A qualitative assessment of emergency physicians' experiences with robust emergency department buprenorphine bridge programs.

OBJECTIVES: Emergency departments (EDs) are a critical point of entry into treatment for patients struggling with opioid use disorder (OUD). When initiated in the ED, buprenorphine is associated with increased addiction treatment engagement at 30 days when initiated. Despite this association, it has had slow adoption. The barriers to ED buprenorphine utilization are well documented; however, the benefits of prescribing buprenorphine for emergency physicians (EPs) have not been explored. This study utilized semistructured interviews to explore and understand how EPs perceive their experiences working in EDs that have successfully implemented ED bridge programs (EDBPs) for patients with OUD. METHODS: Semistructured interviews were conducted with EPs from four geographically diverse academic hospitals with established EDBPs. Interviews were recorded and transcribed, and emergent themes were identified using codebook thematic analysis. Analysis credibility and transparency were confirmed with peer debriefing. RESULTS: Twenty-two interviews were conducted across the four sites. Three key themes were constructed during the analyses: (1) provided EPs agency; (2) transformed EPs' emotions, attitudes, and behaviors related to treating patients with OUD; and (3) improved EPs' professional quality of life. CONCLUSIONS: Participants in this study reported several common themes related to participation in their hospital's BP. Overall our results suggest that physicians who participate in EDBPs may feel a renewed sense of fulfillment and purpose in their personal and professional lives. These positive changes may lead to increased job satisfaction in hospitals that have successfully launched EDBP.

Systems that promote mental health in the teeth of oppression.

Emotional distress can disproportionately disable individuals from minoritized groups, such as Black Americans, due to multiple intersecting factors. Addressing these challenges requires a comprehensive, culturally sensitive approach to mental health care that promotes inclusivity, accessibility, and representation within the field, to foster empowerment and resilience among minoritized communities. Given the weight of negative factors that can lead to psychological distress and mental illness, the wellness of Black Americans and how they support their mental health is important to acknowledge. In this Series paper, we propose that Black Americans have developed systems for managing many of these threats to their survival and wellbeing.

"You get what you need when you need it": A mixed methods examination of the feasibility and acceptability of a tailored digital tool to promote physical activity among women in midlife.

During midlife (ages 40-60), women experience myriad changes that elevate their risk for cardiovascular disease (CVD), including decreased physical activity (PA). Women cite lack of social support for PA and lack of active peers who can serve as role models as key barriers. Digital tools such as web applications can provide exposure to these social inputs; they are also accessible in daily life and require modest time investment. However, as few tools have been designed to meet the unique needs of women in midlife with CVD risk, our research team previously built a web application that is tailored for this population. In the present study, we used a convergent mixed methods design to develop a deep understanding of the feasibility, usability, and acceptability of this web application in a sample of identified end users. Participants (N = 27, MAge = 53 years, MBMI = 32.6 kg/m2) used the web application at the start of each day for 7 days and completed a 1-hour qualitative interview at the end of this test period. Integration of findings from two-level multilevel models (quantitative) and thematic analysis (qualitative) indicated support for the feasibility, usability, and acceptability of the new web application among women in midlife with CVD risk conditions and identified critical opportunities for improving the user experience. Findings also speak to the utility of options for content selection that can meet women's needs in daily life and highlight women's desire for PA resources that prioritize their perspectives.

Black sexual and gender diverse scholars' contributions to psychology.

Psychology has a long history of perpetuating scientific racism and pathologizing gender and sexually diverse individuals. The field has been criticized for the reproduction of racism, sexism, cissexism, and other social inequities. This intersectional epistemological exclusion has led to a lack of appreciation for the work of Black sexual and gender diverse (SGD) scholars within the field of psychology. To highlight and center the contributions of Black SGD scholars in the field, we conducted an in-depth literature search of the work of 62 Black SGD scholars whose names and curricula vitae were obtained through email listservs, Twitter, and snowball sampling. In analyzing the work of the scholars, a total of 34 Black SGD scholars met inclusion criteria and had their research included in our review. We summarize their major contributions to the field of psychology in this article. Implications of these scholars' works and their potential to help address the lack of visibility of Black SGD scholars in mainstream psychology journals are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Spirituality, self-compassion, and anxiety among sexual minority men: a longitudinal mediation analysis.

BACKGROUND AND OBJECTIVE: Research related to anxiety among sexual minority men (SMM) typically focuses on risk factors. It has seldom examined factors that may be associated with lower levels of anxiety. This gap in the literature represents an opportunity to explore positive psychological factors that may be related to lower levels of anxiety among this group. Spirituality and self-compassion are two positive psychological factors that have been associated with reduced anxiety in general samples but have been understudied among SMM. This study aimed to determine the longitudinal associations between spirituality, self-compassion, and anxiety. DESIGN AND METHODS: Guided by an Afrocentric psychological framework, we conducted a secondary quantitative analysis with data from a racially and ethnically diverse sample of 697 U.S. SMM. RESULTS: Utilizing Hayes PROCESS Macro Model 4, we found that spirituality at baseline was positively associated with self-compassion at baseline, which in turn was inversely associated with anxiety at 12-month follow-up. CONCLUSIONS: Overall, our findings provide evidence that spirituality and self-compassion are two positive psychological factors that are inversely associated with anxiety among SMM.

Relationship Quality and Health Among Black Same-Sex Male Couples: Protocol for a Symbolic Netnography Study.

BACKGROUND: Across a range of studies, health scientists have found that being in a romantic relationship can have positive and negative influences on one's health. A couple's health outcomes are often influenced by relationship quality-or how they perceive the positive or negative character of their relationship. These findings have important implications for how scientists and interventionists may leverage romantic relationships facilitating good health among couples. However, in general, couples research has not included Black same-sex male couples in large enough numbers to make previous studies' findings relevant to them. This represents a gap in the scientific literature and, more importantly, a missed opportunity to understand how romantic relationships influence health for a group that must navigate distinct, multilevel health and social inequities. OBJECTIVE: This study aims to (1) decode and understand the ways in which Black same-sex male couples express their romantic relationships in virtual contexts via symbolic indicators, (2) determine how Black same-sex male couples describe the quality of their romantic relationships, and (3) explore how Black same-sex male couples make meaning of their relationship quality and its impact on their relational and individual health. METHODS: We will use joint dyadic interviews embedded within a symbolic netnography research design to accomplish our aims. We will use grounded theory to analyze our qualitative data. We will then triangulate our findings to determine how well they answer our research questions. RESULTS: This study received ethical approval on October 8, 2020 and we began data collection in November 2020. Results are expected to be available no later than December 31, 2022. CONCLUSIONS: This study will apply novel symbolic netnographic qualitative methods to further our understanding of Black same-sex male couples' romantic relationships and how they contribute to their health. The findings will be used to develop programs to improve Black same-sex male couples' health in community and virtual settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29589.

"The Awesomeness and the Vastness of Who You Really Are:" A Culturally Distinct Framework for Understanding the Link Between Spirituality and Health for Black Sexual Minority Men.

Despite health inequities, many Black sexual minority men are resilient and often utilize spirituality as a culturally distinct self-protective and self-enhancing resource to maintain their health. However, little is known about how spirituality impacts health within a cultural framework that is specific to Black sexual minority men. We conducted 10 individual in-depth interviews, reaching code saturation, with Black sexual minority men across the USA. Our study was guided by grounded theory and a Black psychology theoretical framework. Seven themes were discovered and revealed that participants' level of spiritual consciousness influenced their engagement in psychological and behavioral processes that were related to mental and physical health. These themes were: (a) suboptimal worldview, (b) emotional revelation, (c) emotional emancipation, (d) emotional regulation, (e) health motivations, (f) health behaviors, and (g) links between spiritual consciousness, mental health, and physical health. Implications of these findings for clinicians and researchers are discussed.

A Systematic Review of Black American Same-Sex Couples Research: Laying the Groundwork for Culturally-Specific Research and Interventions.

ABSTRACTThis article presents the findings of a systematic review of the empirical literature related to Black American same-sex couples (BASCs). We found 16 articles that met inclusion criteria. Most articles were published in journals that focused on interdisciplinary studies, HIV/AIDS, and couples and families' studies. Approximately 63% of the articles reported external funding support. However, only one of these grants was awarded to a Black investigator. Articles predominately focused on BASCs composed of Black sexual minority men residing in major U.S. cities. Only 25% of the articles focused on couples where both partners were Black. Most studies were cross-sectional, used convenience samples, and were reported without mention of a theoretical framework that explicated the philosophical assumptions that guided the research. The articles focused on a range of topics such as resilience, relationship dynamics, couple-level social support, rituals with extended families, and partner-health associations. The implications of these findings for advancing culturally-specific behavioral and social science health research and interventions with BASCs are presented.

Religious Coping and Depressive Symptoms Among Black Americans Living with HIV: An Intersectional Approach.

This exploratory quantitative study examined the association between religious coping and depressive symptoms among a sample of 216 Black Americans living with HIV (BALWH) in the Southeastern United States. Descriptive analyses and multiple linear regression were used to determine statistically significant associations between religious coping styles and depressive symptoms, and to investigate the potential of sexual orientation and gender to moderate the associations between religious coping styles and depressive symptoms. Negative religious coping, but not positive religious coping, significantly predicted depressive symptoms. Sexual orientation, but not gender, significantly moderated the association between positive religious coping and depressive symptoms so that the relationship was only significant for heterosexual BALWH. Implications of these findings for future research and clinical work with BALWH are discussed.

Spirituality and Multiple Dimensions of Religion Are Associated with Mental Health in Gay and Bisexual Men: Results From the One Thousand Strong Cohort.

The purpose of this study was to determine the association between religion, spirituality, and mental health among gay and bisexual men (GBM). A U.S. national sample of 1,071 GBM completed an online survey that measured demographic characteristics, religiosity, religious coping, spirituality, and four mental health constructs (i.e., depressive symptoms, rejection sensitivity, resilience, and social support). Hierarchal linear regressions determined the associations between each mental health construct, demographic variables, and the spirituality and religion variables. Controlling for demographic characteristics, spirituality was negatively associated with depression and rejection sensitivity, and positively associated with resilience and social support (all p < .001). Religiosity was positively associated with rejection sensitivity (p < .05) and negatively associated with resilience (p < .01). Religious coping was positively associated with depression (p < .001) and rejection sensitivity (p < .05) and negatively associated with resilience (p < .05) and social support (p < .05). The interaction of spirituality with religion was significantly associated with all mental health variables. In general, religious GBM with higher levels of spirituality had better mental health outcomes. Spirituality was significantly positively associated with positive mental health outcomes and negatively associated with negative ones. Religion-solely expressed through behaviors and lacking the functional components of spirituality such as meaning-making and connection to the sacred-was associated with mental health problems among GBM. Public health interventions and clinical practice aimed at decreasing negative mental health outcomes among GBM may find it beneficial to integrate spirituality into their work.

Positive religious coping predicts self-reported HIV medication adherence at baseline and twelve-month follow-up among Black Americans living with HIV in the Southeastern United States.

This paper presents the results of secondary data analyses investigating the influence of religious coping on HIV medication adherence across time among 167 Black Americans living with HIV (BALWH) in the Southeastern United States. Participants were recruited from a large urban clinic in Atlanta, GA and completed questionnaires about their religious coping at baseline assessment and about their medication adherence at baseline and 12-month follow-up assessment. Descriptive analyses and multiple linear regression were used to determine the association between religious coping and HIV medication adherence. Findings indicated that after controlling for age and depressive symptoms at baseline, positive religious coping significantly predicted medication adherence at baseline and 12-month follow-up. Negative religious coping was inversely associated with medication adherence at baseline after controlling for age and depressive symptoms but not at 12-month follow-up. The implications of these findings for future research and intervention work related to medication adherence among BALWH are discussed.

Black Sexual Minority Men's Disclosure of Sexual Orientation Is Associated With Exposure to Homonegative Religious Messages.

Previous research has highlighted the homonegative atmospheres of many religious communities in Western society and their harmful impact on Black sexual minority (SM) people's mental and physical health. However, few studies have examined the relationship between sexual orientation disclosure to church members and exposure to homonegative religious messages in religious settings. This online quantitative study investigated this relationship among a sample of 320 Black SM men. The participants for this study were recruited nationally from across the United States and had a mean age of 34 years. Descriptive statistics and linear regression analyses were conducted. Findings indicated that sexual orientation disclosure to church members was significantly associated with exposure to homonegative religious messages, even when controlling for geographic region of residence and denominational affiliation. Black SM men who had higher levels of disclosure were exposed to fewer homonegative religious messages. The implications of these findings for health research and clinical work with Black SM men are discussed in detail.

Race, ethnicity, religious affiliation, and education are associated with gay and bisexual men's religious and spiritual participation and beliefs: Results from the One Thousand Strong cohort.

OBJECTIVES: This study examined the rates of spirituality, religiosity, religious coping, and religious service attendance in addition to the sociodemographic correlates of those factors in a U.S. national cohort of 1,071 racially and ethnically diverse HIV-negative gay and bisexual men. METHOD: Descriptive statistics were used to assess levels of spirituality, religiosity, religious coping, and religious service attendance. Multivariable regressions were used to determine the associations between sociodemographic characteristics, religious affiliation, and race/ethnicity with four outcome variables: (1) spirituality, (2) religiosity, (3) religious coping, and (4) current religious service attendance. RESULTS: Overall, participants endorsed low levels of spirituality, religiosity, and religious coping, as well as current religious service attendance. Education, religious affiliation, and race/ethnicity were associated with differences in endorsement of spirituality and religious beliefs and behaviors among gay and bisexual men. Men without a 4-year college education had significantly higher levels of religiosity and religious coping as well as higher odds of attending religious services than those with a 4-year college education. Gay and bisexual men who endorsed being religiously affiliated had higher levels of spirituality, religiosity, and religious coping as well as higher odds of religious service attendance than those who endorsed being atheist/agnostic. White men had significantly lower levels of spirituality, religiosity, and religious coping compared to Black men. Latino men also endorsed using religious coping significantly less than Black men. CONCLUSIONS: The implications of these findings for future research and psychological interventions with gay and bisexual men are discussed. (PsycINFO Database Record

Uptake of HIV Pre-Exposure Prophylaxis (PrEP) in a National Cohort of Gay and Bisexual Men in the United States.

OBJECTIVES: The HIV care cascade provides milestones to track the progress of HIV-positive people from seroconversion through viral suppression. We propose a Motivational pre-exposure prophylaxis (PrEP) Cascade involving 5 stages based on the Transtheoretical Model of Change. METHODS: We analyzed data from 995 men in One Thousand Strong, a longitudinal study of a national panel of HIV-negative gay and bisexual men in the United States. RESULTS: Nearly all (89%) participants were sexually active in the past 3 months and 65% met Centers for Disease Control criteria for PrEP candidacy. Of those identified as appropriate candidates, 53% were Precontemplative (stage 1; unwilling to take or believing they were inappropriate candidates for PrEP) and 23% were in Contemplation (stage 2; willing and self-identified as appropriate candidates). Only 11% were in PrEParation (stage 3; seeing PrEP as accessible and planning to initiate PrEP) and 4% were in PrEP Action (stage 4; prescribed PrEP). Although few of those who were identified as appropriate candidates were on PrEP, nearly all PrEP users (98%) reported adhering to 4 or more doses per week and most (72%) were returning for recommended quarterly medical visits, resulting in 9% of PrEP candidates reaching Maintenance and Adherence (stage 5). CONCLUSIONS: The large majority of participants were appropriate candidates for PrEP, yet fewer than 1 in 10 were using and adherent to PrEP. These findings highlight the need for interventions tailored to address the unique barriers men face at each stage of the cascade, particularly at the earliest stages where the most dramatic losses were identified.

Preintervention Profiles of Information, Motivational, and Behavioral Self-Efficacy for Methamphetamine Use and HIV Medication Adherence Among Gay and Bisexual Men.

Although rates of crystal methamphetamine use in the United States have fallen from their peak in the mid-2000s, use remains a major public health concern, which disproportionately affects gay and bisexual men (GBM). It poses a particular challenge for HIV-positive men, for whom it has been linked to medication adherence problems as well as compromised immune function. Although the information, motivation, and behavioral skills (IMB) model has been widely used to conceptualize health behavior, little is known about GBM's initial levels of information, motivation, and behavioral self-efficacy to improve HIV medication adherence and to reduce crystal methamphetamine use at the outset of treatment. The present study identified profiles of IMB factors related to HIV medication adherence and crystal methamphetamine use in a sample of 210 HIV-positive GBM who consented to participate in an intervention study. Results indicated three distinct patterns of IMB factors. The largest group was ready to change both adherence and methamphetamine use (n = 104). This group also had depression scores that were significantly lower than other groups. A second group appeared ready to change medication adherence, but was ambivalent about changing methamphetamine use (n = 60). This group reported significantly more symptoms of methamphetamine dependence than the other groups. A third group was characterized by global IMB barriers to change (n = 46). Results are discussed in the context of tailoring psychoeducation, motivational interviewing, and cognitive behavioral interventions to match these preintervention patterns of IMB factors.

Religion and Spirituality's Influences on HIV Syndemics Among MSM: A Systematic Review and Conceptual Model.

This paper presents a systematic review of the quantitative HIV research that assessed the relationships between religion, spirituality, HIV syndemics, and individual HIV syndemics-related health conditions (e.g. depression, substance abuse, HIV risk) among men who have sex with men (MSM) in the United States. No quantitative studies were found that assessed the relationships between HIV syndemics, religion, and spirituality. Nine studies, with 13 statistical analyses, were found that examined the relationships between individual HIV syndemics-related health conditions, religion, and spirituality. Among the 13 analyses, religion and spirituality were found to have mixed relationships with HIV syndemics-related health conditions (6 nonsignificant associations; 5 negative associations; 2 positive associations). Given the overall lack of inclusion of religion and spirituality in HIV syndemics research, a conceptual model that hypothesizes the potential interactions of religion and spirituality with HIV syndemics-related health conditions is presented. The implications of the model for MSM's health are outlined.

Extracting dirt from water: a strengths-based approach to religion for African American same-gender-loving men.

Religion is one of the most powerful and ubiquitous forces in African American same-gender-loving (SGL) men's lives. Research indicates that it has both positive and negative influences on the health behaviors and outcomes of this population. This paper presents a review of the literature that examines religion as a risk and protective factor for African American SGL men. A strengths-based approach to religion that aims to utilize its protective qualities and weaken its relation to risk is proposed. Finally, recommendations are presented for the use of a strengths-based approach to religion in clinical work and research.