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Shankar V, Thompson KH, Wylie-Rosett J, Segal-Isaacson CJ. Validation and reliability for the updated REAP-S dietary screener, (Rapid Eating Assessment of Participants, Short Version, v.2). BMC Nutr 2023; 9:88. [PMID: 37468939 PMCID: PMC10357781 DOI: 10.1186/s40795-023-00747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The American Heart Association (AHA) chose the REAP-S dietary screener in 2020 as one of three US dietary screeners recommended for integrating dietary assessment into clinical care. The REAP-S v.2 is an updated version that is aligned with the 2020-2025 US Dietary Guidelines and is easily incorporated into electronic medical records and taught to medical students. METHODS The University of New England, Institutional Review Board, approved the study protocol. We evaluated the reliability and validity of the REAP-S v.2 scale by having first-year medical students (n = 167) complete both the REAP-S v.2 and a three-day food record and then analyzing their data with the following statistical techniques: Internal consistency was measured using Cronbach's alpha. Construct validity was assessed with exploratory factor analysis. Criterion validity was evaluated using analysis of variance (ANOVA) that explored the associations between REAP-S v.2 scale item responses and selected nutrient estimates from the food record analyses. The hierarchical cluster analysis classified healthy and unhealthy diet grouping under each subscale. Further using these groupings, cut points for "good" and "bad" diets for each of the three main REAP-S v.2 subscales (Food Sufficiency/Food Insufficiency; Healthy Eating Pattern and Low Nutrient Density Foods) were calculated using receiver operating characteristics (ROC) analysis. Students analyzed their three-day food intake records using an online USDA application called SuperTracker. RESULTS The Cronbach's alpha measuring internal consistency was acceptable for the overall scale at 0.71. The exploratory factor analysis extracted three factors that roughly paralleled the three main subscales, suggesting construct validity. Most selected food record-derived nutrient values were significantly associated with scale items confirming criterion validity. The score cut points suggest that dietary counseling might be needed at ≤ 8, ≤ 10, and ≤ 16 for the above subscales. CONCLUSION The REAP-S v.2 is intended for clinicians to use as a brief dietary screener with their patients. Tested in a population of first-year medical students, the REAP-S v.2 brief dietary screener showed acceptable internal consistency, criterion, and construct validity. It is easily scored and incorporated into the electronic medical record.
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Affiliation(s)
- Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn H. Thompson
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - C. J. Segal-Isaacson
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
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2
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Karran EL, Grant AR, Lee H, Kamper SJ, Williams CM, Wiles LK, Shala R, Poddar CV, Astill T, Moseley GL. Do health education initiatives assist socioeconomically disadvantaged populations? A systematic review and meta-analyses. BMC Public Health 2023; 23:453. [PMID: 36890466 PMCID: PMC9996883 DOI: 10.1186/s12889-023-15329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Health education interventions are considered critical for the prevention and management of conditions of public health concern. Although the burden of these conditions is often greatest in socio-economically disadvantaged populations, the effectiveness of interventions that target these groups is unknown. We aimed to identify and synthesize evidence of the effectiveness of health-related educational interventions in adult disadvantaged populations. METHODS We pre-registered the study on Open Science Framework https://osf.io/ek5yg/ . We searched Medline, Embase, Emcare, and the Cochrane Register from inception to 5/04/2022 to identify studies evaluating the effectiveness of health-related educational interventions delivered to adults in socio-economically disadvantaged populations. Our primary outcome was health related behaviour and our secondary outcome was a relevant biomarker. Two reviewers screened studies, extracted data and evaluated risk of bias. Our synthesis strategy involved random-effects meta-analyses and vote-counting. RESULTS We identified 8618 unique records, 96 met our criteria for inclusion - involving more than 57,000 participants from 22 countries. All studies had high or unclear risk of bias. For our primary outcome of behaviour, meta-analyses found a standardised mean effect of education on physical activity of 0.05 (95% confidence interval (CI) = -0.09-0.19), (5 studies, n = 1330) and on cancer screening of 0.29 (95% CI = 0.05-0.52), (5 studies, n = 2388). Considerable statistical heterogeneity was present. Sixty-seven of 81 studies with behavioural outcomes had point estimates favouring the intervention (83% (95% CI = 73%-90%), p < 0.001); 21 of 28 studies with biomarker outcomes showed benefit (75% (95%CI = 56%-88%), p = 0.002). When effectiveness was determined based on conclusions in the included studies, 47% of interventions were effective on behavioural outcomes, and 27% on biomarkers. CONCLUSIONS Evidence does not demonstrate consistent, positive impacts of educational interventions on health behaviours or biomarkers in socio-economically disadvantaged populations. Continued investment in targeted approaches, coinciding with development of greater understanding of factors determining successful implementation and evaluation, are important to reduce inequalities in health.
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Affiliation(s)
- E L Karran
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - A R Grant
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - H Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal, Sciences, University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - S J Kamper
- School of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - C M Williams
- University of Newcastle, Sydney, NSW, Australia.,Population Health, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - L K Wiles
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - R Shala
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.,Department of Physiotherapy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - C V Poddar
- Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - T Astill
- Western Sydney University, Sydney, NSW, Australia
| | - G L Moseley
- IIMPACT in Health, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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Gardea-Resendez M, Winham SJ, Romo-Nava F, Cuellar-Barboza A, Clark MM, Andreazza AC, Cabello-Arreola A, Veldic M, Bond DJ, Singh B, Prieto ML, Nunez NA, Betcher H, Moore KM, Blom T, Colby C, Pendegraft RS, Kelpin SS, Ozerdem A, Miola A, De Filippis E, Biernacka JM, McElroy SL, Frye MA. Quantification of diet quality utilizing the rapid eating assessment for participants-shortened version in bipolar disorder: Implications for prospective depression and cardiometabolic studies. J Affect Disord 2022; 310:150-155. [PMID: 35545158 PMCID: PMC9721194 DOI: 10.1016/j.jad.2022.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/05/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Recognizing bipolar disorder as a multi-system metabolic condition driven, in part, by binge eating behavior and atypical depressive symptoms, this study aimed to quantify diet quality and evaluate clinical correlates in a bipolar disorder cohort. METHODS Participants from the Mayo Clinic Bipolar Disorder Biobank (n = 734) completed the Rapid Eating Assessment for Participants - Shortened version (REAP-S) to determine diet quality. The average REAP-S score for a U.S. omnivorous diet is 32 (range 13 to 39) with higher scores indicating healthier diet. Demographic variables were collected in a standardized clinical questionnaire. Depressive symptoms were assessed by the Bipolar Inventory of Symptoms Scale. Cardiometabolic variables were retrieved from the electronic health record. Associations between continuous variables and REAP-S scores (total, 'healthy foods' and 'avoidance of unhealthy foods') were assessed using linear regression. RESULTS Overall, our sample had a mean REAP-S score of 27.6 (4.9), suggestive of a lower diet quality than the average general population in the US. There was a significant inverse relationship between mean REAP-S lower scores with increased BMI, waist circumference, disordered eating and depression. All these associations were significantly stronger in female participants. LIMITATIONS EHR cross-sectional data. CONCLUSIONS Our data suggest unhealthy diet quality in bipolar disorder is associated with depression, obesity and cardiometabolic abnormalities. Additional work is encouraged to prospectively track mood and diet quality to further understand the bidirectional relationship and clarify if dietary interventions can positively impact mood. Further delineating potential sex differences in diet quality and depression may provide greater appreciation of modifiable risk factors for future cardiometabolic burden.
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Affiliation(s)
| | - Stacey J. Winham
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Francisco Romo-Nava
- Lindner Center of HOPE/Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Mason, OH, USA
| | | | - Matthew M. Clark
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ana Cristina Andreazza
- Department of Pharmacology and Toxicology and Psychiatry, University of Toronto, Temerty Faculty of Medicine, Toronto, Canada
| | | | - Marin Veldic
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - David J. Bond
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Balwinder Singh
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Miguel L. Prieto
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA, Department of Psychiatry, Facultad de Medicina, Universidad de los Andes, Santiago, Chile, Mental Health Service, Clínica Universidad de los Andes, Santiago, Chile, Center for Biomedical Research and Innovation, Universidad de los Andes, Santiago, Chile
| | - Nicolas A. Nunez
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Hannah Betcher
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas Blom
- Lindner Center of HOPE/Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Mason, OH, USA
| | - Colin Colby
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Sydney S. Kelpin
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Aysegul Ozerdem
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Miola
- Department of Neurosciences, Psychiatry Unit, University-Hospital of Padova, Padova, Italy
| | | | - Joanna M. Biernacka
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Susan L. McElroy
- Lindner Center of HOPE/Department of Psychiatry and Behavioral Neurosciences, University of Cincinnati College of Medicine, Mason, OH, USA
| | - Mark A. Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA, Corresponding author at: Department of Psychiatry and Psychology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA. (M.A. Frye)
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4
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Marchello NJ, Daley CM, Sullivan DK, Nelson-Brantley HV, Hu J, Gibbs HD. Nutrition Literacy Tailored Interventions May Improve Diet Behaviors in Outpatient Nutrition Clinics. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1048-1054. [PMID: 34521594 DOI: 10.1016/j.jneb.2021.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Nutrition literacy examines the intersection of nutrition knowledge and skills; however, no evidence shows interventions tailored to nutrition literacy deficits affect diet behaviors. This study examined the effects of nutrition interventions tailored to individual nutrition literacy deficits on improving diet-related behaviors. METHODS Five outpatient clinics were randomized to 2 arms. The nutrition literacy and diet behaviors of patients were assessed before intervention with a dietitian and again 1 month later. Intervention-arm dietitians received patient nutrition literacy levels and tailored interventions toward nutrition literacy weaknesses. Differences in diet behaviors between arms were analyzed using Mann-Whitney U-tests and within-arms using Wilcoxon signed-rank tests. RESULTS Intervention-arm patients improved 10 of 25 measured diet behaviors; control-arm patients improved 6 behaviors. Similarly, intervention-arm patients reported increased green vegetable consumption from baseline to follow-up (z = 2.00; P = 0.04). CONCLUSIONS AND IMPLICATIONS Nutrition interventions tailored toward nutrition literacy deficits may play an important role in improving patient diet behaviors.
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Affiliation(s)
- Nicholas J Marchello
- School of Nutrition, Kinesiology, and Psychological Science, University of Central Missouri, Warrensburg, MO
| | - Christine M Daley
- Department of Family Medicine Research, University of Kansas Medical Center, Kansas City, KS
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS
| | | | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS
| | - Heather D Gibbs
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS.
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5
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Lederer AM, Stolow JA. Will Student Contracts Keep Campuses Safe From COVID-19? A Behavioral Science Perspective. Public Health Rep 2021; 136:274-280. [PMID: 33617386 DOI: 10.1177/0033354921994899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alyssa M Lederer
- 25812 Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Jeni A Stolow
- Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA
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6
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Ramirez-Garcia MP, Gagnon MP, Colson S, Côté J, Flores-Aranda J, Dupont M. Mind-body practices for people living with HIV: a systematic scoping review. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:125. [PMID: 31185970 PMCID: PMC6560810 DOI: 10.1186/s12906-019-2502-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mind-body practices are frequently used by people living with HIV to reduce symptoms and improve wellbeing. These include Tai Chi, Qigong, yoga, meditation, and all types of relaxation. Although there is substantial research on the efficacy of mind-body practices in people living with HIV, there is no summary of the available evidence on these practices. The aim of this scoping review is to map available evidence of mind-body practices in people living with HIV. METHODS The Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) methodological framework was used. A search of 16 peer-review and grey literature databases, websites, and relevant journals (1983-2015) was conducted. To identify relevant studies, two reviewers independently applied the inclusion criteria to all abstracts or full articles. Inclusion criteria were: participants were people living with HIV; the intervention was any mind-body practice; and the study design was any research study evaluating one or several of these practices. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second, as needed, using the criteria that Cochrane Collaboration recommends for systematic reviews of interventions (Higgins and Green, Cochrane handbook for systematic reviews of intervention. 2011). A tabular and narrative synthesis was carried out for each mind-body practice. RESULTS One hundred thirty-six documents drawing on 84 studies met the inclusion criteria. The most widely studied mind-body practice was a combination of least three relaxation techniques (n = 20), followed in declining order by meditation (n = 17), progressive muscle relaxation (n = 10), yoga (n = 9) and hypnosis (n = 8). Slightly over half (47/84) of studies used a RCT design. The interventions were mainly (46/84) conducted in groups and most (51/84) included daily individual home practice. All but two studies were unblinded to participants. CONCLUSION The amount of available research on mind-body practices varies by practice. Almost half of the studies in this review were at high risk of bias. However, mindfulness, a combination of least three relaxation techniques and cognitive behavioral strategies, and yoga show encouraging results in decreasing physical and psychological symptoms and improving quality of life and health in people living with HIV. More rigorous studies are necessary to confirm the results of Tai Chi, Qigong, and some relaxation techniques.
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Affiliation(s)
- Maria Pilar Ramirez-Garcia
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marie-Pier Gagnon
- Faculty of Nursing, Université Laval, Québec, Canada
- Research Center of the Centre Hospitalier Universitaire, Québec, Canada
| | - Sébastien Colson
- Faculty of Medicine, Aix Marseille Université, Marseille, France
| | - José Côté
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Jorge Flores-Aranda
- University Institute on Addiction, Montreal-Island-South-Center Integrated University Health and Social Services Centre, Montréal, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada
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7
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Weiss JJ, Sanchez L, Hubbard J, Lo J, Grinspoon SK, Fitch KV. Diet Quality Is Low and Differs by Sex in People with HIV. J Nutr 2019; 149:78-87. [PMID: 30624677 PMCID: PMC6351143 DOI: 10.1093/jn/nxy241] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background People with HIV (PWH) are at risk for developing metabolic comorbidities driven, in part, by immune activation/inflammation. Little is known about diet quality, a potential modifiable factor in PWH. Objectives This study aimed to explore diet quality in terms of conformance with US dietary guidelines by calculating Healthy Eating Index-2010 (HEI) scores among adults with and without HIV in Boston, MA, and determine associations with HEI and markers of immune activation/inflammation. Methods One-hundred and three HIV-infected [50 women, 53 men; mean ± SD age: 47 ± 7 y; body mass index (BMI, in kg/m2): 26 ± 5] and 38 uninfected adults (17 women, 21 men; age: 46 ± 7 y; BMI: 28 ± 4) were included in this cross-sectional analysis. Participants who completed a 4-d food record from which HEI could be calculated were included. HEI was compared between participants with and without HIV, within HIV-infected participants stratified by sex, and by HIV serostatus and sex. In the HIV group, predictors of HEI were determined in multivariable modeling. Univariate associations with diet quality and inflammation/immune markers were assessed. Results The HEI score was 51.3 in the HIV-infected participants and 57.3 in the HIV-uninfected participants (P = 0.052). In the comparison by HIV serostatus and sex, HIV-infected women had significantly lower HEI (49.2) compared with HIV-infected men (55.7) (P = 0.005) and HIV-uninfected men (61.8) (P = 0.002). Adjusting for potential confounding factors, sex remained an independent predictor of HEI in HIV (P = 0.02). In the HIV group, higher log HEI was associated with lower concentration of the immune activation marker sCD14 (P = 0.009). Conclusions Diet quality tended to be lower in HIV-infected individuals compared with HIV-uninfected individuals and was lower among HIV-infected women compared with HIV-infected men, and HIV-uninfected men. There may also be an association with diet quality and sCD14 in PWH. Future prospective studies are needed to confirm these findings and determine whether improving diet quality is a useful strategy to reduce metabolic abnormalities in this population. This study was registered at clinicaltrials.gov as NCT00455793.
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Affiliation(s)
- Julian J Weiss
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Laura Sanchez
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jane Hubbard
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA
| | - Janet Lo
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven K Grinspoon
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Kathleen V Fitch
- Program in Nutritional Metabolism, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Address correspondence to KVF (e-mail: )
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8
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Scott-Sheldon LAJ, Carey KB, Johnson BT, Carey MP. Behavioral Interventions Targeting Alcohol Use Among People Living with HIV/AIDS: A Systematic Review and Meta-Analysis. AIDS Behav 2017; 21:126-143. [PMID: 28831609 PMCID: PMC5660648 DOI: 10.1007/s10461-017-1886-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Alcohol use is often reported among people living with HIV/AIDS (PLWHA) and is associated with increased sexual risk and poor medication adherence. This meta-analysis evaluated the efficacy of behavioral interventions addressing alcohol use among PLWHA. Twenty-one studies (N = 8461 PLWHA) that evaluated an individual-level intervention addressing alcohol use alone or as part of a more comprehensive alcohol/HIV intervention, included a control condition, and were available through December 2016 were included. Independent raters coded study, sample, and intervention content. Weighted mean effect sizes, using random-effects models, were calculated. Results indicate that interventions reduced alcohol consumption, increased condom use, and improved medication adherence relative to controls (d +s = 0.10-0.24). Plasma viral load was also reduced in intervention versus control participants (d + = 0.14, 95% CI = 0.02, 0.26; k = 7). These findings show that behavioral interventions addressing alcohol use can successfully reduce alcohol consumption and also improve HIV-related outcomes among PLWHA.
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Affiliation(s)
- Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA.
| | - Kate B Carey
- Brown School of Public Health, Center for Alcohol and Addiction Studies, Providence, RI, USA
| | - Blair T Johnson
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Ave., Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
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9
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Translating an Evidence-Based Behavioral Intervention for Women Living with HIV into Clinical Practice: The SMART/EST Women's Program. Int J Behav Med 2015; 22:415-24. [PMID: 24623475 DOI: 10.1007/s12529-014-9399-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The process of translating scientific findings into clinical and public health settings has only recently received priority attention within the scientific community. PURPOSE Fueled by "Funding Opportunity Announcements" from the National Institutes of Health and Centers for Disease Control and Prevention, scientists have begun to explore the pathways to effectively "transfer" promising research accomplishments into effective and sustainable service programs within the health care delivery system. METHOD Using Glasgow's RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) model as a guide, this research team enrolled 428 socially disadvantaged, culturally diverse women living with HIV/AIDS to test the dissemination and implementation of an evidence-based behavioral intervention designed to improve and sustain the physical and emotional health of participants into the Community Health Center (CHC) setting when conducted by trained CHC staff. RESULTS Findings demonstrate the ability of trained CHC staff group leaders to attain results equivalent or superior to those achieved when conducted by research staff on the three principal study outcomes: depression, medication adherence and HIV viral load. Four of five CHCs involved in the study also identified and successfully obtained funding to continue to run intervention groups, supporting the adoption and sustainability components of the translation model. CONCLUSION This study confirmed (a) the "translatability" of the Stress Management And Relaxation Training/Emotional Supportive Therapy (SMART/EST) Women's Program, from academic to CHC settings in two geographic regions with high HIV prevalence among women, (b) the ability of local staff (using the "train the trainer" model) to successfully achieve program fidelity and clinical outcomes, and (c) the sustainability the program beyond the auspices of research support, through supportive CHC leadership securing continued program funding.
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10
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Translating evidence-based interventions from research to practice: challenges and lessons learned. Transl Behav Med 2015; 5:233-41. [PMID: 26029285 DOI: 10.1007/s13142-015-0307-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Despite the increasing popularity of translation research, few studies have described the process and challenges involved in implementing a translation study. The main objective was to determine whether a multi-component group behavioral intervention could be successfully translated from an academic setting into the community health system of federally qualified health centers (FQHCs) funded by the Health Resources and Services Administration (HRSA) in Miami, NY, and NJ. Key challenges and "lessons learned" from the dissemination and implementation process for the SMART/EST (Stress Management And Relaxation Training/Emotional Supportive Therapy) Women's Project (SWP) III in low-resource primary care settings are described. The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) model served as the theoretical framework for the translation of the study. This study outlines several essential factors related to Glasgow's RE-AIM model that need to be considered in order to accomplish successful translation of evidence-based interventions from traditional academia to "real-world" community health center settings.
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11
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Kaye HL, Moreno-Leguizamon CJ. Nutrition education and counselling as strategic interventions to improvehealth outcomes in adult outpatients with HIV: a literature review. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 9:271-83. [PMID: 25860631 DOI: 10.2989/16085906.2010.530183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Malnutrition poses a significant risk for people living with HIV and accelerates disease progression. This is because adequate nutrition is essential for optimal immune function. This article discusses research on the role and use of nutrition education or counselling as a strategic intervention to improve health outcomes through better health behaviour in adult outpatients with HIV. Ten studies (five quantitative and five qualitative) met the inclusion criteria of the literature review. The findings of the studies related to the following outcomes of nutrition interventions: increases in fat-free and lean body mass; offsetting the adverse effects of HIV infection in patients with a low CD4 cell count; significant improvement in dietary patterns with resultant greater adherence to HIV medications and fewer side effects; and agreement on the importance of addressing the nutrition concerns. The article discusses the five prominent themes that emerged from the literature review: 1) ethical issues in HIV/AIDS research; 2) the role of health and culture in nutrition interventions; 3) HIV stigma and its impact on nutrition interventions; 4) the socioeconomics of HIV and AIDS; and 5) food security and emotional wellbeing among persons with HIV. Although the evidence base is limited and raises questions about key aspects of the quality of the research conducted to date, the overall results show that providing HIV-positive adults with culturally relevant and practical nutrition strategies can improve health outcomes, health behaviour and quality of life. Current and future nutrition interventions for persons with HIV disease should be targeted, sustainable, and rigorously evaluated. There is an urgent need for research on this topic in developing countries, particularly African ones, which are some of the most affected by HIV.
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Affiliation(s)
- Hannah L Kaye
- a 108 Third Avenue, Kenilworth 7708 , Cape Town , South Africa
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12
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Jones DL, Lopez M, Simons H, Diaz-Gloster M, Tobin JN, Weiss SM. Translation of a comprehensive health behavior intervention for women living with HIV: the SMART/EST Women's Program. Transl Behav Med 2013; 3:416-25. [PMID: 24294330 PMCID: PMC3830012 DOI: 10.1007/s13142-013-0213-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Translation of behavioral interventions into community settings for people living with HIV/AIDS can decrease the risk of comorbid conditions. This study was designed to determine whether a multiple health behavior intervention for women with HIV/AIDS could be effectively translated into community health centers (CHCs), delivered by CHC primary care staff. Health Resources and Services Administration-supported CHCs in Miami, FL, and the New York metropolitan area participated. Six health behavior domains were assessed at baseline, 6 months, and 12 months post-intervention: nutrition, physical activity, sexual risk behavior, alcohol use, drug use, and tobacco use. Behavioral outcomes were compared between research staff-led and CHC staff-led intervention groups. Research staff and CHC staff outcomes were similar for the majority of outcomes. Results indicate that complex, multicomponent behavioral interventions can be translated into community-based settings with existing CHC staff and can produce clinical effects similar to those achieved by research staff.
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Affiliation(s)
- Deborah L Jones
- />Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, 1400 NW 10th Ave., Miami, FL 33136 USA
| | - Maria Lopez
- />Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, 1400 NW 10th Ave., Miami, FL 33136 USA
| | | | | | - Jonathan N Tobin
- />Clinical Directors Network, New York, NY USA
- />Center for Clinical and Translational Science, The Rockefeller University, New York, NY USA
| | - Stephen M Weiss
- />Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, 1400 NW 10th Ave., Miami, FL 33136 USA
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Feldman MB, Torino JA, Swift M. A group intervention to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS. Eat Disord 2011; 19:377-91. [PMID: 21932969 DOI: 10.1080/10640266.2011.609084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A healthy diet is essential to maintaining a strong immune system for people living with HIV and AIDS. Prior studies have shown that HIV-positive gay and bisexual men are more susceptible to poor body image, which can negatively impact dietary habits. Interventions that simultaneously address body image and nutrition are therefore critical for this population. This paper describes the curriculum for a 14-week group designed to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS.
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Weiss SM, Jones DL, Lopez M, Villar-Loubet O, Chitalu N. The many faces of translational research: a tale of two studies. Transl Behav Med 2011; 1:327-330. [PMID: 21765882 PMCID: PMC3135386 DOI: 10.1007/s13142-011-0044-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Translational research can take many forms: bench to bedside, across cultural groups, across geographical boundaries, among others. This case study will share how we addressed all three "translational" issues using two evidence-based studies (USA, Zambia) to illustrate these "roads less traveled." Our implementation and dissemination efforts were anchored by the "train the trainer" strategy, and the Glasgow RE-AIM model provided programmatic guideposts and direction. Keeping all stakeholders (scientific, community, political) involved in the implementation and dissemination process was an essential, perhaps determining factor in the success of the translation process.
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Affiliation(s)
- Stephen M Weiss
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL 33136 USA
| | - Deborah L Jones
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL 33136 USA
| | - Maria Lopez
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL 33136 USA
| | - Olga Villar-Loubet
- />Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Miami, FL 33136 USA
| | - Ndashi Chitalu
- />University of Zambia School of Medicine, Lusaka, Zambia
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Stuifbergen AK, Morris M, Jung JH, Pierini D, Morgan S. Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence. Disabil Health J 2011; 3:133-45. [PMID: 20628583 DOI: 10.1016/j.dhjo.2009.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. OBJECTIVE The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions. METHODS The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics. RESULTS Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly. CONCLUSIONS Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.
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Affiliation(s)
- Alexa K Stuifbergen
- The University of Texas at Austin School of Nursing, Center for Health Promotion and Disease Prevention Research in Underserved Populations, 1700 Red River, Austin, Texas 78701, USA.
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Ignoring the group in group-level HIV/AIDS intervention trials: a review of reported design and analytic methods. AIDS 2011; 25:989-96. [PMID: 21487252 DOI: 10.1097/qad.0b013e3283467198] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Studies evaluating the efficacy of HIV/AIDS interventions often involve the random assignment of groups of participants or the treatment of participants in groups. These studies require analytic methods that take within-group correlation into account. We reviewed published studies to determine the extent to which within-group correlation was dealt with properly. DESIGN We reviewed group-randomized trials (GRTs) and individually randomized group treatment (IRGT) trials published in HIV/AIDS and general public health journals 2005-2009. METHODS At least two of the authors reviewed each article, recording descriptive characteristics, sample size estimation methods, analytic methods, and judgments about whether the methods took intraclass correlation into account properly. RESULTS Of those articles including sufficient information to judge whether analytic methods were correct, only 24% used only appropriate methods for dealing with the intraclass correlation. The percentages differed substantially for GRTs (41.7%) and IRGT trials (8.0%). Most of the articles (69.2%) also made no mention of a priori sample size estimation. CONCLUSION A majority of the articles in our review reported analyses ignoring the intraclass correlation. This practice may result in underestimated variance, inappropriately small P values, and incorrect conclusions about the effectiveness of interventions. Previous trials that were analyzed incorrectly need to be re-analyzed, and future trials should be designed and analyzed with appropriate methods. Also, journal reviewers and editors need to be aware of the special requirements for design and analysis of GRTs and IRGT trials and judge the quality of articles reporting on such trials according to appropriate standards.
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Weiss SM, Tobin JN, Antoni M, Ironson G, Ishii M, Vaughn A, Cassells A, Jones D, Schneiderman N, Brondolo E, LaPerriere A, Lopez M, Villar-Loubet O, Camille J, Kumar M, Page JB. Enhancing the health of women living with HIV: the SMART/EST Women's Project. Int J Womens Health 2011; 3:63-77. [PMID: 21445376 PMCID: PMC3061850 DOI: 10.2147/ijwh.s5947] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Indexed: 11/23/2022] Open
Abstract
THE PRINCIPAL OBJECTIVE OF THESE MULTISITE STUDIES (FLORIDA, NEW YORK, NEW JERSEY: epicenters for human immunodeficiency virus [HIV] among women) was to develop and implement effective combinations of behavioral interventions to optimize the health status of the most neglected and understudied population affected by the acquired immunodeficiency syndrome (AIDS) epidemic in the United States: poor women of color living with HIV. The two studies enrolled nearly 900 women randomly assigned to "high intensity" (cognitive-behavioral stress management training combined with expressive-supportive therapy [CBSM]+ group) or "low intensity" (individual psychoeducational program) treatment conditions over a period of 9 years. The initial study of the stress management and relaxation training/expressive-supportive therapy (SMART/EST) Women's Project (SWP I) focused on reducing depression and anxiety, as well as improving self-efficacy and overall quality of life for women with case-defined AIDS. Findings from this study demonstrated the utility of CBSM+ in reducing distress (depression, anxiety) and denial, while improving social support, self-efficacy, coping skills, and quality of life. The second study (SWP II), which included all women living with HIV, extended these findings by demonstrating that exposure to CBSM+ significantly improved the ability of the participants to take advantage of a health behavior change program encouraging the adoption and maintenance of healthier lifestyle behaviors (high levels of medication adherence, appropriate nutritional intake and physical activity, safer sexual practices, and reduced alcohol use/abuse) essential for optimal health in the context of living with HIV. SWP II also determined that the intervention program was equally beneficial to less-acculturated segments of the affected population (ie, non-English speaking HIV+ women) through the creation of culturally and linguistically sensitive Spanish and Creole versions of the program. A third study (SWP III) is currently underway to "translate" this evidence-based treatment program into Community Health Centers in Miami, New York City, and metropolitan New Jersey.
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Mahadevan M, Fisher CB. Factors Influencing the Nutritional Health and Food Choices of African American HIV-Positive Marginally Housed and Homeless Female Substance Abusers. APPLIED DEVELOPMENTAL SCIENCE 2010. [DOI: 10.1080/10888691003697945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: translating research findings to the real world clinic. Curr HIV/AIDS Rep 2010; 7:44-51. [PMID: 20425057 PMCID: PMC3607373 DOI: 10.1007/s11904-009-0037-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The success of potent combination antiretroviral therapy (ART) for HIV infection is compromised primarily by failure to maintain optimal levels of adherence over the long term. Recent reviews suggest behavioral interventions to promote ART adherence can have significant effects, but these tend to be small and to diminish over time; sustained improvements in biomarkers are particularly elusive. In this article, we update current reviews, focusing specifically on the 13 studies evaluating behavioral interventions to promote ART adherence published since September 2007. We describe the range of intervention strategies employed and qualitatively summarize findings of their efficacy. In conclusion, we consider implications and offer strategies for enhancing adherence in clinic-based HIV care prior to ART initiation, at initiation, and over the course of treatment.
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Affiliation(s)
- Jane M. Simoni
- Department of Psychology, University of Washington, Campus Box 351525, Seattle, WA 98195-1525, USA,
| | - K. Rivet Amico
- Center for Health, Intervention & Prevention, University of Connecticut, 2006 Hillside Road, Storrs, CT 06269, USA,
| | - Laramie Smith
- Center for Health, Intervention & Prevention, Department of Psychology, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269, USA,
| | - Kimberly Nelson
- Department of Psychology, University of Washington, Campus Box 351525, Seattle, WA 98195-1525, USA,
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Scott-Sheldon LAJ, Kalichman SC, Carey MP, Fielder RL. Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006. Health Psychol 2008; 27:129-39. [PMID: 18377131 DOI: 10.1037/0278-6133.27.2.129] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.
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Lopez E, Jones DL, Ishii M, Tobin JN, Weiss SM. HIV Medication Adherence and Substance Use: The Smartest Women's Project. ACTA ACUST UNITED AC 2007; 3:240-247. [PMID: 18668183 DOI: 10.3844/ajidsp.2007.240.247] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Antiretroviral (ARV) medication for substance users has been a controversial issue with respect to whether current substance users can successfully maintain their medication regimens. This study compared ARV adherence across current substance users, former substance users and those with no history or current use and the relative impact of a medication adherence intervention on all three groups. Of the 481 predominantly African American and Latina women from Miami, New York and New Jersey enrolled in the SMARTEST Women's Program, 338 participants were prescribed antiretroviral medication at study entry. All three groups, current users (n=60), former users (n=107) and never users (n=171), reported relatively high levels of adherence at baseline. Of those participants with less than 80% adherence at baseline, former users showed the most significant decrease in viral load post-intervention and at long term (two year) follow-up. These findings suggest former users to be the most reliable source of self-reported adherence and to profit most from the study intervention. They also suggest that additional research on targeted interventions for current substance users may be necessary to improve medication adherence for this group of women living with HIV.
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Affiliation(s)
- Eliot Lopez
- University of Miami Miller School of Medicine
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Jones DL, McPherson-Baker S, Lydston D, Camille J, Brondolo E, Tobin JN, Weiss SM. Efficacy of a group medication adherence intervention among HIV positive women: the SMART/EST Women's Project. AIDS Behav 2007; 11:79-86. [PMID: 17028992 PMCID: PMC2525666 DOI: 10.1007/s10461-006-9165-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This intervention sought to improve overall quality of life and health behavior in women living with human immunodeficiency virus (HIV). We contrasted the effect of a group cognitive behavioral stress management expressive supportive therapy (CBSM+) intervention plus a healthier lifestyles (HL) component with an individual educational/informational format plus HL on HIV-medication adherence. Women, n = 237, predominantly African-American and Latina, living with HIV were recruited from Miami, New York and New Jersey and randomized to group or individual conditions (ten weekly sessions) plus group or individual HL, i.e., four conditions. Women reported relatively high levels of adherence at baseline. Participants in any of the group conditions increased self-reported adherence and emotion-focused coping skills in comparison with individual participation. This study suggests that group interventions may be an important adjunct in increasing medication adherence for HIV positive women.
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Affiliation(s)
- Deborah L Jones
- Department of Psychology, Barry University, 11300 NE 2nd Avenue, Miami Shores, FL 33161-6695, USA.
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