HIV Prevention Services in Residential Substance Use Disorder Treatment Facilities in the United States.

Residential substance use disorder treatment is designed to treat more severe substance use disorders. Considering the strong association between substance use and HIV, providing HIV prevention services during residential substance use disorder treatment is imperative. However, not all treatment facilities offer the same services, and differences in residential substance use disorder treatment facilities providing HIV prevention services might stem from facility-level characteristics. Using 3 years (2018-2020) of cross-sectional data from the National Survey of Substance Abuse Treatment Services, we examined which treatment facility characteristics were associated with having HIV prevention services. Using a logistic regression model with HIV prevention services as the outcome, we found that facilities that were accredited, engaged in community outreach, and offered assistance with housing and transportation were more likely to provide HIV prevention services. Furthermore, facilities in the Midwest and West were less likely to provide HIV prevention services than those in the South.

Household food insecurity and educational outcomes in school-going adolescents in Ghana.

OBJECTIVES: We examined the association of household food insecurity with educational outcomes and explored the moderating effect of gender and school lunch programme. DESIGN: The study used a cross-sectional design. Data were collected in 2014 using interviewer-administered questionnaires and school administrative records. We measured household food insecurity using the Household Food Insecurity Access Scale. Educational outcomes referred to knowledge, attitudes and skills that students are expected to obtain while attending school. We obtained sixteen different measures of educational outcomes, ranging from academic grades to beliefs and attitudes towards school and education. Data were analysed using multilevel modelling with covariates at the student and school levels. We conducted moderation tests by adding a two-way interaction between food insecurity and gender, and between food insecurity and school lunch programme. SETTING: The study was conducted in 100 schools located in fifty-four districts within Ghana's eight administrative regions in 2014. PARTICIPANTS: Participants included 2201 school-going adolescents aged 15-19 years. RESULTS: More than 60 % of adolescents were from food-insecure households. Household food insecurity was negatively associated with Math grade and school attendance. Food insecurity was also inversely associated with socio-emotional outcomes, including academic self-efficacy, commitment to school and academic aspirations and expectations. We did not find a moderating effect of gender and school lunch programme. CONCLUSIONS: Food insecurity is negatively associated with wide-ranging educational outcomes related to both learning and socio-emotional abilities. Our study supports prior evidence suggesting the importance of food access on both cognitive and non-cognitive educational outcomes.

Evidence of non-economic indicators as markers of success for youth in youth employability programs: Insights from a South African study.

Evaluation studies of youth employment programs prioritize employment and earnings outcomes and use these indicators to determine what labor market interventions are most successful. Evidence from pre and post data of a cluster randomized controlled longitudinal study, consisting of 1 892 youth between 18 and 25 years who participated in Youth Employability Programs (YEPs) in South Africa, confirms the importance of the inclusion of non-economic indicators to measure success for youth. This study provides evidence that non-economic markers of success such as job-search resilience, self-esteem, self-efficacy and future orientation are potentially important in the transition to employment in the longer term and points to the need for more evaluations that use these markers to predict youth's success in employment. The findings further suggest that these non-economic outcomes, which were conceptualized as intermediary outcomes, can influence how young people manage the increasingly protracted and difficult transition to work. The study enlarges our understanding of the non-linear and protracted pathways of youth transitions to work in a development context, and how to best support youth in this transition period. These findings have implications for rethinking YEP evaluation outcomes that could lead to adaptive programming and management of interventions.

The Association of Material Hardship with Medication Adherence and Perceived Stress Among People Living with HIV in Rural Zambia.

The intersection of poverty and HIV/AIDS has exacerbated socioeconomic inequalities in Zambia. For example, the downstream consequences of HIV/AIDS are likely to be severe among the poor. Current research has relied on multidimensional indicators of poverty, which encompass various forms of deprivation, including material. Although comprehensive measures help us understand what constitutes poverty and deprivation, their complexity and scope may hinder the development of appropriate and feasible interventions. These limitations prompted us to examine whether material hardship, a more practicable, modifiable aspect of poverty, is associated with medication adherence and perceived stress among people living with HIV (PLHIV) in Zambia. We used cross-sectional data from 101 PLHIV in Lundazi District, Eastern Province. Data were collected using a questionnaire and hospital records. Material hardship was measured using a five-item scale. Perceived stress was measured using the ten-item perceived stress scale. Adherence was a binary variable measured using a visual analog scale and medication possession ratio (MPR) obtained from pharmacy data. We analyzed the data with multivariable linear and logistic regressions using multiply imputed datasets. Results indicated that greater material hardship was significantly associated with MPR nonadherence (odds ratio = 0.83) and higher levels of perceived mental distress (ß = 0.34). Our findings provide one of the first evidence on the association of material hardship with treatment and mental health outcomes among PLHIV. The findings also draw attention to the importance of economic opportunities for PLHIV and their implications for reducing material hardship and improving adherence and mental health status.

The importance of self-efficacy and educational aspirations for academic achievement in resource-limited countries: Evidence from Ghana.

INTRODUCTION: Research on the influence of academic self-efficacy and educational aspirations on academic performance is underdeveloped in resource-limited countries. This study replicates and expands on earlier research that investigated a complex network of relationships between academic self-efficacy, educational aspirations, and academic performance. METHODS: Data from 4282 adolescents in Ghana and path analysis were used to test the causal pathways, and path invariance analysis was used to assess the moderation role of gender. Instrumental variable techniques were used to validate the path models. RESULTS: Increase in academic self-efficacy indirectly accounts for improvement in academic performance through the mediational role of educational aspirations. The effects of self-efficacy on educational aspirations, and educational aspirations were stronger for boys than for girls. CONCLUSIONS: These findings suggest that in resource-limited countries where the financial burden of schooling tends to be a demotivating factor, interventions that target adolescents' academic self-efficacy may be an effective means to boost educational aspirations and academic performance. Interventions should be tailored to meet the needs of all students so that all children can think of school as an important part of their lives and aspire to achieve, now and in the future.

Food insecurity, sexual risk taking, and sexual victimization in Ghanaian adolescents and young South African adults.

OBJECTIVES: The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16-24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender. METHODS: Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study's binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity. RESULTS: Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender. CONCLUSIONS: Our findings underscore the importance of food access on young people's sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.

Exploring the relationship between welfare participation in childhood and depression in adulthood in the United States.

OBJECTIVE: Depression is a serious mental health disorder, and untangling its causal agents is a major public health priority in the United States. This study examines the relationship between participating in welfare programs during childhood and experiencing depression during young adulthood. METHOD: This study used wave I and IV data from the Add Health (N = 15,701). Multiple imputation is used to deal with missing data. Propensity score matching is used to reduce the selection bias, and then multiple regressions were used to examine the welfare participation and depression relationships. RESULTS: Overall, young adults from welfare-recipient families reported significantly higher depression scores, rather than the clinical diagnosis of depression. Subgroup analyses showed only the poor group had significantly higher depression scores, whereas only the near-poor group had a significantly diagnosed depression outcome. Additionally, significantly higher depression scores were found for female youth from welfare-recipient families. However, no significant differences were found between the gender groups regarding diagnosed depression. DISCUSSION: Using welfare participation as an economic marker, the subgroup analyses help to identify target populations for future intervention. Implications of this study will be of interest to policy makers and have value for informing policy decisions.

Chuma na Uchizi: A Livelihood Intervention to Increase Food Security of People Living with HIV in Rural Zambia.

The objective of this study was to evaluate the impact of Chuma na Uchizi, a livelihood intervention for people living with HIV (PLHIV) in rural Eastern Province, Zambia, on food security. The intervention included cash transfers to purchase income-generating assets, access to a savings account, and life-skills training. The study employed a non-equivalent groups design to compare intervention (n = 50) and control participants (n = 51) who were receiving outpatient care from two comparable health facilities in distinct constituencies in the same geographic area. We collected data before and after implementation of the intervention. Chuma na Uchizi improved access to food. At follow-up, the intervention group reported lower food insecurity scores compared with the control group (ß = -5.65; 95% CI - 10.85 --0.45). Livelihood programs for PLHIV are practical and may be a promising approach to address food insecurity and its adverse effects.

Socioeconomic correlates of dietary diversity and its association with adherence and psychosocial functioning of people living with HIV in rural Zambia.

BACKGROUND: The intersection of nutrition and HIV underscores the importance of adequate food and a diverse diet. In communities with high prevalence of food insecurity and HIV, there is a substantial co-occurrence of low dietary diversity, undernutrition, and adverse health outcomes. AIM: The aim of this study was to identify correlates of individual dietary diversity (IDD) and its association with health outcomes for people living with HIV (PLHIV) in rural Zambia. METHODS: The study used a cross-sectional design using data from 101 PLHIV. We calculated IDD using a composite score based on dietary diversity, food frequency, and the relative nutritional importance of different food groups. Adherence was measured using the visual analog scale. Psychosocial functioning was measured using the Structural Barriers to Medication-taking Scale and the Perceived Stress Scale. Data were analyzed using linear and logistic regressions. Multiple imputation was conducted to address missing data. RESULTS: Staples were the most commonly consumed food group. Income and household size were negatively associated with IDD scores. Assets were positively associated with IDD scores. Residing in Lundazi and having a poor or fair self-rated health were associated with lower IDD scores. IDD was also associated, albeit not significant, with desirable health outcomes, including adherence and lower levels of perceived barriers to pill taking and stress. CONCLUSIONS: Findings suggest a heterogeneous effect of socioeconomic variables on IDD. Understanding this heterogeneity is important for the design of interventions. Interventions that combine opportunities to generate economic resources with food and nutrition coaching may be appropriate and effective.

Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status.

In Zambia, more people living with HIV now have access to lifesaving antiretroviral therapy than ever before. However, progress in HIV treatment and care has not always resulted in lower mortality. Adherence remains a critical barrier to treatment success. The objective of this study was to examine the barriers and facilitators of antiretroviral therapy adherence, particularly the role of household economic status. The study included a cross-sectional sample of 101 people living with HIV (PLHIV) in two rural communities in eastern Zambia. Adherence was measured using patient self-assessment and pharmacy information. Household economic status included components such as occupation, income, assets, food security, and debt. Multivariable logistic regression was conducted to examine the associations between household economic factors and adherence. Our findings suggest that the role of economic status on adherence appears to be a function of the economic component. Debt and non-farming-related occupation were consistently associated with non-adherence. The association between assets and adherence depends on the type of asset. Owning more transportation-related assets was consistently associated with non-adherence, whereas owning more livestock was associated with self-reported adherence. Additionally, living in a community with fewer economic opportunities was associated with non-adherence. The associations between place of residence and pharmacy refill adherence and between transportation assets and self-reported adherence were statistically significant. Improving adherence requires a multifaceted strategy that addresses the role of economic status as a potential barrier and facilitator. Programmes that provide economic opportunities and life-skills training may help PLHIV to overcome economic, social, and psychological barriers.

A Multilevel Conceptual Framework to Understand the Role of Food Insecurity on Antiretroviral Therapy Adherence in Low-Resource Settings: From Theory to Practice.

The objective of this study was to describe a multilevel conceptual framework to understand the role of food insecurity on antiretroviral therapy adherence. The authors illustrated an example of how they used the multilevel framework to develop an intervention for poor people living with HIV in a rural and low-resource community. The framework incorporates intrapersonal, interpersonal, and structural-level theories of understanding and changing health behaviors. The framework recognizes the role of personal, social, and environmental factors on cognition and behavior, with particular attention to ways in which treatment adherence is enabled or prevented by structural conditions, such as food insecurity.

Prevalence and Predictors of Food Insecurity among People Living with HIV Enrolled in Antiretroviral Therapy and Livelihood Programs in Two Rural Zambian Hospitals.

The objective of this study was to examine the prevalence and predictors of food insecurity among people living with HIV (PLHIV) in two rural communities in Zambia. A cross-sectional sample of 101 PLHIV was surveyed using the Household Food Insecurity Access Scale. In multivariable linear regression models, income, household possessions, and perceived coping strategies were significantly associated with decreased food insecurity. Debt and perceived mental distress were significantly associated with increased food insecurity. Programs that tackle economic disadvantage and its adverse effect on stress may be an appropriate strategy to improve food security of PLHIV in low-resource communities.

Transforming wealth: using the inverse hyperbolic sine (IHS) and splines to predict youth's math achievement.

The natural log and categorical transformations commonly applied to wealth for meeting the statistical assumptions of research may not always be appropriate for adjusting for skewness given wealth's unique properties. Finding and applying appropriate transformations is becoming increasingly important as researchers consider wealth as a predictor of well-being. We present an alternative transformation-the inverse hyperbolic sine (IHS)-for simultaneously dealing with skewness and accounting for wealth's unique properties. Using the relationship between household wealth and youth's math achievement as an example, we apply the IHS transformation to wealth data from US and Ghanaian households. We also explore non-linearity and accumulation thresholds by combining IHS transformed wealth with splines. IHS transformed wealth relates to youth's math achievement similarly when compared to categorical and natural log transformations, indicating that it is a viable alternative to other transformations commonly used in research. Non-linear relationships and accumulation thresholds emerge that predict youth's math achievement when splines are incorporated. In US households, accumulating debt relates to decreases in math achievement whereas accumulating assets relates to increases in math achievement. In Ghanaian households, accumulating assets between the 25th and 50th percentiles relates to increases in youth's math achievement.

HIV risk among young Ghanaians in high school: validation of a multidimensional attitude towards condom use scale.

Condom use remains low among sexually active youth in sub-Saharan Africa. Theoretical and empirical evidence suggests that attitudes towards condom use are important predictors of actual condom use. However, few attempts have been made to systematically develop a valid scale that measures attitudes towards condom use among youth, particularly high school students in sub-Saharan Africa. Using the health belief model, we developed an instrument that measures such attitudes. We analysed survey data collected from 6252 Ghanaian junior high school students. We assessed construct validity using confirmatory factor analysis. Results indicate that attitudes towards condom use among young Ghanaians are best represented by a multidimensional construct. Young Ghanaians differentiate constructs related to perception of benefits and barriers to condom use, as well as perception of severity and susceptibility to HIV. This instrument offers a valid tool for assessing high school students' attitudes towards condom use and their HIV risk.

Cultural and ethical issues concerning research on American Indian youth.

A study of American Indian youths illustrates competing pressures between research and ethics. A stakeholder-researcher team developed three plans to protect participants. The first allowed participants to skip potentially upsetting interview sections. The second called for participants to skip potentially upsetting interview sections. The second called for participants flagged for abuse or suicidality to receive referrals, emergency 24-hr clinical backup, or both. The third, based on the community's desire to promote service access, included giving participants a list of service resources. Interviewers gave referrals to participants flagged as having mild problems, and reported participants with serious problems to supervisors for clinical backup. Participants seldom chose to skip sections, so data integrity was not compromised. However, participants did have more problems than expected (e.g., 1 in 3 had thought about suicide, 1 in 5 had attempted suicide, and 1 in 4 reported abuse), so service agencies were not equipped to respond. Researchers must accept the competing pressures and find ethically appropriate compromises that will not undermine research integrity.