Hidden cues for approach and avoidance motivation: implicit cognitive associations among patients with Nonadherence to HIV treatment.

Although patient motivation related to HIV treatment is widely acknowledged as a key factor related to consistent adherence and engagement with medical care, research has predominantly focused on explicit rather than implicit cognitive processes that underlie motivation. This study identified and examined implicit cognitive processes that influence approach and avoidance treatment motivation in a sample of 30 HIV patients with suboptimal adherence and poor engagement with medical care. Study participants were predominantly African American (87%) and gay/bisexual (63%). We examined 173 thought statements about treatment collected from patients during two previous studies. Thematic analysis described how implicit cognitive associations influenced patients to approach or avoid treatment and medical care. Findings revealed three major contextual categories of treatment-related thoughts: links with routines and habits, connections to physical changes and reactions, and interpersonal associations. Within each category, implicit cognitive associations about treatment in terms of these daily life events and experiences cued approach and avoidance motivational tendencies without the patient's awareness. Findings from this study support the need for interventions that use implicit, less effortful approaches aimed at promoting adherence and improving the retention of patients with poor engagement.

Evaluating the relationship between rail transit and industrial agglomeration: An observation from the Dallas-fort worth region, TX.

Recent studies have suggested that rail transit not only facilitates urban growth but also promotes urban agglomeration. Yet research that links industrial agglomeration with rail transit is scant-what types of industries are likely to cluster near rail stations? To what extent can rail transit access be seen as having an influence on industrial agglomeration? And how do these interactions vary as rail transit proximity increases? To answer these and related questions, we investigate the relationship between industrial agglomeration and rail transit in the Dallas-Fort Worth metropolitan area using the Longitudinal Employer Dynamics (LEHD) employment data from 2014 at the census block level. First, we use the Local Indicator of Spatial Association statistics (LISA) tests to identify industrial agglomeration patterns within the study area. We then use logistics models to reveal the relationship between rail transit proximity and industrial agglomeration. Our study finds that the impacts of rail transit on industrial agglomeration, in terms of magnitudes and signs, are mixed across industries. The varying results suggest that the benefits of rail transit access exhibit considerable demand from certain industry sectors including the manufacturing, knowledge, and services industries, while exerting weaker forces in pulling agglomeration in its immediate environs among other industries (including the retail trade sector). In practice, these results are useful for justifying evidence-based rail transit planning.

Antiretroviral therapy adherence in a sample of men with low socioeconomic status: The role of task-specific treatment self-efficacy.

Disparities continue to persist in HIV care and treatment outcomes among racial/ethnic minorities, men who have sex with men (MSM), and individuals with low socioeconomic status. Much research has identified treatment self-efficacy as a key factor in antiretroviral therapy adherence and subsequent treatment outcomes. Few studies, however, have elaborated on these links and their potential in reducing HIV treatment disparities by examining the role of task-specific types of treatment self-efficacy. In this study, we examined the effect of four types of task-specific treatment self-efficacy on antiretroviral adherence among patients in a predominantly racial/ethnic minority sample of HIV-seropositive MSM with low socioeconomic status. We grouped participants by duration of treatment to determine whether certain types of self-efficacy were more salient based on treatment experience. We found that participants with optimal adherence tended to have higher levels of task-specific self-efficacy related to medication management and mood management than participants with suboptimal adherence. After a Bonferroni correction for multiple comparisons, only task-specific self-efficacy for medication management showed significant effects on adherence. Findings suggest that using focused, task-specific measures of treatment self-efficacy could strengthen our ability to aid patients at risk for adherence difficulties and tailor interventions to more effectively meet their needs.

THE USE OF SELF-MANAGED TREATMENT STRATEGIES IN A PREDOMINANTLY LOW-INCOME, AFRICAN-AMERICAN SAMPLE OF WOMEN LIVING WITH HIV.

While low-income and ethnic minority women represent a growing proportion of new HIV cases in the United States, little is known about how they manage their antiretroviral medication regimens. Using a predominantly low-income, African-American sample (N = 85), this study examined medication self-management strategies among HIV seropositive women undergoing antiretroviral therapy in a major metropolitan area. Most study participants (95%; n = 81) reported employing a specific medication management strategy during the previous week. Pillboxes, use of daily activities, and receiving reminders from another person were the most common strategies. Most participants (80.2%) employed two or more strategies. Age, education, and motivation were associated with alarm, pillbox, and visual aid usage.

Individualized Web-Based Attention Training With Evidence-Based Counseling to Address HIV Treatment Adherence and Psychological Distress: Exploratory Cohort Study.

BACKGROUND: The prevalence of mood, trauma, and stressor-related disorders is disproportionately higher among people living with HIV than among individuals without the virus. Poor adherence to HIV treatment and heightened psychological distress have been linked to symptoms associated with these disorders. OBJECTIVE: The objective of this exploratory pilot study was to develop and implement an intervention that combined individualized web-based attention training with evidence-based counseling to promote HIV treatment adherence and reduce psychological distress among people living with HIV. The study targeted African American and Latino young men who have sex with men, two population groups in the US that continue to experience disparities in HIV treatment outcomes. METHODS: Study participants with elevated symptoms of depression and suboptimal adherence to antiretroviral therapy were recruited primarily through referrals from Los Angeles health and social service providers as well as postings on social media. Participants enrolled in the 4-week intervention received weekly counseling for adherence and daily access to web-based attention training via their personal mobile devices or computers. RESULTS: Of the 14 participants who began the intervention, 12 (86%) completed all sessions and study procedures. Using a pretest-posttest design, findings indicate significant improvements in adherence, depressive symptoms, and attention processing. Overall, the proportion of participants reporting low adherence to antiretroviral therapy declined from 42% at baseline to 25% at intervention completion (P=.02, phi=0.68). Mean depressive symptoms measured by the 9 item Patient Health Questionnaire (PHQ-9) showed a substantial reduction of 36% (P=.002, Cohen d=1.2). In addition, participants' attentional processing speeds for all types of stimuli pairings presented during attention training improved significantly (P=.01 and P=.02) and were accompanied by large effect sizes ranging from 0.78 to 1.0. CONCLUSIONS: Our findings support the feasibility of web-based attention training combined with counseling to improve antiretroviral therapy adherence among patients with psychological distress. Future research should include a larger sample, a control group, and longer-term follow-up.

Everyday challenges in context: the influence of contextual factors on everyday problem solving among young, middle-aged, and older adults.

The authors examined the experimental effects of social context on everyday problem-solving performance by older, middle-aged, and younger adults. Participants were presented with six everyday problems constructed by framing two behavioral challenges in social contexts representative of the lives of older, middle-aged, and younger adults. As predicted, participants performed best when problems were situated in contexts representative of their own age group. Older adults also outperformed the other age groups on problems set in older adult contexts, suggesting that when problems are set in ecologically relevant contexts, one may not observe previously reported age-related declines in performance.

Developing a Biomedical Information System for Clinical Assessments and Interventions of Mental Health and Substance Abuse Patients Belonging to YMSM of Color with HIV Using Multidimensional Scaling Analysis and Paired Comparisons Techniques.

In mental health and substance abuse treatment, individualized assessments provide information on the specific thoughts and cognitive processes influencing a person's behavior, emotional responses, and psychological functioning. Given the lack of automated assessment procedures or individualized clinical interventions in the growing health disparities in the South Los Angeles of USA, we developed a novel system using idiographic techniques to automatically and quickly generate individualized patient assessment data for use in clinical interventions.

Another look at depressive symptoms and antiretroviral therapy adherence: The role of treatment self-efficacy.

Depression has been strongly associated with poor HIV treatment adherence, but little research has explored how individuals manage to follow their regimens despite symptoms of major depression. Using a sample of antiretroviral therapy patients with clinically significant depressive symptoms (n = 84), we examined whether patients with optimal adherence differed from those with suboptimal adherence in terms of the types of depressive symptoms experienced and treatment self-efficacy. There were no significant differences between participants with regard to types of depressive symptoms. Findings indicate that patients with high treatment self-efficacy were more likely to report optimal levels of adherence than patients with low self-efficacy.

Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study.

OBJECTIVE: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement. METHOD: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program. RESULTS: The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen's d = 0.84). CONCLUSION: MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general.

Goal Setting and Treatment Adherence Among Patients With Chronic Illness and Depressive Symptoms: Applying a Patient-Centered Approach.

OBJECTIVE: Poor treatment adherence is a major problem among individuals with chronic illness. Research indicates that adherence is worsened when accompanied by depressive symptoms. In this preliminary study, we aimed to describe how a patient-centered approach could be employed to aid patients with depressive symptoms in following their treatment regimens. METHODS: The sample consisted of 14 patients undergoing antiretroviral therapy (ART) for HIV who reported clinically-significant depressive symptoms. Participant ratings of 23 treatment-related statements were examined using two assessment and analytic techniques. Interviews were conducted with participants to determine their views of information based on the technique. RESULTS: Results indicate that while participants with optimal adherence focused on views of treatment associated with side effects to a greater extent than participants with poor adherence, they tended to relate these side effects to sources of intrinsic motivation. CONCLUSION: The study provides examples of how practitioners could employ the assessment techniques outlined to better understand how patients think about treatment and aid them in effectively framing their health-related goals.

Postmortem detection of 25I-NBOMe [2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine] in fluids and tissues determined by high performance liquid chromatography with tandem mass spectrometry from a traumatic death.

We present a traumatic fatality of a 19-year-old man who had ingested blotter paper containing 25I-NBOMe [2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine]. Postmortem specimens were analyzed by high performance liquid chromatography with tandem mass spectrometry (HPLC/MS/MS). Toxicology findings for fluids based upon blood or urine calibrators were as follows: peripheral blood, 405 pg/mL; heart blood, 410 pg/mL; urine, 2.86 ng/mL; and vitreous humor, 99 pg/mL. While findings based upon the method of standard additions were: gastric contents, 7.1 µg total; bile, 10.9 ng/g; brain, 2.54 ng/g and liver, 7.2 ng/g. To our knowledge the presented case is the first postmortem case of 25I-NBOMe intoxication documented by toxicological analysis of tissues and body fluids.

Psychological pathways from childhood sexual and physical abuse to HIV/sexually transmitted infection outcomes among homeless women: the role of posttraumatic stress disorder and borderline personality disorder symptoms.

This study examines the psychological factors linking childhood abuse and HIV/sexually transmitted infection outcomes among 190 single homeless women in New York City. Participants were assessed for mental health symptoms, sexually transmitted infections, and exposure to childhood sexual and physical abuse. Findings indicate that the relationship between childhood abuse and HIV/sexually transmitted infection diagnoses during adulthood is mediated by a combination of posttraumatic stress disorder and borderline personality disorder symptoms. Screening single homeless women who report childhood abuse histories for symptoms of both disorders may aid in the identification of individuals particularly vulnerable for HIV infection. Implications for clinical interventions are discussed.

Assessing treatment motivation among patients receiving antiretroviral therapy: a multidimensional approach.

Using multidimensional scaling (MDS) analysis, this study examined how patient conceptualisations of treatment motivation compare with theoretically based assumptions used in current assessment approaches. Patients undergoing antiretroviral therapy for HIV/AIDS (n=39) rated for similarity between all possible pairings of 23 treatment descriptions, including descriptors of intrinsic, extrinsic, approach and avoidance motivation. MDS analyses revealed that patient perceptions of intrinsic and extrinsic motivations often differ from those based on definitions derived from common interpretations of self-determination theory. Findings also showed that patients reported motivation for avoiding treatment when they associated their medication regimens with side effects and other negatively valenced outcomes. The study describes new applications of MDS in assessing how patients perceive the relationship between treatment behaviours and specific forms of motivation, such as intrinsic and extrinsic motivations. In addition, the study suggests how MDS may be used to develop behavioural strategies aimed at helping patients follow their regimens consistently by identifying treatment conceptualisations and contexts that facilitate or impede adherence.

Intimate partner abuse among gay and bisexual men: risk correlates and health outcomes.

Little is known about the patterns and types of intimate partner abuse in same-sex male couples, and few studies have examined the psychosocial characteristics and health problems of gay and bisexual men who experience such abuse. Using a cross-sectional survey sample of 817 men who have sex with men (MSM) in the Chicago area, this study tested the effect of psychological and demographic factors generally associated with intimate partner abuse and examined their relationship to various health problems. Overall, 32.4% (n = 265) of participants reported any form of relationship abuse in a past or current relationship; 20.6% (n = 168) reported a history of verbal abuse ("threatened physically or sexually, publicly humiliated, or controlled"), 19.2% (n = 157) reported physical violence ("hit, kicked, shoved, burned, cut, or otherwise physically hurt"), and 18.5% (n = 151) reported unwanted sexual activity. Fifty-four percent (n = 144) of men reporting any history of abuse reported more than one form. Age and ethnic group were unrelated to reports of abuse. Depression and substance abuse were among the strongest correlates of intimate partner abuse. Men reporting recent unprotected anal sex were more likely to also report abuse, Wald (1, n = 773) = 9.02, p < .05, Odds Ratio (OR) = 1.61, Confidence Interval (CI) = 1.18-2.21. We discuss psychosocial issues faced by gay and bisexual men who experience intimate partner abuse as they may pertain to interventions among this group.

Is the Web the culprit? Cognitive escape and Internet sexual risk among gay and bisexual men.

Men who have Sex with Men (MSM) who find partners on the Internet tend to be sexually risky. A "cognitive escape" perspective maintains that feeling overwhelmed by rigorous sexual norms may lead one to cognitively disengage from these demands as a coping strategy. We thus proposed that the Internet might facilitate less restrained behavior among men whose psychological characteristics make them vulnerable to "escape"-based risk. We tested this in a socio-economically and ethnically diverse cross sectional survey sample of MSM, n=817. Men who sought sex on-line reported more unprotected sex and sexually transmitted infections, controlling for demographics and overall number of sex partners. Consistent with an escape perspective, partner choice and sexual context, alcohol and drug use, and "burnout" or fatigue over sexual safety mediated the relationship between Internet use and sexual risk. The Internet is not an isolated source of risk; interventions must address the psychosocial aspects of this venue.