Complementing the United States Household Food Security Survey Module with Items Reflecting Social Unacceptability

BACKGROUND

Social unacceptability of food access is part of the lived experience of food insecurity but is not assessed as part of the United States Household Food Security Survey Module (HFSSM).

OBJECTIVES

The objectives were as follows: 1) to determine the psychometric properties of 2 additional items on social unacceptability in relation to the HFSSM items and 2) to test whether these 2 items provided added predictive accuracy to that of the HFSSM items for mental health outcomes.

METHODS

Cross-sectional data used were from the Intersection of Material-Need Insecurities and HIV and Cardiovascular Health substudy of the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study. Data on the 10-item HFSSM and 2 new items reflecting social unacceptability were collected between Fall 2020 and Fall 2021 from 1342 participants from 10 United States cities. The 2 social unacceptability items were examined psychometrically in relation to the HFSSM-10 items using models from item response theory. Linear and logistic regression was used to examine prediction of mental health measured by the 20-item Center for Epidemiologic Studies Depression scale and the 10-item Perceived Stress Scale.

RESULTS

The social unacceptability items were affirmed throughout the range of severity of food insecurity but with increasing frequency at higher severity of food insecurity. From item response theory models, the subconstructs reflected in the HFSSM-10 and the subconstruct of social unacceptability were distinct, not falling into one dimension. Regression models confirmed that social unacceptability was distinct from the subconstructs reflected in the HFSSM-10. The social unacceptability items as a separate scale explained more (∼1%) variation in mental health than when combined with the HFSSM-10 items in a single scale, and the social unacceptability subconstruct explained more (∼1%) variation in mental health not explained by the HFSSM-10.

CONCLUSIONS

Two social unacceptability items used as a separate scale along with the HFSSM-10 predicted mental health more accurately than did the HFSSM-10 alone.

Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for people with HIV who use drugs: study protocol for a mixed-methods, multisite, observational study

INTRODUCTION

Our previous pilot work suggests relational harm reduction strengthens relationships between people with HIV (PWH) who use drugs and their healthcare providers and improves HIV health outcomes. However, there is limited research examining ways that structural (eg, strategies like syringe service programmes) and/or relational (patient-provider relationship) harm reduction approaches in HIV clinical settings can mitigate experiences of stigma, affect patient-provider relationships and improve outcomes for PWH who use drugs. Our mixed methods, multisite, observational study aims to fill this knowledge gap and develop an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings.

METHODS AND ANALYSIS

Aim 1 will explore the relationship between healthcare providers' stigmatising attitudes towards working with PWH who use drugs and providers' acceptance and practice of structural and relational harm reduction through surveys (n=125) and interviews (n=20) with providers. Aim 2 will explore the interplay between patient-perceived harm reduction, intersectional stigma and clinical outcomes related to HIV, hepatitis C (if applicable) and substance use-related outcomes through surveys (n=500) and focus groups (k=6, total n=36) with PWH who use drugs. We will also psychometrically evaluate a 25-item scale we previously developed to assess relational harm reduction, the Patient Assessment of Provider Harm Reduction Scale. Aim 3 will use human-centred design approaches to develop and pretest an intervention to operationalise harm reduction care for PWH who use drugs in HIV clinical settings.

ETHICS AND DISSEMINATION

This study was approved via expedited review by the University of Pittsburgh Institutional Review Board (STUDY21090002). Study findings will be presented in peer-reviewed journals and public health conferences as well as shared with patient participants, community advisory boards and harm reduction organisations.

TRIAL REGISTRATION NUMBER

NCT05404750.

"All We Had Were the Streets": Lessons Learned From a Recreation-Based Community Health Space for Young Black MSM and Trans Women Across the HIV Prevention and Care Continuum

Young Black men who have sex with men (MSM) and transgender people experience disparities in HIV incidence and HIV outcomes. To effectively engage these communities in HIV-related programming, we developed a recreation-based community health space. We sought to examine the challenges and successes in implementing this program. Qualitative data were collected from federal progress reports and by a process evaluator who recorded interviews with staff, stakeholders, and participants. These data were coded for themes related to barriers and successes. We consolidated themes into four key domains: community engagement, service provision, stigma, and violence. Each of these domains was determined to significantly affect programmatic success during the implementation period. Young Black MSM and transgender people experience stigmas that pose challenges to effective engagement in HIV-related programming. These lessons learned offer strategies for community engagement and for addressing violence and stigma to maximize programmatic effectiveness.

FROM BIAS TO BISEXUAL HEALTH DISPARITIES: ATTITUDES TOWARD BISEXUAL MEN AND WOMEN IN THE UNITED STATES

PUROPSE

A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed "biphobia." However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity.

METHODS

Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates.

RESULTS

Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men; and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values <.05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values <.001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values <.05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values <.05).

CONCLUSION

This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.

Administration of ziprasidone for 10 days increases cocaine toxicity in mice

Long-term treatment with antipsychotic medications alters the regional density of several of the neurotransmitter receptors that mediate cocaine toxicity. However, the effect of either up- or down-regulation of the neurotransmitter receptors on cocaine toxicity is unknown. In this study, we determined if subacute administration of the atypical antipsychotic ziprasidone altered the toxic effects of cocaine in mice. Ziprasidone (4 mg/kg) or placebo was administered to the first two groups of CF-1 mice for 10 days and, then on day 10, an estimated LD50 dose of cocaine (102 mg/kg) was given to these mice. In a third group, in order to produce a ziprasidone withdrawal state, we administered ziprasidone for 10 days, followed by no treatment for 2 days before cocaine administration. There was no significant difference among the three groups in overall survival: 63% in the treatment group, 60% in the withdrawal group, and 80% in the placebo group. Survival time was significantly shorter for the withdrawal group than for the control group. Our study may have been limited by lower than expected serum ziprasidone concentrations and lower than expected lethality from cocaine. However, our findings suggest that administration of an atypical antipsychotic for 10 days may increase the toxic effects of cocaine.

Aneurysms of the infrarenal abdominal aorta: principles and results of surgical treatment

With the surgical treatment of closed abdominal aortic aneurysms, the patient can have long-term survival and the danger of rupture can be avoided. Surgical repair on asymptomatic closed aneurysms can be performed with a very low risk (a mortality rate of below 1%). The main prerequisite for such protective surgery is an early diagnosis, best done by a routine check-up of all elderly people suffering from arterial hypertension, peripheral occlusive disease or other signs of arteriosclerosis. Computerized tomography (CT) and the ultrasound technique have gained a predominant position in such protective screening programs. Through the standardization and simplification of the operative techniques, surgical repair has been made simpler, safer and shorter, and the operative risk for patients with intact aneurysms has been remarkably reduced. A ten-year retrospective evaluation of 162 operated patients demonstrates a reduction in operative mortality from 14.3% to 2.8% in the group of patients with nonruptured aneurysms in the last period (1975-1979). On the other hand, progress has been made much more limited in surgery for ruptured aneurysms (operative mortality only reduced from 61.1% to 52.3%). The repair of closed or ruptured aortic aneurysms should be mainly restricted to special units with a highly trained surgical team. This type of surgery should no longer be the subject of occasional intervention by general surgeons.

[Aneurysm of the infrarenal abdominal aorta]

The experience with 125 consecutive patients who underwent operations for infrarenal aortic aneurysm is presented. Two intervals of four years each were reviewed and compared: period A (1970-1974) and period B (1975-1978). With a simpler and shorter technique (dissection method), and more frequent operations (+72%), the operative mortality in cases of nonruptured aneurysms decreased from 14.3% (A) to 2,1% (B); in cases of ruptured aneurysms, from 61,1% (A) to 48,4% (B). In cases of elective operation there was no significant correlation of mortality to age, concomitant coronary disease (52,5%), and occlusive disease of peripheral vessels. The improved results are due to simplification and standardization of operative procedures and to use of efficient intensive care possibilities.