Skin cancer risk behaviors in sexual minority men: A mixed methods approach.

OBJECTIVE: Sexual minority men experience disproportionately elevated rates of skin cancers, likely driven by excess ultraviolet radiation exposure-namely through tanning behaviors. However, limited integrated theoretical models exist to explain sexual minority men's elevated skin cancer risk. The aim of the current study is to further test and refine an integrated theory of skin cancer risk behaviors among sexual minority men by incorporating minority stress into the integrated health behavior model of tanning. METHOD: The study employed a parallel mixed methods design, with a Phase 1 qualitative stage (N = 30) and a Phase 2 quantitative stage (Model 1: N = 320; Model 2: N = 319). In both phases, participants were sexual minority men, equally stratified as those with versus without recent tanning exposure and were recruited from across the United States. RESULTS: Qualitative and quantitative data supported the overall integrated model, with some quantitative paths varying depending on the tanning behavior outcome. Overall, appearance-related motives to tan and beliefs that tanning regulates affect emerged as the most consistent proximal predictors. Minority stress significantly predicted holding more positive attitudes toward tanning as an effective affect regulation strategy. CONCLUSIONS: The results from this mixed methods study support the inclusion of minority stressors into the adapted integrative health behavior model of tanning. Replication within prospective designs would strengthen the evidence for this model, which may be helpful in guiding future skin cancer prevention programs tailored to sexual minority men. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interpersonal and Community-Level Influences Across the PrEP Cascade Among Young Adult Latinx Men who Have Sex with Men Living in a US-Mexico Border Region: A Qualitative Study.

Latinx men who have sex with men (MSM) are an at-risk population for new HIV diagnoses. Pre-exposure prophylaxis (PrEP) is a suite of biomedical approaches to prevent HIV infection. Latinx MSM are less likely to take PrEP compared to non-Latinx White MSM. This qualitative study identified interpersonal- and community-level barriers and facilitators of PrEP among young adult Latinx MSM. Using stratified purposeful sampling, 27 Latinx men, ages 19-29 years and living in a US-Mexico border region, completed self-report demographic surveys and participated in semi-structured in-depth interviews assessing barriers and facilitators to PrEP. Directed content analysis was used to identify both a priori and emerging themes. Most participants reported that other people, including peers, friends, partners, and health care providers were both supportive and discouraging of PrEP use. Participants' intersectional identities as members of both Latinx and LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer) communities both hindered and facilitated PrEP use.

Open to interpretation: An integrated primary care behavioral health training approach for treating linguistically diverse patients.

INTRODUCTION: Integrated primary care settings serve an increasingly high volume of linguistically diverse patients. In English language-dominant countries, limited English proficiency (LEP) is associated with disparities in access and quality of behavioral health (BH) care. Interpretive services (IS) aim to address these disparities by assisting in the delivery of clinical care between patients and providers who speak different languages. Yet, there is a need for greater emphasis on the utilization of IS in clinical training for BH professionals (e.g., psychology, social work, counseling, and family therapy). METHOD: In this conceptual article, we describe a BH practicum rotation for predoctoral psychology trainees in a free, student-run integrated primary care clinic that largely serves uninsured adults with LEP. First, we discuss our training model which includes a 90-min didactic lecture on IS for BH and supervised applied clinical experiences (e.g., psychotherapy, warm handoffs, and consultation). Then, we present vignettes prepared by trainees about the challenges and benefits associated with delivering BH care with IS at the predoctoral level of training. RESULTS: From the practicum experience, clinical psychology trainees reported improved knowledge and competencies in utilizing IS as well as generalizable skills for delivering BH care with a focus on multicultural practice. DISCUSSION: We recommend that other integrated primary care BH training sites consider emphasizing training in IS. This article concludes with recommendations for implementation and dissemination of our training model on other sites. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of remotely-delivered physical activity education on exercise beliefs and intentions of active and nonactive cancer survivors and their partners.

Physical activity (PA) is recommended for cancer survivors and their romantic partners yet cancer couples may be unaware of the benefits of PA specific to them. Exercise interventions targeting survivors and partners simultaneously may prove effective at increasing exercise knowledge, intentions, and outcomes. To examine the effects of a remotely-delivered cancer-specific exercise education video on cancer survivors' and their partners' exercise knowledge, beliefs, and intentions. Cancer survivors (N = 209) and their romantic partners (N = 155) completed an online survey with an embedded education video randomized to half the sample. Group differences (education vs. control) on study constructs among the whole sample and on a subset of the sample not meeting exercise guidelines [i.e., less than 150 min of moderate to vigorous physical activity (MVPA) per week; 50.5% survivors, 45.1% partners] were examined. Group differences on study constructs were also tested between survivors and partners meeting exercise guidelines or not. Survivors and partners in the education condition were more likely to correctly report the MVPA guidelines. The education increased survivors' personal exercise importance, outcome expectations, and likelihood of joining an individual exercise program. Participants meeting guidelines were significantly different on multiple exercise beliefs compared to those who were not. Among those not meeting guidelines, the education increased survivors' belief in the importance of exercising with their partner. A remotely-delivered exercise education video increased exercise knowledge and beliefs, which represents an important step in the development of couples' exercise interventions for cancer survivors and their romantic partners.

Exercise, defined as intentional physical activity, is recommended for cancer survivors and their romantic partners. However, few know the specific benefits of exercise following a cancer diagnosis. Theories of health behavior change suggest that access to information may influence individuals' valued importance of and intentions for a health practice. This work tested if an online video about cancer-specific exercise benefits could modify cancer survivors' and their romantic partners' exercise knowledge and beliefs. Cancer survivors and their romantic partners individually completed an online survey. The educational video was randomly embedded into the survey for half of participants. Survivors and partners who received the educational video were more likely to correctly report established exercise guidelines compared to those who did not get the video. The educational video also increased survivors' personal exercise importance, outcome expectations for exercise, and likelihood of joining an individual exercise program. Among survivors who were less active than the recommended guidelines, the educational video increased their importance of exercising with their partner. This research shows that an online video about exercise after cancer increased both survivors' and their partners' exercise knowledge as well as survivors' exercise beliefs and intentions to take part in an exercise program.

Psychometric Properties of a Scale on Judgmental Communication with Peers About Sex Among YMSM and Their Close Friends in Lebanon.

We are not aware of any validated sexual health communication scales for use with young men who have sex with men (YMSM). We used data from an HIV prevention study in Lebanon with 226 YMSM aged 18-29 to assess the psychometric characteristics of our scale, Judgmental Communication with Peers about Sex (JCPS). The construct validity of the JCPS scale was supported by it being negatively correlated with general social support, percentage of alters perceived to be supportive, and the percentage of peers who are perceived to use condoms. The scale was positively correlated with gay-related discrimination, feeling part of the gay community, and gay social integration. These findings reflect a reliable, valid measure to assess judgmental sexual health communication between YMSM.

Pilot randomised controlled trial of a patient navigation intervention to enhance engagement in the PrEP continuum among young Latino MSM: a protocol paper.

INTRODUCTION: Men who have sex with men (MSM) are one of the most at-risk group for contracting HIV in the USA. However, the HIV epidemic impacts some groups of MSM disproportionately. Latino MSM comprise 25.1% of new HIV infections among MSM between the ages of 13 and 29 years. The daily medication tenofovir/emtricitabine was approved by the Food and Drug Administration for pre-exposure prophylaxis (PrEP) in 2012 and has demonstrated strong efficacy in reducing HIV acquisition. METHODS AND ANALYSIS: Through extensive formative research, this study uses a pilot randomised controlled trial design and will examine the feasibility and acceptability of a patient navigation intervention designed to address multiple barriers to improve engagement in the PrEP continuum among 60 Latino MSM between the ages of 18 and 29 years. The patient navigation intervention will be compared with usual care plus written information to evaluate the feasibility and acceptability of the intervention and study methods and the intervention's potential in improving PrEP continuum behaviours. The results will be reviewed for preparation for a future full-scale efficacy trial. ETHICS AND DISSEMINATION: This study was approved by the institutional review board at San Diego State University and is registered at ClinicalTrials.gov. The intervention development process, plan and the results of this study will be shared through peer-reviewed journal publications, conference presentations and healthcare system and community presentations. REGISTRATION DETAILS: Registered under the National Institutes of Health's ClinicalTrials.gov (NCT04048382) on 7 August 2019 and approved by the San Diego State University (HS-2017-0187) institutional review board. This study began on 5 August 2019 and is estimated to continue through 31 March 2021. The clinical trial is in the pre-results stage.

Motivation for Physical Activity among U.S. Adolescents: A Self-Determination Theory Perspective.

BACKGROUND: Promoting adolescent physical activity is crucial as this marks a time when physical activity rates decline. PURPOSE: This study examined motivation for physical activity from a self-determination theory (SDT) perspective in a large sample of adolescents in the USA across three settings: in school, out of school, and on weekends. METHODS: Participants (N = 1,661) were adolescents from the National Cancer Institute's Family Life, Activity, Sun, Health, and Eating study. Participants had a mean age of 14.47 (standard deviation = 1.61) and were 50.2% female. In this national sample balanced to match the U.S. population on several key demographics, 64.2% were non-Hispanic White. Analyses included three linear regression models in which estimated weekly minutes of moderate-to-vigorous physical activity (MVPA) in school, out of school, and on weekends were entered as dependent variables. Five forms of motivation (intrinsic, integrated, identified, introjected, and external) were entered simultaneously as independent variables. Age, body mass index, gender, and race/ethnicity were also included as covariates. RESULTS: All models were significant. For MVPA in school, external regulation, introjected regulation, identified regulation, and intrinsic motivation were positively associated with MVPA. For MVPA out of school, external regulation, introjected regulation, identified regulation, integrated regulation, and intrinsic motivation were positively associated with MVPA. For MVPA on weekends, integrated regulation, and intrinsic motivation were positively associated with MVPA. CONCLUSIONS: The relationship between motivation and MVPA varies across settings. These findings have important implications for motivating adolescents to engage in physical activity and may inform future interventions aimed at increasing physical activity.

Body image and condomless anal sex among Young Latino sexual minority men.

OBJECTIVE: To investigate body image and condomless anal sex (CAS) among young Latino sexual minority men (SMM)-a population with health disparities in HIV and body image concerns. METHODS: Participants were 151 young Latino SMM from the San Diego area who were HIV-negative or unknown. Participants completed a questionnaire online in either English or Spanish, which included body image and sexual behavior items. A binary CAS variable was created based on the number of CAS partners reported (0 vs 1 + over past 3 months). A logistic regression was conducted with body dissatisfaction, appearance investment, and their interaction term entered as predictor variables and CAS as the outcome. RESULTS: Of 151 participants, 54 (35.8%) reported no CAS in the past 3 months. Appearance investment, but not body dissatisfaction, was associated with higher odds of CAS. However, a significant interaction indicated that body dissatisfaction was associated with higher odds of CAS when appearance investment was high. CONCLUSIONS: Young Latino SMM who are highly invested in, and dissatisfied with, their appearance may be at significantly increased risk for acquiring HIV through elevated odds of CAS. Reducing appearance concerns in this population may lead to reductions in HIV risk behaviors.

Organizational Religious Activity, Hypertension, and Sexual Orientation: Results From a Nationally Representative Sample.

Background: Hypertension is a major public health concern, given prevalence and morbidity. Among the general population, greater religious attendance is associated with lower blood pressure (BP). However, no known studies have examined the association between religious attendance and BP among sexual minorities. Purpose: To examine the association between BP/hypertension and organizational religious activity as a function of sexual orientation. Methods: Data were utilized from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a publicly available, U.S. nationally representative data set. Of the 4,874 individuals included in analyses, 366 participants were identified as a sexual minority. An organizational religious activity variable was created by summing responses of two separate items. BP was measured as systolic blood pressure (SBP) and diastolic blood pressure (DBP). Increasing levels of clinical severity of hypertension were also examined. Relevant covariates were controlled for in two separate models. Significant interactions between religious attendance and sexual orientation were explored in simple slope analyses. Results: Overall, results indicated that sexual orientation moderated the association between organizational religious activity, and BP/hypertension. Crossover interactions were present for the dependent variables SBP, DBP, and prehypertension and higher (prehypertension, and hypertension 1 and 2). Generally, a negative association between organizational religious activity and hypertension was revealed among the heterosexual group, whereas a positive association was found among the sexual minority group. Conclusions: Organizational religious activity is differentially associated with BP/hypertension among sexual minority versus heterosexual individuals. Organizational religious activity may represent a risk factor for hypertension among sexual minority individuals.

Mechanism of Change in Cognitive Behavioral Therapy for Body Image and Self-Care on ART Adherence Among Sexual Minority Men Living with HIV.

Body image disturbance is a common problem reported among sexual minority men living with HIV, and is associated with poor antiretroviral therapy (ART) adherence. Recently, a novel integrated intervention (cognitive behavioral therapy for body image and self-care; CBT-BISC) was developed and pilot tested to simultaneously improve body image and ART adherence in this population. Although CBT-BISC has demonstrated preliminary efficacy in improving ART adherence, the mechanisms of change are unknown. Utilizing data from a two-armed randomized controlled trial (N = 44 sexual minority men living with HIV), comparing CBT-BISC to an enhanced treatment as usual (ETAU) condition, sequential process mediation via latent difference scores was assessed, with changes in body image disturbance entered as the mechanism between treatment condition and changes in ART adherence. Participants assigned to CBT-BISC reported statistically significant reductions in body image disturbance post-intervention, which subsequently predicted changes in ART adherence from post-intervention to long term follow-up (b = 20.01, SE = 9.11, t = 2.19, p = 0.028). One pathway in which CBT-BISC positively impacts ART adherence is through reductions in body image disturbance. Body image disturbance represents one, of likely several, mechanism that prospectively predicts ART adherence among sexual minority men living with HIV.

Current and ideal skin tone: Associations with tanning behavior among sexual minority men.

Sexual minority men have high rates of skin cancer, yet little is known about skin cancer risk behaviors in this population. It was hypothesized that current skin tone would moderate the association between darker ideals and tanning behaviors. Data were collected online from 231 sexual minority men in San Diego, United States of America, with a mean age of 24.66 (SD = 5.44). Ideal and current skin tone ratings and indoor and outdoor tanning behaviors were assessed. Darker ideals were significantly associated with increased indoor and outdoor tanning. The effect of darker ideals on tanning was strongest among individuals with lighter current skin tone, indicating a significant interaction. Sexual minority men whose perceived skin tone did not match their ideal were more likely to engage in skin cancer risk behaviors. Future skin cancer prevention programs aimed at sexual minority men may consider techniques that modify ideal skin tone internalization.

A Randomized Controlled Trial of Rise, a Community-Based Culturally Congruent Adherence Intervention for Black Americans Living with HIV.

BACKGROUND: Evidence-based HIV treatment adherence interventions have typically shown medium-sized effects on adherence. Prior evidence-based HIV treatment adherence interventions have not been culturally adapted specifically for Black/African Americans, the population most affected by HIV disparities in the USA, who exhibit lower adherence than do members of other racial/ethnic groups. PURPOSE: We conducted a randomized controlled trial of Rise, a 6-month culturally congruent adherence counseling intervention for HIV-positive Black men and women. METHODS: Rise was delivered by a trained peer counselor who used a problem-solving approach to address culturally congruent adherence barriers (e.g., medical mistrust, HIV stigma) and assisted with linkage to supportive services. A total of 215 participants were randomized to the intervention group (n = 107) or a wait-list control group (n = 108). Adherence was assessed daily via electronic monitoring. RESULTS: In a repeated measures multivariate logistic regression model of dichotomous adherence (using a clinically significant cutoff of 85% of doses taken), adjusted for sociodemographic and medical covariates, adherence in the intervention group improved over time relative to the control group, (OR = 1.30 per month (95% CI = 1.12-1.51), p < 0.001), representing a large cumulative effect after 6 months (OR = 4.76, Cohen's d = 0.86). CONCLUSIONS: Rise showed a larger effect on adherence than prior HIV adherence intervention studies. For greater effectiveness, interventions to improve adherence among Black people living with HIV may need to be customized to address culturally relevant barriers to adherence. ( ClinicalTrials.gov #NCT01350544).

Dissemination as Dialogue: Building Trust and Sharing Research Findings Through Community Engagement.

A fundamental feature of community-based participatory research (CBPR) is sharing findings with community members and engaging community partners in the dissemination process. To be truly collaborative, dissemination should involve community members in a two-way dialogue about new research findings. Yet little literature describes how to engage communities in dialogue about research findings, especially with historically marginalized communities where mistrust of researchers may exist because of past or present social injustices. Through a series of interactive community presentations on findings from a longitudinal study, we developed a process for community dissemination that involved several overlapping phases: planning, outreach, content development, interactive presentations, and follow-up. Through this process, we built on existing and new community relationships. Following each interactive presentation, the research team debriefed and reviewed notes to identify lessons learned from the process. Key themes included the importance of creating a flexible dissemination plan, tailoring presentations to each community group, establishing a point person to serve as a community liaison, and continuing dialogue with community members after the presentations. Core strategies for developing trust during dissemination included engaging community members at every step, reserving ample time for discussion during presentations, building rapport by sharing personal experiences, being receptive to and learning from criticism, and implementing input from community members. This process led to a deeper understanding of research findings and ensured that results reached community members who were invested in them.

Getting PrEPared for HIV Prevention Navigation: Young Black Gay Men Talk About HIV Prevention in the Biomedical Era.

Biomedical HIV prevention strategies, such as pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), represent new opportunities to reduce critically high HIV infection rates among young black men who have sex with men (YBMSM). We report results of 24 dyadic qualitative interviews (N=48), conducted in Los Angeles, CA, exploring how YBMSM and their friends view PrEP and PEP. Interviews were analyzed using a grounded theory approach. Participants had widely divergent levels of knowledge about these prevention methods. Misconceptions and mistrust regarding PrEP were common, and concerns were expressed about PrEP-related stigma and the potential for gossip among peers who might assume a person on PrEP was HIV-positive. Yet participants also framed PrEP and PEP as valuable new options within an expanded "tool kit" of HIV prevention strategies that created possibilities for preventing new HIV infections, dating men with a different HIV status, and decreased anxiety about exposure to HIV. We organized themes around four main areas: (1) information and misinformation about biomedical HIV prevention; (2) expectations about PrEP, sexual behavior, and stigma; (3) gossip, disclosure, and "spreading the word" about PrEP and PEP; and (4) the roles of PrEP and PEP in an expanded HIV prevention tool kit. The findings suggest a need for guidance in navigating the increasingly complex array of HIV-prevention options available to YBMSM. Such "prevention navigation" could counter misconceptions and address barriers, such as stigma and mistrust, while helping YBMSM make informed selections from among expanded HIV prevention options.