Predictors of serostatus nondisclosure in mothers living with human immunodeficiency virus receiving a disclosure intervention: Analysis of a randomized clinical trial intervention arm.

OBJECTIVE: The current study applied survival analysis to examine factors associated with nondisclosure of human immunodeficiency virus (HIV) serostatus among mothers living with HIV (MLH) who had participated in a cognitive-behavioral intervention to disclose their HIV status to their children. METHOD: Data were utilized from MLH in the intervention arm of the teaching, raising, and communicating with kids (TRACK; Schulte et al., 2021) trial focusing on serostatus disclosure/nondisclosure across four time points (baseline, 3, 9, and 15 months). MLH (Mage = 39.4) resided in California or Georgia and identified as Latina (33%), Black (54%), White (5%), or multiracial (8%). Physical, mental health, and psychosocial measures from the 3-month assessment were used to predict nondisclosure applying Cox regression survival analysis. RESULTS: Nondisclosure was associated with MLH reporting better physical and mental health, less conflict with their child, better cohesion within their families, and less perceived stigma. MLH reporting better physical functioning were 58% less likely to disclose compared to those reporting physical limitations (hazard ratio [HR] = 0.42). Those reporting lower levels of disclosure self-efficacy were 59% less likely to disclose than those reporting higher levels (HR = 2.47); by 67 weeks into the study, the nondisclosure rate was 56% for those reporting lower self-efficacy compared to 24% for those reporting higher self-efficacy. CONCLUSIONS: Addressing the inclination not to disclose when the MLH is feeling healthy may be an aspect to incorporate into future interventions. Furthermore, improving disclosure self-efficacy to a high level appears to be a critical component to intervention success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adolescent, Parent, and Provider Perspectives of a Social-Media-Based Support Tool for Parents of Teens in Treatment for Substance Use.

ABSTRACT: Adolescent substance use disorder contributes to negative psychosocial and physical health outcomes. Parents best support their child's treatment and recovery when they are equipped with knowledge and skills; however, barriers hinder parental engagement. Social-media-based groups present an opportunity for parents who may not otherwise seek support. Qualitative data were collected via focus groups to examine the opinions of adolescents, parents, and treatment providers on the potential utility and possible concerns of a Facebook-based parent support group; input constituted the development phase for an online group (PURPOSE). Fifty-eight participants, recruited through adolescent treatment programs, took part in six focus groups: two parent ( n = 18), two adolescent ( n = 21), and two provider ( n = 19) groups. Groups were audio recorded and transcribed, and themes were extracted. Three main themes emerged: (a) traditional support groups and treatment services, (b) PURPOSE intervention content and delivery, and (c) issues related to PURPOSE implementation. Traditional treatment/support groups can be helpful, but participation in them is limited. Emotional support offered by peers is valuable, but parents also need and seek out psychoeducation, parenting skills, and self-care support. PURPOSE could offer easy access to skills and real-time peer support.

Implementing a multisite efficacy trial to facilitate maternal disclosure to children: the TRACK HIV Disclosure Intervention.

HIV remains prevalent, stigmatized, and requires parents to decide whether and how to disclose to their serostatus to their children. Teaching Raising And Communicating with Kids (TRACK), an intervention to support maternal disclosure of HIV status to children, demonstrated efficacy through a pilot and a full-scale multisite trial. In response to the limited availability of best practices for conducting multisite research and recognizing the importance of identification of key intervention components, the current manuscript presents the traditional elements of an implementation paper along with secondary data analyses to identify drivers of the intervention's effects. Black, Latinx, and White mothers living with HIV (mean age = 39.27, SD = 7.89) and their children (51% female, mean age = 9.65, SD = 2.48) were recruited in Southern California and Atlanta (N = 176 dyads). Following baseline assessments, half were randomized to the intervention. Follow-up assessments occurred at 3, 9, and 15 months. Implementation and quality assurance protocols revealed the need for a broad range of recruitment and retention strategies, ongoing assessment of participants' psychological distress, and joint initial training of study personnel with ongoing supervision. Based on linear growth modeling, key intervention components (i.e., parent-child communication, positive parent involvement and reinforcement, family routines) significantly contributed to disclosure self-efficacy, the primary intervention target. Lessons learned emphasized the need to balance fidelity to the research protocol with strategies for managing site-based differences and the importance of including all key intervention components for future implementation at clinical or community-based sites.

Multisite longitudinal efficacy trial of a disclosure intervention (TRACK) for HIV+ mothers.

OBJECTIVE: The Teaching, Raising, And Communicating with Kids (TRACK) study was a full-scale longitudinal efficacy trial of a previously successful pilot intervention, which aims to assist mothers living with HIV (MLH) with serostatus disclosure to their children. The study looked to test the key components of the theoretical model with a more diverse sample than that of the pilot. METHOD: MLH (mean age = 39.27, SD 7.89) and their children (6-14 years) were recruited in Southern California and Atlanta and randomized to an intervention or wait-list control group (N = 176 dyads). TRACK used behavioral exercises within three individual sessions, with assessments at baseline, 3-, 9-, and 15-month follow-ups regarding HIV disclosure, targeted intermediate variables (communication, parental coping, family routines, and disclosure self-efficacy), and outcome variables for MLH's health and mental health, children's mental health, and family relationships/functioning. RESULTS: TRACK MLH were four times more likely to disclose their HIV serostatus than controls, with the rate increasing to six times more likely applying generalized estimating equation (GEE) logistic regression. Intervention MLH showed improvements in communication, social support, family routines, and most significantly, disclosure self-efficacy. Intervention MLH demonstrated decreased anxiety and better mental health scores; their children reported significantly more decline in worry than controls. This full-scale trial, over and above the pilot, showed the intervention improved outcomes across multiple sites, and found all targeted intermediate variables improved in the intervention group relative to the control group. CONCLUSIONS: TRACK helped mothers to disclose their status to their children and improved mental health outcomes, especially anxiety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

HIV and Mother-Child Conflict: Associations with Mother's Mental and Physical Health.

Maternal illness is a stressor that can disrupt family processes and contribute to negative child outcomes, and researchers have considered family variables that mediate or moderate the maternal illness-child outcome relationship. Through reliance on a diverse sample (ethnically and racially, as well as geographically), the current study expands prior literature with a focus on parent-child conflict. Specifically, associations between aspects of HIV positive mothers' illness and mother-child conflict were explored. One goal of the study was to determine if there were direct or indirect associations with aspects of mothers' HIV and mother-child conflict. HIV-positive mothers (N = 136) provided CD4 count and completed measures assessing their perceived level of physical functioning, depressive symptoms, HIV health-related anxiety, and mother-child conflict with their healthy school-age children. Path analysis considered the pattern of relationships across variables. Results showed maternal vitality and depressive symptoms were directly associated with mother-child conflict. CD4 cell count and health-related anxiety operated indirectly through maternal depressive symptoms. Mediation analyses further assessed the influence of maternal CD4 cell count on mother-child conflict behavior; results indicated an indirect effect was mediated by vitality. HIV health-related anxiety and vitality separately showed indirect effects on mother-child conflict, mediated by maternal depressive symptoms. These findings are the first to focus on mother-child conflict among children affected by maternal HIV and highlight the need for screening and intervention to address depressive symptoms among HIV-positive mothers.

Alcohol use, mental health, and parenting practices among HIV-positive mothers.

Mothers living with HIV (MLH) must balance childcare, their illness, and oftentimes other mental health problems/stressors. It is important to understand how a maladaptive coping strategy, (alcohol use) is linked to poorer parenting practices. We assessed the relationship between mental health/coping (anxiety, depression, alcohol use, social support) and parenting/family dimensions (communication, parenting style/stress, family routines/cohesion) among 152 MLH. Mothers reporting more psychiatric symptoms and less social support also reported poorer parenting practices and interactions. Further, MLH who used more alcohol reported less parenting involvement and fewer family interactions. Alcohol use, even at subclinical levels, can negatively impact the parent-child relationship.

Validation of a brief measure of HIV health-related anxiety among women living with HIV.

Anxiety symptoms related to health are often present in populations coping with chronic illness, and among women living with HIV (WLWH), anxiety has been linked to a range of negative outcomes. This paper describes the validation of a four-item instrument designed to measure health-related anxiety (HRA) in WLWH by assessing the impact of thinking about HIV status and health on difficulty sleeping, lack of appetite, reduced desire to socialize, and difficulty concentrating at school or work. The scale was administered to 238 adult WLWH across three studies. Exploratory factor analysis revealed a one-factor solution; multi-group confirmatory factor invariance analyses supported the single factor model. For construct and criterion validity, correlations between the HRA scale and validated instruments measuring psychological, psychosocial, and physical distress were as predicted. Results support the validity of the HRA scale among WLWH as a brief measure of anxiety related to HIV status and health.

Maternal Parenting Stress and Child Perception of Family Functioning Among Families Affected by HIV.

Mothers living with HIV (MLWH) experience stressors inherent to parenting, often within a context characterized by poverty, stigma, and/or limited social support. Our study assessed the relationship between parenting stress and child perceptions of family functioning in families with MLWH who have healthy school-age children. MLWH and their children (N = 102 pairs) completed measures addressing parenting stress and perceptions of family functioning (i.e., parent-child communication, family routines, and family cohesion). We used covariance structural modeling to evaluate the relationship between these factors, with results showing greater maternal parenting stress associated with poorer family functioning outcomes (reported by both the child and the mother). Findings offer support for the parenting stress-family functioning relationship by providing the child perspective along with the maternal perspective, and point to the need for interventions aimed at minimizing the impact of maternal parenting stress on family functioning.

Real-World Strategies to Engage and Retain Racial-Ethnic Minority Young Men Who Have Sex with Men in HIV Prevention Services.

Racial/ethnic minority young men who have sex with men (YMSM)-particularly African Americans and Hispanics/Latinos-are at particularly high risk for HIV infection. Devising strategies to improve engagement and retention in HIV prevention services among minority YMSM is critical if the United States is going to achieve the National HIV/AIDS Strategy goal of reducing HIV health-related disparities. This article presents findings from a national summit on racial/ethnic YMSM services convened by the Substance Abuse and Mental Health Services Administration-funded Center of Excellence on Racial and Ethnic Minority Young Men Who Have Sex with Men and Other Lesbian, Gay, Bisexual, and Transgender Populations (YMSM + LGBT CoE) in September 2015. The summit included (1) subgroup discussions focused on issues related to treatment access, outreach/engagement/retention, continuing care/recovery support, and health literacy for minority YMSM; and (2) a ranking process, where the NIATx Nominal Group Technique was used to identify the strategies and approaches that summit participants believed to be most promising for engaging and retaining minority YMSM in HIV prevention services. Analyses of results from summit activities highlight four key cross-cutting strategies-utilizing peers, providing holistic care, making services fun, and utilizing technology-as critical for engaging minority YMSM in HIV prevention care. Examples of programs that utilize these strategies and implications of these findings for policy and practice are discussed.

Substance Use and Associated Health Conditions throughout the Lifespan.

A life stage perspective is necessary for development of age-appropriate strategies to address substance use disorders (SUDs) and related health conditions in order to produce better overall health and well-being. The current review evaluated the literature across three major life stages: adolescence, adulthood, and older adulthood. FINDINGS: 1) Substance use is often initiated in adolescence, but it is during adulthood that prevalence rates for SUDs peak; and while substance involvement is less common among older adults, the risk for health complications associated with use increases. 2) Alcohol, tobacco, marijuana, and, increasingly, prescription medications, are the most commonly misused substances across age groups; however, the use pattern of these and other drugs and the salient impact vary depending on life stage. 3) In terms of health outcomes, all ages are at risk for overdose, accidental injury, and attempted suicide. Adolescents are more likely to be in vehicular accidents while older adults are at greater risk for damaging falls. Adulthood has the highest rates of associated medical conditions (e.g., cancer, sexually transmitted disease, heart disease) and mental health conditions (e.g., bipolar disorder, anxiety disorders, antisocial personality disorder). CONCLUSION: Prolonged heavy use of drugs and/or alcohol results in an array of serious health conditions. Addressing SUDs from a life stage perspective with assessment and treatment approaches incorporating co-occurring disorders are necessary to successfully impact overall health.

Gender differences in factors influencing alcohol use and drinking progression among adolescents.

While prevalence rates for alcohol use and related disorders differ widely between adult men and women, male and female adolescents do not exhibit the same disparity in alcohol consumption. Previous research and reviews do not address the emergence of differences in drinking patterns that occur during late adolescence. Therefore, a developmental perspective is presented for understanding how various risk and protective factors associated with problematic drinking affect diverging alcohol trajectories as youth move into young adulthood. This review examines factors associated with risk for developing an alcohol use disorder in adolescent girls and boys separately. Findings indicate that certain biological (i.e., genetic risk, neurological abnormalities associated with P300 amplitudes) and psychosocial (i.e., impact of positive drinking expectancies, personality characteristics, and deviance proneness) factors appear to impact boys and girls similarly. In contrast, physiological and social changes particular to adolescence appear to differentially affect boys and girls as they transition into adulthood. Specifically, boys begin to manifest a constellation of factors that place them at greater risk for disruptive drinking: low response to alcohol, later maturation in brain structures and executive function, greater estimates of perceived peer alcohol use, and socialization into traditional gender roles. On an individual level, interventions which challenge media-driven stereotypes of gender roles while simultaneously reinforcing personal values are suggested as a way to strengthen adolescent autonomy in terms of healthy drinking decisions. Moreover, parents and schools must improve consistency in rules and consequences regarding teen drinking across gender to avoid mixed messages about acceptable alcohol use for boys and girls.

Adolescent satisfaction with brief motivational enhancement for alcohol abuse.

Although many investigations point to the importance of treatment satisfaction and working alliance as predictors of treatment engagement and outcome, few studies have closely examined these issues among adolescents. This study investigates satisfaction among a nonclinical adolescent sample participating in a school-based alcohol-prevention program. Adolescents self-selected to one of three formats: individual, group, and website. Three hundred nineteen satisfaction measures completed at the time of each participant's final session were used for analyses. Hierarchical regression analyses examined predictors of consumer satisfaction. In general, greater participation in the program was significantly related to satisfaction. Students who participated in the group and individual formats reported greater satisfaction than students who participated in the website format. Current alcohol users were less satisfied with the session focusing on how experimental use can lead to problem use; lifetime abstainers were more satisfied with the session focusing on stress and coping. These analyses have implications for informing future adolescent school-based interventions for alcohol problems.

Impact of relapse predictors on psychosocial functioning of SUD youth one year after treatment.

This investigation examined how personal, environmental and substance use factors predicted psychosocial functioning for youth with alcohol and drug problems. Four hundred twenty-four adolescents (M = 15.9, SD = 1.3) completed comprehensive assessments, including personal characteristics (e.g., Axis I diagnosis, motivation, self-esteem), environmental factors (e.g., family history, social supports) and substance use, at study intake and throughout the year following inpatient treatment. Treatment outcomes were assessed by measures of academic functioning, family relations, social functioning as well as health status and mental health treatment at one year. Aspects of the proposed model significantly predicted all treatment outcome domains, except family functioning, in the year following treatment. Psychosocial functioning at one year was predicted by age, gender, SES, comorbid psychopathology, family influence and nonusing social supports prior to treatment and relapse status after treatment. The utility of variables associated with substance use treatment outcomes in predicting psychosocial outcomes is considered.

Substance use treatment outcomes for youth: integrating personal and environmental predictors.

This investigation examined personal and environmental predictors of substance treatment outcomes in youth. A 424 adolescents (M=15.9 years, S.D.=1.3) completed comprehensive assessments, including substance use, environmental factors (e.g., family history, social supports), and person-centered variables (e.g., Axis I diagnosis, motivation, self-esteem), at study intake and throughout the year following inpatient treatment. Youth treatment outcomes were assessed by relapse status (abstaining, minor relapse, major relapse) and DSM-IV dependence symptoms at 1 year. Relapse status was predicted by demographic (age), environmental (social supports), and person-centered factors (diagnosis) while dependence symptoms were best predicted by substance use variables alone. Consideration of the general and specific nature of risk and protection within the adolescent developmental context were explored.

Facilitating youth self-change through school-based intervention.

Early interventions for youth with high rates of alcohol use have often suffered from lack of willing participation due to negative stereotypes about treatment and the impression that alcohol interventions are not developmentally relevant for adolescents. This study evaluated the effectiveness of a school-based voluntary secondary intervention for alcohol use (Project Options). 1254 high school students (55% girls; M age = 15.9, SD = 1.2) with a history of lifetime drinking completed survey measures after the first year of Project Options in 3 schools. These results suggest that the intervention was successful in recruiting high-frequency drinkers into the intervention as well as facilitating attempts to cut down or quit alcohol use in this group of adolescents. This study provides preliminary support for a consumer-based approach to alcohol intervention and design and use of voluntary secondary interventions in a school-based population.