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Kane JC, Mauro PM, Hahn JA, Chander G, Tobin KE, Martins SS, Paniagua-Avila A, Latkin CA. HIV stigma and disclosure of alcohol use to physicians: examining the mediating role of depression among persons living with HIV. AIDS Care 2023; 35:1661-1666. [PMID: 37314960 PMCID: PMC10791146 DOI: 10.1080/09540121.2023.2214864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 05/11/2023] [Indexed: 06/16/2023]
Abstract
Alcohol use among persons living with HIV (PWH) can lead to poor disease outcomes. Disclosure of alcohol consumption to physicians is critical to inform HIV care. HIV stigma is associated with poor care engagement, and this relationship is partially mediated by depression. However, less is known about how HIV stigma and depression affect reporting of alcohol use to care providers. We used baseline data from an HIV intervention trial of 330 adult PWH in Baltimore, MD. We fit a path model to examine whether HIV stigma was associated with increased depression symptoms and whether higher levels of depression were, in turn, associated with underreporting of alcohol use to physicians. Among PWH reporting past 6-month alcohol use (n = 182, 55%), 64% met symptom criteria for probable depression, 58% met criteria for hazardous drinking, and 10% reported not disclosing alcohol use to their physician. HIV stigma was associated with higher levels of depression (β = 0.99, p < .0001); depression was associated with a lower likelihood of alcohol disclosure (β = -0.04, p < .0001); and depression mediated the indirect pathway from stigma to alcohol disclosure (β = -0.04, p < .01). Methods to augment or strengthen alcohol self-report may be useful in HIV care, particularly among PWH experiencing HIV stigma and depression.
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Affiliation(s)
- Jeremy C. Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | - Pia M. Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | - Judith A. Hahn
- Department of Medicine, University of California San Francisco
| | | | - Karin E. Tobin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | | | - Carl A. Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health
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Falade-Nwulia O, Felsher M, Kidorf M, Tobin K, Yang C, Latkin C. The impact of social network dynamics on engagement in drug use reduction programs among men and women who use drugs. J Subst Abuse Treat 2022; 137:108713. [PMID: 34969578 PMCID: PMC9086095 DOI: 10.1016/j.jsat.2021.108713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/02/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cross-sectional studies have shown strong relationships between social network characteristics and substance use disorder (SUD) treatment engagement. The current study examined associations between longitudinal changes in egocentric social networks of male and female people who use drugs (PWUD) and engagement in drug use reduction programs, broadly defined as either formal SUD treatment or self-help groups. METHOD Using data from an HIV prevention and care study in Baltimore, MD, this study categorized PWUD into those who engaged and did not engage in any drug use reduction programs over two follow-ups during a one-year observation window. The study used multivariate logistic generalized estimating equations (GEE) to examine associations between network composition and stability measures and drug use reduction program engagement, stratified by gender. RESULTS Of the 176 subjects participating in drug use reduction programs at baseline, 56.3% remained engaged at one year. Among both male and female respondents, higher turnover into non-kin networks was associated with increased odds of engagement in drug use reduction programs (AOR 1.4; 95% CI: 1.1-1.9, AOR 1.3; 95% CI: 1.0-1.8, respectively). For males, retention of intimate partner networks was associated with increased odds of program engagement (AOR 2.9; 95% CI: 1.1-7.6); for females, higher turnover into kin networks was associated with decreased odds of engagement (AOR 0.8; 95% CI: 0.5-1.0). CONCLUSION Evaluation of associations between social network characteristics and drug use reduction program engagement appears to benefit from longitudinal analyses that are stratified by gender. Efforts to improve retention in formal SUD treatment or self-help groups might consider intervening through social networks, perhaps by increasing overall levels of social support.
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Affiliation(s)
| | - Marisa Felsher
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Karin Tobin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Cui Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Rudolph AE. Integrating a web-based survey application into Qualtrics to collect risk location data for HIV prevention research. AIDS Care 2022; 34:397-403. [PMID: 34839777 PMCID: PMC9016781 DOI: 10.1080/09540121.2021.2008860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aspects of the physical and social environment play an important role in shaping HIV-related risk/prevention behaviors and access to prevention and treatment services. Here, we describe the feasibility of integrating a web-based survey application to collect risk locations into Qualtrics and compare this approach with a JavaScript-based alternative. Between 2017 and 2018, we enrolled 29 persons living with HIV in Boston Massachusetts to complete an interviewer-administered questionnaire using Qualtrics. Surveys collected demographics; sex/drug use risk behaviors; locations where participants met sex partners, had condomless sex, attended group sex events, and shared a syringe or injection equipment with someone else (up to 10 locations each); and the locations where participants (a) had sex with each sex partner (past 6 months) and (b) used drugs with each drug use partner (past 6 months). Location data were collected using embedded links to an encrypted web-based survey application. Overall, participants provided valid coordinates 93% of the time; when an exact location was not provided, a neighborhood was provided instead, resulting in little missing data. Our findings suggest that this web-based data collection tool (alone or with embedded links in Qualtrics) is a feasible and secure option for collecting risk location data.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, USA
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Rudolph AE, Dembo RS, Tobin K, Latkin C. Perceived HIV Treatment Norms Modify the Association Between HIV-Related Stigma and Adherence to Antiretroviral Therapy Among Persons Living with HIV in Baltimore, Maryland. AIDS Behav 2022; 26:537-548. [PMID: 34338899 PMCID: PMC8807774 DOI: 10.1007/s10461-021-03409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014-2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15-0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65-1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA.
| | - Robert S Dembo
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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E Rudolph A, Fernau DJ, Tobin KE, Latkin C. Individual and social network correlates of recent treatment for substance use disorders among persons who use drugs in Baltimore, MD (2014 - 2017). Drug Alcohol Depend 2020; 217:108278. [PMID: 32949885 PMCID: PMC7736566 DOI: 10.1016/j.drugalcdep.2020.108278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This analysis examined individual and network correlates of treatment enrollment for substance use disorders (SUDs) in the past 6 months and whether these factors varied by type(s) of drug(s) used and type of SUD treatment received. METHODS Between 2014 and 2017, 330 Baltimore residents who reported using heroin, crack, and/or cocaine in the past 6 months completed a survey to assess demographics, substance use, recent SUD treatment enrollment, and information about their network members. The primary outcome was recent enrollment in any type of SUD treatment (i.e., methadone maintenance, detox, residential, outpatient, and meetings/self-help) vs. none. Using logistic regression, recent SUD treatment enrollment was regressed on individual and network characteristics. RESULTS Overall, 214 were enrolled in some form of SUD treatment in the past 6 months (56.6% Methadone Maintenance, 29.8% Detox, 25.9% Residential, 47.8% Outpatient, and 90.7% Meetings/Self-Help). The median number of network members listed was 4.0 (interquartile range: 4-6). In the adjusted model, the odds of SUD treatment enrollment increased with each additional network member who was currently enrolled in SUD treatment (Adjusted Odds Ratio [AOR]:2.22; 95%CI:1.47-3.33). The odds of SUD treatment enrollment decreased by 35% for each additional network member who used heroin, crack, and/or cocaine and could provide them with social support (AOR:0.65; 95%CI:0.48-1.88). CONCLUSIONS Our findings suggest a complex link between the intersecting roles of network members and SUD treatment outcomes among persons who use drugs and the importance of collecting detailed social network information on the different domains of social support provided.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Philadelphia PA 19122, USA.
| | - Deborah J Fernau
- Department of Epidemiology, Boston University School of Public Health, Talbot Building 715 Albany St., Boston University, Boston, MA 02118, USA
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
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Rudolph AE, Young AM, Havens JR. Privacy, Confidentiality, and Safety Considerations for Conducting Geographic Momentary Assessment Studies Among Persons Who Use Drugs and Men Who Have Sex with Men. J Urban Health 2020; 97:306-16. [PMID: 30324355 DOI: 10.1007/s11524-018-0315-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Geographic momentary assessments (GMA) collect real-time behavioral data in one's natural environment using a smartphone and could potentially increase the ecological validity of behavioral data. Several studies have evaluated the feasibility and acceptability of GMA among persons who use drugs (PWUD) and men who have sex with men (MSM), but fewer have discussed privacy, confidentiality, and safety concerns, particularly when illegal or stigmatized behavioral data were collected. This study explores perceptions regarding privacy, confidentiality, and safety of GMA research among PWUD and MSM recruited in three different settings (rural Appalachia, a mid-sized city in the South, and a mid-Atlantic city). Between November 2014 and April 2017, we recruited 35 PWUD from rural Appalachian Kentucky (N = 20) and Baltimore, Maryland (N = 15) and 20 MSM from Lexington, Kentucky to complete semi-structured qualitative interviews. Through thematic analyses, we identified and compared privacy, confidentiality, and safety concerns by demographic characteristics, risk behaviors, and setting. Privacy, confidentiality, and safety concerns varied by setting, age, smartphone ownership, use of illegal drugs, and history of drug-related arrests. Among those who used drugs, participants reported concerns with being tracked and burden associated with carrying and safeguarding study phones and responding to survey prompts. Privacy and confidentiality concerns were noted in each setting, but tracking concerns were greatest among Baltimore participants and led many to feel that they (or others) would be unwilling to participate or comply with study procedures. While locations considered to be sensitive varied by setting, participants in all settings said they would take measures to prevent sensitive information from being collected (i.e., intentionally disable devices, leave phones at home, alter response times). Privacy, confidentiality, and safety concerns may limit the accuracy of risk location information, study compliance, and participation. As concerns were often greatest among those engaging in illegal behaviors and with the highest risk behaviors, selection bias and non-response bias could negatively influence the representativeness and validity of study findings.
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Nelson EJ, Loux T, Arnold LD, Siddiqui ST, Schootman M. Obtaining contextually relevant geographic data using Facebook recruitment in public health studies. Health Place 2019; 55:37-42. [PMID: 30466814 DOI: 10.1016/j.healthplace.2018.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/08/2018] [Accepted: 11/06/2018] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Online participant recruitment for public health research studies has increased dramatically in recent years, particularly as traditional recruitment strategies have waned in efficiency. The emergence of e-epidemiology offers possibilities for reaching understudied populations as well as conducting large-scale studies. METHODS We conducted a cross-sectional survey focused on self-reported neighborhood characteristics, perceived stress, and feasibility of obtaining work/residential addresses via online recruitment in St. Louis, Missouri, USA from February 2017 to December 2017. We report the process of using Facebook recruitment and demonstrate how this strategy can enhance collection of geospatial data to better understand context and spatial patterns of disease. RESULTS A total of 425 participants were recruited via Facebook advertisements. All participants reported their residential and work ZIP codes, though only 64.7% and 45.6% provided their complete residential and work street addresses, respectively. Those who reported their complete residential street addresses were more likely to be female (69.8% vs. 56.1% of males, χ2 = 7.89, 1 df, p = 0.005), though no differences were observed by race, age, or employment status. DISCUSSION These findings indicate that valuable location data can be successfully collected via Facebook recruitment - data that could potentially include residential history or prospective follow-up time or be combined with other emerging technologies for geographic data in order to better understand the context and the effects of place on health outcomes. CONCLUSIONS Facebook recruitment may be an underutilized resource for obtaining accurate geospatial and contextually relevant health data and should be considered as a means for finding participants due to the cost-effectiveness, efficiency and flexibility of this recruitment approach.
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