Opposing Discourses Surrounding Type 2 Diabetes in Eastern Appalachian Kentucky.

Type 2 diabetes disproportionately affects individuals in Appalachia. This study investigated discourse among friends and family with different diabetes risk levels in Central Appalachia. Eighteen semistructured, in-depth interviews were conducted with Appalachian Kentuckians. Thematic analysis revealed 2 dialectic tensions centered on disease management (health as a personal problem vs diabetes management requiring social support) and disclosure (openness vs closedness). Health professionals should consider the powerful influence of speech with respect to family relations and support, along with the need to communicate early, clearly, and often in a manner that emphasizes family, friends, and connectedness.

Zika virus knowledge and attitudes in Ecuador.

Since its discovery in 1947 in Uganda, ZIKV has spread to 61 countries with a total of 229,238 confirmed human cases worldwide. Specifically, Ecuador has recorded 3,058 confirmed cases and 7 confirmed cases of congenital syndrome associated with ZIKV. Using the Health Belief Model (HBM), this pilot study was conducted to assess Zika virus-related knowledge and attitudes among adults in Ecuador. The survey data were collected in public places in rural and urban areas of Ecuador in May 2016. Seven items measured ZIKV knowledge and 23 items measured attitudes toward ZIKV. A total of 181 Ecuadorians participated in this study. The average age of the sample was 33.4. With respect to ZIKV knowledge, the majority of the participants had heard of ZIKV (n = 162, 89.5%). More males reported first hearing of ZIKV on the internet (p = 0.02), more rural individuals reported knowing someone diagnosed with ZIKV (p = 0.02), more primary school educated individuals reported hearing about ZIKV first from their doctor/nurse (p = 0.03), and more high school graduates correctly identified that ZIKV could be transmitted from mother to child (p = 0.03). As for the HBM constructs, there was a statistically significant difference between gender and cues to action (p = 0.04), with males having a statistically significant lower mean on the cues to action items compared to females. There were also statistically significant differences between those categorized as having "adequate" knowledge compared to "low" knowledge on the benefits construct (p = 0.04) and the perceived severity construct (p = 0.03). There is a clear need for education about the transmission and prevention of ZIKV. High levels of self-efficacy for prevention behaviors for ZIKV combined with low perceived barriers in this community set the stage for effective educational interventions or health promotion campaigns that can ameliorate the knowledge deficits surrounding transmission and prevention.

Factors Associated with HIV Related Stigma among College Students in the Midwest.

In general, U.S. college students have low perceived susceptibility of acquiring HIV infection while 15-25 percent of youth have had negative perceptions towards HIV positive individuals. Factors associated with HIV stigma among college students were examined in a convenience sample of 200 students. Descriptive and inferential statistics were utilized to summarize the data. Only four percent of participants responded correctly to HIV transmission knowledge items. HIV transmission knowledge scores were significantly higher for participants who were single with partner and those who resided outside university residential dorms (p < 0.05). There was a significant negative correlation between composite HIV knowledge scores and stigma scores r = -0.18 (p < 0.05). After adjusting for confounders, a marginal significant negative linear relationship emerged (ß = -0.09, p = 0.06) between HIV knowledge and stigma. HIV prevention education among college students needs to be addressed with nuance to minimize HIV knowledge gaps, stigma and student risk perception that impacts HIV prevention and stigma against those living with HIV.

Lessons from Ebola: Sources of Outbreak Information and the Associated Impact on UC Irvine and Ohio University College Students.

Objectives. We examined the role of outbreak information sources through four domains: knowledge, attitudes, beliefs, and stigma related to the 2014 Ebola virus disease (EVD) outbreak. Methods. We conducted an online survey of 797 undergraduates at the University of California, Irvine (UCI) and Ohio University (OU) during the peak of the outbreak. We calculated individual scores for domains and analyzed associations to demographic variables and news sources. Results. Knowledge of EVD was low and misinformation was prevalent. News media (34%) and social media (19%) were the most used sources of EVD information while official government websites (OGW) were among the least used (11%). Students who acquired information through OGW had higher knowledge, more positive attitudes towards those infected, a higher belief in the government, and were less likely to stigmatize Ebola victims. Conclusions. Information sources are likely to influence students' knowledge, attitudes, beliefs, and stigma relating to EVD. This study contains crucial insight for those tasked with risk communication to college students. Emphasis should be given to developing effective strategies to achieve a comprehensive knowledge of EVD and future public health threats.

Social Constructions of Stigmatizing Discourse Around Type 2 Diabetes Diagnoses in Appalachian Kentucky.

Type 2 diabetes is a growing problem among Appalachian Kentucky residents. Several issues contribute to diabetes disparities in the region, including lack of access to health care and geographic isolation. Previous studies also indicate that social stigma may be associated with type 2 diabetes. We used 28 semistructured interviews to explore how stigma is socially constructed across health status (diagnosed/undiagnosed). Perceived severity of the disease is high, yet the etiology of diabetes is not well understood. Thus, onset is perceived to occur "out of the blue," and a positive diagnosis is perceived as having life-threatening consequences. Diagnosed participants, who had learned more about the disease's etiology, prevention, and management, expressed intrapersonal stigma. In interpersonal situations, the visible indicators of a diabetes diagnosis (i.e., physical weight, insulin injection), rather than diagnosis status, tended to evoke stigmatizing interactions. These findings form the foundation for our recommendations for prevention messages in the region.

Efficacy of an Educational Intervention to Increase Consent for HIV Testing in Rural Appalachia.

This study sought to assess barriers and enhance readiness to consent to home and Planned Parenthood HIV testing among 60 out-patients from a mental health and substance abuse clinic in rural Appalachia. Testing barriers included not knowing where to get tested, lack of confidentiality, and loss of partners if one tested sero-positive. The intervention yielded lowered HIV stigma, increase in HIV knowledge, and agreement to take the HIV home test. These results are encouraging because they suggest that a brief educational intervention is a critical pathway to the success of the National Institutes on Drug Abuse's Seek, Test, Treat, and Retain initiative in poor rural counties.

A cross-cultural comparison of psychological distress among individuals living with HIV in Atlanta, Georgia, and Eldoret, Kenya.

Elevated psychological distress during HIV infection has been consistently correlated with negative HIV-related health outcomes in studies conducted in various regions of the world. This study was conducted to compare the nature and range of psychological distress among HIV-infected individuals who had sought mental health care as part of their HIV care in Kenya and the United States. The Brief Symptom Inventory (BSI) was completed by 234 individuals with HIV in Atlanta, Georgia, USA, and 284 in Eldoret, Kenya. The US-based sample expressed markedly higher levels of psychological distress symptoms on the anxiety, depression, interpersonal sensitivity, obsessive-compulsive, and psychoticism dimensions, as well as the overall global severity index. Substantial proportions of both the US and Kenya cohorts expressed higher levels of somatization and paranoid ideation that suggested further psychological evaluation. This study revealed psychological distress expression varied drastically among individuals who self-enrolled into HIV-related mental health care within two different care infrastructures.

Do intervention fidelity and dose influence outcomes? Results from the move to improve worksite physical activity program.

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; chi(2) = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

Symptoms of psychological distress: a comparison of rural and urban individuals enrolled in HIV-related mental health care.

Over the past decade, the number of individuals who have been diagnosed with HIV in nonmetropolitan areas (population of less than 50,000 individuals) has increased; however, the majority of the research has been conducted in metropolitan areas. Even less research has examined the levels of psychological distress among rural individual living with HIV. The purpose of this study was to explore the nature and range of psychological distress symptoms experienced by individuals living in rural areas who had self-enrolled into HIV-related mental health care and to compare their levels of distress to their urban counterparts accessing care at the same clinic. Data were collected from 95 individuals who self-enrolled in HIV-related mental health at either a rural (n = 47) or urban (n = 48) clinic. All participants completed the Brief Symptom Inventory (BSI), the instrument used in this study to assess symptoms of psychological distress. Rural participants had significantly higher mean scores on the hostility dimension of the BSI, F(1, 93) = 8.77, p = 0.004, than their urban counterparts. Furthermore, the rural participants had a greater proportion of individuals who had a T-score >or=63, a level indicative of a need for further psychological evaluation, for generalized anxiety, hostility, and psychoticism. The results indicated that rural individuals presented with higher levels of symptoms of psychological distress than their urban counterparts. These differences may be reflective of situational circumstances in rural areas where access to care, social isolation, and perceived stigma may delay screening for, and treatment of, psychological distress.

Relationship of psychological distress and unprotected sex among individuals with HIV seeking mental health care.

This study examined the prevalence of sexual behavior and its relationship with psychological distress among individuals with HIV who were seeking mental health care. Upon self-enrollment in HIV-related mental health care, 845 participants completed self-assessments of demographics, psychological distress, and sexual behaviors. Participants were categorized by sexual risk as determined by their reported unprotected sexual activity within the previous 30 days: receptive anal or vaginal sex (high-risk), insertive anal or vaginal sex (moderate-risk), oral sex (low-risk), and no sex (no-risk). The majority of the sample was classified as no-risk, 11% low-risk, 5% moderate-risk, and 17% were high-risk. Levels of psychological distress did not differ across risk levels. Overall psychological distress levels were elevated, 19% of the sample expressed severe distress. Use of illicit drugs, alcohol, and no-AIDS diagnosis predicted high-risk sexual behaviors. A substantial proportion of the sample reported engaging in high-risk sexual behaviors, which signifies the need to further incorporate sex-related prevention efforts among HIV-infected populations.

Predictors of exercise stage of change among individuals living with HIV/AIDS.

BACKGROUND: Although the transtheoretical model (TTM) is good at detecting motivation to alter behavior, one of the frequently cited methodological problems is related to the validity of the staging instruments. Few studies have examined the ability of the TTM constructs (decisional balance, self-efficacy, and processes of change) to predict the stages of change in healthy populations, and it has never been applied in this manner among individuals living with HIV/AIDS. PURPOSE: To determine the accuracy of the TTM constructs to predict the stages of change for exercise behavior in individuals living with HIV/AIDS. METHODS: Cross-sectional self-report data were collected from 208 individuals living with HIV/AIDS. RESULTS: Predictive discriminant analysis classified individuals into the correct stages 42% of the time, which was 25% better than chance (Z = 6.79, P < 0.05). Precontemplation was predicted 48% of the time, contemplation 25% of the time, preparation 70% of the time, and maintenance 63% of the time. These four stages were all predicted better than chance alone; however, no one was accurately predicted in the action stage. CONCLUSIONS: This was one of the first studies to examine the TTM in individuals living with HIV/AIDS, and the validity of the staging measure among individuals living with HIV/AIDS was supported. However, more research is needed to assess whether the action stage is appropriate for exercise behavior in this population segment.

Telephone-delivered, interpersonal psychotherapy for HIV-infected rural persons with depression: a pilot trial.

OBJECTIVE: Rural areas account for approximately 6% of AIDS cases in the United States. Many HIV-infected persons in rural areas live with elevated levels of psychiatric distress, suicidal ideation, and loneliness. This pilot study tested whether brief interpersonal psychotherapy delivered via telephone could reduce psychiatric distress among persons living with HIV-AIDS in rural areas in the United States. METHODS: Seventy-nine participants were assigned randomly to a usual care control condition or to a six-session, telephone-delivered, interpersonal psychotherapy intervention (hereafter referred to as the teletherapy group); participants in the teletherapy group continued to receive standard services available to them in the community. Participants completed self-administered surveys pre- and postintervention that assessed depressive and psychiatric symptoms, perceptions of loneliness, and social support. RESULTS: Participants in the teletherapy group evidenced greater reductions in depressive symptoms and in overall levels of psychiatric distress, compared with those in the control group. Nearly one-third of teletherapy participants reported clinically meaningful reductions in psychiatric distress from pre- to postintervention. CONCLUSIONS: The telephone-delivered interpersonal therapy intervention showed potential to reduce depressive and psychiatric symptoms among HIV-infected persons in rural areas. On the basis of these encouraging findings, additional research examining this intervention with this clinical population is warranted.

Psychological distress and engagement in HIV-related services among individuals seeking mental health care.

In the US, HIV-related mental health care has been funded for its ability to help engage and retain individuals living with HIV into other components of HIV-related care and treatment. However, little is known empirically about the types of HIV prevention and care with which they are, or need to be, connected. To explore this, data were collected from 617 individuals upon their self-enrollment in HIV-related mental health care in a large US city with high rates of HIV infection. Nearly a third of the participants (n=195) were "minimally engaged" in care services, 53% were "moderately engaged" and 15.6% were "highly engaged". There were significant differences between level of care engagement according to one's ethnicity, X(2)(4, n=617)=38.05; p<.001; Cramer's V=.18, with African-Americans and Latinos more likely to be highly engaged in care services compared to their Caucasian counterparts. Furthermore, individuals who were highly engaged in services had significantly lower levels of depression than their less engaged peers, F(2, 614)=8.18; p<.001; eta(2)=.03. Results suggest that while ethnic minorities were engaged in a higher number of care services, they were enrolling in mental health care following enrollment in other care services. Given the numerous benefits of engaging in HIV-related mental health early in the course of infection, it is important that case managers and primary care physicians educate African-Americans and Latinos on the benefits of mental health care in order to facilitate earlier engagement in HIV-related mental health services.

HIV provider perspectives: the impact of stigma on substance abusers living with HIV in a rural area of the United States.

Recent literature has documented growing concerns related to access to HIV care services for rural individuals living with both HIV and a dual diagnosis of substance abuse. Previous research has investigated issues from a client perspective, but limited research has investigated provider perspectives of rural issues surrounding HIV and substance abuse. The purpose of this qualitative study was to examine issues that impact the ability of care providers to create sustainable linkages to care for dual diagnosed individuals who live in rural areas. In-depth interviews were conducted in late 2005 with 39 HIV service providers at 11 agencies that provided HIV-related services to individuals in rural areas of a Midwestern state in the United States. Findings suggest multidimensional stigma in the medical referral network as the leading factor that presents challenges to service providers in rural areas. The service providers reported verbal stigma in the form of insults, a loss of role/respect, and a global loss of resources such as poorer quality health care or no health care provided. The stigma is conceptualized in four themes: (1) staff of medical referral sources stigmatizing against rural dual-diagnosis clients, (2) physicians stigmatizing against rural dual-diagnosis clients, (3) medical specialists stigmatizing against rural dual-diagnosis clients, and (4) client-perceived stigma. These themes were expressed equally among all of the providers, regardless of geographic location, type of HIV-related organization, or job title.

Symptoms of psychological distress among African Americans seeking HIV-related mental health care.

The purpose of this study was to examine the prevalence of symptoms of psychological distress experienced by African Americans upon self-enrollment in HIV-related mental health care and to compare the symptoms in this sample to the Brief Symptom Inventory (BSI) normative sample, the instrument used in this study to assess symptoms of psychological distress. Data were collected from 575 African Americans living with HIV who self-enrolled at an HIV-related mental health clinic located in a large city in the southeastern United States. Nearly 20% of the sample reported a t score >/= 63 for both somatization and paranoid ideation, a level indicative of a need for further psychological evaluation. Compared to the normative sample, this sample had significantly lower levels (p < 0.05) of anxiety, depression, phobic anxiety, interpersonal sensitivity, and global severity index than the normative sample and had significantly higher levels of paranoid ideation and somatization than the normative sample. These results indicate that, overall, African Americans presented for mental health services with lower levels of symptoms of psychological distress than the normative sample. To that end, it is possible that African Americans living with HIV may underreport symptoms of psychological distress or may experience symptoms of psychological distress differently than other individuals. As a result, it is important that HIV-related service providers recognize these patterns of psychological distress and provide appropriate referrals to HIV-related mental health providers.

The transtheoretical model and exercise among individuals living with HIV.

OBJECTIVE: To examine the distribution of the stages of change for exercise among individuals living with HIV as well as to identify the differences between the transtheoretical model (TTM) constructs. METHODS: Cross-sectional self-report data were collected from 208 individuals accessing HIV-related care services. RESULTS: More than half of the sample was in the action and maintenance stages, indicating a higher level of physical activity in this sample than the general population. Furthermore, the patterns of the TTM constructs across stages were consistent with past research. CONCLUSIONS: Stage-matched TTM interventions can be developed for individuals living with HIV.