Partner-Based HIV Treatment for Seroconcordant Couples Attending Antenatal and Postnatal Care in Rural Mozambique: A Cluster Randomized Controlled Trial.

INTRODUCTION: There is evidence that a supportive male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral therapy initiation and adherence, and increases HIV-free infant survival. Most male partner engagement clinical strategies have focused on increasing uptake of couple-based HIV testing and counseling. We delivered a couple-based care and treatment intervention to improve antiretroviral therapy adherence in expectant couples living with HIV. METHODS: We implemented a cluster randomized controlled trial for seroconcordant couples living with HIV, comparing retention (using a patient's medication possession ratio) in HIV care for a couple-based care and treatment intervention vs. standard of care services in rural Mozambique. The intervention included couple-based treatment, couple-based education and skills building, and couple-peer educator support. RESULTS: We recruited 1080 couples to participate in the study. Using a linear mixed effect model with a random effect for clinic, the intervention had no impact on the medication possession ratio among women at 12 months. However, the intervention increased men's medication ratio by 8.77%. Our unadjusted logistic regression model found the odds of an infant seroconverting in the intervention group was 30% less than in the control group, but the results were not statistically significant. DISCUSSION: Our study found no difference in maternal outcomes by study arm, but our intervention resulted in an improved medication possession ratio among male partners. We provide a community/clinic-based treatment framework that can improve outcomes among male partners. Further work needs to be done to improve social support for pregnant women and to facilitate prevention of vertical transmission to infants among couples living with HIV.

Charting the longitudinal trajectories and interplay of critical consciousness among youth activists.

Critical consciousness (CC) is associated with beneficial developmental outcomes among youth contending with oppression, yet we know little about how CC develops and how the three dimensions of CC (i.e., critical action, critical motivation, and critical reflection) interrelate over time. Therefore, this study employed second-order latent growth modeling to illuminate the longitudinal interplay between the three dimensions of CC among 518 youth activists (Mage = 16; girls = 53%; 11% Asian, 20% Black, 39% Latinx, 8% Multiracial, and 6% White). Youth demonstrated significant growth in critical reflection and action over time, but not in critical motivation. Participation in community-based activism was positively associated with CC development. Altogether, these findings illuminate channels for fostering youth CC and increase our understanding of CC's dynamic development.

Exploratory validation of relationship functioning and non-pregnant partner behavior scales in pregnant people living with HIV in Mpumalanga Province, South Africa.

Partner engagement in antenatal care can improve care for pregnant people living with HIV. However, concerns about engaging unsupportive non-pregnant partners warrant further study to avoid engaging partners who pressure their pregnant partner to refuse testing or treatment and/or perpetuate intimate partner violence. We adapted established relationship functioning and partner behaviour questionnaires among pregnant people living with HIV initiating antenatal care in rural South Africa. We identified 13 previously validated psychometric scales with 255 items that assess relationship functioning and partner behaviour, but, to our knowledge, had not been used in Southern Africa. After item translation and cognitive interviewing with 30 pregnant people, we recruited an additional 208 pregnant people living with HIV receiving antenatal care. We conducted an exploratory factor analysis with maximum-likelihood extraction and oblique promax rotation with the 58 items and 10 scales that remained after translation and cognitive interviewing. We used parallel analysis, scree plots, and the Kaiser criterion to guide factor retention and assessed internal factor consistency via Cronbach's alpha. Of the 208 participants recruited, 197 (95%) answered each question and were included in the analysis. Exploratory factor analysis revealed 7 factors that assessed partner social support, sexual relationship power, emotional intimacy, threatened or enacted violence, sexual intimacy, violence in relationships, and partner engagement in pregnancy care via 37 items. Factor absolute Spearman correlations ranged from 0.012 to 0.518 and Cronbach's alpha ranged from 0.84 to 0.92. This preliminary analysis will guide further scale development. Future developments will also include relevant clinical outcomes to assess the predictive validity of the resulting measures. These steps will further refine these questions into a succinct screening tool to assess relationship functioning and partner behaviour. This screening tool may eventually guide the selection of partner-based interventions during pregnancy to improve outcomes for pregnant people and their partners.

Dyadic Validation of Relational Processes in Seroconcordant Mozambican Couples: Social Support, Physician Trust, and Stigma.

Psychometric instruments can quantify how people living with HIV experience three key barriers to antiretroviral therapy (ART) and retention: partner support, trust in medical professionals, and internalized HIV-related stigma. However, two challenges arise when using these instruments to measure and interpret relational processes among Mozambican couples, especially those participating in a couples intervention. First, relational measures have almost exclusively been developed and normed with Western, middle-class, and/or White adults. Second, traditional measurement approaches neglect the relational processes between partners. Using dyadic modeling, this paper demonstrates metric and scalar invariance for instruments measuring partner support (CFI = 0.964, TLI = 0.965, RMSEA = 0.034, SRMR = 0.052), trust in medical professionals (CFI = 0.978, TLI = 0.980, RMSEA = 0.033, SRMR = 0.039), and internalized HIV-related stigma (CFI = 0.960, TLI = 0.961, RMSEA = 0.050, SRMR = 0.060) within the novel context of seroconcordant HIV+ couples in Zambézia province.

RESUMEN: Los instrumentos psicométricos pueden cuantificar cómo las personas que viven con VIH experimentan tres barreras claves para la terapia antirretroviral (TAR) y la retención: el apoyo de la pareja, la confianza en los profesionales médicos y el estigma internalizado del VIH. Sin embargo, surgen dos desafíos cuando se utilizan estos instrumentos para medir e interpretar los procesos relacionales entre las parejas mozambiqueñas, especialmente aquellas que participan en una intervención de pareja. Primero, las medidas relacionales se han desarrollado y normado casi exclusivamente con adultos occidentales, de clase media y/o blancos. En segundo lugar, los enfoques tradicionales de medición descuidan los procesos relacionales entre parejas. Con modelos diádicos, este artículo demuestra la invariancia métrica y escalar de los instrumentos que miden el apoyo de la pareja (CFI = 0.964, TLI = 0.965, RMSEA = 0.034, SRMR = 0.052), la confianza en los profesionales médicos (CFI = 0.978, TLI = 0.980, RMSEA = 0.033, SRMR = 0.039) y el estigma internalizado del VIH (CFI = 0.960, TLI = 0.961, RMSEA = 0.050, SRMR = 0.060) en el contexto novedoso de parejas seroconcordantes VIH positivas en la provincia de Zambézia.

Disentangling longitudinal trajectories of racial discrimination and critical action among Black and Latinx college students: What role do peers play?

Objectives: Critical action (sociopolitical action to combat social inequity) provides racially marginalized youth with a pathway to coping. Sociocultural factors (like experiences of racial discrimination and contact with racially marginalized peers) are integral for fostering critical action among racially marginalized youth, yet few empirical studies have explored these relationships longitudinally. This study examines: (a) longitudinal trajectories of critical action and racial discrimination among Black and Latinx college students, (b) whether racial discrimination or critical action predict the other's longitudinal trajectory, and (c) whether having Black and Latinx friends and ethnic-racial club participation strengthen these relationships. Method: These trajectories were assessed by estimating growth models with a longitudinal sample of 504 Black and Latinx college students. Results: Analyses revealed that racial discrimination significantly increased over the first 2 years of college, whereas critical action significantly declined. Additionally, racial discrimination predicted changes in critical action, but critical action did not predict changes in racial discrimination. Ethnic-racial club participation slowed the decline of critical action. Conclusions: Our findings suggest that the transition to college is associated with changes in racial discrimination and critical action and these trajectories are enhanced by ethnic-racial club participation. Implications of these findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Youth anti-racism action: Contributions of youth perceptions of school racial messages and critical consciousness.

The current study examined whether youth perceptions of school racial messages that acknowledged the reality of racism (critical consciousness [CC] messages) or denied racism (color-blind messages) predicted youth anti-racism action through interpersonal and communal/political means. We further tested whether youths' critical reflection of perceived inequality and anger toward social injustice-psychological aspects of CC development-mediated relations between school messages and youth actions. These questions were explored using structural equation modeling with 372 racially/ethnically diverse adolescents (Mage = 17.00; standard deviation = 1.29; female = 51.0%). Results indicated that youth perceptions of CC messages predicted their involvement in both interpersonal and communal/political anti-racism action. Youths' anger toward social injustice mediated links between school racial messages and anti-racism action, albeit in unique ways. These findings underscore the power of schools in prompting youth anti-racism action. Implications of the importance of partnerships between schools and youth community organizing groups to stimulate youth anti-racism action were discussed.

Pushing the envelope: The who, what, when, and why of critical consciousness.

Deep-seated structural racism in the U.S. has been thrown into bold relief by the racially disproportionate impacts of COVID-19 and a series of highly visible police murders of Black Americans. Longstanding and intergenerational economic inequalities have been laid bare by the ensuing economic recession. This special issue's focus on how people critique, challenge, negotiate and change inequities is therefore particularly (and, unfortunately) relevant and timely. These three papers approach critical consciousness from three distinct angles. In this commentary, I will offer several points of praise for these three papers, along with a few suggestions on ways that the authors' lines of thinking could be extended or more nuanced. I will identify a few themes that cut across these three papers: (1) the importance of focusing on critical action, (2) how these papers advance our thinking on how, when, and for whom CC develops, with specific attention paid to the social identities, life phases, and events that impact CC, and (3) a deepening of our understanding of the antecedents and consequences of CC. In reviewing these three papers, I consider how each of them adds to the collective conversation about the ways that we might recognize, challenge, and work to change marginalizing systems and transform inequity to create a more just world.

Interpersonal reactivity index adaptation among expectant seroconcordant couples with HIV in Zambézia Province, Mozambique.

BACKGROUND: The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) - an empathy scale - among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial - a cluster randomized controlled trial assessing couple-based versus individual treatment on viral suppression - in Zambézia Province, Mozambique. METHODS: Using baseline data from 1332 HoPS+ trial participants (666 couples), an exploratory factor analysis assessed culturally relevant questions from the IRI. Because empathy is interdependent among couples, we validated the results of the exploratory factor analysis using a dyadic confirmatory factor analysis (CFA) with dyadic measurement invariance testing. Finally, we assessed the relationship between scores on our final scale and basic demographic characteristics (sex, age, education, and depression) using t-tests. RESULTS: We found two subscales: 1) a seven-item cognitive empathy subscale (Cronbach's alpha 0.78) and 2) a six-item affective empathy subscale (Cronbach's alpha 0.73). The dyadic CFA found acceptable model fit and metric invariance across partners (Comparative Fit Index (CFI) = 0.914, Tucker Lewis Index = 0.904, Root Mean Squared Error of Approximation = 0.056, ΔCFI = 0.011). We observed higher cognitive (p: 0.012) and affective (p: 0.049) empathy among males and higher cognitive (p: 0.031) and affective (p: 0.030) empathy among younger participants. More educated participants had higher affective empathy (p: 0.017) and depressed participants had higher cognitive empathy (p: < 0.001). This two-subscale, 13-item version of the IRI measures cognitive and affective empathy in HoPS+ trial participants and adults while accounting for the interdependent nature of empathy within partner dyads. CONCLUSIONS: This scale will allow us to assess the interplay between empathy and other psychometric constructs (stigma, social support, etc.) in the HoPS+ trial and how each relates to retention in HIV, adherence to treatment, and prevention of maternal to child HIV transmission. Furthermore, this scale can be adapted for other sub-Saharan African populations, which will allow researchers to better assess HIV-related intervention efficacy. TRIAL REGISTRATION: This study is within the context of the HoPS+ trial, registered at ClinicalTrials.gov as number NCT03149237 . Registered May 11, 2017.

Interpersonal reactivity index adaptation among expectant seroconcordant couples with HIV in Zambézia Province, Mozambique

The ability to understand another's emotions and act appropriately, empathy, is an important mediator of relationship function and health intervention fidelity. We adapted the Interpersonal Reactivity Index (IRI) ­ an empathy scale ­ among seroconcordant expectant couples with HIV in the Homens para Saúde Mais (HoPS+) trial ­ a cluster randomized controlled trial assessing couple-based versus individual treatment on viral suppression ­ in Zambézia Province, Mozambique. Methods: Using baseline data from 1332 HoPS+ trial participants (666 couples), an exploratory factor analysis assessed culturally relevant questions from the IRI. Because empathy is interdependent among couples, we validated the results of the exploratory factor analysis using a dyadic confirmatory factor analysis (CFA) with dyadic measurement invariance testing. Finally, we assessed the relationship between scores on our final scale and basic demographic characteristics (sex, age, education, and depression) using t-tests. Results: We found two subscales: 1) a seven-item cognitive empathy subscale (Cronbach's alpha 0.78) and 2) a six-item affective empathy subscale (Cronbach's alpha 0.73). The dyadic CFA found acceptable model fit and metric invariance across partners (Comparative Fit Index (CFI) = 0.914, Tucker Lewis Index = 0.904, Root Mean Squared Error of Approximation = 0.056, ΔCFI = 0.011). We observed higher cognitive (p: 0.012) and affective (p: 0.049) empathy among males and higher cognitive (p: 0.031) and affective (p: 0.030) empathy among younger participants. More educated participants had higher affective empathy (p: 0.017) and depressed participants had higher cognitive empathy (p: < 0.001). This two-subscale, 13-item version of the IRI measures cognitive and affective empathy in HoPS+ trial participants and adults while accounting for the interdependent nature of empathy within partner dyads. Conclusions: This scale will allow us to assess the interplay between empathy and other psychometric constructs (stigma, social support, etc.) in the HoPS+ trial and how each relates to retention in HIV, adherence to treatment, and prevention of maternal to child HIV transmission. Furthermore, this scale can be adapted for other sub-Saharan African populations, which will allow researchers to better assess HIV-related intervention efficacy. Trial registration: This study is within the context of the HoPS+ trial, registered at ClinicalTrials.gov as number

Correction to: Charting How Wealth Shapes Educational Pathways from Childhood to Early Adulthood: A Developmental Process Model.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Latinx and Black young adults' pathways to civic/political engagement.

OBJECTIVES: Latinx and Black young adults' experiences with the U.S. political system have been contentious. Despite this, they utilize psychological strengths, such as their critical consciousness (CC), to participate in the political process. This research explored relations between CC (e.g., critical reflection of social inequality and voting likelihood) and forms of civic/political engagement (e.g., sociopolitical action and social media engagement) among Latinx and Black young adults. METHOD: Measurement invariance (MI) tests and structural equation modeling (SEM) were used with Latinx (N = 354, Mage = 26.08, SD = 5.03) young adults who were slightly predominately male (55.1%) and Black American young adults (N = 160, Mage = 25.84, SD = 4.98) who were slightly predominately female (52.5%). RESULTS: MI results indicated measures were not invariant (i.e., they were measured differently) across groups. Therefore, the hypothesized model was examined separately for groups. SEM analyses suggested both groups' critical reflection positively predicted voting likelihood and sociopolitical action. For Latinx young adults, voting likelihood mediated the relation between critical reflection and social media engagement. Black young adults' voting likelihood was unrelated to sociopolitical action and social media engagement. Alternative models examined bidirectional relations between CC and civic/political engagement. CONCLUSIONS: Findings suggest civic/political engagement pathways differ for Latinx and Black young adults. However, fostering critical reflection has the potential to stimulate both groups' intent to vote and sociopolitical action. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Charting How Wealth Shapes Educational Pathways from Childhood to Early Adulthood: A Developmental Process Model.

Wealth plays a pervasive role in sustaining inequality and is more inequitably distributed than household income. Research has identified that wealth contributes to children's educational outcomes. However, the specific mechanisms accounting for these outcomes are unknown. Using the Panel Study of Income Dynamics (PSID) and its supplements, SEM was used to test a hypothesized longitudinal chain of mediating processes. Framed by the parent investment model, this study tracks children and their parents over twenty-seven years, from pre-birth to early adulthood. The analytic sample was comprised of 1247 young people who were between 6-12 years of age (M= 5.66, SD= 2.12) in 1997, the first wave of the PSID's Child Development Supplement. This analytic sample was roughly equivalent by gender (N= 774; 53% identified as female and N= 693; 47% identified as male). The racial/ethnic background of participants was nearly an equal split between individuals who identified as White (N= 666; 45%) or Black (N= 634; 43%), with an additional 7% (N= 97) who identified as "Hispanic," 2% (N= 40) as "Other," 1% (N= 20) as Asian or Pacific Islander, and less than 1% (N= 6) who identified as American Indian or Alaskan Native. The results indicated that wealth (a) engenders parental and child processes-primarily expectations and achievement-that promote educational success, (b) plays a different role across the life course, and (c) that pre-birth wealth has a significant mediated relationship to educational attainment seventeen years later. These findings advance understanding of specific mediating mechanisms by which wealth may foster children's educational success across the life course, as well as how wealth may differentially shape educational outcomes in childhood, adolescence, and young adulthood.

Political identification, political ideology, and critical social analysis of inequality among marginalized youth.

This study applies multiple indicator and multiple causes modeling to examine to what extent critical social analysis of inequality, a dimension of critical consciousness (CC), may be explained by political party identification (i.e., Republican vs. Democrat) or political ideology (i.e., conservative vs. liberal). These issues were examined among 237 public high school students from a large Midwestern city, who generally came from historically marginalized groups. Analyses suggest that political party identification was only marginally associated with critical social analysis of inequality and political ideology had a small positive association with critical social analysis of inequality. Further, political identification and political ideology only explained between 2% and 4% of the variance in critical social analysis of inequality. These results suggest complexity in how youth think about political institutions and inequality, while also providing evidence that a critical social analysis of inequality is largely independent of political identification and ideology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Threats and Supports to Female Students' Math Beliefs and Achievement.

This study examines how student perceptions of teacher practices contribute to female high school students' math beliefs and achievement. Guided by the expectancy-value framework, we hypothesized that students' motivation beliefs and achievement outcomes in mathematics are fostered by teachers' emphasis on the relevance of mathematics and constrained by gender-based differential treatment. To examine these questions, structural equation modeling was applied to a longitudinal panel of 518 female students from the Maryland Adolescent Development in Context Study. While controlling for prior achievement and race, gendered differential treatment was negatively associated with math beliefs and achievement, whereas relevant math instruction was positively associated with these outcomes. These findings suggest inroads that may foster positive math motivational beliefs and achievement among young women.

Critical action as a pathway to social mobility among marginalized youth.

Marginalized youth's development occurs in contexts rife with racialized, gendered, and socioeconomic social identity threats and barriers to social mobility. An emergent line of inquiry suggests critical action-a component of critical consciousness, defined as engaging in individual or collective social action to produce social change-may bolster career development for those experiencing marginalization. Yet, the specific mechanisms underlying critical action-career development associations are not well understood. Applying structural equation modeling (SEM) to 4 waves of longitudinal data from the Maryland Adolescent Development in Context Study (when participants were 17, 19, 21, and 29 years old), the authors explore the role of critical action for African American participants from lower-SES households (n = 261). The obtained model, which links critical action to career expectancies in adolescence and occupational attainment in adulthood, converges with earlier research linking critical consciousness to career development, social mobility pathways, and occupational attainment among marginalized youth. This study adds to previous literature by suggesting that critical action: (a) plays a significant role in fostering career expectancies in adolescence, particularly during high school, among marginalized youth; and (b) may promote the attainment of higher-status occupations in adulthood. Given the role of occupational attainment in social mobility and inclusion, these findings suggest an important mechanism by which social inequities may be narrowed. (PsycINFO Database Record

The Psychology of Working Theory.

In the current article, we build on research from vocational psychology, multicultural psychology, intersectionality, and the sociology of work to construct an empirically testable Psychology of Working Theory (PWT). Our central aim is to explain the work experiences of all individuals, but particularly people near or in poverty, people who face discrimination and marginalization in their lives, and people facing challenging work-based transitions for which contextual factors are often the primary drivers of the ability to secure decent work. The concept of decent work is defined and positioned as the central variable within the theory. A series of propositions is offered concerning (a) contextual predictors of securing decent work, (b) psychological and economic mediators and moderators of these relations, and (c) outcomes of securing decent work. Recommendations are suggested for researchers seeking to use the theory and practical implications are offered concerning counseling, advocacy, and public policy.

Promotive and Corrosive Factors in African American Students' Math Beliefs and Achievement.

Framed by expectancy-value theory (which posits that beliefs about and the subjective valuation of a domain predict achievement and decision-making in that domain), this study examined the relationships among teacher differential treatment and relevant math instruction on African American students' self-concept of math ability, math task value, and math achievement. These questions were examined by applying structural equation modeling to 618 African American youth (45.6 % female) followed from 7th to 11th grade in the Maryland Adolescent Development in Context Study. While controlling for gender and prior math achievement, relevant math instruction promoted and teacher differential treatment corroded students' math beliefs and achievement over time. Further, teacher discrimination undermined students' perceptions of their teachers, a mediating process under-examined in previous inquiry. These findings suggest policy and practice levers to narrow opportunity gaps, as well as foster math achievement and science, technology, engineering and math success.

Unraveling the Complexity of Critical Consciousness, Political Efficacy, and Political Action Among Marginalized Adolescents.

This research examines the complex patterns by which distinct dimensions of critical consciousness may lead marginalized adolescents toward distinct forms of political action. Structural equation modeling was applied to nationally representative data from the Civic Education Study (2,811 ninth graders; Mage  = 14.6), first establishing the measurement invariance of constructs across samples of poor or working class African American and Latino/a adolescents. Perceptions of societal inequality and aspirational beliefs that society ought to be more equal differentially predicted expected voting, conventional political action, and social action-while controlling for civic achievement and with nuances between ethnic and racial groups. Contrary to hypotheses and extant scholarship, political efficacy did not mediate or moderate relations between critical reflection and disparate forms of political action.

Fostering marginalized youths' political participation: longitudinal roles of parental political socialization and youth sociopolitical development.

This study examines the roles of parental political socialization and the moral commitment to change social inequalities in predicting marginalized youths' (defined here as lower-SES youth of color) political participation. These issues are examined by applying structural equation modeling to a longitudinal panel of youth. Because tests of measurement invariance suggested racial/ethnic heterogeneity, the structural model was fit separately for three racial/ethnic groups. For each group, parental political socialization: discussion predicted youths' commitment to produce social change and for two groups, longitudinally predicted political participation. This study contributes to the literature by examining civic/political participation among disparate racial/ethnic groups, addresses an open scholarly question (whether youths' commitment to create social change predicts their "traditional" participation), and emphasizes parents' role in fostering marginalized youths' civic and political participation.

Longitudinal roles of precollege contexts in low-income youths' postsecondary persistence.

Low-income youths enroll at postsecondary institutions less frequently, drop out more often, are less likely to return after dropping out, and are less likely to attain a postsecondary degree than their more affluent peers. It is therefore important to understand how low-income youths develop the capacity to persist in the postsecondary setting. This article explores how contextual supports contribute to low-income (and predominantly racial/ethnic minority) youths' educational expectancies and postsecondary persistence. The authors examined these questions by applying structural equation modeling to a longitudinal panel of youths surveyed 3 times over a 5-year period, while controlling for academic achievement, age, and gender. The obtained structural model suggests meditating "chains" by which parents and peers foster educational expectancies and postsecondary persistence over time. This article suggests that precollegiate contexts and expectancies clearly matter in explaining how low-income youths progress through intermediate checkpoints-postsecondary persistence-on the path to degree completion.