The moderating role of diabetes distress on the effect of a randomized eHealth intervention on glycemic control in Black adolescents with type 1 diabetes.

OBJECTIVE: Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black adolescents with type 1 diabetes and elevated depressive symptoms. The present study is a secondary analysis of these clinical trial data examining the moderating effect of diabetes distress on the efficacy of the intervention. METHODS: Using secondary data from a multicenter randomized clinical trial (Clinicaltrials.gov [NCT03168867]), caregiver-adolescent dyads were randomly assigned to either up to three sessions of an eHealth parenting intervention (n = 75) or a standard medical care control group (n = 74). Black adolescents (10 years, 0 months to 14 years, 11 months old) with type 1 diabetes and a caregiver willing to participate were eligible. Adolescents reported their diabetes distress at baseline, and hemoglobin A1c (HbA1c) data were collected at baseline, 6-, 13-, and 18-month follow-up. RESULTS: No between-group contrasts emerged in a linear mixed-effects regression (p's > .09). Within-group contrasts emerged such that adolescents assigned to the intervention who reported high diabetes distress had lower HbA1c at the 18-month follow-up relative to baseline (p = .004); the 18-month decrease in HbA1c was -1.03%. CONCLUSIONS: Black adolescents with type 1 diabetes and high levels of diabetes distress showed significant decreases in HbA1c following a family-based eHealth intervention, suggesting diabetes distress may be a key moderator of intervention efficacy within this population.

Development of the non-occupational post-exposure prophylaxis (NPEP) knowledge scale among Chinese men who have sex with men.

BACKGROUND: Nonoccupational post-exposure prophylaxis (NPEP) is a short course of medication taken to reduce the likelihood of acquiring human immunodeficiency virus (HIV) infection upon exposure. A review of the literature demonstrates an urgent need for an empirically validated instrument that measures detailed knowledge of NPEP among the key population of men who have sex with men (MSM). METHODS: Semi-structured interviews, focus groups, and a cross-sectional survey with a sample of 419 MSM was conducted in 2018 in China to develop and psychometrically evaluate the new instrument, the NPEP Knowledge Scale. Exploratory and confirmatory factor analyses, differential item functioning analyses, and structural equation modeling were conducted using Mplus 7.4. RESULTS: The NPEP Knowledge Scale demonstrated excellent reliability and validity. Cronbach's alpha was 0.903. The range of item R2 were 0.527-0.969, p's < 0.001. Model estimated inter-item correlations ranged between 0.534 and 0.968. In addition, HIV knowledge, NPEP use, and NPEP knowledge were all significantly correlated. CONCLUSIONS: The NPEP Knowledge Scale is suitable for research, program evaluation, and clinical and community services that require using NPEP to minimize the ever-present risk of new HIV infections.

Predictors of adherence to controller medication in urban African American emerging adults with uncontrolled persistent asthma.

BACKGROUND: African American emerging adults tend to have low adherence to asthma controller medication, as well as a disproportionate burden of asthma morbidity and mortality. This study explored constructs from the Information-Motivation-Behavioral Skills model as predictors of controller medication adherence in urban African Americans ages 18-29 (N=152) with uncontrolled asthma using multiple measures of self-reported adherence. METHODS: Structural equation modeling (SEM) was employed to test the hypothesized mediation model that specified the relationship among psychological distress, substance use, asthma knowledge, motivation, self-efficacy, and adherence. RESULTS: Results suggested that motivation is an important predictor of adherence to medication; moreover, higher self-efficacy was associated with higher motivation. Results also highlighted psychological distress as an important intervention target to improve medication adherence in emerging adults. CONCLUSIONS: The model tested in this study may offer a feasible framework for beginning to understand adherence to controller medication in this population.

Daytime sleepiness, addictive-like eating, and obesity sequelae in Black and African American youth with obesity.

OBJECTIVES: The purpose of the current study was to examine the association between poor sleep health (ie, excessive daytime sleepiness), obesity sequelae (ie, percent overweight and serum leptin levels), and addictive-like eating behaviors, an obesity phenotype, in a sample of Black/African American (B/AA) adolescents. DESIGN: The current study analyzed archival baseline data from a sample of B/AA adolescents with obesity enrolled in a sequential randomized clinical trial. SETTING: Data were collected in the participants' homes by trained research assistants unaware of treatment condition. PARTICIPANTS: A sample of 181 B/AA adolescents with obesity between the ages of 12 and 16 years (M = 14.26, SD = 1.46) and having a body mass index (BMI) above the 95th percentile for age and gender were sampled. MEASUREMENTS: Self-report measures included the Cleveland Adolescent Sleepiness Questionnaire and the Yale Food Addiction Scale-Children (YFAS-C). Anthropomorphic data and blood samples were used to determine BMI and serum leptin levels, respectively. RESULTS: Excessive daytime sleepiness was positively correlated with YFAS-C symptom count, r = 0.295, P < .001. Serum leptin levels and percent overweight were both positively correlated with each other, r = 0.445, P < .001 and with YFAS-C symptom count, r = 0.215, P = .006. After controlling for age and gender, results supported an indirect effect from daytime sleepiness to both serum leptin levels (estimate = 2.210, SE = 0.932, P = .018) and percent overweight (estimate = 2.817, SE = 1.415, P = .046) through YFAS-C symptom count. CONCLUSIONS: Culturally informed interventions on eating behaviors (ie, addictive-like eating) when excessive daytime sleepiness is reported are needed. Early intervention may help prevent the onset or worsening of obesity among adolescents.

Asthma and Technology in Emerging African American Adults (The ATHENA Project): Protocol for a Trial Using the Multiphase Optimization Strategy Framework.

BACKGROUND: Asthma causes substantial morbidity and mortality in the United States, particularly among African American emerging adults (AAEAs; aged 18-30 years), but very few asthma programs have targeted this population. Interventions that provide education and address underlying motivation for managing asthma may be the most effective. However, intensive face-to-face interventions are often difficult to implement in this population. OBJECTIVE: The purpose of this study is to develop an effective mobile asthma management intervention to improve control among AAEAs. METHODS: We will assess the ability of multiple technologic components to assist and improve traditional asthma education. The first component is the Motivational Enhancement System for asthma management. It is a mobile 4-session intervention using supported self-regulation and motivational interviewing. Personalized content is based on each participant's activity level, daily experiences, and goals. The second component is supportive accountability. It is administered by asthma nurses using targeted mobile support (Skype/voice calls) to provide education, promote self-efficacy, and overcome barriers through a motivational interviewing-based framework. The third component is SMS text messaging. It provides reminders for asthma education, medication adherence, and physical activity. The fourth component is physical activity tracking. It uses wearable technology to help meet user-defined physical activity goals. Using a multiphase optimization strategy (MOST) framework, we will test intervention components and combinations of components to identify the most effective mobile intervention. The MOST framework is an innovative, and cost- and time-effective framework that uses engineering principles to produce effective behavioral interventions. We will conduct a component selection experiment using a factorial research design to build an intervention that has been optimized for maximum efficacy, using a clinically significant improvement in asthma. Participants (N=180) will be randomized to 1 of 6 intervention arms. Participants will be recruited from multiple sites of the American Lung Association-Airway Clinical Research Centers network and ambulatory care clinics at the Detroit Medical Center. Data collections will occur at baseline, and 3, 6, and 12 months. RESULTS: At study completion, we will have an empirically supported optimized mobile asthma management intervention to improve asthma control for AAEAs. We hypothesize that postintervention (3, 6, and 12 months), participants with uncontrolled asthma will show a clinically significant improvement in asthma control. We also hypothesize that improvements in asthma management behaviors (including physical activity), quality of life, symptoms, adherence, and exacerbation (secondary outcomes) will be observed. CONCLUSIONS: AAEAs are disproportionately impacted by asthma, but have been underrepresented in research. Mobile asthma management interventions may help improve asthma control and allow people to live healthier lives. During this project, we will use an innovative strategy to develop an optimized mobile asthma management intervention using the most effective combination of nurse-delivered asthma education, a smartphone app, and text messaging. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37946.

Victimization and Food Addiction Symptoms: Direct and Indirect Effects through Emotion Dysregulation, Impulsivity, and Loss-of-Control Eating.

Previous research suggests that dating, intimate partner, and sexual violence victimization throughout the lifespan are predictive of numerous adverse health outcomes including addictive behaviors, psychopathology, and physical health symptoms. Self-medication hypotheses posit that victims may drink heavily, use substances, or rely on food to cope with negative affect and psychological symptoms. We examined a self-medication hypothesis-driven model linking dating and sexual violence victimization with food addiction symptoms through their relationships with emotion regulation, impulsivity, and loss-of-control eating in a sample of 313 single, non-treatment-engaged, college student women aged 18-25 years old enrolled in a minority serving, urban university. Participants completed an online survey with measures of dating and sexual violence victimization since age 14 years, emotion regulation, impulsivity, loss-of-control eating, and food addiction symptoms. Seventy-nine percent of participants reported experiencing some form of intimate partner violence victimization. Using path analyses, we found some support for our model, as well as significant, positive, direct pathways from victimization to loss-of-control eating and food addiction symptoms. Clinicians and policy makers should incorporate these findings into practice by honoring the experiences of past victimizations in current health behaviors and by utilizing trauma-informed care practices. To extend this study's findings, researchers should examine the role of trauma-informed interventions targeting emotional regulation and impulsivity to decrease loss-of-control eating and food addiction symptoms.

Feasibility of Ethyl Glucuronide Nail Testing Biomarker for Alcohol Use Among Youth Living With HIV.

PURPOSE: We assessed the feasibility of the ethyl glucuronide biomarker (EtG) through nail sampling to measure alcohol use among youth living with HIV in the United States (YLWH, N = 183); we also evaluated concordance between this EtG biomarker and self-reported measures of alcohol use, specifically, the Alcohol Timeline Followback (TFLB) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). METHODS: EtG, TFLB, and ASSIST were collected at 4 points over 1 year. At baseline and 52 weeks, 78.1% and 70.1%, respectively, provided a valid (full or partial) sample. RESULTS: At 16 weeks, EtG was associated with ASSIST (r = .25, p < .05). At 28 weeks and 52 weeks, TFLB and ASSIST were correlated with EtG (at 28 weeks r = .23, p < .05 and r = .41, p < .01, respectively; at 52 weeks r = .34, p < .01 and r = .25, p < .05, respectively). CONCLUSIONS: We found that nail-based EtG biomarker was feasible to measure alcohol use among YLWH; we also found concordance between EtG, TLFB, and ASSIST, supporting ongoing use of self-reported alcohol use measures with YLWH.

Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity.

BACKGROUND: Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity. PURPOSE: The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design. METHODS: Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight. RESULTS: All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%). CONCLUSIONS: Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.

African-American Adolescents' Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial.

OBJECTIVE: Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment. METHOD: One hundred and eighty six African-Americans adolescents with obesity and their caregiver were first randomly assigned to complete 3 months of cognitive-behavioral and motivational interviewing family-based weight loss treatment in their home or in the research office (Phase 1). Nonresponders (i.e., those who lost < 3% of initial weight, n = 161) were rerandomized to 3 months of continued skills training (n = 83) or contingency management (n = 78) for Phase 2; responders were allocated to 3 months of relapse prevention (n = 20). Adolescents' frequency of weight loss skills utilization was assessed via questionnaire at treatment midpoint and end. RESULTS: Higher treatment attendance was associated with better skill utilization. Higher skill utilization was associated with more weight loss at treatment end, whereas higher baseline confidence was associated with more weight loss at follow-up. CONCLUSIONS: This study indicates the importance of attending weight loss intervention sessions to develop and strengthen weight loss skills in African-American adolescents with obesity, and strengthening confidence to use such skills for continued weight loss.

Associations between young adult men's patterns of alcohol use and sexual behavior: A latent profile analysis of two independent samples.

Men's alcohol consumption and casual sexual behavior peak in early adulthood. Although there is a strong positive association between these behaviors, most studies have utilized a between-subjects approach rather than a person-centered approach to assess this relationship. A person-centered approach allows for an examination of subgroups of drinkers that may differ in their casual sexual behaviors. To address this gap, secondary data analyses were conducted with two independent samples totaling 906 men between the ages of 18 and 29 from the Midwestern United States. In both studies, participants reported their alcohol expectancies and consumption, sexual behaviors, and sexual attitudes. Multiple group latent profile similarity analyses were conducted using the alcohol-related variables. Four similar profiles emerged in both samples; thus, the data were combined. Casual sex-related variables were then examined in relation to the profiles. The two lighter drinking groups differed from one another in their alcohol consumption and sexual attitudes; however, they did not differ in their alcohol expectancies or number of sex partners. The two heavier drinking groups differed from one another in their liquid courage expectancies, alcohol consumption, one-time-only partners, and sexual attitudes; however, they did not differ from each other in their sex-drive expectancies or lifetime partners. Person-centered approaches can be used to develop more tailored interventions, particularly for those at greater risk for the negative health consequences of engaging in sexual behavior with multiple one-time-only partners.

Food addiction prevalence and concurrent validity in African American adolescents with obesity.

Food addiction, measured by the Yale Food Addiction Scale (YFAS), has been associated with obesity, eating-related problems (e.g., bingeing), and problematic consumption of highly processed foods. Studies on this topic have primarily examined adult samples with an overrepresentation of White individuals, and little is known about addictive-like eating in adolescents, particularly African American adolescents who exhibit high rates of obesity and eating pathology. The current study examined the prevalence of food addiction and its convergent validity with percent overweight, eating-related problems, and self-reported dietary intake in a sample of 181 African American adolescents with obesity. Approximately 10% of participants met for food addiction, measured by the YFAS for children (YFAS-C). YFAS-C scores were most strongly associated with objective binge episodes (OBE), though significant relationships were also observed with objective overeating episodes (OOE), percent overweight relative to age- and sex-adjusted body mass index (BMI), and, more modestly, subjective binge episodes (SBE). YFAS-C scores were also related to greater consumption of all nutrient characteristics of interest (calories, fat, saturated fat, trans fat, carbohydrates, sugar, added sugar), though most strongly with trans fat, a type of fat found most frequently in highly processed foods. These findings suggest that the combination of exhibiting a loss of control while consuming an objectively large amount of food seems to be most implicated in food addiction for African American adolescents with obesity. The present work also provides evidence that individuals with food addiction may consume elevated quantities of highly processed foods, relative to those without addictive-like eating. (PsycINFO Database Record

Building Motivation in African American Caregivers of Adolescents With Obesity: Application of Sequential Analysis.

Objective: We sought to examine communication between counselors and caregivers of adolescents with obesity to determine what types of counselor behaviors increased caregivers' motivational statements regarding supporting their child's weight loss. Methods: We coded 20-min Motivational Interviewing sessions with 37 caregivers of African American 12-16-year-olds using the Minority Youth Sequential Coding for Observing Process Exchanges. We used sequential analysis to determine which counselor communication codes predicted caregiver motivational statements. Results: Counselors' questions to elicit motivational statements and emphasis on autonomy increased the likelihood of both caregiver change talk and commitment language statements. Counselors' reflections of change talk predicted further change talk, and reflections of commitment language predicted more commitment language. Conclusions: When working to increase motivation among caregivers of adolescents with overweight or obesity, providers should strive to reflect motivational statements, ask questions to elicit motivational statements, and emphasize caregivers' autonomy.

Behavioral Economic Factors Related to Pediatric Obesity.

Behavioral economics (BE) suggests that food and activity choices are governed by costs, available alternatives, and reinforcement. This article reviews basic, translational, and intervention research using a BE framework with overweight or obese children up to age 18. We address BE concepts and methods, and discuss developmental issues, the continuum of BE intervention approaches, findings of studies focused on increasing the cost of unwanted behaviors (ie, energy-dense food intake and sedentary behavior) and decreasing the cost of desired behaviors (ie, healthy food intake and PA), and our team's recent basic behavioral studies using BE approaches with minority adolescents.

Effective Patient-Provider Communication in Pediatric Obesity.

Effective patient-provider communication is not a primary focus of medical school curricula. Motivational interviewing (MI) is a patient-centered, directive communication framework appropriate for in health care. Research on MI's causal mechanisms has established patient change talk as a mediator of behavior change. Current MI research focuses on identifying which provider communication skills are responsible for evoking change talk. MI recommends informing, asking, and listening. Research provides evidence that asking for and reflecting patient change talk are effective communication strategies, but cautions providers to inform judiciously. Supporting a patient's decision making autonomy is an important strategy to promote health behaviors.

Side effects, adherence self-efficacy, and adherence to antiretroviral treatment: a mediation analysis in a Chinese sample.

Antiretroviral therapy (ART) is a lifelong treatment. To date, ART adherence is suboptimal for most patients in resource-poor settings. Previous research indicates that medication side effects are perceived to be a significant barrier of high ART adherence. Data regarding the role of adherence self-efficacy in mediating the relationship between side effects from ART and adherence to ART are limited; thus, this study examines this potential mediational role of self-efficacy. A cross-sectional survey of 2987 people living with HIV aged ≥18 years was conducted in 2012-2013 in Guangxi Autonomous Region (Guangxi) which has one of the fastest-growing HIV rates in China. Of the total sample, 2146 (72.1%) participants had initiated ART. Participants reported the number of days of completing the daily dose of ART in the past month; adherence was defined as completing the daily dose at least 28 days in the last month (≥90%). Side effects were significantly negatively related to adherence to ART. Mediation analyses indicated that adherence self-efficacy significantly mediated the side effects-adherence relationship. Future interventions to increase adherence self-efficacy and effective coping with side effects among HIV patients are needed in order to improve their ART adherence.

Predictors of Self-Reported Adherence to Antiretroviral Medication in a Multisite Study of Ethnic and Racial Minority HIV-Positive Youth.

OBJECTIVE: To test social cognitive predictors of medication adherence in racial/ethnic minority youth living with HIV using a conceptual model. METHODS: Youth were participants in two descriptive studies by the Adolescent Trials Network for HIV/AIDS Interventions. Minority youth ages 16-24 years who were prescribed antiretroviral medication were included (N = 956). Data were collected through chart extraction and/or laboratory testing and by Audio Computer-Assisted Self-Interview. RESULTS: 39% of youth reported suboptimal adherence. Path analysis was used to explore predictors of medication adherence. Higher self-efficacy predicted higher readiness and adherence. Greater social support predicted higher self-efficacy. Psychological symptoms and substance use were associated with several predictors and lower adherence. CONCLUSIONS: The model provided a plausible framework for understanding adherence in this population. Culturally competent, but individually tailored, interventions focused on increasing self-efficacy to take medication and reducing risk behaviors (e.g., substance use) may be helpful for racial or ethnic minority youth with HIV.

Men's Intentions to Have Sex With a New Partner: Sexual and Emotional Responding, Alcohol, and Condoms.

Findings regarding the relation between alcohol and intentions to have sex have been mixed, and little research has examined the role of condom availability on intentions to have sex. Sexual and emotional responding may influence subsequent sexual decisions. Thus, a better understanding of sexual and emotional responding combined with situational factors such as condom presence could help explain the discrepancies in findings regarding alcohol's effect on intentions to have sex. The effects of alcohol and condom presence on men's intentions to have sex were examined using an experimental paradigm involving an alcohol administration study and a second-person eroticized scenario. The effects of sexual and emotional responding were also examined in relation to intentions to have sex. It was found that alcohol increased positive mood, which was associated with higher intentions to have sex. In addition, condom presence was directly associated with higher intentions to have sex. More sexual desire was related to increased likelihood of sexual intentions. These findings increase understanding of mechanisms underlying the relation between alcohol and intentions to have sex.

Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American Adolescents.

The purpose of this study was to develop an adaptive behavioral treatment for African American adolescents with obesity. In a sequential multiple assignment randomized trial, 181 youth ages 12-16 years with primary obesity and their caregiver were first randomized to 3 months of home-based versus office-based delivery of motivational interviewing plus skills building. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based skills or contingency management. Primary outcome was percent overweight and hypothesized moderators were adolescent executive functioning and depression. There were no significant differences in primary outcome between home-based or office-based delivery or between continued home-based skills or contingency management for nonresponders to first-phase treatment. However, families receiving home-based treatment initially attended significantly more sessions in both phases of the trial, and families receiving contingency management attended more sessions in the second phase. Overall, participants demonstrated decreases in percent overweight over the course of the trial (3%), and adolescent executive functioning moderated this effect such that those with higher functioning lost more weight. More potent behavioral treatments to address the obesity epidemic are necessary, targeting new areas such as executive functioning. Delivering treatment in the home with contingency management may increase session attendance for this population.

Men's condom use resistance: Alcohol effects on theory of planned behavior constructs.

OBJECTIVE: This study is a novel investigation of (a) the utility of the Theory of Planned Behavior (TPB) to predict men's condom use resistance (CUR; i.e., attempts to avoid condom use with a partner who wants to use one and (b) the effects of alcohol on endorsement of TPB-CUR constructs. METHOD: Using an alcohol administration protocol, a between- and within-subjects experiment was conducted with a community sample of 312 young male nonproblem drinkers who have sex with women. After assessing endorsement of TPB-CUR constructs (e.g., attitudes, norms, self-efficacy, control, and intentions) in a sober state, beverage condition was experimentally manipulated between subjects and endorsement of TPB-CUR constructs was reassessed. RESULTS: Analyses included repeated measures multivariate analyses of variance (MANOVAs) with beverage condition (no alcohol vs. alcohol) as the between-subjects factor and time (prebeverage vs. postbeverage) as the within-subjects factor. Between-subjects, intoxicated participants reported significantly stronger CUR intentions, more favorable CUR attitudes and normative perceptions, and greater CUR self-efficacy than sober participants. There were significant within-subject changes for CUR intentions, attitudes, normative perceptions, and self-efficacy. Neither between- nor within-subjects effects were found for CUR control. An exploratory multigroup path analysis indicated that the relationships among the TPB-CUR constructs were similar for alcohol and no alcohol groups. CONCLUSIONS: Findings indicated that alcohol intoxication increased men's CUR intentions and self-efficacy and led to more positive CUR attitudes and norms, yet had no effect on CUR control. Future research should examine whether there are similar effects of intoxication on TPB constructs related to other sexual risk behaviors.