Pilot trial of a parenting and self-care intervention for HIV-positive mothers: the IMAGE program.

A pilot study was conducted to assess the effects of the IMAGE pilot intervention (Improving Mothers' parenting Abilities, Growth, and Effectiveness) on mothers living with HIV (MLH). Based on Fisher and Fisher's IMB model [1992. Changing AIDS risk behavior. Psychological Bulletin, 111, 455-474], the intervention focused on self-care and parenting behavior skills of MLH that affect maternal, child, and family outcomes. A randomized pre-test-post-test two-group design with repeated assessments was used. MLH (n = 62) and their children aged 6-14 (n = 62; total N = 124) were recruited for the trial and randomized to the theory-based skills training condition or a standard care control condition. Assessments were conducted at baseline with follow-ups at 3, 6, and 12 months. Maternal, child, and family outcomes were assessed. Results show significant effects of the intervention for improving parenting practices for mothers. The intervention also improved family outcomes, and showed improvements in the parent-child relationship. IMAGE had a positive impact on parenting behaviors, and on maternal, child, and family outcomes. Given MLH can be challenged by their illness and also live in under-resourced environments, IMAGE may be viewed as a viable way to improve quality of life and family outcomes.

Gender differences in treatment and clinical characteristics among patients receiving extended release naltrexone.

Further research is needed to investigate real-world acceptability of extended-release naltrexone for alcohol and opioid use disorders, and potential gender differences. This study examines treatment and clinical characteristics among men and women receiving extended-release naltrexone in a large, publicly funded substance use disorder treatment system (N = 465; 52% female). Patient demographics, treatment characteristics, and the number of extended-release naltrexone doses received were collected from administrative data and treatment program staff. Additionally, patients provided information on experiences with extended-release naltrexone in an open-ended format at 1, 2, and 3 weeks following their first injection. For a subsample of patients (N = 220), alcohol/opioid cravings and specific adverse effects were also assessed. Compared to men, women reported experiencing a higher rate and mean number of adverse effects. Overall, craving scores showed substantial reductions over time. However, among patients taking extended-release naltrexone for alcohol use, women showed a significantly greater reduction in craving scores compared to men. No gender differences were observed in the number of extended-release naltrexone doses received. Although women may have a greater need for additional support in managing early adverse effects, extended-release naltrexone as an adjunct to psychosocial treatment may be an acceptable and promising treatment approach for both men and women, and particularly for women prescribed extended-release naltrexone for alcohol use. This study contributes further information on patients' experiences during the early course of extended-release naltrexone treatment in real-world settings. Understanding these experiences may assist policy makers and treatment providers in addressing challenges of implementing this treatment into wider practice.

Career readiness and externalizing behaviors of children affected by maternal HIV/AIDS: 15-year outcomes of the PACT study.

The purpose of this 15-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent career readiness and externalizing behaviors. Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning and depression) and child/adolescent outcomes (e.g., career readiness, conduct disorder, drug use, sexual behaviors, parent attachment and youth autonomy) were assessed over 20 time-points. Individual growth and GEE logistic regression models showed lower variability in maternal viral load was positively associated with better career readiness and parent attachment among adolescent/young adults. Externalizing behaviors (conduct disorder, alcohol and crystal methamphetamine use) were positively associated with maternal depression. Adolescent coping efficacy was shown to be a protective factor when applied to models on career readiness. Stability in MLH health positively affects children's career readiness over time, particularly career planning and career choices. The finding that adolescent coping efficacy may act as a protective factor against poor career planning has important implications for developing interventions to assist children in coping with parental HIV.

Parenting Deficits of Mothers Living with HIV/AIDS who have Young Children.

The purpose of this study was to examine a model of the relationships between parenting deficits and skills, along with child outcomes, in a sample of mothers living with HIV (MLH) and their 6 to 14 year old children. Sixty-two MLH (61% Latina, 26% black, 3% white, & 10% multiracial) and their well children (age 6 - 14) were recruited from the greater Los Angeles, California, region to participate in an intervention (IMAGE: Improving Mothers' parenting Abilities, Growth, and Effectiveness) designed to assist MLH with parenting and self-care skills. Constructs examined included parenting deficits, parenting skills, and child outcomes. Covariance structural modeling was used for the analyses. Covariance structural modeling confirmed the hypothesized set of construct associations. As predicted, fewer parenting deficits were associated with better parenting skills, which, in turn, were associated with better child outcomes. This study delineated further the parenting issues with which MLH struggle, providing information on the interventions needed for this population. MLH who have little confidence they can enact parenting skills and limited knowledge of basic parenting practices appear to be less likely to provide family routines consistently, monitor their children, or to engender family cohesion or a close parent-child relationship. Such parenting skills were found to be associated with child functioning.

Mortality, causes of death, and health status among methamphetamine users.

This study examines causes of death, years of life lost, and health and drug use characteristics associated with mortality over an 8 to 10 year period in a sample of methamphetamine users who had and had not received substance use disorder treatment (N = 563). Decedents reported initiating their methamphetamine use for different reasons than surviving methamphetamine users, and some of these differences varied by treatment status. Study findings provide additional detail on long-term health and mortality outcomes in a diverse sample of methamphetamine users, which may inform public health strategies targeting the comparable and divergent needs of treated and untreated populations.

A qualitative study of methamphetamine users' perspectives on barriers and facilitators of drug abstinence.

To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n = 20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core; e.g., "I didn't realize how dark and mean I was … I was like a different person." Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no-treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users' experiences with MA use, addiction, and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery.

Pregnancy and fetal loss reported by methamphetamine-using women.

To better understand substance use disorder treatment needs of pregnant and parenting women who use methamphetamine (MA), this paper describes pregnancy histories and fetal losses for women who were treated for MA use (N = 153) with reference to a national sample, and describes their drug use, sexual risk behaviors, and mental health status. MA users reported an average of 4.6 total pregnancies and 2.1 fetal losses, whereas women in a general population survey reported 3.2 and 1.2, respectively. Higher numbers of pregnancies and fetal losses were correlated with specific substance abuse and mental health problems including early sexual abuse and cognitive problems. The combination of MA users' especially high numbers of pregnancies, fetal losses, and rates of risk behaviors suggest high social and health care costs for this population. Prenatal care may provide a vector through which women can be connected to risk reduction interventions and gender-responsive treatment services addressing substance use and mental health needs.

Poly-drug and marijuana use among adults who primarily used methamphetamine.

This study examines health and legal problems associated with use of commonly reported substances and combinations of substances in a sample of adults with long histories of methamphetamine (meth) use. Data are from a 2009-11 eight-year follow-up interview in an intensive natural history study (N = 373). Respondents who had not used illicit substances in the year preceding the follow-up interview (38%) were compared to users of marijuana-only (16%), meth-only (7%), and poly-drug users who used meth + marijuana but not heroin or cocaine (19%), and poly-drug users who used heroin and/or cocaine (20%). Multinomial regression results indicate that compared to drug-abstinent individuals, greater depressive symptomatology was reported for poly-drug users of meth + marijuana (p = .001), and arrest rates were higher for poly-drug users who used heroin/cocaine (p = .006); no differences in health, mental health, or criminal involvement were observed for meth-only users compared to abstinent individuals. Users of marijuana-only and poly-drug users of heroin/cocaine experienced poorer physical health status than those who were abstinent. To further explore this finding, use of marijuana for medical reasons was examined by drug use group. Overall, health and criminal outcomes varied based on type and combination of substances used, and these differences should be considered when planning treatment strategies.

Substance use and mental health characteristics associated with cognitive functioning among adults who use methamphetamine.

This study describes cognitive functioning and its relation to psychiatric and substance use severity among adults with long duration methamphetamine use. Study participants (N = 405) completed a battery of tests from the Automated Neuropsychological Assessment Metrics that examined cognitive accuracy, processing speed, and efficiency. Multivariate analyses indicate that lower accuracy but faster speed on learning, spatial memory and delayed memory were correlated with more days of past-month methamphetamine use. Lifetime months of methamphetamine use was not related to cognitive functioning. Poorer cognitive efficiency was related to other problems, including crack/cocaine use, symptoms of depression, and poorer emotional state.

Adolescent response to having an HIV-infected mother.

In this study, late adolescents/early adults whose mothers were living with HIV (MLH) were interviewed in order to explore their perceptions of what it had been like for them to grow up under the shadow of their mothers' illness. Adolescents were asked to describe what the difficult aspects of growing up with an HIV-positive mother were as well as what, if any, were the more rewarding aspects. Interviews were conducted in 2009-2010 with a random sample of 40 adolescents being followed up in a longitudinal assessment study. All study participants were English or Spanish speaking. Mean age was 18.9 years (SD = 1.9); 67.5% were Latino; 27.5% African-American; and 5% other/multiracial. Results revealed that growing up with an HIV-positive mother had both challenges as well as rewards. On the challenge side, adolescents mentioned six main issues: (1) disappointment regarding mothers' missing of childhood activities and events; (2) worry about mothers' health; (3) worry about the possibility of mothers' death; (4) increased burden of adult responsibilities/caregiving; (5) feelings of secrecy/stigma associated with HIV/AIDS; and (6) need to self-monitor behavior and communication to avoid maternal stress. On the positive side, adolescents mentioned three main rewarding aspects of growing up with an HIV-positive mother: increased closeness in the mother-child relationship; fostering of positive personality traits (e.g., resilience, gratitude, open-mindedness); and "perks" accorded to HIV-affected families.

Patterns of treatment utilization and methamphetamine use during first 10 years after methamphetamine initiation.

The study examined joint trajectories of methamphetamine (MA) use and substance abuse treatment utilization and identified differences among pattern groups for a sample of 348 treated for MA use. Results from group-based trajectory modeling showed that treatment utilization during the first 10 years after initiation of MA use could be categorized into three distinctive patterns: about half the MA users have a pattern of low treatment utilization; one-fourth follow a quicker-to-treatment trajectory with higher probability of treatment during the first 5 years of MA use and less treatment in the next 5 years; and one-fourth have a slower-to-treatment trajectory with more treatment during the second half of the 10-year period. Four MA use patterns were identified: consistently low use, moderate, and high use, as well as a decreasing use pattern. Periods of greater likelihood of treatment participation were associated with periods of decreasing or lower frequency of MA use.

Racial/ethnic differences in health status and morbidity among adults who use methamphetamine.

Higher disease rates among ethnic-minority populations compared to Whites have been pervasive and persistent over time, and as methamphetamine (MA) use continues to penetrate ethnically diverse geographic regions across the United States, minority populations may be at increased risk for adverse MA-related health consequences, thus further contributing to poorer health among vulnerable populations. This study examines racial/ethnic differences in health status and health conditions among individuals who used MA. Data are from a natural history interview study of adult MA users (N = 512), half of whom received treatment for MA abuse, and a comparison group who had not received substance abuse treatment. Chi-square and logistic regression analyses examined differences by race/ethnicity in self-reported health status and morbidity, adjusting for age, gender, and health behaviors including MA use severity and tobacco use. Overall, back/neck injuries (27%), severe dental problems (26%), gunshot/knife injury (25%), and sexually transmitted diseases (STDs) (24%) were commonly reported. Racial/ethnic differences were observed for conditions including gunshot/knife injuries, hearing loss, and learning disabilities disproportionately affecting Latino populations, and asthma and STDs disproportionately affecting African-Americans. Results varied by whether treatment for MA abuse was received. Although poor health and morbidity were common overall, each ethnic group may be at higher risk for specific health problems. Health status and conditions in this MA-using sample are examined and discussed with reference to general population data. These findings may assist researchers and treatment providers in addressing health consequences of the increasing prevalence of MA use among minority populations. Understanding ethnic differences in health status among MA users may assist in developing interventions to target specific health care needs.

Trajectories of Delinquency from Age 14 to 23 in the National Longitudinal Survey of Youth Sample.

This study utilized data from the National Longitudinal Survey of Youth to investigate risk trajectories for delinquency and factors associated with different trajectories, particularly substance use. The sample (N = 8,984) was 49% female. A group-based trajectory model was applied, which identified four distinct trajectories for both males and females: (1) a High group with delinquency rates consistently higher than other groups, with some decrease across the age range; (2) a Decreased group, beginning at high levels with substantial decrease to near zero; (3) a Moderate group experiencing some decline but remaining at moderate rates of delinquency through most of the age range; and (4) a consistently Low group, having low rates of delinquency declining to near zero by mid- to late-teens. The Low group was distinguished by several protective factors, including higher rates of maternal authoritative parenting style, possible lower acculturation (higher rates of non-English spoken at home), higher rates of religious activity, later substance use initiation, lower rates of early delinquent activity, less early experience with neighborhood or personal violence, and higher rates of perceiving penalty for wrongdoing. Conversely, the High group was characterized by several vulnerability factors-essentially the converse of the protective factors above.

Impact of maternal HIV health: a 12-year study of children in the Parents And Children Coping Together project.

PURPOSE: The purpose of this 12-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent well-being and behavioral outcomes, extending an earlier published account. METHODS: Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS, who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning, and depression) and child/adolescent outcomes (e.g., depression, anxiety/worry, aggression, and self-concept) were assessed over 16 time points. RESULTS: Using growth curve modeling, results show a negative effect of maternal health status on child/adolescent outcomes, including child/adolescent depression, anxiety/worry, aggression, and self-concept. Interaction effects within the growth models suggest younger children are more impacted by poor maternal health than are older children/adolescents. CONCLUSIONS: This is the first study to follow a cohort of children of mothers living with HIV/AIDS over such an extended age range, through late adolescence/early adulthood, to determine the impact of maternal health status throughout the entire developmental period.

Self-competence Among Early and Middle Adolescents Affected by Maternal HIV/AIDS.

Adolescent children of mothers with HIV face a host of stressors that place them at increased risk for poor outcomes. Using covariance structure analysis, this study examines adolescent risk outcomes and their relationships to maternal health, as well as the potentially protective factors of family environment and self-competence. The final model indicated that poor maternal health was negatively related to a protective family environment, which in turn was negatively related to adolescent risk outcomes. A protective family environment was also positively related to adolescent self-competence, which was negatively related to adolescent risk outcomes. Implications of the study are discussed, including how these findings can influence interventions aimed at reducing the risk for poor outcomes among adolescent youth with HIV-infected mothers.

HIV-positive mothers with late adolescent/early adult children: "empty nest" concerns.

In-depth interviews about the "empty nest" were conducted with 57 HIV-positive mothers of late adolescent/early adult children. Empty nest worries included the following: (a) identity loss, (b) loss of social support, (c) financial insecurity, (d) worsening of physical health, and (e) death/dying. Hopes included the following: (a) self-improvement, (a) change of life focus, (c) travel, (d) romantic partners, and (e) familial ties. Respondents' HIV/AIDS status colored their thoughts/feelings about the empty nest; some worries were specific to being HIV positive and would not occur for nonill mothers. Midlife HIV-positive women need health care/social service resources as they navigate health and social-psychological challenges to successful aging.

HIV-positive Mothers' Communication About Safer Sex And STD Prevention With Their Children.

Mothers play an important role in promoting the sexual health of their adolescent children. Fifty-seven HIV-positive mothers with adolescent children participated in an in-depth, qualitative interview regarding whether they have talked to their children about safer sex and STD prevention, including at what age they began such discussions, and what messages they gave to their children. The majority of mothers (95%) had talked with their child about safer sex; some began such discussions when the children were as young as 6 years old, but most began when the children were around 12 years old. Mothers' messages fell into the following areas: (1) protecting oneself from STDs; (2) giving factual information regarding STDs, including HIV; (3) avoiding pregnancy; (4) empowering and respecting oneself; and (5) communicating with sexual partners. The mothers' own HIV status impacted the discussions with their children. Content of mothers' messages, child reactions, and child outcomes are discussed.

Effects of Maternal HIV on Children's Psychosocial Adjustment with Peers and with Their Mother.

A longitudinal assessment was undertaken of young adolescents' psychosocial outcomes affected by maternal HIV/AIDS, focusing on both parent-child psychosocial ties and peer relationships. Data were taken from the Parents and Children Coping Together study (PACT), a 15-year study assessing mothers with HIV/AIDS and their well children every 6 months. Families (N = 118) who participated in PACT II and PACT III are included in the current analyses, who were assessed every 6 months for 36 months in PACT II, and every 6 months for 18 months in PACT III (providing 11 time points of data across 8 years). Growth curve modeling was applied to assess the associations of maternal health on adolescent psychosocial outcomes. In terms of their relationship with their mother living with HIV (MLH), adolescent psychosocial functioning was negatively impacted by maternal illness, specifically viral load count and vitality levels, while several indicators of increased maternal illness (including viral load, vitality, illness symptoms, health-related anxiety) predicted less attachment with peers. In addition, MLH increased illness was associated with more adolescent autonomy.

HIV Disease Impact on Mothers: What They Miss During Their Children's Developmental Years.

Adjusting to chronic illness is very complicated for families with children, as they are already faced with the challenge of development and childrearing. In this study, qualitative interviews were conducted with HIV positive mothers on a number of issues related to being an HIV positive mother raising young children. One topic of the interview was whether or not they felt that HIV had caused them to miss activities with their children while the children were growing up, what types of activities they had missed, the age of the child for each example, and how HIV had led to missing these activities. Interviews were conducted in 2008 with a random sample of 57 mothers being followed in a longitudinal assessment study. All study participants were English or Spanish speaking. Mean age was 44.1 (SD = 5.6) years; 47% were Latina; 35% African American; 11% White; and 7% other race. About 60% of the mothers disclosed that their HIV status had caused them to miss out on activities with their children while their children were growing up, ranging from daily care activities to major school and extra-curricular activities. Some mothers missed significant amounts of time with their children due to hospitalizations. In some cases mothers felt forced into a choice between mothering ability and their own health, including adherence to medications. Implications for the mothers and the children are discussed.

Pilot trial of a disclosure intervention for HIV+ mothers: the TRACK program.

OBJECTIVE: The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLHs) to disclose their serostatus to their young children (age 6-12 years). METHOD: MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had 3 individual sessions and 1 follow-up phone call. The sessions focused on preparing MLHs for disclosure through behavioral exercises using Derlega's model (V. J. Derlega, B. A. Winstead, K. Greene, J. Serovich, & W. N. Elwood, 2004) of HIV disclosure. Both MLHs and their child were assessed across multiple time points (baseline, 3, 6, and 9 months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mother's health, child's mental health, and family outcomes). RESULTS: MLHs in the intervention group were 6 times more likely to disclose their HIV status than those in the control group (OR = 6.33, 95% CI [1.64, 24.45]), with 33% disclosing in the intervention group compared with 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness. CONCLUSIONS: TRACK was found to be successful in helping MLHs disclose their HIV status to their children, with positive outcomes noted for both MLHs and their children.