Multilevel modeling in psychosomatic medicine research.

The primary purpose of this study is to provide an overview of multilevel modeling for Psychosomatic Medicine readers and contributors. The article begins with a general introduction to multilevel modeling. Multilevel regression modeling at two levels is emphasized because of its prevalence in psychosomatic medicine research. Simulated data sets based on some core ideas from the Familias Unidas effectiveness study are used to illustrate key concepts including communication of model specification, parameter interpretation, sample size and power, and missing data. Input and key output files from Mplus and SAS are provided. A cluster randomized trial with repeated measures (i.e., three-level regression model) is then briefly presented with simulated data based on some core ideas from a cognitive-behavioral stress management intervention in prostate cancer.

'Eat coffee candy and die': sex, death and Huli funerals.

BACKGROUND: Sex and death have traditionally been linked in Huli culture in the Southern Highlands in Papua New Guinea. Huli regarded that close contact with women could result in men becoming sick or dying. However, there has been rapid social and economic development in the area and Huli traditions are changing. At the same time, HIV prevalence is rising. METHODS: Twenty-five semistructured in-depth interviews were carried out with key informants during a study on HIV risk in the Southern Highlands. Interviews were conducted mostly in Tok Pisin. Interviews were transcribed and the data were analysed though thematic coding. RESULTS: Huli people use 'eating coffee candy' as a metaphor for engaging in sex at funerals. This is very new and against traditional values, where women attended funerals and men only built the coffins and buried the body. Nowadays, sex occurs at funerals. This change has disturbed older people because it has not only changed the customary meaning of the funeral space, but it has also encouraged the spread of HIV. Huli use the fatalistic expression 'Eat coffee candy and die,' to refer to funerals as a space of HIV risk. CONCLUSION: Huli community and church leaders, and health workers are attempting to deal with the situation by not allowing men to stay at the funeral site overnight, burying the dead on the same day they die and using customary village law to charge men caught having sex at a funeral. However, traditional beliefs and rapid social change in the context of an HIV epidemic need to be taken into account.

Characteristics of high-risk sexual behaviors for human immunodeficiency virus infection among Iranian drug abusers.

OBJECTIVES: This study was conducted to estimate the prevalence and the associated factors of high-risk sexual behaviors among drug abusers referred to a methadone clinic in Gorgan, the capital of Golestan province in the northeast of Iran, to help health care decision makers on designing interventional programs. METHODS: In this cross-sectional study, 400 drug abusers referred to our methadone clinic were evaluated for high-risk sexual behavior. A logistic regression model was fitted for the association between independent variables and high-risk sexual behavior. RESULTS: Approximately a quarter of patients (25.5%) had high-risk sexual behavior among which 47% had not used a condom in their last sexual contact. Drug abusers who had poor economic status had a lower chance of high-risk sexual behavior than those with good economic status (adjusted odds ratio [AOR] = 0.35, 95% confidence interval [CI] = 0.13-0.96). Also, 1-year increase in age reduced the chance by 6% (AOR = 0.94, 95% CI = 0.91-0.98). Heroin abusers, compared with opium abusers, had a duplicated chance of having high-risk sex (AOR = 2.11, 95% CI = 1.12-3.96). CONCLUSION: According to this study, high-risk sexual behavior in the drug abusers referred to methadone clinic was associated with younger age, good economic status, and heroin addiction. Hence, in interventional planning, more attention should be paid to young drug abusers, patients with good economic status, and heroin addicts as well.

Religiosity and HIV risk behaviors in African-American students.

The participants were 256 African-American students between the ages of 18 and 25, from two historically Black universities. The purpose of this study was to see how dimensions of religiosity and spirituality influenced the HIV risk behavior in African-American college students. Each participant completed the Expressions of Spirituality Inventory (ESI) and a survey of sexual attitudes, beliefs, and behaviors. The data were analyzed using a series of ANOVAs, t tests, and correlations. The results from the study confirmed that there was a relationship between religiosity/spirituality and one's tendency to engage in HIV risk behaviors in the population of African-American college students. Interestingly, this study was able to reveal that traditional indicators of religiosity, such as association and church attendance, were not predictors of any of the risky sexual behaviors or attitudes. The portions of religiosity with the greatest impact on these behaviors were the Experiential/Phenomenological, the Existential Well-being, and the Cognitive dimensions, with high scores on each indicative of less likelihood of engaging in risky sexual behaviors.

Risk behaviors among Asian women who work at massage parlors in San Francisco: perspectives from masseuses and owners/managers.

This study investigates cognitive, cultural, and contextual factors that influence HIV-related risk behaviors among Asian women who engage in sex work at massage parlors in San Francisco. Focus groups and qualitative interviews were conducted for Vietnamese and Thai masseuses and massage parlor owners/managers. Economic pressure as well as subjective evaluation of customers for the risk of HIV/STD infection increase unprotected sexual behaviors among Asian masseuses. Massage parlor owners/managers do not establish a clear policy for condom use at their parlors. Consequently, male customers often manipulate their intention not to use a condom while negotiating with masseuses. HIV/STD prevention intervention programs should address specific risks and needs for Asian masseuses, owners/managers, and male customers in order to promote health and well being among Asian masseuses who have been neglected by public health and social services.

"Hanging in" with HIV/AIDS in the rural north of Thailand: a grounded theory study.

A study was undertaken in 1997 through 2000 in the rural north of Thailand to describe and theorize the HIV/AIDS experiences of wives and widows there. Participants confronted four causally interrelated problems in their struggle to survive with HIV/ AIDS: physical, economic, psychoemotional, and sociocultural, and they used two social processes to manage them: namely, "hiding out" and "hanging in" with HIV/AIDS. This report describes and discusses the second of these basic social processes through which wives and widows in the rural north of Thailand cope with their HIV/AIDS infection. Hanging in involves a range of very active strategies derived from both traditional Thai culture and Western medicine and aimed at allowing participants to make the best of their predicament. In addition, this report renders explicit what is typically left implicit in grounded theory research; that is, that culture is the source both of the problems participants experienced and the means to their effective amelioration.

Social factors related to risk for violence and sexually transmitted infections/HIV among Asian massage parlor workers in San Francisco.

Asian women who work at massage parlors in San Francisco have high levels of risk for sexually transmitted infections (STIs), including HIV, and being victims of violence, which jeopardizes their health and wellbeing. On the basis of mapping, the targeted districts in San Francisco where massage parlors were located, 23 massage parlors were identified where commercial sex activity took place. Using snowball-sampling methods, 43 Asian female massage parlor workers were recruited for focus groups; 21 participants were Vietnamese and 22 were Thai. Qualitative analyses revealed frequent exposure to violence including verbal or physical abuse from customers and gang members, as well as persistent HIV risk behaviors associated with multiple daily sex partners, inconsistent condom use with customers, and forced sex. Social factors related to gender, immigration status, and socioeconomic status appeared to be closely tied to the health and wellbeing of Asian masseuses. Study findings suggest that individualized as well as community-level interventions are necessary to improve these women's health and decrease their prolonged exposure to risks for STIs and violence.