Assessing HIV-related stigma in the clinical setting: are providers in Florida interested?

HIV-related stigma is a key contributor to poor HIV-related health outcomes. The purpose of this study is to explore implementing a stigma measure into routine HIV care focusing on the 10-item Medical Monitoring Project measure as a proposed measure. Healthcare providers engaged in HIV-related care in Florida were recruited. Participants completed an interview about their perceptions of measures to assess stigma during clinical care. The analysis followed a directed content approach. Fifteen participants completed the interviews (87% female, 47% non-Hispanic White, case manager 40%). Most providers thought that talking about stigma would be helpful (89%). Three major themes emerged from the analysis: acceptability, subscales of interest, and utility. In acceptability, participants mentioned that assessing stigma could encourage patient-centered care and serve as a conversation starter, but some mentioned not having enough time. Participants thought that the disclosure concerns and negative self-image subscales were most relevant. Some worried they would not have resources for patients or that some issues were beyond their influence. Participants were generally supportive of routinely addressing HIV-related stigma in clinical care, but were concerned that resources, especially to address concerns about disclosure and negative self-image, were not available.

Building an HIV Learning Health Care Community for Youth in Florida: Opportunities and Challenges.

In Florida, 33% of new HIV infections among men and 21% of new infections among women are among those younger than 29 years of age. We describe the development of a Learning Health Care Community for youth (Y-LHCC) in Orange County, FL. Its core implementation team (iTeam) was composed of representatives from community agencies and academics, whose work was informed by data from the Florida Department of Health (FDOH) and regional research, in-depth interviews (IDIs) with agency representatives, and a pilot implementation of Tailored Motivational Interviewing (TMI) to improve service provision. IDIs revealed limited programming specifically for youth, significant structural challenges providing them with PrEP, and differences in use of evidence-based behavioral interventions to improve HIV services. FDOH provided data on new HIV infections, linkage to care, viral suppression, and PrEP coverage, however, limitations such as minimal data on PrEP referrals and use, agency level data, and inability to generate data quarterly (which would facilitate program improvement) were encountered. Thirty staff members from five agencies serving youth in Orange County participated in TMI training. About half the agency staff (n = 16) completed at least three of the four online training sessions. MI skills improved from pre- (n = 28; M = 1.96) to post TMI training (n = 11; M = 2.48, SD = 0.57); (t(37) = - 3.14, p = 0.0033). The iTeam held seven remote meetings and two in-person half-day meetings at the end of the study, during which they reassessed areas of focus for improving youth services. They also reiterated their commitment to continuing to meet beyond the study period and to engage other agencies in the newly established coalition. Findings highlight the potential of creating a Y-LHCC in Florida as well as some of the challenges that will need to be overcome to achieve ending the HIV Epidemic goals for young people in the region.

RESUMEN: En Florida, el 33% y 21% de las nuevas infecciones del VIH entre hombres y mujeres, respectivamente, fueron entre personas menores de 29 años de edad. Describimos el desarrollo de una Comunidad de Aprendizaje de Atención Médica para jóvenes (Y-LHCC) en el Condado de Orange, FL. Su equipo central de implementación (iTeam) estuvo compuesto de representantes de agencias comunitarias y académicos, cuyo trabajo se basó en datos del Departamento de Salud de Florida (FDOH) e investigaciones regionales, entrevistas en profundidad con representantes de agencias y un programa piloto de implementación de la Entrevista Motivacional a la Medida (TMI) para mejorar la prestación de servicios. Las entrevistas revelaron poca programación específica para los jóvenes, desafíos estructurales significativos para proporcionarles PrEP, y diferencias en el uso de intervenciones conductuales basadas en evidencia para mejorar los servicios de VIH. El FDOH proporcionó datos sobre nuevas infecciones por el VIH, vinculación con la atención médica, supresión viral y cobertura de PrEP. Sin embargo, se encontraron limitaciones en la data, tales como datos limitados sobre derivaciones u uso de PrEP, falta de datos a nivel de agencia, e incapacidad para generar datos trimestrales (lo que facilitaría la mejora de programas en la agencia). Treinta miembros del personal de cinco agencias que atienden a jóvenes en el Condado de Orange participaron en la capacitación de TMI. Aproximadamente la mitad del personal de la agencia (n = 16) completó al menos tres de las cuatro sesiones de capacitación remota. Las habilidades de MI mejoraron desde antes (n = 28; M = 1.96, SD = .042) hasta después del entrenamiento de TMI (n = 11; M = 2.48, SD = 0.57); (t(37) = − 3.14, p = 0.0033). El iTeam realizó siete reuniones remotas y dos reuniones en persona de medio día al final del estudio, durante las cuales reevaluaron las áreas de enfoque para mejorar los servicios para jóvenes. También reiteraron su compromiso de continuar reuniéndose más allá del período de estudio y de involucrar a otras agencias en la coalición recién establecida. Los hallazgos destacan el potencial de crear un Y-LHCC en Florida, así como algunos de los desafíos que deberán superarse para lograr los objetivos de terminar con la epidemia de VIH para los jóvenes de la región.

Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor-Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily.

BACKGROUND: Alcohol misuse is highly prevalent in the United States and results in a huge financial and public health burden. Current alcohol reduction treatments are underused, and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, although it is unclear how best to incorporate such a device into an alcohol intervention. OBJECTIVE: We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor-based alcohol intervention for adults who drink heavily. METHODS: Participants were recruited through an alcohol contingency management study, a contact registry, and participant referral. To qualify, participants had to be aged at least 40 years, report drinking at least twice per week, and indicate interest in reducing their drinking. We conducted a semistructured interview with each participant via Zoom (Zoom Video Communications, Inc). The interview guide addressed general thoughts on the wrist-worn biosensor, how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking, types of information that participants would want to receive from the biosensor, how they would want to receive this information, and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. RESULTS: The sample comprised 20 adults (mean age 55.1, SD 6.1 years; 11/20, 55%, women; and 17/20, 85%, Black). Of the 20 participants, 9 (45%) had previous experience with the Secure Continuous Remote Alcohol Monitor continuous alcohol monitoring ankle biosensor from participating in an alcohol contingency management study. The desirable features could be grouped into 5 main themes: features that would influence willingness to use the biosensor (it should look attractive and be both comfortable to wear and accessible), personalized messaging (personalized biosensor-based prompts and feedback could be helpful), preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect), sharing data with others (this was appealing to many but not to all), and mental health support (many felt that mental health support could be incorporated into the biosensor). CONCLUSIONS: Five main themes that would maximize interest in using a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform the development of a just-in-time adaptive intervention that uses a wrist-worn biosensor to help adults who drink heavily reduce their alcohol use.

Correspondence between alcohol use measured by a wrist-worn alcohol biosensor and self-report via ecological momentary assessment over a 2-week period.

BACKGROUND: Transdermal alcohol biosensors measure alcohol use continuously, passively, and non-invasively. There is little field research on the Skyn biosensor, a new-generation, wrist-worn transdermal alcohol biosensor, and little evaluation of its sensitivity and specificity and the day-level correspondence between transdermal alcohol concentration (TAC) and number of self-reported drinks. METHODS: Participants (N = 36; 61% male, M age  = 34.3) wore the Skyn biosensor and completed ecological momentary assessment (EMA) surveys about their alcohol use over 2 weeks. A total of 497 days of biosensor and EMA data were collected. Skyn-measured drinking episodes were defined by TAC > 5 µg/L. Skyn data were compared to self-reported drinking to calculate sensitivity and specificity (for drinking day vs. nondrinking day). Generalized estimating equations models were used to evaluate the correspondence between TAC features (peak TAC and TAC-area under the curve (AUC)) and number of drinks. Individual-level factors (sex, age, race/ethnicity, body mass index, human immunodeficiency virus status, and hazardous drinking) were examined to explore associations with TAC controlling for number of drinks. RESULTS: Using a minimum TAC threshold of 5 µg/L plus coder review, the biosensor had sensitivity of 54.7% and specificity of 94.6% for distinguishing drinking from nondrinking days. Without coder review, the sensitivity was 78.1% and the specificity was 55.2%. Peak TAC (ß = 0.92, p < 0.0001) and TAC-AUC (ß = 1.60, p < 0.0001) were significantly associated with number of drinks. Females had significantly higher TAC levels than males for the same number of drinks. CONCLUSIONS: Skyn-derived TAC can be used to measure alcohol use under naturalistic drinking conditions, additional research is needed to accurately identify drinking episodes based on Skyn TAC readings.

Does the Relationship Between HIV Stigma Subtypes and Viral Suppression Differ by Age?: A Stratified Analysis of Data from the Florida Medical Monitoring Project.

HIV-related stigma is recognized as a top barrier to achieve viral suppression in the United States, but data describing who is most affected by HIV stigma is limited. The study sought to (1) identify the relationships between HIV-related stigma and unsuppressed viral load and (2) examine whether the association between HIV stigma subtypes and unsuppressed viral load differ by age group (i.e., 18-34, 35-49, and 50+ years-old) using surveillance data from the Florida Medical Monitoring Project (n = 1195). Most participants were 50+ years-old (55%), male (71%), and Black (51%). Enacted stigma was significantly associated with unsuppressed viral loads among the 18-34-year-old age group (OR 1.68, CI 1.09-2.60). After adjusting for potential confounders, only enacted stigma was independently associated with unsuppressed viral load in the 18-34-year-old age group. Results highlight the need for targeted interventions to reduce enacted stigma among younger persons with HIV to achieve viral suppression.

Identifying the best measures of alcohol consumption to predict future HIV viral suppression trajectories.

Alcohol use is associated with poor outcomes among people living with HIV (PLWH), but it remains unclear which alcohol use measures best predict future HIV viral non-suppression over time. This study aimed to compare the ability of five alcohol use measures to predict risk of suboptimal HIV viral load trajectories over 36 months. We analyzed data from a cohort of PLWH in Florida including survey data linked to the state HIV surveillance system on prospective HIV viral loads over 36 months (n = 783; 66% male; 55% Black; Mage=46, SD = 11). Four trajectory patterns for HIV viral load were identified: consistently low (65.1%), decreasing (15.9%), increasing (10.6%), and consistently high (8.4%). Past year alcohol use frequency (OR = 2.1, CI:1.0-4.4), drinks consumed on a typical drinking day (OR = 2.2, CI:1.2-4.1), frequency of binge drinking (OR = 2.6, CI:1.3-5.2), and alcohol-related problems score (OR = 1.7, CI:1.1-2.7) were the measures predictive of the risk of future viral non-suppression above specific thresholds.

RESUMEN: El consumo de alcohol está asociado con malos resultados entre las personas que viven con el VIH (PLWH), pero aún no está claro qué medidas de consumo de alcohol predicen mejor la falta de supresión viral del VIH en el futuro con el tiempo. Este estudio tuvo como objetivo comparar la capacidad de cinco medidas de consumo de alcohol para predecir el riesgo de trayectorias subóptimas de la carga viral del VIH durante 36 meses. Analizamos datos de una cohorte de PLWH en Florida, incluidos datos de encuestas vinculadas al sistema estatal de vigilancia del VIH sobre posibles cargas virales del VIH durante 36 meses (n = 783; 66% hombres; 55% afroamericanos; Maños=46, SD = 11). Se identificaron cuatro patrones de trayectoria para la carga viral del VIH: consistentemente baja (65,1%), decreciente (15,9%), creciente (10,6%) y consistentemente alta (8,4%). Frecuencia de consumo de alcohol en el último año (OR = 2,1, IC: 1,0­4,4), bebidas consumidas en un día típico de consumo de alcohol (OR = 2,2, IC: 1,2­4,1), frecuencia de consumo excesivo de alcohol (OR = 2,6, IC: 1,3­5,2), y la puntuación de problemas relacionados con el alcohol (OR = 1,7, IC: 1,1­2,7) fueron las medidas predictivas del riesgo de no supresión viral futura por encima de umbrales específicos.

Prevalence of HIV-related stigma in adults living with HIV & disability in Florida, 2015-2016.

Using data collected from the Florida Medical Monitoring Project, we sought to compare the prevalence of overall HIV-related stigma, including its subdimensions among persons with HIV and disability(s) and persons with HIV without disability in Florida. Disability was classified as having difficulty in one or more areas: activity limitations, participation restrictions, and functional or sensory activities. HIV-related stigma was assessed using the HIV Stigma Scale, which measures (1) overall stigma (2) negative self-image, (3) personalized, and (4) anticipated stigma. Multivariate analysis indicates that the crude prevalence ratios of overall stigma, including negative self-image, personalized, and anticipated stigma among persons with HIV and disability(s) were 1.43, 1.24, 1.20, and 1.23 compared to persons with HIV without disability, respectively. After adjusting for confounders, the prevalence ratios of HIV-related stigma ranged from 1.33-1.07 among persons with HIV and disability(s) compared to persons with HIV without disability. The implications of these findings reveal that persons with HIV and disability(s) are more vulnerable to HIV-related stigma. Researchers could consider distinct stigma interventions tailored towards persons with HIV and disability(s) in Florida.

The Meaning and Perceptions of HIV-Related Stigma in African American Women Living With HIV in Rural Florida: A Qualitative Study.

ABSTRACT: African Americans are disproportionally affected by HIV/AIDS compared with other races/ethnicities, yet few studies have examined the cultural and/or attitudinal precursors that can make African American women vulnerable to HIV-related stigma in the rural South. This study qualitatively explored the meaning and perceptions of HIV-related stigma among African American women in Florida. Thirteen semi-structured interviews were conducted using an empirical phenomenological approach. Five observer perspectives and 26 participant perspectives emerged. Participants described stigma through self-conceptualizations (e.g., ignorance), experiences (e.g., judgments), psychological dysfunction (e.g., mental health), intersectionality (e.g., race, disability), and overcoming stigma (e.g., advocacy). Our findings reveal that HIV-related stigma is unpleasant for African American women. However, over time, women in this study developed strategies to combat stigma. Elements of stigma reduction described in this study may be an important starting point for designing a culturally targeted intervention for African American women living with HIV.

Negative Consequences of Alcohol Use among People Living with HIV.

Introduction: Among people living with HIV (PLWH), alcohol use can have negative impacts beyond HIV-related outcomes. The objectives of this study are to identify the most common alcohol-related consequences among PLWH in Florida and describe factors associated with experiencing more alcohol-related consequences. Methods: Data were collected from PLWH in the Florida Cohort study who drank at least monthly in the past year (n=397). Self-reported consequences were assessed by the 15-item Short Inventory of Problems Revised (SIP-2R). Nonparametric tests and a generalized estimating equation model with inverse probability of exposure weighting were used to evaluate associations between the total SIP-2R score and socio-demographics, mental health, and substance use while controlling for alcohol use. Results: Over half (56%) endorsed at least one consequence and 29% endorsed 5 or more consequences. The most common consequences were doing something they regretted and taking foolish risks (both endorsed by 37% of participants), both in the impulse control domain. After controlling for alcohol use and other covariates, homelessness and injection drug use remained significantly associated with greater SIP-2R scores. Conclusion: PLWH who are experiencing homelessness or injecting drugs could benefit from receiving additional screening for alcohol-related consequences if they report any alcohol use.

Enacted HIV-Related Stigma's Association with Anxiety & Depression Among People Living with HIV (PLWH) in Florida.

Research has shown that HIV-related stigma contributes to people living with HIV having a higher risk of mental health disorders. Our study examines the association between enacted HIV-related stigma and symptoms of anxiety and depression among PLWH. We used baseline data from 932 PLWH collected from the Florida Cohort study between 2014 and 2018. The sample was majority 45 + years of age (63.5%), male (66.0%), and Black (58.1%). The majority had previously experienced enacted HIV-related stigma (53.1%). Additionally, 56.6% and 65.2% showed mild to moderate/severe levels of anxiety and depression, respectively. Those who experienced any levels of enacted HIV-related stigma (vs none) had significantly greater odds of mild and moderate/severe levels of anxiety (vs no/minimal) (AOR[CI] 1.54[1.13, 2.10], p = 0.006; AOR[CI] 3.36[2.14, 5.26], p < 0.001, respectively) and depression (AOR[CI] 1.61[1.19, 2.18], p = 0.002; AOR[CI] 3.66[2.32, 5.77], p < 0.001, respectively). Findings suggest a need to evaluate interventions for PLWH to reduce the deleterious effects of enacted HIV-related stigma on mental health.

RESUMEN: Investigaciones previas han documentado que el estigma relacionado con el VIH contribuye al alto riesgo de trastornos de salud mental entre las personas que viven con VIH. Nuestro estudio examina la asociación entre el estigma declarado y síntomas de ansiedad y depresión entre las personas que viven con VIH. Utilizamos datos de referencia recopilados por el "Florida Cohort Study" de 932 personas que viven con VIH. La mayoría de la muestra sobrepasaba 45 años (63.5%), era masculina (66.0%), y racialmente negra (58.1%). La mayoría había experimentado estigma declarado (53.1%). Además, 56.5% y 65.2% mostro niveles de síntomas leves a moderados/severos de ansiedad y depresión, respectivamente. Aquellos que experimentaron cualquier nivel de estigma declarado (vs ninguno) tenían mayores probabilidades de niveles de síntomas leves y moderados/severos de ansiedad (vs ninguno) (ORa[IC] 1.54[1.13, 2.10], p = 0.006; ORa[IC] 3.36[2.14, 5.26], p < 0.001, respectivamente) y depresión (ORa[IC] 1.61[1.19, 2.18], p = 0.002; ORa[IC] 3.66[2.32, 5.77], p < 0.001, respectivamente). Los resultados sugieren la necesidad de evaluar las intervenciones para las personas que viven con VIH para reducir los efectos nocivos del estigma declarado en la salud mental.

The Florida Cohort study: methodology, initial findings and lessons learned from a multisite cohort of people living with HIV in Florida.

In 2013, Florida had the highest rate of new HIV infections and only 56% of persons living with HIV (PLWH) were virally suppressed. In response, we initiated a new HIV cohort in Florida to better understand issues affecting HIV health outcomes. This manuscript will describe the procedures of the Florida Cohort; summarize information regarding enrollment, follow-up, and findings to date; and discuss challenges and lessons learned during the establishment of a multisite cohort of PLWH. Florida Cohort participants were enrolled from eight clinics and community-based organizations geographically diverse counties across Florida. Data were obtained from participant questionnaires, medical records, and state surveillance data. From 2014-2018, 932 PLWH (44% ≥50 years, 64% male, 55% black, 20% Latinx) were enrolled. At baseline, 83% were retained in care and 75% were virally suppressed. Research findings to date have focused on outcomes such as the HIV care continuum, HIV-related comorbidities, alcohol and drug use, and mHealth interventions interest. Strengths included the diversity of the sample and the linkage of participant surveys with existing surveillance data. However, the study had several challenges during planning and follow-up. The lessons learned from this study can be helpful when initiating a new longitudinal cohort study.

HIV-related stigma and life goals among people living with HIV (PLWH) in Florida.

PURPOSE: Goals are an important component of quality of life (QoL) as they provide motivation to accomplish tasks we strive to achieve. Stigma has been identified as a factor that may be deleterious to achieving personal goals. People living with HIV(PLWH) continue to face HIV-related stigma. As HIV prevalence continues to grow in the U.S., it is important to focus on factors that can help improve the health and QoL of PLWH. This study aims to examine the association between HIV-related stigma and goal-setting behaviors among PLWH in Florida. METHODS: We used baseline data collected from the Marijuana and Potential Long-term Effects (MAPLE) observational cohort study. We collected life goals data using an abbreviated version of the Personal Projects Analysis inventory. Participants listed up to three goals in five domains and were asked about each goal's difficulty and importance. HIV-related stigma was measured using an abbreviated version of the Herek HIV-related stigma scale. Relative risk estimates and 95% confidence intervals were estimated using multivariate linear regression models. RESULTS: The overall sample (n = 232) was majority male (52.4%), Black (72.4%), and non-Latino (84.9%). HIV-related stigma was positively associated with the total number of listed goals (ß = 0.042[0.003, 0.082]; p = 0.037) and perceived goal difficulty (ß = 0.010[0.003, 0.017]; p = 0.004), but not significantly associated with perceived goal importance (ß = 0.001[- 0.002, 0.004]; p = 0.562). CONCLUSION: The results suggest that HIV-related stigma may be affecting the pursuit of goals among PLWH. There is a need to develop and evaluate QoL interventions that are tailored to PLWH and focused on achieving goals in the face of HIV-related stigma.

Fall Prevention Decision Making of Acute Care Registered Nurses.

OBJECTIVE: The aim of this study was to examine acute care registered nurses' (RNs') fall prevention decision-making. BACKGROUND: The RN decision-making process related to fall prevention needs to be investigated to ensure that hospital policies align with nursing workflow and support nursing judgment. METHODS: Qualitative semistructured interviews based on the Critical Decision Method were conducted with RNs about their planning and decision making during their last 12-hour shift worked. RESULTS: Data saturation was achieved with 12 RNs. Nine themes emerged related to the RN decision-making process and included hospital-level (eg, fear of discipline), unit-level (eg, value of bed alarm technology), and nurse-level (eg, professional judgment) factors that could influence fall prevention. CONCLUSIONS: Nursing administrators should consider a multilevel approach to fall prevention policies that includes promoting a practice environment that embraces self-reporting adverse events without fear of shame or being reprimanded, evaluating unit-level practice and technology acceptance and usability, and supporting autonomous nursing practice.

Recruitment, experience, and retention among women with HIV and hazardous drinking participating in a clinical trial.

BACKGROUND: Despite efforts by the NIH to enhance the participation of women and minorities in clinical research, women with HIV continue to remain underrepresented in alcohol intervention research. The purpose of this study is to better understand the reasons why women with HIV and hazardous drinking participated in the WHAT-IF? study and to discuss their experience (positive or negative) in the study. The WHAT-IF? study was a randomized clinical trial that evaluated pharmacotherapy for a reduction in drinking among women with HIV. METHODS: Convenience and theoretical sampling were used to recruit women with HIV and hazardous drinking to complete qualitative interviews. These women had previously completed a clinical alcohol intervention trial and had consented to be contacted in the future for study-related purposes. The biopsychosocial model was used to frame the interview questions that assessed multiple determinants of drinking behavior and helped explain linkages to broader health constructs. RESULTS: A total of 20 women with HIV and hazardous drinking completed the qualitative interview. Several factors were identified by the women as influential in their decision to participate in the WHAT-IF? study, such as the ability to quit or reduce their drinking to nonhazardous levels (biological), the ability to gain knowledge or a greater understanding of the negative effects of hazardous drinking on HIV disease progression (psychological), and peer pressure and monetary compensation (social). Also, the women identified factors (positive or negative) associated with their clinical trial experience, such as the effects of the study medication on the woman's body (biological), thoughts and feelings toward study procedures (i.e. medication, lab work, study assessments) and the length of the study (psychological), and the interactions with the WHAT-IF? study staff (social). CONCLUSION: Recruiting and retaining women with HIV in alcohol intervention research remains a challenge. Findings from this study suggest that women with HIV who are hazardous drinkers may benefit from participating in research studies that could help them to reduce or quit their drinking, increase their knowledge about specific behavior changes, and earn monetary compensation. Also, positive staff interactions may be instrumental in retaining minority women in alcohol intervention research.

The relationship between individual characteristics and HIV-related stigma in adults living with HIV: medical monitoring project, Florida, 2015-2016.

BACKGROUND: Human Immunodeficiency Virus (HIV) disproportionately affects the Southern United States, accounting for approximately 46% of people living with HIV. HIV-related stigma is recognized as a barrier to testing, treatment, and prevention efforts. However, little is known about HIV-related stigma experiences in Florida. Using data collected from the Florida Medical Monitoring Project, we sought to examine individual characteristics associated with HIV-related stigma. METHODS: We analyzed secondary data from the 2015-2016 Medical Monitoring Project in Florida (n = 603). Stigma was measured using the 10-item HIV Stigma Scale. Exploratory factor analysis of the HIV Stigma Scale revealed three subscales: negative self-image, anticipated, and personalized stigma. Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV Stigma Scale. RESULTS: Multivariate analysis indicated that people with severe depression scores (OR: 3.13; CI: 1.38-7.13) and persons with disability (OR: 1.64; CI: 1.03-2.61) had significantly increased odds of higher overall stigma. In the subscale analyses, negative self-image was significantly associated with alcohol misuse (OR: 2.02; CI: 1.15-3.56) depression (OR: 2.81; CI: 1.38-5.72) and/or those who identify as homosexual (OR: 0.54; CI: 0.31-0.93). Anticipated stigma was significantly associated with people who had mild-moderate depression (OR: 3.03; CI: 1.20-7.65), severe depression (OR: 2.87; CI: 1.38-5.98), identified as Black (OR: 0.60; CI: 0.37-0.98), non-injection drug use (OR: 0.55; CI: 0.33-0.91), and/or people aged 50 years and older (OR: 0.28; CI: 0.09-0.82). Personalized stigma was not associated with any of the variables examined. CONCLUSIONS: The implications of these findings reveal that certain individuals are more vulnerable to stigma. Researchers could consider distinct stigma interventions strategies based on the characteristics of specific individuals (i.e., targeting depression, disability, sexual orientation, avoidant coping, racial/ethnic groups, and youth) in Florida.

Facilitators and barriers to a contingency management alcohol intervention involving a transdermal alcohol sensor.

Research on contingency management is limited due to feasibility issues with monitoring adherence. Incentives usually depend on objective measures to verify compliance; therefore, biological markers for identifying alcohol use are not as dependable for the use of financial contingency studies. The Secure Continuous Remote Alcohol Monitor (SCRAM) is an objective alcohol biosensor that can be locked onto a person's ankle to address these limitations. In preparation for a large, contingency management study for HIV-positive and HIV-negative persons with heavy drinking, the aims for the study were to (1) explore barriers and facilitators to participating in a contingency management intervention using the SCRAM ankle monitor as the potential alcohol measure for the intervention; (2) explore levels of appropriate compensation for using the SCRAM and for study assessments as part of a contingency management intervention study; and (3) attitudes and beliefs on lifestyle changes as a consequence of wearing the SCRAM among HIV-positive and HIV-negative heavy drinkers in Florida. Five focus groups were conducted and we collected qualitative data from thirty-seven individuals (18 men; 19 women). During the analysis, six themes were identified as barriers and facilitators for participation in a contingency management intervention using the SCRAM sensor to measure alcohol use: (1) health assessment, (2) monetary incentives including payment structure and levels of compensation, (3) stigma associated with wearing the SCRAM sensor, (4) aesthetics and other related concerns with wearing the SCRAM sensor, (5) motivation to stop drinking, and (6) social support. Stigma was a major barrier for wearing the SCRAM sensor; however, if participants were motivated to change their behavior then the monetary incentives became a facilitator to wearing the sensor. In addition to the financial contingency method, social support may further increase the odds for participants to change their behaviors.

Using an Electronic Medication Event-Monitoring System for Antiretroviral Therapy Self-Management Among African American Women Living With HIV in Rural Florida: Cohort Study.

BACKGROUND: HIV remains a significant health issue in the United States and disproportionately affects African Americans. African American women living with HIV (AAWH) experience a particularly high number of barriers when attempting to manage their HIV care, including antiretroviral therapy (ART) adherence. To enable the development and assessment of effective interventions that address these barriers to support ART adherence, there is a critical need to understand more fully the use of objective measures of ART adherence among AAWH, including electronic medication dispensers for real-time surveillance. OBJECTIVE: This study aimed to evaluate the use of the Wisepill medication event-monitoring system (MEMS) and compare the objective and subjective measures of ART adherence. METHODS: We conducted a 30-day exploratory pilot study of the MEMS among a convenience sample of community-dwelling AAWH (N=14) in rural Florida. AAWH were trained on the use of the MEMS to determine the feasibility of collecting, capturing, and manipulating the MEMS data for an objective measure of ART adherence. Self-reported sociodemographic information, including a self-reported measure of ART adherence, was also collected from AAWH. RESULTS: We found that the majority of participants were successful at using the electronic MEMS. Daily use of the MEMS tended to be outside of the usual time participants took their medication. Three 30-day medication event patterns were found that characterized ART adherence, specifically uniform and nonuniform medication adherence and nonuniform medication nonadherence. There were relatively few MEMS disruptions among study participants. Overall, adjusted daily ART adherence was 81.08% and subjective ART adherence was 77.78%. CONCLUSIONS: This pilot study on the use and evaluation of the Wisepill MEMS among AAWH in rural Florida is the first such study in the United States. The findings of this study are encouraging because 10 out of 12 participants consistently used the MEMS, there were relatively few failures, and objective adjusted daily and overall subjective ART adherence were very similar. On the basis of these findings, we think researchers should consider using the Wisepill MEMS in future studies of AAWH and people living with HIV in the United States after taking into account our practical suggestions. The following practical considerations are suggested when measuring objective medication adherence: (1) before using an MEMS, be familiar with the targeted populations' characteristics; (2) choose an MEMS that aligns with the participants' day-to-day activities; (3) ensure the MEMS' features and resulting data support the research goals; (4) assess the match among the user's ability, wireless features of the MEMS, and the geographic location of the participants; and (5) consider the cost of MEMS and the research budget.

Perceptions and Use of Electronic Nicotine Delivery Systems Among Floridian Middle and High School Students: Secondary Analysis of Cross-sectional Survey Results.

INTRODUCTION: Rapid increase in youth use of Electronic Nicotine Delivery Systems (ENDS) led the state and the federal governments to implement minimum-age policies to restrict minors' access to vaping products. Limited success of the age restrictions fueled efforts to increase the distribution age of all tobacco products to 21 (ie, Tobacco 21 or T21 policies). With limited data on the T21 policies, the current study examines the prevalence of ENDS use and the perceptions about ENDS among youth in the pre- and post-policy-implementation periods for one of these bans in the state of Florida. METHODS: This study conducted secondary analysis on the responses from the 2014 and 2015 Florida Youth Tobacco Survey, which collected cross-sectional data. RESULTS: Compared to the data from spring of 2014, the minimum-age policy enacted on July 1, 2014 did not lead to a significant decrease in Florida's high school and middle school students' ever ENDS use (14.9% in 2014 vs 25.8% in 2015) and current ENDS use (7.5% in 2014 vs 12.4% in 2015). There was some ambiguity among students regarding the ENDS harm-more students in 2015 thought of ENDS as both equally (11.0% vs 7.7%) and less (32.4% vs 28%) harmful than cigarettes. There was a decrease in the proportion of students who were unsure about their answer to this question (51.5% vs 59.2%). CONCLUSIONS: Policy change alone may not be effective in shifting the trend of ENDS use among middle and high school students. Although students may know about some of the ENDS effects, many of them are still not aware about the harms. Interventions in school and in the community should be aiming to raise this awareness.

Age, Sex, Race, Ethnicity, Sexual Orientation: Intersectionality of Marginalized-Group Identities and Enacted HIV-Related Stigma Among People Living with HIV in Florida.

HIV-related stigma is associated with many negative health outcomes among people living with HIV (PLHIV). The theory of intersectionality suggests that the interactions of social identities affect PLHIV's experiences of stigma. This study aims to identify individual and interactive marginalized-group identities correlated with enacted HIV-related stigma among PLHIV in Florida. The sample (n = 932) was majority male (66.6%), Black (58.5%), and non-Latino (80.2%) with 53% reporting experiences of HIV-related stigma. In multinomial regression models, the interaction between race and ethnicity was significant where non-White Latinos had higher odds of experiencing high levels of enacted stigma [AOR (CI) 7.71 (2.41, 24.73), p < 0.001] compared to white non-Latinos. Additionally, racial minorities were less likely to have experienced moderate or high levels of enacted stigma [AOR (CI) 0.47 (0.31, 0.72), p < 0.001; AOR (CI) 0.39 (0.22, 0.70), p = 0.002, respectively]. Moreover, women had higher odds of experiencing high levels of enacted stigma [AOR (CI) 2.04 (1.13, 3.67), p = 0.018]. The results suggest that intersectionality is important to consider in HIV-related stigma research and future interventions.

Designing Online and Mobile Diabetes Education for Fathers of Children With Type 1 Diabetes: Mixed Methods Study.

BACKGROUND: Fathers make unique and central contributions to the health of their children. However, research in type 1 diabetes (T1D) education largely ignores the needs of fathers, including during the development of online and mobile educational materials. OBJECTIVE: The purpose of this study was to solicit and incorporate input from fathers of children with T1D into the design, content, and infrastructure of a suite of online diabetes self-management education and support (DSMES) resources. METHODS: The study took part in three phases: (1) exploratory research, (2) website and subdomain development, and (3) evaluation. Fathers of children with T1D (n=30) completed surveys and semistructured qualitative interviews. Thematic content analysis was used to identify fathers' content and design preferences. An online DSMES website (T1DToolkit.org) and a separate mobile subdomain targeting fathers (Mobile Diabetes Advice for Dads, or mDAD) were developed. A prototype of the site for fathers was evaluated by 33 additional father participants. End user feedback was elicited via survey. RESULTS: Participants in the exploratory phase were enthusiastic about the online diabetes resources. Preferences included high-quality design, availability via mobile phone and tablet, brief text content supplemented with multimedia and interactive features, reminders via text or email, endorsement by medical professionals, and links to scientific evidence. The mDAD subdomain received high usability and acceptability ratings, with 100% of participants very likely or likely to use the site again. CONCLUSIONS: The development of eHealth educational platforms for fathers of children with T1D remains an unmet need in optimizing diabetes management. This study incorporated fathers' feedback into the development of a suite of online diabetes education resources. The findings will serve as the basis for future research to assess the clinical efficacy of the website, its subdomain targeting fathers, and additional subdomains targeting unique populations.