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.

Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model.

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

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.

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 influence of multiple oppressions on women of color's experiences with insidious trauma.

In this study, we examined the relations between multiple forms of oppressive experiences (i.e., racism, sexism, and sexual objectification) and trauma symptoms among Women of Color (WOC). In addition, self-esteem was explored as a partial mediating variable in these links, and ethnic identity strength was proposed to buffer the negative relationship between multiple forms of oppression and self-esteem, and the positive relationship between oppressive experiences and trauma symptoms. Results suggested that self-esteem partially mediated the positive relationship between racist experiences and trauma symptoms, such that racism was related to lower self-esteem, which was then related to more trauma symptoms. Sexism and sexual objectification were directly linked with trauma symptoms. Moreover, average and high levels of ethnic identity strength buffered the positive link between racism and trauma symptoms. Consistent with an additive intersectionality framework, results demonstrate the importance of attending to multiple forms of oppression as they relate to trauma symptoms among WOC. (PsycINFO Database Record

Open science: Friend, foe, or both to an antiracist psychology?

The open science framework has garnered increased visibility and has been partially implemented in recent years. Open science underscores the importance of transparency and reproducibility to conduct rigorous science. Recently, several journals published by the American Psychological Association have begun adopting the open science framework. At the same time, the field of psychology has been reckoning with the current sociopolitical climate regarding anti-Blackness and White supremacy. As psychology begins to adopt the open science framework into its journals, the authors underscore the importance of embracing and aligning open science with frameworks and theories that have the potential to move the field toward antiracism and away from the embedded White supremacy value systems and ideals. The present article provides an overview of the open science framework; an examination of White supremacy ideology in research and publishing; guidance on how to move away from these pernicious values; and a proposal on alternate value systems to center equity, diversity, and inclusion with the aim of establishing an antiracist open science framework. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining a Race-Sex Interaction Effect on Binge Drinking Among Afro-Latina/o Adults in the US.

Latinx/es are often racially homogenized in alcohol use disparities research, leaving the behavioral and mental health status of Afro-Latinx/es unknown. Though Latina/o and Black adults consume less alcohol than non-Latina/o Whites, they may binge drink to cope with discrimination. Gendered racism uniquely and negatively affects Black women's psychological well-being and may increase their chances of engaging in risky drinking. This may be the case for Afro-Latina women, but no study has disaggregated alcohol use disparity outcomes among a nationally representative sample of Latina/o adults by race and sex. This study (1) examines the relationship between racial self-classification (White-Latina/os vs. Afro-Latina/os) and binge drinking in the past year and (2) tests whether sex (male vs. female) moderates the relationship between race and binge drinking. Secondary data that included a respondent sample of 9415 Latina/o adults was obtained and analyzed from the 2013-2018 National Health Interview Survey. Multivariate analyses included logistic regression models to assess the main effects of race, sex, and interaction effect of the two on binge drinking while controlling for sociodemographic variables. The probability of Afro-Latina/o adults binge drinking trends lower than White-Latina/os. Respondents' sex moderated the association between racial self-classification and binge drinking. We discuss racial identity salience, mujerismo, and gendered racism as possible protective and risk factors for Afro-Latina/os and Afro-Latina women to contextualize these findings.

Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory.

There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.

Transgender and gender diverse adults' reflections on alcohol counseling and recommendations for providers.

Transgender and gender diverse (TGD) populations experience health disparities due to societal stigma that increases TGD individuals' sources of stress and decreases access to health protective resources. Research has linked experiences of stigma to risky alcohol use, yet there remains a dearth of culturally sensitive alcohol use interventions that meet the needs of TGD people. The present study was conducted to inform modifications to the content and delivery of an existing brief, telehealth, motivational intervention to decrease at-risk alcohol use among TGD adults. Individual semi-structured in-depth qualitative interviews were conducted with TGD adults who reported recent alcohol use (n = 18) to explore factors that facilitate positive interactions with health care providers and identify relevant information for alcohol use disorder treatment. Participants were recruited from an LGBTQ +-focused health center in Los Angeles, California. Two major themes and recommendations emerged: (a) A multicultural orientation of humility is important to develop productive therapeutic relationships with TGD clients when delivering motivational interviewing; (b) Due to insufficient appropriate data on alcohol use and health in TGD populations, feedback used in motivational alcohol counseling needs to be modified to better serve TGD clients. These findings show that counselors' philosophy and behavior, as well as session content, need to be considered when working with TGD populations within the context of alcohol counseling. These findings also have implications for intervention development, clinical treatment, and future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Latinx Sexual Minority Adolescent Substance Use: State of the Science and Call for Intersectional Minority Stressors and Protective Factors.

Purpose of review: Latinx sexual minority adolescents (LSMA) are at an intersection of ethnic and sexual minority (SM) status and may experience heighten risk of substance use and related problems. These youth may also hold unique protective factors that help mitigate the effects of minority stress and curb substance use. Little is known, however, about the intersectional minority stressors (i.e., due to ethnicity and SM status) and protective factors related to substance use among this population. Recent Findings: According to the minority stress model, there are unique minority stressors and resiliency factors that can help explain differences in behavioral health rates between white SM and SM of color. Research supports the notion that minority stressors (e.g., stigma/risk, homophobic bullying, and family rejection of SM status) confer risk for substance use among LSMA. In terms of resilience, less is known, but there may be some protective factors that have not been measured that could explain lower rates in some substances (i.e., club drugs and methamphetamine). Summary: Little is known about how the intersections of ethnicity and SM status are associated with substance use in adolescence. Future research should assess the temporal relationship of multilevel (i.e., intrapersonal, relational, and system), intersectional (i.e., ethnicity and SM status) minority stressors and protective factors unique to LSMA on substance use. We propose that the findings from these future studies will help to create socioculturally appropriate behavioral health treatments that consider the intersectional risks and strengths within the LSMA population.

Mindfulness for Reducing Minority Stress and Promoting Health Among Sexual Minority Men: Uncovering Intervention Principles and Techniques.

Objectives: Tailored, evidence-based interventions are in high need for sexual minority men (gay, bisexual, and queer men who have sex with men) to address prevalent mental health issues and HIV/STI risk. This study describes the formative research that informed the development of Mindfulness-Based Queer Resilience (MBQR): a mindfulness-based intervention for health promotion among sexual minority men. Methods: Guided by the ADAPT-ITT model, we conducted a series of interviews with community stakeholders, including sexual minority men with anxiety and depressive symptoms (n = 15) and mindfulness service providers with experience working with sexual minority men (n = 11). Thematic analysis was used for data analysis. Results: Six intervention principles and seven key techniques/delivery considerations emerged relevant to intervention development. Principles included (a) reducing minority stress as a key theoretical guide, (b) affirming LGBTQ + identity and facilitating healthy identity development, (c) attending to intersectionality, (d) facilitating resilience and self-empowerment, (e) trauma sensitivity, and (f) promoting healthy relationships and a healthy community. Key techniques represent the pathways through which MBQR may address the adverse impacts of minority stress, including through attention control practice to facilitate agency and self-awareness, enhancing emotion regulation, reducing reactivity to minority stress-informed thoughts, self-compassion to increase self-acceptance, and reducing behavioral avoidance. Delivery considerations also included careful navigation regarding mindfulness and religion, as well as using modern technology to increase reach, access, and engagement. Conclusions: If proven to be feasible and efficacious, MBQR may offer the potential to alleviate adverse impacts of minority stress and improve mental and sexual health of sexual minority men.

Discrimination and alcohol problems among heavy drinking HIV-positive men who have sex with men: The buffering effect of a brief Motivational Intervention to reduce alcohol use.

INTRODUCTION: Heavy alcohol use negatively impacts health outcomes among people with HIV and is especially prevalent among men who have sex with men (MSM). Alcohol problems among MSM with HIV may occur, in part, due to increased stress caused by experiences of identity-based discrimination, such as heterosexism, HIV stigma, and racism. The current study examined (a) whether MSM with HIV who experience greater identity-based discrimination reported higher levels of alcohol problems over time in the absence of alcohol intervention, and (b) whether motivational interviewing (MI) to reduce alcohol use would attenuate the effects of discrimination on alcohol problems. METHODS: Data came from a clinical trial in which MSM with HIV were randomized into brief MI for alcohol harm reduction [n = 89] or an HIV treatment as usual assessment only control [TAU; n = 91]. Alcohol use and problems were assessed at baseline, 3, 6, and 12 months. RESULTS: Generalized Estimating Equations found a significant interaction between MI and baseline identity-based discrimination, such that in those not receiving MI, discrimination prospectively predicted alcohol problems over time (B = 0.065, SE = 0.018, p < .001, 95% Wald CI [.030- 0.100]). In those receiving MI, discrimination did not have an effect (B = - 0.002, SE = 0.131, p = .987, 95% Wald CI [- 0.258 to 0.254]). CONCLUSIONS: Even without explicitly targeting experiences of identity-based discrimination, a person-centered intervention, like MI, appears to mitigate the negative impact of identity-based discrimination on alcohol-related problems.

Examining the Impact of Race on Motivational Interviewing Implementation and Outcomes with HIV+ Heavy Drinking Men Who Have Sex with Men.

Motivational interviewing (MI)-based interventions focus on changing behavior through building client motivation. It is unknown how racial mismatch between clients and providers may impact MI implementation and subsequent behavior. We used a mixed methods approach to examine differences in Motivational Interviewing Skill Code (MISC) coded sessions and post-session outcomes between a sample of HIV-positive cisgender men who have sex with men (MSM) participants of an MI-based intervention to reduce heavy drinking who identified as persons of color (POC; n = 19) and a matched sample of White participants (n = 19). We used quantitative methods to analyze how providers implemented the intervention (i.e., MISC codes) and post-session drinking. We used qualitative analyses of session transcripts to examine content not captured by MISC coding. Quantitative analyses showed that providers asked fewer open-ended questions and had a lower ratio of complex reflections to simple reflections when working with POC participants, but no significant differences were observed in drinking post-intervention between participants. Qualitative analyses revealed that participants discussed how racial and sexual orientation discrimination impacted their drinking. Allowing clients to share their experiences and to explore individually meaningful reasons for behavioral change may be more important than strict adherence to MI techniques.