Association of ART regimen and adherence to viral suppression: an observational study of a clinical population of people with HIV.

Adherence to antiretroviral therapy (ART) is essential for the effective management of HIV, which includes keeping the HIV viral load undetectable. This study aimed to determine whether certain ART medications are more "forgiving" of poor adherence in achieving viral suppression. We identified subgroups of ART medication usage and determined the extent to which ART adherence is associated with viral suppression across those subgroups. Data came from claims and clinical records (2017-2019) of 3,552 HIV-positive adult members of a Medicaid managed care plan. Pharmacy fill data were examined to characterize ART medications using latent class analysis (LCA), which captures the complexity of real-world ART usage (i.e., multiple medications, ART switching). LCA yielded five ART medication patterns over three years, mostly characterized by recent medications and formulations of ART, though they varied in number of tablets and in medication class. Mixed effects logistic regression models were estimated to determine whether odds of viral suppression differed by ART adherence level. After adjusting for covariates, those with at least 90% adherence (i.e., 90 to < 95%) did not significantly differ from those with 95% adherence or greater in terms of viral suppression, which corroborates existing clinical recommendations. These findings can inform provider-patient communication for people with HIV, especially those who have difficulty maintaining adherence. This includes those experiencing unstable housing, mental health conditions, or substance use.

Intersectionality Can Shape the Support Networks of Older Women with HIV.

Older women living with HIV are an especially vulnerable population due to their experience of multiple stigmas resulting from intersectional identities. Using an intersectional convoy model to conceptualize social relations, we consider how HIV-related stigma, age, gender, race/ethnicity, and socioeconomic position shape access to support resources through personal networks. We briefly review existing research on how intersecting identities and structural inequities might influence the structure, composition, and function of support networks among older people with HIV. Potential applications of the intersectional convoy model and implications for research and practice are discussed.

Beyond the Nuclear Family: Children's Social Networks and Depressive Symptomology.

This study identified social network profiles among children, determined whether profiles vary across sociodemographic characteristics, and investigated links between childhood profiles and depressive symptomology using three waves of data spanning 23 years (Wave 1, 1992 Metro-Detroit representative sample: n = 193, ages 8-12). Latent profile analysis revealed three profiles: Close Family (22%), Varied Family (57%), Friend and Family (21%). White children were more likely than Black children to be in the Friend and Family profile. Children in the Close Family profile reported the lowest levels of depressive symptomology in childhood, but exhibited the steepest increase over time. Findings suggest that close, family centric networks are protective in childhood, but less so as children develop into adulthood, highlighting the importance of considering developmental perspectives.

Gender-based stigma and the prevention and treatment of HIV/AIDS among older women: A scoping review protocol.

INTRODUCTION: The population of women aged 50 years and older living with HIV is increasing. Older women face unique challenges in the prevention and management of HIV; however, they are often under engaged in HIV/AIDS research. One such challenge is gender-based stigma, which can be manifested through harmful gendered stereotypes, discrimination, prejudice, and sexism that could potentially hinder HIV care engagement among this population. We propose a scoping review to identify and synthesize evidence pertaining to how experiences of gender-based stigma impacts HIV prevention and care among older women. MATERIALS AND METHODS: We will use the framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) to conduct this scoping review. We will search MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus for empirical literature published between January 1981 and the date of search commencement. Supplementary screening will be conducted using backwards citation chaining of the final list of included full-text articles. Two reviewers will independently screen all titles and abstracts for articles that meet the predetermined inclusion criteria. Two reviewers will also screen full-text articles and chart data using a standardized data collection form. RESULTS: We will synthesize the findings through tables, charts, and narrative summaries. We will also identify gaps in the current literature and provide recommendations for future research. Findings will be shared at conferences and submitted to a peer-reviewed publication. DISCUSSION: To our knowledge, this will be the first scoping review to examine gender-based stigma in relation to HIV prevention and care among older women. We anticipate that our results will be of interest to older women living with HIV, healthcare providers, policy makers, and community activists working to improve quality of life and care experiences for older women living with HIV.

Interconnected social convoys: Understanding health and well-being through linked personal networks.

The convoy model of social relations describes how social relationships contribute to an individual's health and well-being from a life course and lifespan perspective. In large part, this model focuses on the unique, personal experiences of an individual, without due consideration of the reciprocal and shared relationships among those whose lives are inextricably linked. Here, we extend the convoy model to directly integrate Elder's concept of linked lives by considering the composition, structure, and function of linked personal networks, or social convoys, among close others, and the important implications of these network characteristics on the health of all involved. We illustrate this extension within the context of family, one of the most pivotal social contexts that can shape an individual's life course. Features of interconnected social convoys can help improve our understanding of how social ties shape and are shaped by life events not just for individuals, but for larger units of inquiry - such as, couples, parent-child triads, and nuclear families. Importantly, the interconnected convoy includes both family and non-family ties, providing a framework that considers how peoples' social spheres are linked as they jointly experience shared situations. Using informal caregiving as an example, we highlight the advantages that interconnected convoys bring to the concept of linked lives and provide direction on how this framework can advance our understanding of how social relationships influence either directly or indirectly health and well-being of individuals and families across the life course.

Taking Charge: Social Support Dynamics among Older Adults and Their Significant Others in COVID-19 Vaccination and Mitigation Efforts.

Older people have been disproportionately affected by the COVID-19 pandemic and are often portrayed as passive victims of this global health crisis. However, older adults do take responsibility for their own health and that of others in large part through social network dynamics. The purpose of this study was to understand the processes whereby older adults' social networks shape their own health behaviors, and vice versa, in the context of COVID-19 vaccination and other mitigation efforts. Qualitative data from 77 older adults between ages 65 and 94 obtained through focus groups or individual interview participants were analyzed. Participant narratives demonstrated the reciprocal nature of social support and health behaviors and provided evidence that COVID-19-related health behaviors in this population were motivated by social support, altruism, and life experience. These findings emphasize older adults' active role as health promoters in their families and communities, keeping themselves and their significant others safe from COVID infection. Implications for the role of older adults in community health promotion efforts are discussed.

Development of social convoys: Trajectories of convoy structure and composition from childhood through adulthood.

Personal networks undergo changes in structure and composition throughout the life span, adapting to developmental transitions and changing circumstances in a dynamic way. This study examines stability and change in social convoys from childhood to adulthood and variation in trajectories of convoy characteristics by gender and race. Multilevel models for convoy structure and composition characteristics were estimated using three waves of longitudinal data spanning 23 years. The regionally representative sample included 193 children aged 8 to 12 in Wave 1 (1992) who were surveyed again in their 20s (Wave 2) and 30s (Wave 3). The Wave 1 sample comprised 52% girls, 32% Black children, and 59% White children with average maternal educational attainment of 13 years. Overall, changes in composition, proximity, and contact frequency were observed at each wave. Between Waves 1 and 2, the changes reflect age-normative trends toward network diversification typical of the transition to adulthood, whereas between Waves 2 and 3, the changes were consistent with those expected as young adults settle into stable roles. We also identified convoy characteristics that differed between men and women and between Black and White individuals, emphasizing the importance of considering personal characteristics to fully understand form and function of social relations. Social convoy trajectories early in the life span provide direction for more in-depth examinations of the implications of social ties during these critical life periods. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Stress, coping, and positive aspects of caregiving among caregivers of children with rare disease.

OBJECTIVE: Caregivers of children with rare diseases often consider caregiving to be a rewarding experience, despite high levels of burden. The present study examined associations between caregiver stress and positive aspects of caregiving (PAC); investigated associations between interpersonal coping strategies and PAC; and determined whether coping strategies moderated associations between stressors and PAC. DESIGN: Survey data came from a study on caregivers across different caregiving conditions, including caregivers of children diagnosed with inherited metabolic conditions (n = 167), undiagnosed diseases (n = 23), and caregivers of typically-developing children (n = 74). MAIN OUTCOME MEASURES: Positive Aspects of Caregiving (PAC) scale. RESULTS: Results from generalized linear models indicated that perceived burden was not associated with PAC. Venting was negatively associated with PAC (b= -0.09, p=.03), whereas emotional support was associated with increased PAC for caregivers of children with undiagnosed conditions (b = 0.15, p=.02). Care needs were associated with greater PAC among caregivers engaged in high levels of emotional support coping (b = 0.10, p=.01) and venting (b = 0.09, p=.03). CONCLUSION: These findings illuminate important differences in PAC based on the caregiving condition, and aspects of the caregiver stress process model that might be universal to caregivers. Results inform stress process theory and highlight the potential of support-based interventions for promoting PAC.

Interpersonal Correlates of Dementia Caregivers' Emotional Support Networks: Considering Family History.

Caregiving networks of individuals with Alzheimer's disease and related dementias (ADRD) are comprised of family and friends directly involved in caregiving activities and those supporting these activities. The purpose of this study was to investigate whether caregiving-related behaviors and interactions (i.e., uplift, malfeasance, and nonfeasance), kinship tie (i.e., friend, family), and family history of ADRD were associated with caregivers' emotional support networks. Seventy-one caregivers across 30 families provided information about 776 network members. Perceived emotional support and interactions representing uplift, malfeasance, and nonfeasance were assessed. Results indicated that uplift and friendship were associated with increased, whereas nonfeasance was associated with decreased, likelihood of perceived emotional support. Caregivers with a family history of ADRD were particularly more likely to report emotional support from friends and uplifting network members. Findings suggest the need for differential strategies based on families' prior caregiving experience to facilitate positive and minimize negative interactions within caregiving networks.

Beyond destructive conflict: Implications of marital tension for marital well-being.

The present study expanded upon existing literature to investigate a broader construct of negativity, marital tension, and its implications for marital well-being across the early years of marriage. Marital tension captures feelings of irritation, resentment, and disappointment surrounding the relationship, and is distinct from conflict and specific conflict strategies. Longitudinal data spanning 16 years from the Early Years of Marriage Study (n = 373 couples) were analyzed using actor-partner interdependence models. Competing hypotheses derived from the enduring dynamics and emergent distress models of marriage were tested using measures of both partners' marital tension in Year 1 of marriage, as well as changes in marital tension from Year 1. Husbands and wives who reported greater marital tension in Year 1 of marriage, or showed increases in tension from Year 1, reported lower marital well-being. The link between respondents' own Year 1 tension and marital well-being was strengthened by their partners' reports of tension, but an amplification effect of both partners' changes in marital tension was observed only among wives. These results persisted even after accounting for the influence of destructive conflict. Findings provide evidence for both models of marriage, indicating that negativity should be assessed more broadly, include both members of the couple, and recognize the critical role of early marital tension as well as increased tension for marital well-being. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Better Off Alone: Daily Solitude Is Associated With Lower Negative Affect in More Conflictual Social Networks.

BACKGROUND AND OBJECTIVES: Older adults are often considered at risk for social isolation. Little is known, however, about how often older adults lack social contact (in person, phone, electronic) throughout the day, the implications of lacking contact (i.e., solitude), and whether the effects of solitude vary by the broader social context. RESEARCH DESIGN AND METHODS: Participants were from the Daily Experiences and Well-being Study (DEWS) which included 313 older adults (aged 65+) who completed baseline interviews followed by 5-6 days of ecological momentary assessments approximately every 3 hr. RESULTS: Individuals reported having no social contact (i.e., solitude) on 11% of the occasions. Solitude predicted lower negative and positive affect on those occasions. The solitude-negative affect link varied by social network quality. Solitude predicted lower negative affect among individuals with more conflictual social networks but not among those with less conflictual networks. DISCUSSION AND IMPLICATIONS: Overall, solitude may serve as an adaptive strategy for individuals embedded in demanding or irritating social contexts.

Intergenerational exchange of healthful eating encouragement: Consideration of family ancestry and disease history.

INTRODUCTION: Improving diet is a prime target for the prevention and management of chronic disease. The communal coping model suggests that families can mitigate shared risk of chronic disease through encouragement of healthful eating, eliciting preventive behaviors. METHOD: Using network data from 69 Australian families across three ancestry groups (Anglo, Italian, and Asian) with varied family health histories, the present study applied social network analysis to identify patterns of intergenerational encouragement of healthful eating behavior within families, and assess whether patterns varied by family ancestry or disease density. RESULTS: Findings indicated variation in patterns of health encouragement by ancestry such that Asian-Australian families were most distinct from the other ancestry groups. While there was no main effect of familial disease history, it moderated the effect of Italian ancestry on intergenerational encouragement patterns. DISCUSSION: These results provide important context for future family based interventions that leverage normative patterns of intergenerational exchange of encouragement or aim to modify such patterns in an effort to improve family health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality.

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time. Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012). Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking. Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

Social Relations and Technology: Continuity, Context, and Change.

Social relations, although basic to human nature, health and well-being, have become increasingly complicated as a result of changing population demography and technology. In this essay, we provide a historical overview of social relations, especially as they affect older people. We briefly review the evolution of theory and measurement surrounding social relations as well as early empirical evidence. We consider how social relations have changed over time as well as continuity and change regarding basic characteristics of social relations. Of special interest is the emerging influence of technology on how people maintain contact, especially the changing ways people can use technology to increase, decrease, maintain, or avoid social relations. We consider both negative and positive aspects of these new technologies and their influence on health and well-being. Finally, we conclude that new and emerging technologies hold great promise for the future by overcoming traditional barriers to maintaining social contact, support exchange, and information acquisition. Nevertheless, we caution that these new technologies can have the dehumanizing effect of distance thus creating the potential for insensitivity and increased negativity. In sum, we are cautiously optimistic about the promise of technology to expand, but not replace, traditional forms of social contact.

Daily interactions with aging parents and adult children: Associations with negative affect and diurnal cortisol.

Midlife adults report greater investment in their children than in their parents, and these ties have important implications for well-being. To date, little research has addressed daily experiences in these ties. The present study examines daily experiences (negative and positive) with aging parents and adult children and their associations with daily negative affect and diurnal cortisol rhythms. Participants were middle-aged adults (N = 156; 56% women) from Wave 2 of the Family Exchanges Study, conducted in 2013, who completed a 7-day daily diary study, which included assessments of daily negative and positive social encounters and negative affect, and 4 days of saliva collection, which was collected 3 times a day (upon waking, 30 min after waking, and at bedtime) and assayed for cortisol. Multilevel models revealed that individuals were more likely to have contact with adult children than with parents but more likely to have negative experiences (negative interactions, avoidance, negative thoughts) with parents than with adult children. Nevertheless, contact and negative experiences with adult children were more consistently associated with negative affect and daily cortisol patterns than were interactions with parents. Findings are consistent with the intergenerational stake hypothesis, which suggests that individuals have a greater stake in their children than in their parents. Indeed, negative experiences with adult children may be more salient because tensions with adult children occur less frequently than do tensions with parents. (PsycINFO Database Record