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.

Motivations for Prescription Drug Misuse Related to Mental Health Problems in Adults.

BACKGROUND: Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms. OBJECTIVES: This project investigates the connections between PDM motivations and mental health to inform intervention efforts. METHODS: Using nationally representative adult data from the 2016-2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics. RESULTS: Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to "relax or relieve tension" were more likely to have all categories of mental health problems. Those that misused prescription stimulants to "help study" had lower odds of all mental health problems. CONCLUSIONS: While there were differences based on prescription drug class, a range of motivations increased adults' likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.

Parenting stress predicts longitudinal change in parental involvement among mothers living with HIV.

Mothers living with HIV (MLH) face unique challenges that may compound parenting stress and impede effective parenting practices. Among the general population, research has demonstrated bidirectional longitudinal relations between parenting stress and parenting practices; yet, despite the additional stressors faced by MLH, these processes have not been examined longitudinally in this population. Utilizing the process model of parenting, the present study examined the longitudinal relations between parenting stress and parental involvement among a sample of MLH with children aged 6-14 years (N = 174). MLH completed self-report measures on their parenting stress and parental involvement at four timepoints spanning 15 months. Latent change score modeling was employed to examine how changes in parenting stress and changes in parental involvement were related across time. Results revealed that increases in parenting stress-specifically distress within the parental role-predicted subsequent decreases in parental involvement. The effects were unidirectional; parental involvement did not predict subsequent changes in parenting stress. Other aspects of parenting stress (perceptions of dysfunctional parent-child interactions and perceptions of the child's temperament as difficult) did not have significant longitudinal associations with changes in parental involvement. Results highlight the central role of parenting stress for MLH as a potential driving factor of parenting quality. Beyond supporting the use of effective parenting skills, clinical prevention and intervention efforts with families affected by HIV should also incorporate stress reduction techniques to increase MLH's capacity for active parental involvement and thereby support positive outcomes for their children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal Bidirectional Relations among Parenting Quality, Parenting Stress, and Child Functioning in HIV-affected Families.

Mothers living with HIV (MLH) face unique stressors impacting parenting, parenting stress, and child psychosocial functioning, but longitudinal, bidirectional relations among family processes have not been examined in this population. This study examined relations among parenting quality, parenting stress, and child functioning in 174 MLH-child dyads (aged 6-14, Mage = 9.65, SD = 2.49; 51% female; 57% Black/African American; 35% Latinx). Families completed self-report questionnaires over four waves spanning 15 months. Cross-lagged panel analysis revealed unidirectional and bidirectional relations between parenting stress and child functioning; parenting quality and child functioning; and parenting quality and parenting stress. The findings suggest that prevention and intervention efforts with HIV-affected families should target both parent factors (e.g., communication skills) and child factors (e.g., emotion regulation), emphasizing parenting stress reduction in order to bolster family outcomes.

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).

A Mixed-Methods Longitudinal Investigation of Mothers' Disclosure of HIV to Their Children.

Mothers living with HIV (MLH) must navigate disclosing their serostatus to their children, but the longitudinal impact on families remains unknown. This study examined HIV disclosure, parenting, parenting stress, and child adjustment among 174 MLH-child dyads (aged 6-14; 35% Latinx; 57% Black/African American). Quantitative data were collected over four waves spanning 15 months. Qualitative data were collected with 14 families in which disclosure had occurred. Latent change score modeling revealed that disclosure led to improvements in parenting stress, communication, and relationship quality. Disclosure did not predict child adjustment. Qualitative themes contextualized these findings, revealing stability and improvements in family functioning. MLH should be supported in disclosing their serostatus to their children to minimize parenting stress and bolster parenting skills.

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.

Presumed structural and functional neural recovery after long-term abstinence from cocaine in male military veterans.

Cumulative evidence suggests that cocaine use could alter the structure and function of different brain systems. However, the extent to which the altered brain structure and function possibly recover over time after cocaine abstinence remains less clear. The present study examines 39 male military veterans with different stages of cocaine addiction and long-term abstinence (from 1 year up to 30 years) and evaluates plausible changes in brain structure and function of specific brain regions that sub-serve addictions. These include the striatum that is involved in cocaine reward; the lateral prefrontal cortex (especially the dorsolateral PFC) that plays a major role in inhibitory control; the insula, which has been implicated in craving; and the medial orbitofrontal (OFC) and ventromedial prefrontal cortex (VMPFC) shown to play key roles in foresight and decision-making. The results suggest that there are differences in both brain structure (gray matter volume, GMV) and function between cocaine USERS and CONTROLS, with USERS showing plausible relative strengthening in neural systems for processing reward and craving, and relative weakening in neural systems involved in inhibitory control and decision-making. Examination of possible neural changes after abstinence suggests that presumed recovery occurs mostly in neural systems related to reward, craving, and inhibitory control, but to a lesser extent in neural systems related to decision-making. Given the limitations of the data in terms of a small sample size, as well as the lack of certainty about occasional use in the abstinent group, these results may be considered as preliminary. However, they are compelling in that they suggest that male military veterans cocaine USERS are indefinitely at a higher risk compared to CONTROLS for making lapses in judgment and decision-making leading to possible relapse, if reward salience and craving become more intense. Understanding the neurobiology of long-term cocaine abstinence in vulnerable populations and beyond could help devising better therapeutic strategies that prevent relapse.

Does Maternal HIV Disclosure Self-Efficacy Enhance Parent-Child Relationships and Child Adjustment?

Nondisclosure of maternal HIV status to young children can negatively impact child functioning; however, many mothers do not disclose due to lack of self-efficacy for the disclosure process. This study examines demographic variations in disclosure self-efficacy, regardless of intention to disclose, and assesses the relationship between self-efficacy and child adjustment via the parent-child relationship among a sample of HIV+ mothers and their healthy children (N = 181 pairs). Mothers completed demographic and self-efficacy measures; children completed measures assessing the parent-child relationship and child adjustment (i.e., worry, self-concept, depression). Across demographics, few mothers reported confidence in disclosure. Results from covariance structural modeling showed mothers endorsing higher self-efficacy had children who reported better relationship quality, and, in turn, reported fewer adjustment difficulties; higher levels of disclosure self-efficacy also directly predicted fewer adjustment problems. Findings offer support for interventions aimed at providing mothers with skills to enhance confidence for disclosing their HIV status.

Adolescent substance use: Latent class and transition analysis.

BACKGROUND: The prevention and intervention of adolescent substance use is a public health priority. Most adolescents will engage in some form of substance use, and a sizeable minority will transition to using multiple substances. An emerging body of research takes a person-centered approach to model adolescent substance use over time; however, the findings have been equivocal. Our study modeled adolescent substance use transition patterns over three years based on a comprehensive list of substances and examined gender as a moderator. METHODS: We used three annual waves of data (Time 2, Time 3, and Time 4) from an ongoing longitudinal study of an ethnically diverse sample of 1042 adolescents originally recruited from multiple high schools in southeast Texas. Participants were 56% female, 32% Hispanics, 30% Whites, 29% African Americans, and 9% other with an average of 16.1years (SD=0.79) at Time 2. Data were analyzed using latent transition analyses. RESULTS: The study identified three substance use statuses (Mild Alcohol Use, Alcohol and Moderate Marijuana Use, and Polysubstance Use) and suggested that adolescents generally remained in the same statuses over time. When they did transition, it was typically to a more harmful substance use status. Further, males were more likely than females to be polysubstance users and had higher probabilities of transiting to and remaining in a more harmful drug use status. CONCLUSIONS: The study identifies overall and gender specific adolescent substance use transition patterns, which are vital to informing intervention development.

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.

Technological aids for improving longitudinal research on substance use disorders.

BACKGROUND: There is a broad consensus that addictive behaviors tend to be chronic and relapsing. But for field studies of substance users, successfully tracking, locating, and following up with a representative sample of subjects is a challenge. METHODS: The purpose of this paper is to provide a general overview of how current technological aids can support and improve the quality of longitudinal research on substance use disorders. The review is grouped into four domains: (1) tracking and locating, (2) prompting/engaging, (3) incentivizing, and (4) collecting data. RESULTS & CONCLUSIONS: Although the technologies described in this review will be modified or replaced over time, our findings suggest that incorporating some or all of these currently available approaches may improve research efficiency, follow-up rates, and data quality.

A Smartphone Application Supporting Recovery from Heroin Addiction: Perspectives of Patients and Providers in China, Taiwan, and the USA.

Smartphone-based interventions are increasingly used to support self-monitoring, self-management, and treatment and medication compliance in order to improve overall functioning and well-being. In attempting to develop a smartphone application (S-Health) that assists heroin-dependent patients in recovery, a series of focus groups (72 patients, 22 providers) were conducted in China, Taiwan, and the USA to obtain their perspectives on its acceptance and potential adoption. Data were analyzed according to the Diffusion of Innovation (DOI) theory of characteristics important to the adoption of innovation. Important to Relative Advantage, USA participants cited S-Health's potential ability to overcome logistical barriers, while those in China and Taiwan valued its potential to supplement currently limited services. In terms of Compatibility, participants across sites reported recovery needs and goals that such an application could be helpful in supporting; however, its utility during strong craving was questioned in China and Taiwan. Important factors relevant to Complexity included concerns about smartphone access and familiarity, individualization of content, and particularly in China and Taiwan, participants wanted assurance of privacy and security. The study results suggest a general acceptance, but also indicate cultural variations in access to therapeutic and other social support systems, legal repercussions of substance use, societal perceptions of addiction, and the role of family and other social support in recovery. Taking these factors into consideration is likely to increase diffusion as well as effectiveness of these smartphone-based interventions.

Maternal mental health and children's internalizing and externalizing behaviors: Beyond maternal substance use disorders.

Maternal substance abuse and mental disorders can have adverse impacts on child development. We investigated the impact of maternal mental health on child behaviors based on a long-term follow-up study of mothers and their children approximately 10 years after mothers' admission to drug abuse treatment. Mothers (n=396) were assessed at admission to drug treatment during 2000 to 2002, and at follow-up in 2010-2011. At follow-up, each mother was asked to assess one target child using the Child Behavior Checklist for ages 6-18 (CBCL). Mothers' mental disorder diagnoses were obtained from records maintained by the California Department of Mental Health in 2009. About 46% of mothers had comorbid mental disorders; 27% had depressive disorder, 15% bipolar disorder, 15% adjustment disorder, 13% anxiety disorder, and 6% psychotic disorder. Of these mothers, more than half had two or more mental disorder diagnoses. The average age of the target child was approximately 10 years old (range 6 to 17). Relative to children of mothers without comorbid mental disorders, children were more likely to demonstrate internalizing behaviors if their mothers had comorbid depression/anxiety disorders (OR=2.0, 95%CI:1.0-4.0) or severe mental disorders (psychoses, bipolar) (OR=3.4, 95%CI:1.5-7.6). For externalizing behaviors, family problems was the only significant predictor (OR=3.2, 95%CI:1.7-6.0 for children of mothers with depression/anxiety disorders, OR=3.9, 95%CI:1.9-7.8 for severe mental disorders). Addressing maternal mental disorders (particularly severe mental disorders) and family problems are important for child well-being as these factors were significantly related to emotional and problem behaviors of children.

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.