Neurodevelopment of children who are HIV-exposed and uninfected in Kenya.

INTRODUCTION: Predictors of neurodevelopment among children who are HIV-exposed uninfected (CHEU) are poorly understood. METHODS: Mothers with and without HIV and their children were enrolled during 6-week postnatal care visits across seven sites in Kenya between March 2021 and June 2022. Infant neurodevelopment was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor and gross motor domains. We used multivariate linear mixed effects models to identify associations between 1-year neurodevelopment scores, HIV and antiretroviral therapy (ART) exposures, and household factors, adjusted for potential confounders and clustered by the site. RESULTS: At 1-year evaluation, CHEU (n = 709) and children who are HIV-unexposed uninfected (CHUU) (n = 715) had comparable median age (52 weeks) and sex distribution (49% vs. 52% female). Mothers living with HIV were older (31 vs. 27 years), had lower education (50% vs. 26% primary) and were more likely to be report moderate-to-severe food insecurity (26% vs. 9%) (p < 0.01 for all). Compared to CHUU, CHEU had higher language scores (adjusted coeff: 0.23, 95% CI: 0.06, 0.39) and comparable social, fine and gross motor scores. Among all children, preterm birth was associated with lower gross motor scores (adjusted coeff: -1.38, 95% CI: -2.05, -0.71), food insecurity was associated with lower social scores (adjusted coeff: -0.37, 95% CI: -0.73, -0.01) and maternal report of intimate partner violence (IPV) was associated with lower fine motor (adjusted coeff: -0.76, 95% CI: -1.40, -0.13) and gross motor scores (adjusted coeff: -1.07, 95% CI: -1.81, -0.33). Among CHEU, in utero efavirenz (EFV) exposure during pregnancy was associated with lower gross motor scores compared to dolutegravir (DTG) exposure (adjusted coeff: -0.51, 95% CI: -1.01, -0.03). Lower fine and gross motor scores were also associated with having a single or widowed mother (adjusted coeff: -0.45, 95% CI: -0.87, -0.03) or a deceased or absent father (adjusted coeff: -0.81, 95% CI: -1.58, -0.05), respectively. CONCLUSIONS: Biologic and social factors were associated with child neurodevelopment. Despite socio-demographic differences between CHEU and CHUU, 1-year neurodevelopment was similar. Addressing IPV and food insecurity may provide benefits regardless of maternal HIV status. DTG use was associated with higher neurodevelopmental scores in CHEU, compared to EFV regimens, potentially contributing to a lack of neurodevelopmental difference between CHEU and CHUU.

Financial strain and the health and well-being of college students during the COVID-19 pandemic.

Objective: This study examined the associations between COVID-19-related financial strain and the stress, mental health, physical health symptoms, and health behaviors of American university students. Participants: Online data were collected from 485 participants between May 2020 and March 2021. Participants were majority female and majority white. Methods: Participants reported on stress (COVID-19 health stress and work stress), mental health (depression, anxiety, loneliness, social support, and subjective well-being), physical health symptoms, and health behaviors (sleep latency, alcohol consumption, alcohol coping, other substance use, exercise, COVID-19 health behaviors). Results: Both Pearson's correlations and Bayesian correlation indicated more stress and worse mental health, health symptoms, and health behaviors for students who experienced more financial strain. Conclusion: Pandemic-related financial strain could have enduring negative effects for students, many of whom already experience financial challenges. This work highlights a need to allocate resources to promote college student health during and after the COVID-19 pandemic.

Demand creation for HIV testing services: A systematic review and meta-analysis.

BACKGROUND: HIV testing services (HTS) are the first steps in reaching the UNAIDS 95-95-95 goals to achieve and maintain low HIV incidence. Evaluating the effectiveness of different demand creation interventions to increase uptake of efficient and effective HTS is useful to prioritize limited programmatic resources. This review was undertaken to inform World Health Organization (WHO) 2019 HIV testing guidelines and assessed the research question, "Which demand creation strategies are effective for enhancing uptake of HTS?" focused on populations globally. METHODS AND FINDINGS: The following electronic databases were searched through September 28, 2021: PubMed, PsycInfo, Cochrane CENTRAL, CINAHL Complete, Web of Science Core Collection, EMBASE, and Global Health Database; we searched IAS and AIDS conferences. We systematically searched for randomized controlled trials (RCTs) that compared any demand creation intervention (incentives, mobilization, counseling, tailoring, and digital interventions) to either a control or other demand creation intervention and reported HTS uptake. We pooled trials to evaluate categories of demand creation interventions using random-effects models for meta-analysis and assessed study quality with Cochrane's risk of bias 1 tool. This study was funded by the WHO and registered in Prospero with ID CRD42022296947. We screened 10,583 records and 507 conference abstracts, reviewed 952 full texts, and included 124 RCTs for data extraction. The majority of studies were from the African (N = 53) and Americas (N = 54) regions. We found that mobilization (relative risk [RR]: 2.01, 95% confidence interval [CI]: [1.30, 3.09], p < 0.05; risk difference [RD]: 0.29, 95% CI [0.16, 0.43], p < 0.05, N = 4 RCTs), couple-oriented counseling (RR: 1.98, 95% CI [1.02, 3.86], p < 0.05; RD: 0.12, 95% CI [0.03, 0.21], p < 0.05, N = 4 RCTs), peer-led interventions (RR: 1.57, 95% CI [1.15, 2.15], p < 0.05; RD: 0.18, 95% CI [0.06, 0.31], p < 0.05, N = 10 RCTs), motivation-oriented counseling (RR: 1.53, 95% CI [1.07, 2.20], p < 0.05; RD: 0.17, 95% CI [0.00, 0.34], p < 0.05, N = 4 RCTs), short message service (SMS) (RR: 1.53, 95% CI [1.09, 2.16], p < 0.05; RD: 0.11, 95% CI [0.03, 0.19], p < 0.05, N = 5 RCTs), and conditional fixed value incentives (RR: 1.52, 95% CI [1.21, 1.91], p < 0.05; RD: 0.15, 95% CI [0.07, 0.22], p < 0.05, N = 11 RCTs) all significantly and importantly (≥50% relative increase) increased HTS uptake and had medium risk of bias. Lottery-based incentives and audio-based interventions less importantly (25% to 49% increase) but not significantly increased HTS uptake (medium risk of bias). Personal invitation letters and personalized message content significantly but not importantly (<25% increase) increased HTS uptake (medium risk of bias). Reduced duration counseling had comparable performance to standard duration counseling (low risk of bias) and video-based interventions were comparable or better than in-person counseling (medium risk of bias). Heterogeneity of effect among pooled studies was high. This study was limited in that we restricted to randomized trials, which may be systematically less readily available for key populations; additionally, we compare only pooled estimates for interventions with multiple studies rather than single study estimates, and there was evidence of publication bias for several interventions. CONCLUSIONS: Mobilization, couple- and motivation-oriented counseling, peer-led interventions, conditional fixed value incentives, and SMS are high-impact demand creation interventions and should be prioritized for programmatic consideration. Reduced duration counseling and video-based interventions are an efficient and effective alternative to address staffing shortages. Investment in demand creation activities should prioritize those with undiagnosed HIV or ongoing HIV exposure. Selection of demand creation interventions must consider risks and benefits, context-specific factors, feasibility and sustainability, country ownership, and universal health coverage across disease areas.

Stigma, Post-traumatic Stress, and COVID-19 Vaccination Intent in Mongolia, India, and the United States.

Background: Stigma and discrimination during the coronavirus (COVID-19) pandemic have increased precipitously worldwide. This multinational study examines how stigma, blaming groups for virus spread, concern regarding contracting the virus, resource loss, life satisfaction, and protective behaviors that help control the spread of COVID-19 are associated with post-traumatic stress and vaccine intent in Mongolia, India, and the United States. Method: 1429 people in Mongolia, India, and the United States completed measures assessing stigma during the COVID-19 pandemic, post-traumatic stress, blame, protective behaviors, and vaccine intent. Results: Mean post-traumatic stress scores in all three countries exceeded the cut-off that is commonly used to determine probable post-traumatic stress. Post-traumatic stress was associated with COVID-19 stigma experience, personal behavior change due to COVID-19 stigma, blaming groups for the spread of COVID-19, fear of COVID-19, and resource loss. In India and the United States, personal behavior change due to COVID-19 stigma, anger at individuals spreading COVID-19, and perceived susceptibility to illness were positively associated with vaccine intent. Conclusions: Stigma is a collateral stressor during the pandemic. The findings underscore the importance of prompt action to address stigma as a deleterious consequence of the pandemic. The findings illuminate potential barriers to receiving the vaccine and provide direction for future research to address barriers.

Expert peer facilitation of the EVERYbody Project: A randomized-controlled evaluation of a diversity-focused, dissonance-based, universal body image program for college students.

OBJECTIVE: A novel peer facilitation model was used to deliver a two session, dissonance-based, inclusive body image intervention that critically examines how internalized size-based oppression intersects with race, class, gender, sexuality, and ability. METHOD: The EVERYbody Project was open to all college students and delivered by "expert" peer facilitators with body image and diversity experience and advanced facilitation skills. Recruitment was halted due to COVID-19; 90 students in the Northwest US (M age = 19.83 years, SD = 2.38; 80% female-identified, 13% male-identified, 7% gender expansive) were randomized to receive the EVERYbody Project or a video-based, low-dissonance comparison intervention. RESULTS: Around half of students (56%) held one or more specific socially marginalized identity (26% with a racial or ethnic identity other than white and non-Hispanic, 39% with a sexual identity other than straight, 7% with a gender identity other than cisgender). The EVERYbody Project produced greater reductions in three outcomes associated with poor body image (internalized appearance norms, body dissatisfaction, and negative affect) compared to the video intervention through 3-month follow-up (ps < .003) with medium between group effects. Both conditions experienced small reductions in eating disorder psychopathology over time. DISCUSSION: Expert peer facilitation may be a viable delivery model for inclusive, diversity-focused dissonance-based body image programs. PUBLIC SIGNIFICANCE: This study explored a novel facilitation approach for a diversity-focused body image program for college students. A brief (4 h) dissonance-based program was open to all college students and delivered by "expert" diverse peer leaders who were screened for facilitation readiness. Body image and related outcomes were improved through 3-month follow-up relative to a comparison condition, suggesting that expert peer facilitation may be a viable option for delivering universal, inclusive body image programming.

Prevalence of Private and Public Health Insurance Among Transgender and Gender Diverse Adults.

BACKGROUND: Little is known about how health insurance payer types differ between transgender and gender diverse (TGD) people and cisgender people. Much of what is known about insurance coverage among TGD adults has been based on research from claims and electronic health record data, which excludes individuals who have not accessed gender-affirming care. Research designed to understand how TGD populations pay for health care to best inform care interventions and public insurance policies is lacking. OBJECTIVE: The objective of this study was to examine differences in the prevalence of public and private health insurance between transgender and cisgender adults. METHODS: Using data from the Behavioral Risk Factor Surveillance System, this study estimated prevalence of health insurance coverage among TGD and cisgender adults residing in 22 states that administered the Sexual Orientation and Gender Identity module and the Healthcare Access module from 2014 to 2019. This study estimated the odds of health insurance coverage (no insurance, private insurance, public insurance) among cisgender adults compared with TGD adults. RESULTS: TGD people had greater odds of being uninsured compared with cisgender women. Among nondisabled, nonelderly respondents, TGD adults had lower odds of having private insurance and higher odds of public insurance compared with cisgender men. Among respondents who were likely Medicaid-eligible, TGD respondents had lower odds of having public insurance and higher odds of being uninsured compared with cisgender women. CONCLUSION: These findings provide foundational information about the payer mix among TGD people and provide insight into barriers to health insurance that TGD adults may face.

Cultural differences in stress and affection following social support receipt.

Culturally appropriate social support predicts better psychological outcomes. Motivation for providing social support may vary cross-culturally, with more independent cultures valuing self-esteem and more interdependent cultures valuing closeness. Participants in the U.S. (N = 85) and Singapore (N = 78) reported on emotions and social support receipt using the Day Reconstruction Method. We examined cultural differences in stress and affection, and tested country as a moderator of the associations between both social support receipt and social support motivation, and next-episode emotions. Multilevel modeling analyses showed that not only did the emotional correlates of social support receipt vary by country, but that recipient perceptions of esteem-building and closeness-fostering SS also differentially correlated with subsequent emotion. For example, esteem-building SS predicted greater next-episode stress for Singaporean participants, but less stress in the U.S. Esteem-building SS predicted more next-episode affection only in the U.S. Culturally appropriate social support predicts positive psychological outcomes. This research highlights the importance of considering culture when examining the dynamic emotional correlates of social support receipt.

Inclusive dissonance-based body image interventions for college students: Two randomized-controlled trials of the EVERYbody Project.

OBJECTIVES: Two randomized-controlled studies explored the feasibility, acceptability, and efficacy of the EVERYbody Project, a gender-inclusive, diversity-focused, dissonance-based body image intervention for college students. METHOD: Trial 1 (N = 98; 80% female, 14% male, and 6% gender-expansive) piloted the two-session intervention delivered by an expert (faculty or staff) and peer cofacilitators compared to a waitlist control. Trial 2 (N = 141; 79% female, 15% male, and 6% gender-expansive) utilized peer leaders, comparing the EVERYbody Project to a video and expressive writing intervention. Around half of the participants in both trials self-identified in one or more specific marginalized identity category. Changes in eating disorder symptoms and risk factors were assessed through 1-month follow-up. Trial 1 also assessed the intervention's impact on students with marginalized identities through qualitative interviews. RESULTS: In Trial 1, the EVERYbody Project produced greater reductions in eating disorder symptoms, internalized appearance norms, body dissatisfaction, and negative affect compared to the waitlist control through 1-month follow-up, with medium effect sizes. The impact was similar in students with marginalized and majority identities, and qualitative interviews suggested specific positives of the intervention. In Trial 2, there were significant changes in two of four outcomes for participants in the EVERYbody Project compared to the video and expressive writing intervention, but overall, the intervention impact was modest. CONCLUSIONS: The EVERYbody Project is a feasible and acceptable inclusive dissonance-based body image program. It appears to be beneficial when delivered via experts, but research is needed to establish whether the program can be delivered using peer leaders with greater impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adolescents' daily face-to-face and computer-mediated communication: Associations with autonomy and closeness to parents and friends.

The amount of time adolescents spend communicating via digital technologies such as smartphones has led to concerns that computer-mediated communication (CMC) is displacing face-to-face (FtF) interactions and disrupting social development. Although many studies have examined CMC in adolescents' relationships with friends, few studies have examined the role of CMC in adolescents' renegotiation of closeness and autonomy with parents. To examine this issue, we administered an online daily diary with 169 U.S. adolescents to estimate the time they spend in CMC and FtF interactions and the number of texts they exchange with friends and parents. On the last day of the survey, we asked adolescents about their emotional closeness to friends and parents and their balance of closeness and volition with parents. Overall, we found more evidence for social stimulation than displacement effects of CMC. Texts and CMC time with friends predicted friend closeness after accounting for FtF time with friends; texts with parents predicted parent closeness after accounting for FtF time with parents. We also found support for our hypothesis that CMC would be associated with greater adolescent volition. CMC time with parents predicted greater volitional dependence (volition plus closeness) whereas texts with friends predicted greater independent decision-making (volition plus distance). We discuss how communication technologies are integrated into U.S. adolescents' relationships with friends and parents and how CMC can facilitate, rather than stifle, adolescents' adjustment of autonomy-relatedness with parents and their construction of emotional closeness with friends. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Did you really need to ask? Cultural variation in emotional responses to providing solicited social support.

Most prior research on culture and the dynamics of social support has focused on the emotional outcomes for social support recipients. Though an existing body of research has identified cross-cultural differences in the emotional correlates of receiving different types of social support, researchers have seldom examined possible cultural differences in the experience of social support providers. This study used the Day Reconstruction Method to examine cultural differences in the emotional correlates of the provision of solicited and unsolicited and emotional and informational social support in the daily lives of Singaporean (n = 79) and American (n = 88) participants. Singaporean participants reported providing more social support overall. Regardless of culture, participants reported more positive emotion (affection, happiness) and less negative emotion (anger, anxiety) when they provided emotional social support. Also, multilevel modeling analyses revealed a 3-way interaction between culture, social support provision, and social support solicitation, indicating cultural differences in negative emotional responses to providing solicited social support. Specifically, results suggest that attempts to provide more solicited social support were associated with more negative emotions in the U.S. In contrast, provider negative emotions were highest in Singapore when the provider did not meet the recipient's request for support. Patterns of cultural differences in social support provision are dissimilar to-rather than simply mirroring-those found in published research on social support receipt, highlighting the importance of studying social support provision as a distinct phenomenon.