID-19 Pandemic on Stress, Isolation, Smoking Behaviors, and Motivation to Quit in People with HIV Who Smoke.

People with HIV (PWH) smoke at higher rates compared with the general population and have lower cessation rates. The primary aim of this study was to examine the impact of the COVID-19 pandemic on smoking in PWH. A survey was administered to participants in two smoking cessation trials in the United States. Mean cigarettes per day was 13.9 (SD 8.6), and participants reported they had smoked on average for 30.93 years (SD 10.4). More than half (55.7%) of participants (N = 140) reported not changing their smoking during the pandemic, while 15% reported decreasing, and 25% reported increasing their smoking. In bivariate analyses, worrying about food due to lack of money (χ2 = 9.13, df 2, p = 0.01) and greater Covid-related worry (rs = 0.19, p = 0.02) were significantly associated with increased smoking. Qualitative research may be needed to more clearly elucidate factors related to smoking behaviors among PWH.

Research and engagement considerations for alcohol use telehealth services within HIV care: a qualitative exploration in federally qualified health centers.

The prevalence of alcohol misuse is high among people with HIV (PWH); however, access to and utilization of evidence-based alcohol misuse interventions remain limited. Telehealth is one treatment approach with the potential for enhancing substance use disorder treatment utilization for PWH served by Federally Qualified Health Centers (FQHCs). However, questions remain regarding barriers to alcohol-focused telehealth service integration and telehealth research in FQHCs. This study employed qualitative methods, guided by the Dynamic Sustainability Framework, to evaluate barriers and cultural factors impacting FQHC telehealth integration. Eighteen qualitative interviews were completed with staff and leaders across four FQHCs. Interviews were analyzed using directed content analysis, and codes were organized into a priori and emergent themes. Key themes included the presence of common workflows for referring clients to substance use disorder treatment; existing research workflows and preferences for active project staff involvement; telehealth barriers including exacerbation of healthcare disparities and high provider turnover; and the importance of cultural humility and telehealth adaptations for sexual, gender, racial and ethnic minority clients. Findings from this study will inform the development of an alcohol-focused telehealth implementation strategy for a Hybrid Type 1 implementation effectiveness trial to enhance FQHC substance use disorder treatment.Trial registration: ClinicalTrials.gov identifier: NCT02563574..

Intersectional forms of racism and sexual minority stress are associated with alcohol use among Latinx sexual minority men with greater Hispanic/Latinx cultural orientation.

Background: Latinx sexual minorities with increased levels of acculturation report higher rates of alcohol use, and discrimination may impact this association. Yet, there is little research examining the concomitant impact of racism and sexual minority stress (i.e. intersectional discrimination) and the additive effect of acculturation on Latinx sexual minority men's risk for hazardous alcohol consumption.Objectives: This study investigated the role of perceived stressfulness of intersectional discrimination in the relation between acculturation (US cultural orientation/Hispanic cultural orientation) and alcohol use among Latinx sexual minority men.Methods: A structural equation model was utilized to test the indirect effect of discrimination between acculturation and alcohol use with a sample of 357 Latinx sexual minority men (Mage = 28.39) recruited via Amazon MTurk.Results: The indirect effect between the Hispanic cultural orientation to alcohol use through intersectional forms of discrimination was significant and positive (b = .19, SE = .03, p < .01). The indirect effect for the US cultural orientation to alcohol use through intersectional forms of discrimination was significant and negative (b = -.10, SE = .03, p < .01).Conclusion: Contrary to previous literature, Latinx sexual minority men with a higher Hispanic cultural orientation reported higher levels of intersectional forms of discrimination, which in turn was associated with increased alcohol use. Those with a higher US cultural orientation reported lower levels of intersectional forms of discrimination, which in turn was associated with decreased alcohol use. These findings may help identify mechanisms that exacerbate health disparities for Latinx sexual minority men.

Computerized Intervention in Primary Care for Women Veterans with Sexual Assault Histories and Psychosocial Health Risks: a Randomized Clinical Trial.

IMPORTANCE: Sexual assault is a public health concern for women and is associated with subsequent psychosocial health risks of posttraumatic stress disorder (PTSD), hazardous drinking, and intimate partner violence (IPV). Sexual assault is associated with social stigma and other barriers shown to inhibit one from seeking mental health care. Digital health technologies may overcome these barriers. OBJECTIVE: To test the impact of a brief computerized intervention delivered in primary care to reduce health risks and increase mental health treatment utilization among women with histories of sexual assault and current health risks. DESIGN, SETTING, AND PARTICIPANTS: The Safe and Healthy Experiences (SHE) program was tested in a randomized controlled trial with N = 153 women veterans at a Veterans Health Administration (VHA) medical center, and they completed assessments at baseline, 2 months, and 4 months. INTERVENTION: SHE is a brief motivational interviewing and psychoeducation-based computerized intervention. SHE was compared to a screen and referral-only control condition. MAIN MEASURES: Health risks were measured via validated self-report instruments. Treatment initiation and utilization were measured via self-report and chart review. RESULTS: SHE did not impact women's number of health risks (all p's > .05). However, women randomized to SHE showed significantly greater increases in treatment use compared to women in the control group, as measured by chart review (χ2 (1, n = 153) = 4.38, p = .036, rs = .16), and self-report (χ2 (1, n = 130) = 5.89, p = .015, rs = .21). SHE was found to be an acceptable intervention. CONCLUSIONS: SHE was effective in improving mental health treatment initiation and utilization compared to a control group. Computer-based interventions to address sexual trauma and its consequences are acceptable, are highly scalable, and can add value to primary care with little cost or increase in provider time. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT02957747.

Daily Instrumental and Affective Attitudes About Exercise: An Ecological Momentary Assessment Study.

BACKGROUND: Daily decisions to exercise may be influenced by day-to-day changes in affective attitudes (AA) and instrumental attitudes (IA) toward exercise. However, the within-day association between AA, IA, and exercise behavior has received little attention. PURPOSE: To examine the effects of more temporally proximal (daily) AA and IA on daily exercise behavior beyond traditionally assessed distal (at the beginning of an exercise program) AA and IA. METHODS: In the context of a 3-month exercise promotion program (N = 50), distal AA and IA were assessed at baseline. Ecological momentary assessment was used to assess proximal AA, IA, and exercise each day. RESULTS: Between-subject differences in distal AA (OR = 1.28, p = .03) and distal IA (OR = 1.34, p = .01) were predictive of average likelihood of exercise each day over the 3-month period. Within-subject differences in proximal AA (OR = 1.19, p = .007), but not proximal IA (OR = 1.11, p = .18), predicted exercise each day beyond the between-subjects effects of distal AA and IA. Exploratory analysis revealed an interaction, such that the within-subjects impact of proximal AA on daily exercise was most evident among individuals who held more negative distal AA at baseline (OR = 0.80, p < .0001). CONCLUSIONS: Attitude type (affective versus instrumental) and temporality (distal versus proximal) are important to consider in attempts to predict and understand exercise behavior. In addition to targeting change in distal attitudes, exercise interventions should target changes in daily AA to impact exercise later in the same day.

Modeling the Impact of Race, Socioeconomic Status, Discrimination and Cognitive Appraisal on Mental Health Concerns Among Heavy Drinking HIV+ Cisgender MSM.

Prior research has attributed mental health disparities between marginalized and non-marginalized populations to socioeconomic differences (i.e., education, income, employment), stigma (e.g., HIV-related discrimination), and cognitive appraisal (i.e., optimism, hostility, satisfaction with life), but the relations among these variables have not been examined concomitantly. The current study utilized structural equation modeling to examine how race and socioeconomic status impact mental health outcomes through increased exposure to stigma and more negative cognitive appraisals. Data came from a randomized controlled trial of motivational interviewing to address heavy drinking in cisgender men with HIV who have sex with men (n = 180). We found that self-reported discrimination experiences related to race/ethnicity, sexual orientation, and HIV status significantly mediated the relation between socioeconomic status and mental health concerns, whereas cognitive appraisal did not. These findings suggest that, among heavy drinking men with HIV who have sex with men, having low socioeconomic resources may increase exposure to discrimination which, in turn, may worsen mental health. Interventions that address social determinants, like socioeconomic disadvantage, and that enhance coping resources related to stigma, may have positive effects on mental health.ClinicalTrials.gov Identifier NCT01328743. Date of Registration 09/09/2019.

RESUMEN: Investigaciones anteriores han atribuido las disparidades de salud mental entre poblaciones marginadas y no marginadas a diferencias socioeconómicas (es decir, educación, ingresos, empleo), estigma (por ejemplo, discriminación relacionada con el VIH) y evaluación cognitiva (es decir, optimismo, hostilidad, satisfacción con la vida), pero las relaciones entre estas variables no han sido examinadas concomitantemente. El estudio actual utilizó modelos de ecuaciones estructurales para examinar cómo la raza y el estatus socioeconómico afectan los resultados de salud mental a través de una mayor exposición al estigma y evaluaciones cognitivas más negativas. Los datos provienen de un ensayo controlado aleatorio de entrevistas motivacionales para abordar el consumo excesivo de alcohol en hombres cisgénero con VIH que tienen sexo con hombres (n = 180). Encontramos que las experiencias de discriminación autoinformadas relacionadas con la raza/etnicidad, la orientación sexual y el estado serológico respecto al VIH mediaron significativamente en la relación entre el estado socioeconómico y los problemas de salud mental, mientras que la evaluación cognitiva no lo hizo. Estos hallazgos sugieren que, entre los hombres con VIH que beben mucho y tienen sexo con hombres, tener bajos recursos socioeconómicos puede aumentar la exposición a la discriminación que, a su vez, puede empeorar la salud mental. Las intervenciones que abordan los determinantes sociales, como la desventaja socioeconómica, y que mejoran los recursos de afrontamiento relacionados con el estigma, pueden tener efectos positivos en la salud mental.

The Relationship Between Drinking Behavior and Conversational Processes During a Brief Alcohol Reduction Intervention for People with HIV.

People with HIV (PWH) frequently engage in unhealthy alcohol use, which can adversely affect antiretroviral adherence and HIV disease progression. Brief interventions based on Motivational Interviewing (MI), including the Brief Negotiated Interview (BNI), can help to reduce drinking. This study examines MI processes observed during a single 15-20 min BNI session delivered by social workers to PWH with unhealthy alcohol use (N = 59) in the context of a stepped care intervention to reduce alcohol consumption. BNI sessions were coded for technical and relational processes encouraged in MI, such as autonomy support, instructive language, and self-exploration. Multiple regression analyses explored the relationship between: (1) Participants' pre-intervention drinking behaviors (weekly drinks and heavy drinking days) and these MI processes, and (2) MI processes and intervention outcomes. Results indicated that PWH who reported more weekly drinks at baseline engaged in less self-exploration, while social workers delivering the BNI used less instructive language for those who reported more heavy drinking days. PWH who engaged in more self-exploration and received more autonomy support had fewer heavy drinking days 6 months after the intervention. These findings suggest the value of providing more opportunities within BNIs to encourage self-exploration, as it may help to enhance intervention efficacy.

Combined Working Memory Training and Transcranial Magnetic Stimulation Demonstrates Low Feasibility and Potentially Worse Outcomes on Delay to Smoking and Cognitive Tasks: A Randomized 2 × 2 Factorial Design Pilot and Feasibility Study.

INTRODUCTION: Repetitive Transcranial Magnetic Stimulation (rTMS) has shown promising results in treating several Substance Use Disorders including Tobacco Use Disorder. However, questions remain regarding how to optimize treatment outcomes. Enhancement of working memory by rTMS is a potential therapeutic mechanism. The current pilot study examined whether rTMS plus a cognitive training program could enhance the effects of rTMS on smoking behaviors using a controlled, factorial design. AIMS AND METHODS: We hypothesized that cognitive training plus stimulation would improve control over smoking behaviors, resulting in enhanced cognitive performance and increased latency to smoke on a delay to smoking analog task. Using a 2 × 2 factorial design, nicotine dependent smokers (n = 43) were randomized to receive 10 sessions of active (10 Hz) or sham rTMS delivered to the left dorsolateral prefrontal cortex, plus active or sham working memory training (WMT) prior to and following stimulation. RESULTS: Contrary to hypotheses, we observed a significant interaction effect, indicating that combining the two active interventions (rTMS+WMT) resulted in worse performance on the smoking analog task (B = -33.0, 95% CI = -64.39, -1.61, p < .05), compared to delivering either intervention alone. Additionally, although active rTMS (compared to sham rTMS) improved letter-sequencing performance (B = 1.23, 95% CI = 0.08-2.38, p < .05), and active WMT (compared to sham WMT) improved back-digit task performance (B = 1.53, 95% CI = 0.02-3.05, p < .05), combining interventions worsened the effect of each on a back-digit task (B = -3.01, 95% CI = -5.96, -0.052, p < .05). CONCLUSIONS: These preliminary findings indicate potential iatrogenic effects of combining rTMS and this working memory training intervention and underscore the need for rigorous evaluation of substance specific conceptual frameworks when selecting future combination interventions. IMPLICATIONS: Counter to hypothesis, this study found no additional benefit of adding a working memory training program to a rTMS protocol in a sample of daily smokers. The combination condition (active rTMS + active training) resulted in worse performance on a delay to smoking analog task and a measure of working memory performance compared to delivering either intervention alone. These preliminary findings inform strategies for optimizing rTMS in smokers and highlight the need for future studies to consider several key components of candidate combination interventions, including effects on regulation of substance use. CLINICAL TRIAL REGISTRATION (IF ANY): The trial was registered at ClinicalTrials.gov (NCT03337113).

Positive Psychological Characteristics and Substance Use in First Nation Adolescents.

BackgroundNorth American Indigenous (NAI) adolescents experience disproportionate harm related to substance use compared to non-Indigenous adolescents. Strengths-based approaches to substance use prevention and treatment are consistent with Indigenous conceptualizations of health, which tend to be holistic and incorporate more spirituality and community than mainstream Western conceptualizations. Despite this, little is known about how positive psychological characteristics that might confer protection relate to substance use among NAI adolescents. Thus, the present study aims to examine the relations among life satisfaction, subjective happiness, self-compassion, and cigarette, marijuana, alcohol, and other drug use. MethodsParticipants were 106 reserve-dwelling First Nation adolescents located in Eastern Canada (Mage= 14.6 years, 50.0% female) who completed a paper-and-pencil survey regarding their substance use and psychological characteristics for a larger community-based participatory research project. ResultsGreater life satisfaction was significantly associated with decreased odds of lifetime (OR = 0.88, 95%CI [0.81, 0.96]) and current cigarette smoking (OR = 0.90, 95%CI [0.82, 0.99]). Greater subjective happiness was significantly associated with decreased odds of current marijuana use (OR = 0.83, 95%CI [0.71, 0.97]). Although significantly correlated with lower lifetime use of other drugs, self-compassion was not significantly associated with lifetime or current odds of substance use after controlling for age, gender, and other positive characteristics. DiscussionThis is one of the first studies to evaluate positive characteristics and substance use in NAI adolescents. Results point to positive characteristics that may be useful in substance use prevention and suggest the need for further research to further elucidate these associations.

The protective effects of self-compassion on alcohol-related problems among First Nation adolescents.

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high-degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e., the ability to be kind and accepting and to extend compassion towards oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N=106, M age =14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b=-.51, p=.01, 95%CI [-.90, -.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b=-.42, p=.04, 95%CI [-.82, -.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b=4.68, p<.001, 95%CI [2.62, 6.73]), but was not significant at high (b=-.29, p=.89, 95%CI [-4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR=0.90, 95%CI [0.83, 0.98], p=.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions.

Discussion of alcohol consequences during a brief motivational intervention session: Comparing those who do and do not increase readiness to change.

The present study was designed to take an inductive, qualitative approach to understanding how discussion of alcohol-related consequences during brief motivational interventions (BMI) relate to readiness to change (RTC) prior to versus at the end of a session. Participants were thirty-four adults (35% female) recruited from the emergency room and enrolled in a randomized clinical trial of a BMI for risky alcohol use and risky sex. Seventeen participants both began and remained low on RTC over the course of the session. We selected 17 additional participants, matched on demographics, but who increased RTC over the session. Transcripts were qualitatively coded and analyzed separately within groups. Among participants who increased their RTC relative to participants who remained low on RTC by BMI end, evaluation of alcohol consequences as negative was more typical. In both groups, several consequences were neutrally evaluated. Many who remained low on RTC attributed consequences to something other than alcohol and/or minimized consequence severity. Study findings highlight the value for clinicians in eliciting and maximizing the importance of subjectively negative recent consequences to perhaps increase heavy drinkers' readiness to decrease heavy alcohol use.

An Experimental Test of the Relationship between Electronic Nicotine Delivery System Use and Alcohol Consumption.

BACKGROUND: Increasing research shows that the use of electronic nicotine delivery systems (ENDS) is associated with a higher rate and quantity of alcohol consumption. METHODS: The present study used a 2-session, within-subjects design to experimentally examine the relationship between ENDS use and laboratory ad libitum alcohol consumption. A total of N = 31 (mean age = 28.71, SD = 11.17; 45.2% women; 54.8% White/Caucasian) healthy adults from the community who use ENDS and endorsed liking beer completed the study, which included a beer consumption taste-test task that assessed the volume of beer consumed by the participants across 2 counterbalanced sessions: 1 in which concurrent ENDS use was allowed and 1 in which it was not. All analyses controlled for age, race, and gender. RESULTS: The effect of ENDS condition on the volume of beer consumed was not statistically significant, F(1, 30) = 0.03, p = 0.86). Results of linear mixed modeling showed that ENDS puffs were significantly related to alcohol sips (estimate = 0.23, SE = 0.07, p = 0.002) across the ad libitum session. CONCLUSIONS: Overall, ENDS use did not increase alcohol consumption; however, the data suggest that ENDS puffs might act as a prime for beer sips or that these 2 behaviors are linked through habit. Future studies should more fully measure and compare global and event-level data on ENDS and alcohol use as they might show disparate patterns of relationships.

Personalized feedback improves cardiovascular risk perception and physical activity levels in persons with HIV: results of a pilot randomized clinical trial.

People with HIV (PWH) have an elevated risk for cardiovascular disease (CVD) compared with the general population. This study examined the feasibility, acceptability and preliminary efficacy of a tailored intervention aimed at increasing CVD risk perception and the adoption of heart-healthy behaviors in PWH. Forty adults were randomized to receive personalized feedback on CVD risk and discussion of risk reduction or health education. Participants were issued pedometers and seen for two treatment sessions. Participants were 60% male and had a mean age of 51.5 years. Ninety percent of participants completed all study sessions indicating good feasibility and acceptability. A medium effect size for the difference between treatment and control groups was found on both the Perceived Risk for Heart Disease (d = .38) and the Rapid Eating and Activity for Patients scales (d = .56) at 12 weeks. Atherosclerotic cardiovascular disease (ASCVD) risk score moderated the effect of treatment, such that at high (but not low) ASCVD risk, active intervention, compared to control, was associated with a greater increase in steps between baseline and both 8 (d = .38) and 12 weeks (d = .55). Findings provide preliminary evidence that tailored interventions delivered by nurses may be effective for primary prevention of CVD in PWH.

Psychological Problems Mediate the Relationship Between Minority Stress and HIV Sexual Risk Among Nigerian Men Who Have Sex with Men: Testing the Minority Stress Model.

Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria bear a disproportionately higher burden of HIV. Meyer's minority stress theory posits that social stress due to the discrimination, violence, and stigma experienced by lesbian, gay, and bisexual men and women (LGBs)-due to their sexual orientation-may contribute to psychological problems, including mental health problems, substance use, and HIV sexual risk-taking. Between March and June 2019, we recruited 406 GBMSM from four states in Nigeria (Abuja, Delta, Lagos, and Plateau) to complete a cross-sectional survey at local community-based organizations. We utilized structural equation modeling to test whether psychological problems and substance use mediated the relationship between minority stress and HIV sexual risk-taking (condomless anal sex and number of sexual partners) among GBMSM in Nigeria. Minority stress (ß = 0.60, 95% CI: 0.44-0.72, p ≤ .001), substance use (ß = 0.43, 95% CI: 0.27-0.59, p = .004), and psychological problems (ß = 0.35, 95% CI: 0.28-0.45 p = .012) had moderate associations with HIV sexual risk-taking. We found that psychological problems mediated the relationship between minority stress and HIV sexual risk-taking. Interventions focused on addressing psychological problems may help mitigate the effects of minority stress on HIV sexual risk-taking among GBMSM in Nigeria.

The Moderating Role of Social Support on the Relationship Between Anxiety, Stigma, and Intention to Use Illicit Drugs Among HIV-Positive Men Who Have Sex with Men.

The present study examined the association between anxiety, stigma, social support and intention to use illicit drugs, and the moderating role of social support on the association between anxiety/stigma and intention to use illicit drugs among 450 Chinese HIV-positive MSM. Findings show that controlling for significant background variables, self-stigma and anxiety were positively associated with intention to use illicit drugs, while social support was negatively associated with intention to use illicit drugs. A significant moderation effect of social support was also observed, that the negative association between self-stigma/anxiety and intention to use illicit drugs was only significant among participants with lower levels of social support. Findings highlight the importance of reducing self-stigma and anxiety, and promoting social support in drug use prevention for HIV-positive MSM.

Affective and Situational Precipitants of Smoking Lapses Among Adolescents.

INTRODUCTION: Most adolescent smokers report a desire to quit, and many have made several unsuccessful quit attempts; however, when adolescents attempt to quit, they often resume smoking quickly. This ecological study aimed to (1) characterize affective and situational precipitants of smoking lapses among adolescents and (2) explore the moderating influence of nicotine dependence severity on lapse precipitants. METHODS: Adolescent daily smokers (n = 166; ages 14-18 years) completed electronic diaries of cigarettes smoked, craving and affective states, and situational variables on handheld computers in their natural environment for 2 weeks following an unassisted quit attempt. On average, adolescents were moderately nicotine dependent (Modified Fagerström Tolerance Questionnaire [mFTQ] score = 4.9; SD = 1.6). RESULTS: Craving was a significant episodic cue for lapse and stable influence on lapse, relating to 44% and 15% increased odds of lapse, respectively. High-arousal affective states-regardless of valence-were associated with 12%-13% increased odds of lapse. Low-arousal positive affective states were associated with 17% decreased odds of lapse. A 1-unit difference in a teen's mFTQ score related to 27% increased odds of lapse, but dependence severity did not moderate proximal lapse influences. CONCLUSIONS: This report provides some of the first ecological data characterizing adolescent smoking lapses following a quit attempt. As in prior work with teens, lapses were nearly universal and quickly followed the quit attempt. Specific situational and affective contexts of smoking lapses for adolescents were implicated, indicating the need for cessation interventions to address craving and high-arousal affective states as precipitators of lapse in this high-risk group. IMPLICATIONS: This report provides some of the first ecological data characterizing smoking lapses among teens attempting to quit smoking on their own. Like adults, adolescents face many barriers when making quit attempts. The present work provides ecological data to suggest that the experience of heightened arousal in teens' daily lives interferes with their efforts to quit smoking. Thus, this work highlights the importance of affective dysregulation, or amplitude of emotional feelings, for teen smoking lapses. Moment-to-moment fluctuation in craving was also implicated as a dynamic precipitator of smoking lapse in this high-risk group.

A Pilot Randomized Controlled Trial of Distress Tolerance Treatment for Weight Concern in Smoking Cessation Among Women.

INTRODUCTION: The majority of women who smoke cigarettes report that concern about weight gain is a barrier to quitting. We developed an intervention incorporating distress tolerance, appetite awareness, and mindful eating skills to target concerns about post-cessation weight gain and emotional eating (DT-W). In the current study, we conducted a pilot randomized controlled trial of DT-W versus a smoking health education (HE) intervention. METHODS: Participants (N = 69 adult female, weight-concerned smokers) were recruited in cohorts of 4-11. Cohorts were randomized to DT-W or HE. DT-W and HE were matched on format (single individual session followed by eight group sessions), inclusion of cognitive behavioral therapy for smoking cessation (CBT) content, and pharmacotherapy (nicotine patches). Follow-up assessments occurred at 1-, 3-, and 6-months post-treatment. RESULTS: The recruitment goal was met; 61 of the 69 participants attended at least one group session. There were no significant differences between DT-W and HE in the number of group sessions attended (DT-W adjusted M = 5.09, HE adjusted M = 5.03, p = .92), ratings of treatment effectiveness or usefulness of skills, or retention at 6-month follow-up (79% in DT-W vs. 78% in HE) (ps > .05), but comprehension ratings were lower in DT-W than in HE (p = .02). CONCLUSIONS: Overall, these results suggest that the study procedures and interventions were feasible and acceptable, but changes to the DT-W intervention content to improve comprehension should be considered prior to conducting a fully powered trial. IMPLICATIONS: A distress tolerance-based treatment targeting fear of weight gain after smoking cessation and post-cessation emotional eating was feasible and acceptable relative to a smoking HE comparison condition, but changes should be considered before conducting a larger trial. Continued innovation in treatment development for weight-concerned smokers is needed.

Validation of depressive symptoms, social support, and minority stress scales among gay, bisexual, and other men who have with men (GBMSM) in Nigeria, Africa: a mixed methods approach.

BACKGROUND: Gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria experience social marginalization, discrimination and violence due to their sexual identity, which may negatively impact physical, mental, and sexual health outcomes. Studies on GBMSM in Africa utilize measurement scales developed largely for populations in the Global North. The validity and reliability of these instruments-to our knowledge-have never been thoroughly investigated among GBMSM in Nigeria. The aim of the current study was to determine the validity and reliability of the English versions of the Center for Epidemiologic Studies Depression Scale (CESD-R), Multidimensional Scale of Perceived Social Support (MSPSS), and LGBT Minority Stress Measure among a large multi-state sample of GBMSM Nigeria. METHODS: Between January and June 2019, we conducted cognitive interviews (N = 30) and quantitative assessments (N = 406) with GBMSM in Nigeria. The cognitive interviews assessed comprehension of scale items and elicited suggestions for scale modifications. The quantitative assessment was used to gather psychosocial health data and to evaluate psychometric properties and construct validity of the modified scales. We utilized confirmatory factor analysis to assess factor structure, correlation coefficients, and Cronbach's alpha to examine scale validity and internal consistency. RESULTS: Based on participant feedback from the cognitive interviews, we made slight modifications (i.e., culturally appropriate word substitutions) to all three scales. Results of quantitative analyses indicated good psychometric properties including high factor loadings, internal consistency and construct validity among the CESD-R, MSPSS, and LGBT Minority Stress Measure among GBMSM in Nigeria. CONCLUSION: These results suggests that modifying research scales to be more culturally relevant likely do not jeopardize their validity and reliability. We found that modified scales measuring depressive symptoms, perceived social support, and minority stress among GBMSM in Nigeria remained valid. More research is needed to explore whether the psychometric properties remain if the scales are translated into broken English (Pidgin) and other traditional Nigerian languages (Yoruba, Igbo and Hausa).