Structural violence within communities and its impact on the well-being of people with HIV (PWH).

Structural violence (SV) is the concept that there are often invisible and intangible structures in place, whether political, economic, legal, cultural, religious, or social, that can inhibit individuals from reaching their full potential. There is a need to better understand the influence of SV on the well-being of people with HIV (PWH) in the Deep South. To address this gap in the literature, we interpreted data using a Structural Violence framework. In this community-based participatory research, in-depth interviews (n = 40) were conducted with PWH who previously established HIV medical care. In our study, we found that SV can have a widespread impact in communities, negatively impacting access to key tangible and emotional resources. SV themes included community crime and instability, financial insecurity, and disparate access to numerous resources known to influence health. Structures exacerbating unequal access to resources appear engrained within communities and often went unrecognized by participants as disadvantageous to achieving optimal HIV health. Greater effort is necessary to elucidate the influence and role of violent structures on access to key resources for and by PWH. A clearer understanding of SV's influence on HIV health can inform changes addressing these structural barriers to HIV health.

"If I have to drive 100 miles, I'll drive 100 miles to get it": a qualitative exploration of HIV care travel behavior.

ABSTRACTAlabama depends heavily on Ryan White HIV/AIDS Program (RWHAP) funding, yet patient enrollment at one large, RWHAP-funded, academically-affiliated HIV clinic in Alabama has steadily increased each year, with approximately 20% bypassing more proximal RWHAP clinics. To understand reasons why patients travel long distances and bypass closer clinics to receive care, we conducted eight focus groups over Zoom, each containing between 2-3 participants (n = 18) and applied thematic analysis to code the data. Primary themes included: (1) Reasons for Traveling Long Distances to Receive HIV Medical Care, (2) Experiences with HIV Medical Care during the COVID-19 Pandemic, and (3) Travel Challenges. Some participants were attracted by the clinic's one-stop-shop model, while others eschewed local clinics to avoid status disclosure. An overarching travel challenge was lack of transportation, yet most participants favored in-person appointments over telehealth despite driving long distances. Future research should explore patient attitudes towards telehealth in greater depth.

Emerging directions of cognitive aging with HIV: practice and policy implications for social work.

Cognitive impairments have been endemic to the HIV epidemic since its beginning and persist to this day. These impairments are attributed to HIV-induced neuroinflammation, the long-term effects of combination antiretroviral therapy, lifestyle factors (e.g., sedentary behavior, substance use), neuro-comorbidities (e.g., depression), age-associated comorbidities (e.g., heart disease, hypertension), and others causes. Normal aging and lifestyle also contribute to the development of cognitive impairment. Regardless of the etiology, such cognitive impairments interfere with HIV care (e.g., medication adherence) and everyday functioning (e.g., driving safely, financial management). With more than half of people with HIV (PWH) 50 years and older, and ~45% of all PWH meeting the criteria for HIV-Associated Neurocognitive Disorder (HAND), those aging PWH are more vulnerable for developing cognitive impairment. This article provides an update to a social work model to identify and monitor PWH for cognitive impairment. Within this update, the state of the science on protecting brain health and cognitive reserve within the context of neuroHIV is also presented. From this, implications for practice and policy to promote successful cognitive functioning in older PWH are provided.

Mother's exposure to domestic and community violence and its association with child's behavioral outcomes.

This study investigated the potential cumulative effect of maternal exposure to violence both at home and in community on children. This study used the data (N = 2506) from the Fragile Families and Child Wellbeing study. We found that maternal nonphysical victimization, either by witnessing violence in the community or by experiencing psychological domestic violence, had a direct negative effect on children's depression and anxiety. Maternal nonphysical victimization also indirectly elevated child's aggression through mother's use of psychological and physical aggression toward the child. Witnessing community violence by mothers, directly and indirectly, worsened the child's withdrawal behaviors through the mother's psychological aggression toward the child. Mother's direct victimization by community violence and physical domestic violence was not related to child's behavioral outcomes after controlling for other risk factors. This study points to important considerations for devising intervention and prevention for mothers and children. Implications for research and practice are discussed.

High Life Satisfaction: Exploring the Role of Health, Social Integration and Perceived Safety among Mexican Midlife and Older Adults.

We sought to investigate the relationship of high life satisfaction with important physical health, mental health, social integration and perceived safety factors among midlife and older Mexican adults. We examined 2,200 midlife and older adults (aged 50-101 years) from the Mexican arm of the Study on global AGEing and adult health (SAGE) and used binary logistic regression models to identify key factors associated with high LSA. Our final logistic regression model revealed self-rated health, affect, interpersonal activities and perceived safety on street to be significantly associated with high life satisfaction. Results from this study add to the nascent literature on subjective well-being of midlife and older Mexicans. Although social work with older adults is not well established in Mexico, researchers and practitioners should collaborate on the development and implementation of social worker-led strategies for prevention and intervention to enhance well-being among midlife and older Mexicans.

Longitudinal Trajectory of Adolescent Exposure to Community Violence and Depressive Symptoms Among Adolescents and Young Adults: Understanding the Effect of Mental Health Service Usage.

Research on the impact of exposure to community violence tends to define victimization as a single construct. This study differentiates between direct and indirect violence victimization in their association with mental health problems and mental health service use. This study includes 8947 individuals from four waves of the National Longitudinal Study of Adolescent to Adult Health and examines (1) whether sub-types of adolescent victimization are linked to depressive symptoms; (2) whether adolescent victimization is linked with mental health service use; and (3) the role of mental health service use in attenuating symptoms arising from victimizations. Adolescents witnessing community violence were more likely to experience depressive symptoms during adolescence but not during their young adulthood; direct exposure to violence during adolescence does not predict depressive symptoms in adolescence but does in adulthood. Use of mental health service mediates report of depressive symptoms for adolescent witnessing community violence.

Longitudinal associations among fathers' perception of coparenting, partner relationship quality, and paternal stress during early childhood.

This study examined the longitudinal and concurrent associations among fathers' perceptions of partner relationship quality (happiness, conflict), coparenting (shared decision making, conflict), and paternal stress. The sample consisted of 6,100 children who lived with both biological parents at 24 and 48 months in the Early Childhood Longitudinal Study-Birth Cohort data set. The results showed that there are significant and concurrent associations between fathers' perceptions of the coparenting relationship and paternal stress, and between partner relationship quality and paternal stress. There was also a positive direct longitudinal association between partner relationship conflict and paternal stress. However, we found only one longitudinal cross-system mediation effect: fathers' perception of coparenting conflict at 48 months mediated the association between partner relationship conflict at 24 months and paternal stress at 48 months. The family practice implications of these findings are discussed.

Immigration, Racialization, and Asian American Older Adults' Cognitive Difficulties.

OBJECTIVES: The sociohistorical experiences of Asian American older adults (AAOA) vary, but limited research has examined how immigration status operates as social determinants. This study builds on an existing framework to examine the relationship among social determinants and the differential effects of immigration status on cognitive difficulties among AAOA. METHODS: Using 5-year estimate data from the 2019 American Community Survey, the study sample consisted of AAOA aged 65 years and older identifying as Chinese, Filipino, Indian, Japanese, Korean, or Vietnamese (N = 100,584). AAOA were categorized as noncitizens, naturalized, or U.S. born for their immigration status. Participants who indicated having difficulty concentrating, remembering, or making decisions were categorized as having cognitive difficulties. RESULTS: Chinese were the most prevalent ethnic group (30%). Over 70% were naturalized citizens. About 8% endorsed having cognitive difficulties. According to bivariate analyses, there were considerable differences in AAOA's characteristics (e.g., age, gender, marital status, medical insurance, employment status) by their immigration status. The results from the logistic regressions showed that immigration status was independently associated with poor cognitive difficulties. By AAOA's immigration status, unique protective and risk factors were presented for cognitive difficulties. DISCUSSION: The differential pattern of cognitive difficulties among AAOA reveals a fuller picture of variations within AAOA by immigration status. The results imply that more research is needed to develop culturally sensitive practices that account for the racialized differences by AAOA's immigration status. Further research into the interplay between structural determinants is necessary to formulate practice and policy interventions to address better successful aging for AAOA.

The Unique Challenges of Older Informal Caregivers Living With HIV in the U.S. Deep South: A Qualitative Study.

ABSTRACT: As people with HIV live longer and healthier, it has become more likely that they will assume a caregiver role for their families and/or friends. Yet, there is a significant gap in the literature that older caregivers with HIV (OCWH) have not received attention from practitioners and researchers. To fill the gap, our qualitative study was conducted with OCWH ( N = 19) to explore various themes such as adjustment to caregiving, caregiving responsibilities, HIV and other health issues, support systems, caregiving outcomes, needs assessment, cognitive health, and the impact of COVID-19. Results indicated that each OCWH faced their own unique challenges (e.g., severity of health conditions, intense caregiving responsibilities, caregiving situation, lack of social support/transportation/financial means), but they expressed positive and fulfilling caregiving outcomes. Understanding the lived experiences of OCWH is requisite to develop holistic service programs to meet their caregiving needs while supporting their HIV health and co-occurring health conditions.

Do late adolescent fathers have more depressive symptoms than older fathers?

Although fathers are increasingly a focus of attention in research, there is a dearth of research on depressive symptoms among fathers, especially young fathers with toddlers. This study used longitudinal data to examine what risk factors, including the age status of fathers (e.g., late adolescence, emerging adulthood, and adulthood), may be associated with depressive symptoms of fathers when their children were 3 and 5 years of age. A subsample of families for which complete data were available on all variables was used in the analyses (n = 1,403). About 46% of study sample was African American, 27% White, 23% Hispanic, and 4% other race/ethnicity. Paternal depressive symptoms were measured using Composite International Diagnostic Interview-Short Form (CIDI-SF). Late adolescent fatherhood was significantly associated with third-year paternal depressive symptoms but not with fifth-year depressive symptoms. Those who reported low social support were more likely to be depressed at both times. Fathers who did not work for regular pay were more likely to be depressed at the third-year follow-up, but not at the fifth-year follow-up. Parenting stress and being booked/charged with a crime were not associated with third-year paternal depressive symptoms, but were with fifth-year paternal depressive symptoms. This study emphasizes the importance of screening for depressive symptoms of fathers even before the birth of their child and monitoring and treating postpartum depressive symptoms, as first-year depressive symptoms was a significant predictor for third- and fifth-year depressive symptoms. Service providers should focus on the mental health of fathers as well as mothers to promote healthy environments for their children.

Risk Factors of Cognitive Decline in Older Caregivers With HIV: An Emerging Hypothesis.

ABSTRACT: People with HIV (PWH) are living longer and healthier lives; thanks to combination antiretroviral therapy. As many PWH age, they find themselves providing care to family members and friends, just as their counterparts without HIV. The literature indicates that becoming a caregiver creates conditions that compromise one's cognitive function. Additionally, nearly 45% of all PWH experience HIV-associated neurocognitive disorder and are already vulnerable to cognitive impairment due to HIV, aging, and accompanying health conditions, and lifestyle factors. Given what is known, we assert that caregivers with HIV, especially as they age, are at additional risk for developing cognitive impairments. The purpose of this commentary was to briefly examine the juxtaposition between cognitive vulnerability of caregiving and the cognitive vulnerability of aging with HIV. Potential factors contributing to impaired cognition include stress, lack of social support, stigma, lifestyle, and comorbidities. Implications for clinical practice and research are provided.

Community-Level Factors and HIV Health Among Older People Living With HIV (PLWH) in Alabama, United States: A Qualitative Analysis.

ABSTRACT: As the number of older people living with HIV (PLWH) is increasing, there is an urgent need for research on community-level factors to better understand the health care needs of this population. In-depth interview transcripts of 20 older PLWH who participated in a community-based participatory research study conducted in Alabama, in the United States, were analyzed through a phenomenological research approach. Results suggest that crime, lack of resources, and social isolation experienced at the community levels were found to be associated with the wellbeing of older PLWH. Moreover, community characteristics may confound older PLWH's comorbid conditions and resultant polypharmacy. An increased understanding of the impact of contextual factors on HIV health can inform more holistic individual- and community-level interventions aimed at addressing barriers to retention or re-engagement in HIV medical care and viral suppression among older PLWH.

Older Caregivers With HIV: An Unrecognized Gap in the Literature.

ABSTRACT: Although the number of older people living with HIV (PLWH) is growing, prior research has focused on older PLWH as care recipients and psychosocial factors (e.g., stigma, social support) associated with their HIV care. Literature on HIV caregiving mainly focuses on family members providing care to PLWH or children of parents with HIV. There is a gap in the literature in terms of older PLWH's roles as caregivers to their family members. Thanks to combination antiretrovirals that help PLWH live longer and have healthier lives, many older PLWH now find themselves in a position to provide care to family members. To help older PLWH age successfully, it is important to understand their role as caregivers while they juggle responsibilities with their own health care needs. This article elucidates this gap in the literature on older PLWH who are caregivers and provides direction for a research agenda and potential clinical implications.

Perceptions and satisfaction with father involvement and adolescent mothers' postpartum depressive symptoms.

This study examined the associations between adolescent mothers' postpartum depressive symptoms and their perceptions of amount of father care giving and satisfaction with father involvement with the baby. The sample included 100 adolescent mothers (ages 13-19; mainly African-American and Latina) whose partners were recruited for a randomized study for fathers only. Controlling for prenatal depressive symptoms and other prenatal and postpartum variables, we found that higher levels of mothers' satisfaction with father involvement rather than perception of amount of fathers' care giving was significantly associated with fewer postpartum depressive symptoms. The relationship between satisfaction with father involvement and depressive symptoms was partially mediated by mothers' sense of parenting competence and not by mothers' parenting stress. Policy and programs should place greater emphasis on early support for adolescent mothers and their partners, particularly when mothers desire the involvement of the father with his child.

Fathers and maternal risk for physical child abuse.

This study set out to examine father-related factors predicting maternal physical child abuse risk in a national birth cohort of 1,480 families. In-home and phone interviews were conducted with mothers when index children were 3 years old. Predictor variables included the mother-father relationship status; father demographic, economic, and psychosocial variables; and key background factors. Outcome variables included both observed and self-reported proxies of maternal physical child abuse risk. At the bivariate level, mothers married to fathers were at lower risk for most indicators of maternal physical child abuse. However, after accounting for specific fathering factors and controlling for background variables, multivariate analyses indicated that marriage washed out as a protective factor, and on two of three indicators was linked with greater maternal physical abuse risk. Regarding fathering factors linked with risk, fathers' higher educational attainment and their positive involvement with their children most discernibly predicted lower maternal physical child abuse risk. Fathers' economic factors played no observable role in mothers' risk for physical child maltreatment. Such multivariate findings suggest that marriage per se does not appear to be a protective factor for maternal physical child abuse and rather it may serve as a proxy for other father-related protective factors.

Adverse childhood experiences, gender, and HIV risk behaviors: Results from a population-based sample.

Recent HIV research suggested assessing adverse childhood experiences (ACEs) as contributing factors of HIV risk behaviors. However, studies often focused on a single type of adverse experience and very few utilized population-based data. This population study examined the associations between ACE (individual and cumulative ACE score) and HIV risk behaviors. We analyzed the 2012 Behavioral Risk Factor Surveillance Survey (BRFSS) from 5 states. The sample consisted of 39,434 adults. Eight types of ACEs that included different types of child abuse and household dysfunctions before the age of 18 were measured. A cumulative score of ACEs was also computed. Logistic regression estimated of the association between ACEs and HIV risk behaviors using odds ratio (OR) with 95% confidence intervals (CIs) for males and females separately. We found that ACEs were positively associated with HIV risk behaviors overall, but the associations differed between males and females in a few instances. While the cumulative ACE score was associated with HIV risk behaviors in a stepwise manner, the pattern varied by gender. For males, the odds of HIV risk increased at a significant level as long as they experienced one ACE, whereas for females, the odds did not increase until they experienced three or more ACEs. Future research should further investigate the gender-specific associations between ACEs and HIV risk behaviors. As childhood adversities are prevalent among general population, and such experiences are associated with increased risk behaviors for HIV transmission, service providers can benefit from the principles of trauma-informed practice.

The role of fathers in risk for physical child abuse and neglect: possible pathways and unanswered questions.

Despite overrepresentation of fathers as perpetrators in cases of severe physical child abuse and neglect, the role they play in shaping risk for physical child abuse and neglect is not yet well understood. This article reviews the possible father pathways that may contribute to physical child abuse and neglect risk and their existing empirical support. The present empirical base implicates a set of sociodemographic factors in physical maltreatment risk, including fathers' absence, age, employment status, and income they provide to the family. As well, paternal psychosocial factors implicated in physical child maltreatment risk include fathers' abuse of substances, their own childhood experiences of maltreatment, the nature of fathers' relationships with mothers, and the direct care they provide to the child. However, the empirical base presently suffers from significant methodological limitations, preventing more definitive identification of risk factors or causal processes. Given this, the present article offers questions and recommendations for future research and prevention.

Do Asian-American women who were maltreated as children have a higher likelihood for HIV risk behaviors and adverse mental health outcomes?

OBJECTIVES: This study is the first to systematically investigate whether multiple child maltreatment is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women. METHODS: We conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women (n = 400), aged 18 to 35, who are identified as children of immigrants, using computer-assisted survey interviews. RESULTS: Approximately 7 in 10 women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Only 15% of our sample reported having sex at age 16 or before, yet almost 60% had ever engaged with potentially risky sexual partners. Contrary to the findings from previous studies of White and Black women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors among Asian-American women. However, it was associated with a marked increase in depression, lifetime suicidal ideation, and suicide attempts. A higher education level was associated with increased odds of HIV risk behaviors, including ever having had anal sex and ever having potentially risky sexual partners. CONCLUSION: There was no evidence indicating that multiple child maltreatment was linked with HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. These empirical patterns of internalizing trauma, suffering alone, and staying silent are in accord with Asian-cultural norms of saving face and maintaining family harmony. The prevention of multiple child maltreatment may reduce high levels of depression and suicidal behaviors in this population. It is urgent to identify victims of multiple child maltreatment and provide culturally appropriate interventions.

Young mother-father dyads and maternal harsh parenting behavior.

OBJECTIVE: This study examined whether the age of parents predicted maternal harsh parenting behavior, specifically whether younger mothers might be at higher risk than older mothers, and which paternal characteristics might be associated with maternal parenting behavior. METHODOLOGY: This study used data from the Fragile Families and Child Wellbeing (FFCW) study. In the present study, the authors examined a subsample of families for which complete data were available on all variables that were used in the analyses (n=1,597). Based on the parents' age at the time of the child's birth, mother-father age-dyad types were classified, and selected paternal factors were used to examine their association with maternal harsh parenting behavior. Psychological aggression, physical aggression, and self-reports of spanking were used as proxies for maternal harsh parenting behavior. RESULTS: Multivariate analyses indicated that adolescent mothers, regardless of how old their partners were, were at higher risk for harsh parenting behavior than older adult mothers. Regarding paternal factors, paternal coercion against mother and the fathers' use of spanking were significantly associated with all three proxies for maternal harsh parenting behavior. Fathers' employment was a risk factor for maternal physical aggression. CONCLUSION: This study supported findings from previous studies that younger mothers may indeed be at greater risk for harsh parenting behavior. It is critical, therefore, that they acquire appropriate parenting behavior and develop a healthy relationship with their children. Additional studies, both cross-sectional and longitudinal, are needed to involve their partners (i.e., their child's father) in order to shed light on ways of preventing harsh parenting behavior and examining the role of fathers in maternal parenting behavior. PRACTICE IMPLICATIONS: The present study calls for more attention to sex education and intervention programs in school and health care settings as important components of prevention services. Practitioners need to better understand the concept of harsh parenting behavior in order to work with young parents and prevent future physical child abuse. Policy makers should support these efforts and research should be done that engages both mothers and fathers and seeks to enhance and modify existing programs for youths.

Early motherhood and harsh parenting: the role of human, social, and cultural capital.

OBJECTIVE: This study examined the role of maternal human, social, and cultural capital in the relationship between early motherhood and harsh parenting behavior. METHODS: This study used data from the Fragile Families and Child Wellbeing (FFCW) Study. Harsh parenting behaviors by mothers who were 19 years or younger at birth of the focal child (n=598) were compared with that of adult mothers 26 years or older (n=1,363). Measures included: For harsh parenting behavior, three proxies were created from the Parent to Child version of the Conflict Tactics Scales (CTS-PC) and self-reports of maternal spanking. For maternal human capital, education, employment, and depression were used. For maternal social capital, expected-social support, paternal support, and lone caregiver status were included. For maternal cultural capital, religious attendance and attachment to race/ethnic heritage were used. RESULTS: Multivariate analyses indicated that adolescent motherhood has a significant impact on all three harsh parenting behavior outcomes even after controlling for demographic and maternal capital characteristics. Working since the birth of the focal child, depression scores, paternal support, expected-social support, and attendance at religious services made independent contributions to the prediction of harsh parenting behavior. CONCLUSIONS: Findings emphasize the importance of the prevention of adolescent motherhood and suggest intervention strategies for reducing the risk of maternal harsh parenting behavior. Further study is necessary to examine the complicated relationships among maternal capital and parenting. One method may be to focus on the development of measures of maternal capital, notably measures of expectations regarding and perceptions of received capital. PRACTICE IMPLICATIONS: Findings from this study have implications for social work practice, particularly for the prevention of adolescent pregnancy and intervention with adolescent mothers and their children. First, the study calls for more recognition of school social work and intervention programs in school settings as important components of prevention services. Second, the importance of identifying fathers and helping them become involved and connected with their young families are highlighted. Finally, practitioners should become more aware of the role of culture in young families as the effect of cultural capital on parenting behavior becomes better understood.