Dimensional Reduction in Barriers and Facilitators to Pre-exposure Prophylaxis (PrEP) Uptake Willingness for Full-Service Sex Workers.

Full-Service Sex Workers (FSSWs) face heightened risk of acquiring HIV, yet exhibit relatively low adoption of pre-exposure prophylaxis (PrEP)-an antiviral that substantially reduces HIV acquisition risk. Little work examines barriers and facilitators to PrEP uptake willingness among FSSWs. This study aimed to identify the distinct components of barriers and facilitators to PrEP uptake willingness for FSSWs. Here, we subjected 19 PrEP barriers and facilitators identified in the literature to a principal component analysis (PCA) among a sample of 83 FSSWs. Preliminary statistics supported factorability of data. PCA revealed three distinct components of barriers and facilitators that explained 62.80% of the total variance in survey responses. We labeled these components Behavioral and Social Concerns (α = 0.93), Access and Affordability (α = 0.67), and Biologically Based Health Concerns (α = 0.79). This study shows promise for future clinical and research utility of these factors and provides a basis for future psychometric studies of barriers and facilitators to PrEP uptake willingness among FSSWs.

Enhancing long-term smoking abstinence among individuals with a history of cervical intraepithelial neoplasia or cervical cancer (Project ACCESS): protocol for a randomized clinical trial.

BACKGROUND: The prevalence of smoking among cervical cancer survivors is high and evidence-based smoking cessation interventions are critically needed. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial (RCT) designed to evaluate the efficacy of a novel, personally tailored SMS-delivered text-based digital treatment adjuvant designed to enhance the long-term efficacy of a "Motivation And Problem-Solving" (MAPS) approach for smoking cessation among individuals with a history of cervical intraepithelial neoplasia (CIN) or cervical cancer. MAPS is a phone counseling approach designed to facilitate long-term abstinence that comprises 6 counseling calls over 12 months. The current trial is evaluating the efficacy of MAPS+, which comprises all MAPS components plus a 24-month digital treatment adjuvant. This trial represents a logical extension of our previous RCT, which compared the efficacy of MAPS to a quitline control condition and found that MAPS resulted in greater than a 2-fold increase in smoking abstinence at 12 months (i.e., 26.4% vs. 11.9%). This treatment effect was no longer significant at 18 months, suggesting that efficacy dissipated as time from the end of treatment increased. The primary aim of the current trial is to compare the efficacy of MAPS + and ST in facilitating long-term abstinence. METHODS: Individuals who smoke and have a history of cervical cancer or CIN (N = 340) are recruited throughout Florida and randomly assigned to Standard Treatment [ST] or MAPS+. ST participants are electronically connected with the Florida Quitline. MAPS + consists of 6 proactive MAPS-based counseling calls over 12 months plus the novel, personally tailored, text message-based treatment adjuvant delivered over 24 months. All participants receive 12 weeks of combination nicotine replacement therapy (patch and lozenge) and are followed for 24 months. Participant recruitment commenced in December 2022 and is ongoing. DISCUSSION: This study builds on promising results from our recent trial which found that MAPS was associated with substantially higher abstinence from smoking at the end of the 12-month treatment period. Finding that this low-burden, personally tailored digital treatment adjuvant improves the long-term efficacy of MAPS would have important clinical and public health implications. TRIAL REGISTRATION: Clinical Trials Registry NCT05645146; https://clinicaltrials.gov/ct2/show/NCT05645146 ; Registered on December 9, 2022.

Smoking cessation interventions for Hispanic/Latino(a) adults in the USA: protocol for a systematic review and planned meta-analysis.

INTRODUCTION: Hispanic smokers face multiple cultural and socioeconomic barriers to cessation that lead to prominent health disparities, including a lack of language-appropriate, culturally relevant, evidence-based smoking cessation interventions. This systematic review will examine the literature on smoking cessation interventions for Hispanic adults in the USA to assess (1) the availability of interventions, (2) the methodological quality of the studies evaluating the interventions and (3) the efficacy of the interventions. METHODS AND ANALYSIS: A systematic literature search will be conducted, in English with no date limits, through the following databases starting at year of inception: Medical Allied Health Literature, Embase, American Psychology Association Psychology Articles, Cumulative Index to Nursing and Allied Health Literature Complete, ScienceDirect, Health & Medicine Collection and Web of Science Core Collection. Trial registries and grey literature sources will be searched to identify ongoing or unpublished studies. Literature search will be rerun prior to eventual submission of the review to ensure the inclusion of relevant studies. Quantitative studies evaluating the efficacy of a smoking cessation intervention (ie, smoking cessation as a measured outcome) for Hispanic adult smokers in the USA will be included in the systematic review. Two authors will independently identify relevant studies, extract data and conduct quality and risk of bias assessments. Discrepancies in coding will be discussed between the two reviewers and pending disagreements will be resolved by a third reviewer. First, the quality of all studies will be assessed, then randomised controlled trials (RCTs) will be further evaluated for risk of bias using Cochrane's Risk of Bias Tool. All eligible studies will be summarised descriptively. If data allow, the efficacy of smoking cessation interventions tested in RCTs, with a minimum follow-up of 6 months, will be quantitatively estimated using ORs and 95% CIs. The association between intervention type/modality and efficacy will be assessed via subgroup analyses. PROSPERO REGISTRATION NUMBER: CRD42022291068.

Exploring political diversity in relation to health and stress, among graduate students in the mental health field.

ObjectiveExamine associations between political diversity, health, and stress in a student sample for whom examining political biases is necessary. Participants: Graduate students in mental health (N = 512) from July 2017 to June 2018. Methods: Participants completed an online survey of political views, health, and stress. Descriptive statistics reported sample characteristics; stepwise regressions tested whether political affiliation and perceived political majority/minority status predicted health and stress. Results: Students identified primarily as liberal, and perceived their counterparts as liberal. Liberal political identification generally predicted more stress and poorer health in several domains; however, those identifying as most politically conservative also reported relatively high stress. Conclusions: Liberal academic environments may relate to stress for those who identify as most politically conservative, while also not protecting liberals against broader sociopolitical stress and related health sequelae. Graduate students in mental health may benefit from increased curricular and supervisory focus on political diversity and related biases.

Engaging African Americans Living with HIV and Serious Mental Illness: Piloting Prepare2Thrive-A Peer-Led Intervention.

BACKGROUND: African American individuals living with HIV (AALWH) and serious mental illness (SMI) represent a vulnerable intersectional group with relatively poor health. These individuals may require consistent treatment engagement to manage both of their chronic conditions; however, due to multilevel factors they are relatively less likely to engage in treatment consistently. OBJECTIVES: To test the acceptability, feasibility, fidelity, and participant outcomes of a brief psychoeducational and behavioral peer-led intervention. METHODS: Participants engaged in four weekly 90-minute pilot intervention sessions developed by the current community-based participatory research (CBPR) team. Sessions focused on problem-solving, communication skills, and coping with stigma, and were delivered by CBPR peerinterventionists. Participants completed pre- and postintervention surveys assessing treatment engagement and self-efficacy. RESULTS: Participants (N = 16) rated the intervention as acceptable, and attendance rates were high (87% average). Intervention leaders demonstrated exceptionally high fidelity to the intervention protocol. Participants reported a trend toward increasing antiretroviral therapy (ART) adherence from pre- to post-intervention (on average, an 8% increase, p = 0.063), notable in the context of a pilot study. Those who attended all four intervention sessions reported a 17.5% increase in ART adherence. From pre- to post-intervention medical appointment attendance decreased, mental health appointment attendance increased, and HIV treatment selfefficacy significantly increased. CONCLUSIONS: This study provides initial evidence for the feasibility of a CBPR-designed and tested, peer-led psychoeducation and behavioral intervention aiming to improve treatment engagement among AALWH and SMI, a marginalized group who could benefit from additional communitybased health research efforts.