Clinical HIV outcome trajectories associated with a history of child protective service out-of-home care: Longitudinal cohort findings with women living with HIV in Canada.

OBJECTIVES: Knowledge gaps exist regarding the effects of experiencing child protective services (CPS) out-of-home care (e.g. foster homes) among women with HIV. We examined whether CPS out-of-home care was associated with HIV clinical outcome trajectories among women with HIV in a longitudinal cohort study in Ontario, British Columbia, and Quebec, Canada. METHODS: At three timepoints across 5 years (2013-2018), we examined self-reported current antiretroviral therapy (ART) use and viral load (VL) detectability (>50 copies/mL). We used latent class growth analysis (LCGA) to identify trajectories of ART use and VL outcomes across study waves. LCGA identifies subgroups (classes) with similar trajectories within the sample. We assessed whether HIV outcome trajectories could be predicted by CPS history. We then conducted a mediation analysis to test whether a mental health latent construct mediated the association between CPS history and detectable VL. RESULTS: Nearly one-fifth (n = 272; 19%) of participants (n = 1422; mean age 42.8 years) reported CPS out-of-home care. Most participants (89%) were in classes that consistently used ART and had an undetectable VL. Individuals with CPS out-of-home care histories were twice as likely to have a consistently detectable VL (ß = 0.72, p = 0.02); there were no differences in ART use trajectories. In mediation analyses, we found an indirect path from CPS history to a consistently detectable VL via baseline mental health status (ß = 0.02, 95% confidence interval 0.005-0.04, p = 0.02), with a significant odds ratio (1.12, z = 2.43, p = 0.02). CONCLUSION: Among women with HIV in Canada, experiencing childhood CPS out-of-home care was associated with a reduced likelihood of achieving viral suppression, via poorer mental health.

Human immunodeficiency virus prevention outcomes associated with arts-based sexual health workshop participation among Northern and Indigenous adolescents in the Northwest Territories, Canada.

BACKGROUND: Contextually tailored, arts-based HIV prevention strategies hold potential to advance adolescent sexual health and wellbeing. We examined HIV prevention outcomes associated with arts-based sexual health workshop participation with Northern and Indigenous adolescents in the Northwest Territories (NWT), Canada. METHODS: An Indigenous community-based youth agency delivered arts-based workshops in school settings to adolescents aged 13-18 in 24 NWT communities. Pre and post-test surveys included socio-demographic characteristics, sexually infections (STI) knowledge, HIV/STI risk perception, sexual relationship equity, condom use self-efficacy, and safer sex efficacy (SSE). Latent change score models were conducted to assess pre-post differences and factors associated with these differences. RESULTS: Among participants (n = 344; mean age 14.3 years, SD: 1.3; Indigenous: 79%) most (66%) had previously attended this workshop. Latent change score models revealed a significant and large effect size for increased STI knowledge (ß = 2.10, SE = 0.48, p < .001) and significant and small effect sizes for increased HIV/STI risk perception (ß = 0.24, SE = 0.06, p < .001) and SSE (ß = 0.16, SE = 0.07, p = .02). The largest increases across several outcomes occurred with first time workshop participants; yet previous workshop participants continued to report increases in HIV/STI risk perception and SSE. CONCLUSION: Arts-based HIV prevention approaches show promise in advancing STI knowledge, risk perception, and SSE with Northern and Indigenous youth.

Examining Pathways from Food Insecurity to Safer Sex Efficacy Among Northern and Indigenous Adolescents in the Northwest Territories, Canada.

BACKGROUND: Food insecurity is a social determinant of health linked with elevated HIV exposure. Safer sex efficacy (SSE), the ability to navigate sexual decision-making and condom use, is an important marker of sexual wellbeing. Pathways from food insecurity to SSE are understudied, particularly among adolescents in Arctic regions who are at the nexus of food insecurity and sexual health disparities. We examined pathways from food insecurity to SSE among adolescents in the Northwest Territories (NWT), Canada. METHODS: We implemented cross-sectional surveys with adolescents aged 13-18 recruited through venue-based sampling in 17 NWT communities. We conducted multivariable logistic regression to assess socio-demographic factors associated with food insecurity. We then conducted structural equation modeling (SEM) using maximum likelihood estimation to assess direct effects of food insecurity on SSE and indirect effects via resilience, depression, and relationship power inequity. We assessed both condom use SSE (e.g., confidence in using condoms) and situational SSE (e.g., SSE under partner pressure). RESULTS: Most participants (n = 410) identified as Indigenous (79%) and 45% reported experiencing food insecurity. In SEM, we did not find a significant direct effect from food insecurity to SSE; however, we found indirect effects from food insecurity to condom use SSE through resilience and depression and from food insecurity to situational SSE through resilience. CONCLUSIONS: Findings call for structural interventions to address food insecurity, alongside resilience-focused strategies that address the intersection of sexual and mental health. Sexual health strategies focused on individual behavior change are insufficient to address larger contexts of poverty among Northern youth.

Pathways From HIV-Related Stigma, Racial Discrimination, and Gender Discrimination to HIV Treatment Outcomes Among Women Living With HIV in Canada: Longitudinal Cohort Findings.

BACKGROUND: HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV. SETTING: Ontario, British Columbia, and Quebec, Canada. METHODS: We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors. RESULTS: There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience. CONCLUSION: Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.

Associations between water insecurity and depression among refugee adolescents and youth in a humanitarian context in Uganda: cross-sectional survey findings.

BACKGROUND: Water insecurity is linked to poor mental health through intrapersonal, relational and community-based stressors. We examined water insecurity and depression among refugee youth in Bidi Bidi, Uganda. METHODS: We conducted a cross-sectional survey and multivariable ordinal logistic regression to examine associations between water insecurity and depression severity, adjusting for gender, resilience, social support and food insecurity. RESULTS: Among participants (n=115; mean age: 19.7 y, SD 2.3), 80.0% reported water insecurity and 18.3% had moderate/severe depression symptoms. Water insecurity was independently associated with higher levels of depression severity (adjusted OR: 5.61; 95% CI 1.20 to 26.30; p=0.03). CONCLUSIONS: Findings suggest water insecurity was commonplace and associated with depression. Water insecurity could be integrated in refugee mental health promotion by policymakers and community-based programmers.

Do siblings influence one another? Unpacking processes that occur during sibling conflict.

This study examined the extent to which 205 sibling dyads influenced each other during conflict. Data were collected between 2013 to 2015. The sample included 5.9% Black, 15.1% South Asian, 15.1% East Asian, and 63.8% White children. Older siblings were between 7-13 years old (Female = 109) and younger siblings were 5-9 years old (Female = 99). Siblings' conflict resolution was analyzed using dynamic structural equation modeling. Modeling fluctuations in moment-to-moment data (20-s intervals) allowed for a close approximation of causal influence. Older and younger siblings were found to influence one another. Younger sisters were more constructive than younger brothers, especially in sister-sister dyads. Sibling age gap predicted inertia in older siblings. Socialization processes within sibling relationships are discussed.

Teaching empathy to mental health practitioners and trainees: Pairwise and network meta-analyses.

OBJECTIVE: Empathy is a foundational therapeutic skill and a key contributor to client outcome, yet the best combination of instructional components for its training is unclear. We sought to address this by investigating the most effective instructional components (didactic, rehearsal, reflection, observation, feedback, mindfulness) and their combinations for teaching empathy to practitioners. METHOD: Studies included were randomized controlled trials targeted to mental health practitioners and trainees, included a quantitative measure of empathic skill, and were available in English. A total of 36 studies (37 samples) were included (N = 1,616). Two reviewers independently extracted data. Data were pooled by using random-effects pairwise meta-analysis and network meta-analysis (NMA). RESULTS: Overall, empathy interventions demonstrated a medium-to-large effect (d = .78, 95% CI [.58, .99]). Pairwise meta-analysis showed that one of the six instructional components was effective: didactic (d = .91 vs. d = .39, p = .02). None of the program characteristics significantly impacted intervention effectiveness (group vs. individual format, facilitator type, number of sessions). No publication bias, risk of bias, or outliers were detected. NMA, which allows for an examination of instructional component combinations, revealed didactic, observation, and rehearsal were included among the most effective components to operate in combination. CONCLUSIONS: We have identified instructional component, singly (didactic) and in combination (didactic, rehearsal, observation), that provides an efficient way to train empathy in mental health practitioners. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada.

INTRODUCTION: Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada. METHODS: This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma. RESULTS AND DISCUSSION: Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave. CONCLUSIONS: Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.

Recent sex work and associations with psychosocial outcomes among women living with HIV: findings from a longitudinal Canadian cohort study.

INTRODUCTION: Sex workers are disproportionately impacted by the HIV pandemic across global contexts, in part due to social and structural contexts of stigma and criminalization. Among women living with HIV, there is a dearth of longitudinal information regarding dynamics of sex work engagement and associated social and health outcomes. In order to better understand the social contexts and health needs of sex working women living with HIV, this study aimed to understand recent sex work prevalence and its longitudinal associations with stigma, psychosocial and clinical HIV outcomes among women living with HIV in Canada. METHODS: We conducted a three-wave prospective cohort survey at 18-month intervals with women living with HIV aged 16 and older in three Canadian provinces between 2013 and 2018. We used generalized estimating equations to examine longitudinal associations between recent (past 6-month) sex work with three types of outcomes: psychosocial (recent violence, recent injection drug use, hazardous alcohol use, clinical depression and post-traumatic stress disorder), clinical HIV (CD4 count and viral load) and stigma (HIV-related stigma, racial discrimination and gender discrimination). Equations were adjusted for socio-demographic factors associated with sex work across all three waves: province, age, income, gender identity, sexual orientation, education level, ethnicity and housing security. RESULTS AND DISCUSSION: Of 1422 participants, 129 (9.1%) reported recent sex work during at least one wave (82 at baseline, 73 at first follow-up and 32 at second follow-up). In adjusted analyses, recent sex work was associated with psychosocial outcomes, including: past 3-month violence (adjusted odds ratio [AOR] = 2.47, 95% CI = 1.70, 3.60), past 6-month injection drug use (AOR = 3.49, 95% CI = 2.21-5.52), hazardous alcohol use (AOR = 2.00, 95% CI = 1.04-3.89) and depression (AOR = 1.51, 95% CI = 1.06-2.15). In unadjusted analyses, sex work was also associated with clinical HIV outcomes and gender discrimination, but not racial discrimination/HIV-related stigma. CONCLUSIONS: Among women living with HIV in Canada, sex work engagement is dynamic, and sex workers are more likely to report recent violence, recent injection drug use, problematic alcohol use and clinical depression. Violence prevention and support, harm reduction, mental health promotion and sex work-affirming programs could be employed to optimize health and rights for sex working women living with HIV.

Teaching home-visitors to support responsive caregiving: A cluster randomized controlled trial of an online professional development program in Brazil.

BACKGROUND: Home-visiting programs are a common and effective public health approach to promoting parent and child well-being, including in low- and middle-income countries. The World Health Organization and UNICEF have identified responsive caregiving as one key component of the nurturing care children need to survive and thrive. Nonetheless, the importance of responsive caregiving and how to coach it is often overlooked in trainings for staff in home-visiting programs. METHODS: To determine whether it is possible to enhance home-visitors' understanding of responsive caregiving and how to coach it, we conducted a cluster randomized controlled trial with 181 staff working in Brazil's national home-visiting program. We used a computerized random number generator to randomly assign half of participants to take an online professional development course about responsive caregiving immediately and the other half to a waitlist. Individuals assessing outcome data were blind to group assignment. RESULTS: Compared to those in the control group (N = 90, both randomized and analyzed), participants assigned to take the course (N = 91, both randomized and analyzed) were more knowledgeable about responsivity (Cohen's d = 0.64, 95% Confidence Interval (CI) = 0.34, 0.94) and its importance for children's socioemotional (odds ratio (OR) = 1.88, 95% CI = 1.00, 3.50) and cognitive (OR = 2.57, 95% CI = 1.15, 5.71) development, better able to identify responsive parental behaviors in videotaped interactions (d = 1.86, 95% CI = 1.51, 2.21), and suggested more effective strategies for coaching parents on responsivity (d = 0.51, 95% CI = 0.21, 0.80) and tracking goal implementation (OR = 3.20, 95% CI = 1.28, 7.99). There were no significant changes in participants' tendency to encourage goal setting and reflection, or their perspective-taking skills. Participants were very satisfied with the course content and mode of delivery and there was no drop-out from the program. CONCLUSIONS: A short, online professional development program created moderate to large improvements in home-visitors' knowledge and intended coaching practices. This suggests that such programs are feasible, even in low-income and rural areas, and provide a low-cost, scalable option for possibly maximizing the impact of home-visiting programs - particularly with regard to parental responsivity, and in turn, child outcomes.

Contextual factors associated with depression among Northern and Indigenous adolescents in the Northwest Territories, Canada.

BACKGROUND: Persons in Arctic regions disproportionately experience depression. Knowledge gaps remain regarding factors associated with depression among adolescents in the Northwest Territories (NWT), Canada, where child and adolescent mental health hospitalizations are nearly 2.5 times the national rate. This study assesses correlates of depression among adolescents in the NWT. METHODS: We conducted a cross-sectional survey with adolescents aged 13-18 in 17 NWT communities. We assessed associations between socio-demographic characteristics, dating violence, food insecurity and depression, measured with the 9-item Patient Health Questionnaire. We conducted ordered logistic regressions to assess associations with no, mild, or moderate/severe depression scores. RESULTS: Participants (n = 399; mean age: 14.3, s.d.: 1.3) were mostly Indigenous (79%) and 45% reported food insecurity. Nearly half (47%) reported minimal/no depression symptoms, 25% mild symptoms and 28% moderate/severe symptoms. In multivariate analyses, participants who were cisgender women compared to other genders, sexually diverse v. heterosexual, and food insecure had double the odds of more severe depression symptoms. Among those dating, dating violence was associated with double the odds of moderate/severe depression symptoms. CONCLUSIONS: Findings support tailored interventions to address material (food insecurity), relational (dating violence) and symbolic (gender and sexual orientation norms) contextual factors associated with depression among adolescents in the NWT.

Teaching Parents to Be Responsive: A Network Meta-analysis.

CONTEXT: Children who receive more responsive care during their early childhood tend to exhibit stronger cognitive development, mental well-being, and physical health across their life course. OBJECTIVE: Determine how to design effective responsivity training programs for caregivers. DATA SOURCES: We searched seven electronic databases through October 2020. STUDY SELECTION: Randomized trials (k = 120) of programs training parents of children ages 0 to 6 to be more responsive. DATA EXTRACTION: Two reviewers independently extracted data. Data were pooled by using random-effects pairwise and network meta-analyses. RESULTS: Programs had, on average, a medium effect (d = 0.56; 95% confidence interval [CI]: 0.47 to 0.65). The most effective programs included didactic teaching and opportunities for parents to observe models, practice skills, and receive feedback (d = 1.07; 95% CI: 0.37 to 1.77), or all these instructional methods in addition to reflection (d = 0.86; 95% CI: 0.64 to 1.09). Programs that had participants observe examples of responsivity (d = 0.70; 95% CI: 0.57 to 0.83), used researchers as facilitators (d = 0.89; 95% CI: 0.66 to 1.12), assigned homework (d = 0.85; 95% CI: 0.66 to 1.02), and had a narrow scope (d = 0.72; 95% CI: 0.57 to 0.87) were more effective than those that did not. LIMITATIONS: Most samples included only mothers from Western countries and lacked follow-up data. CONCLUSIONS: Having parents observe examples of responsive caregiving and complete home-practice in short, focused programs may be an effective, scalable approach to enhancing responsivity in the general population and reducing inequalities in child development.

What makes for responsive family interactions? Disentangling individual, family-level, and socioeconomic contributions.

Families function best, and children benefit the most, when familial interactions are characterized by responsivity-an understanding and consideration of other people's thoughts and feelings. How responsive people are during interactions with others is a product of individual propensities, observed family norms, and unique relationship patterns, though these influences are often hard to disentangle. In the current study, we used a Social Relations Model (SRM) to parse out the extent to which being responsive during family interactions is attributable to individual traits or familial tendencies. Mothers, fathers, and two children each interacted with every other person in the family (N = 198 families) and each person's behavior was coded for the level of responsivity they displayed toward their interactional partner. Data were modeled using a multilevel formulation of the SRM. Between 15% and 30% of the variance in individual's responsivity was attributable to stable traits, with parents tending to be more consistent across all interactional partners than their children. On average, 14% of the variance in responsivity was shared across all members of a given family. Income explained 28% of family-level variance, while other family characteristics, including parent education, parent mental health, interparental conflict, and household chaos, explained little to no variance. Furthermore, it was found that parents contributed more to the family tone of responsivity than did their children. These results provide new insights into what makes family members responsive toward one other and suggest there are likely benefits of providing supports across individual-, family-, and financial-levels to enhance family responsivity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Paternal Sensitivity and Children's Cognitive and Socioemotional Outcomes: A Meta-Analytic Review.

In a series of meta-analyses, paternal sensitivity was associated with children's (age range: 7 months-9 years) overall cognitive functioning (N = 3,193; k = 23; r = .19), including language skills (k = 9; r = .21), cognitive ability (k = 9; r = .18), and executive function (k = 8; r = .19). Paternal sensitivity was not associated with children's overall socioemotional functioning (N = 2,924; k = 24; r = -.03) or internalizing problems, but it was associated with children's emotion regulation (k = 7; r = .22) and externalizing problems (k = 19; r = -.08). In the broad cognitive functioning, executive function, broad socioemotional functioning, and externalizing problems meta-analyses, child age was a significant moderator.

Do Mothers or Children Lead the Dance? Disentangling Individual and Influence Effects During Conflict.

Are mother-child conflict discussions shaped by time-varying, reciprocal influences, even after accounting for stable contributions from each individual? Mothers were filmed discussing a conflict for 5 min, separately with their younger (ages 5-9, N = 217) and older (ages 7-13, N = 220) children. Each person's conflict constructiveness was coded in 20-s intervals and data were analyzed using dynamic structural equation modeling, which separates individual and influence effects. Children influenced their mothers' behavior under certain conditions, with evidence for developmental differences in the magnitude and direction of influence, whereas mothers did not influence their children under any circumstance. Results are discussed in the context of child effects on parent behavior and changes in parenting across middle childhood.