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Publication Metadata only Complementing the united states household food security survey module with items reflecting social unacceptability(Elsevier B.V., 2024) Frongillo, Edward A; Bethancourt, Hilary J; Norcini Pala, Andrea; Maya, Sigal; Wu, Katherine C; Kizer, Jorge R; Tien, Phyllis C; Kempf, Mirjam-Colette; Hanna, David B; Appleton, Allison A; Merenstein, Daniel; D'Souza, Gypsyamber; Ofotokun, Igho; Konkle-Parker, Deborah; Michos, Erin D; Krier, Sarah; Stosor, Valentina; Weiser, Sheri D; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesBackground: Social unacceptability of food access is part of the lived experience of food insecurity but is not assessed as part of the United States Household Food Security Survey Module (HFSSM). Objectives: The objectives were as follows: 1) to determine the psychometric properties of 2 additional items on social unacceptability in relation to the HFSSM items and 2) to test whether these 2 items provided added predictive accuracy to that of the HFSSM items for mental health outcomes. Methods: Cross-sectional data used were from the Intersection of Material-Need Insecurities and HIV and Cardiovascular Health substudy of the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study. Data on the 10-item HFSSM and 2 new items reflecting social unacceptability were collected between Fall 2020 and Fall 2021 from 1342 participants from 10 United States cities. The 2 social unacceptability items were examined psychometrically in relation to the HFSSM-10 items using models from item response theory. Linear and logistic regression was used to examine prediction of mental health measured by the 20-item Center for Epidemiologic Studies Depression scale and the 10-item Perceived Stress Scale. Results: The social unacceptability items were affirmed throughout the range of severity of food insecurity but with increasing frequency at higher severity of food insecurity. From item response theory models, the subconstructs reflected in the HFSSM-10 and the subconstruct of social unacceptability were distinct, not falling into one dimension. Regression models confirmed that social unacceptability was distinct from the subconstructs reflected in the HFSSM-10. The social unacceptability items as a separate scale explained more (∼1%) variation in mental health than when combined with the HFSSM-10 items in a single scale, and the social unacceptability subconstruct explained more (∼1%) variation in mental health not explained by the HFSSM-10. Conclusions: Two social unacceptability items used as a separate scale along with the HFSSM-10 predicted mental health more accurately than did the HFSSM-10 alone.Publication Metadata only Internalized HIV-related stigma and neurocognitive functioning among women living with HIV(Mary Ann Liebert, Inc, 2022) Thompson, Emma C.; Muhammad, Josh N.; Adimora, Adoara A.; Chandran, Aruna; Cohen, Mardge H.; Crockett, Kaylee B.; Goparaju, Lakshmi; Henderson, Emmett; Kempf, Mirjam-Colette; Konkle-Parker, Deborah; Kwait, Jennafer; Mimiaga, Matthew; Ofotokun, Igho; Rubin, Leah; Sharma, Anjala; Teplin, Linda A.; Vance, David E.; Weiser, Sheri D.; Weiss, Deborah J.; Wilson, Tracey E.; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesThe prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B=0.27, t=2.50, p=0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.Publication Metadata only T-cell activation state differentially contributes to neuropsychiatric complications in women with HIV(Elsevier, 2022) Williams, Dionna W.; Flores, Bianca R.; Xu, Yanxun; Wang, Yuezhe; Yu, Danyang; Peters, Brandilyn A.; Adedimeji, Adebola; Wilson, Tracey E.; Merenstein, Daniel; Tien, Phyllis C.; Cohen, Mardge H.; Weber, Kathleen M.; Adimora, Adaora A.; Ofotokun, Igho; Fischl, Margaret; Turan, Janet; Laumet, Geoffroy; Landay, Alan L.; Dastgheyb, Raha M.; Gange, Stephen J.; Weiser, Sheri D.; Rubin, Leah H.; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesNeuropsychiatric complications are common among women with HIV (WWH). The pathophysiological mechanisms underlying these complications are not fully known but likely driven in part by immune modulation. We examined associations between T-cell activation states which are required to mount an effective immune response (activation, co-stimulation/normal function, exhaustion, senescence) and neuropsychiatric complications in WWH. 369 WWH (78% HIV RNA undetectable/<20cp/mL) enrolled in the Women's Interagency HIV Study completed neuropsychological testing and measures of depression (Center for Epidemiological Studies Depression Scale-CES-D), self-reported stress levels (Perceived Stress Scale-10), and post-traumatic stress (PTSD Checklist-Civilian Scale). Multiparametric flow cytometry evaluated T-cell activation state. Partial least squares regressions were used to examine T-cell phenotypes and neuropsychiatric outcome associations after confounder adjustment. In the total sample and among virally suppressed (VS)-WWH, CD4(+) T-cell exhaustion was associated with poorer learning and attention/working memory (P's < 0.05). In the total sample, CD4(+) T-cell activation was associated with better attention/working memory and CD8(+) T-cell co-stimulation and senescence was associated with poorer executive function (P's < 0.05). For mental health outcomes, in the total sample, CD4(+) T-cell activation was associated with more perceived stress and CD4(+) T-cell exhaustion was associated with less depressive symptoms (P's < 0.05). Among VS-WWH, CD4(+) senescence was associated with less perceive stress and CD8(+) T-cell co-stimulation and senescence was associated with higher depression (P's < 0.05). Together, results suggest the contribution of peripheral CD4(+) and CD8(+) T-cell activation status to neuropsychiatric complications in WWH.Publication Metadata only A Bayesian network analysis to examine the effects of HIV stigma processes on self-concept and depressive symptoms among persons living with HIV(Wiley, 2024) Pala, Andrea Norcini; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesObjective: This study examines the relationships between HIV stigma dimensions, self-related mechanisms, and depressive symptoms among persons living with HIV. Background: HIV stigma hinders the well-being of individuals living with HIV, which is linked to depressive symptoms and increased risk of poor clinical outcomes. However, the mechanisms underlying stigma's impact on depression are poorly understood. Psychosocial theories propose that experiencing HIV stigma leads to internalized stigma, impacting self-concept and mental health. Method: Using Bayesian network analysis, we explored associations among HIV stigma processes (experienced, anticipated, internalized, perceived community stigma, and HIV status disclosure) and self-related mechanisms (self-esteem, fear of negative evaluation [FNE], self-blame coping, and social exclusion), and depressive symptoms. Results: Our diverse sample of 204 individuals, primarily men, gay/bisexual, Black, and lower-middle SES, who experienced stigma showed increased anticipated, internalized, and perceived community stigma, FNE, and depressive symptoms. Internalized stigma contributed to self-blame coping and higher depressive symptoms. Anticipated and perceived community stigma and FNE correlated with increased social exclusion. Discussion: This study investigates potential mechanisms through which HIV stigma may impact depression. Identifying these mechanisms establishes a foundation for future research to inform targeted interventions, enhancing mental health and HIV outcomes among individuals living with HIV, especially from minority backgrounds. Insights gained guide evidence-based interventions to mitigate HIV stigma's detrimental effects, ultimately improving overall well-being and health-related outcomes for people with HIV.Publication Metadata only Development and preliminary validation of the PrEP empowerment scale(Springer/Plenum Publishers, 2023) Crockett, Kaylee B.; Batey, D. Scott; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesInformed by the Health Care Empowerment Model, a measure of PrEP Empowerment was developed and assessed for preliminary reliability and validity. Participants (N = 100) were invited to complete a survey during regular clinic visits. A subset (n = 84) volunteered to provide blood samples to assess plasma tenofovir (TFV) levels for recent PrEP adherence. A five-factor measure explained 70% of the total variance. Associations with internalized PrEP stigma, PrEP adherence self-efficacy, and plasma TFV were assessed. Results supported the multidimensional nature of PrEP Empowerment and reliability and validity. Additional research is needed in populations with varying PrEP experience and greater gender and ethnic representation.Publication Metadata only The relationship between HIV pre-exposure prophylaxis stigma and treatment adherence among current HIV pre-exposure prophylaxis users in the Southeastern US(Springer, 2023) Van Gerwen, Olivia T.; Yigit, Ibrahim; Crockett, Kaylee B.; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesDespite efficacy in HIV prevention, Pre-exposure Prophylaxis (PrEP) is underutilized in the US, especially among populations at highest risk. PrEP-related stigma may play a role. We developed measures of PrEP-related stigma dimensions and PrEP adherence. We administered them to current PrEP users. We hypothesized that PrEP-related stigma would negatively impact PrEP adherence. Questionnaire measures were developed using data from previous qualitative work and existing validated HIV-related stigma measures. The resultant survey was administered to current PrEP users from two Birmingham, Alabama PrEP clinics. Plasma tenofovir disoproxil fumarate levels were collected to measure PrEP adherence. Exploratory factor analyses were performed to determine the factor structure of each PrEP-related stigma dimension (internalized, perceived, experienced, anticipated, disclosure concerns). Separate binary logistic (or linear) regressions were performed to assess associations between PrEP-related stigma dimensions and adherence (treatment adherence self-efficacy, self-reported adherence, and plasma tenofovir levels), adjusting for education, race, and time on PrEP. In 2018, 100 participants completed the survey, with 91 identifying as male and 66 as white. Only internalized stigma was associated with lower self-reported PrEP adherence. Exploratory mediation analyses suggested that the association between all stigma dimensions and self-reported PrEP adherence is mediated by PrEP adherence self-efficacy. No associations were found between any PrEP-related stigma measures and plasma tenofovir levels. Internalized PrEP stigma may reduce PrEP adherence, possibly by reducing PrEP adherence self-efficacy among experienced PrEP users. Further investigation of how stigma dimensions affect PrEP adherence in populations at risk for HIV may shed light on drivers of PrEP underutilization.Publication Metadata only Relationships between patient race and residential race context with missed human immunodeficiency virus care visits in the United States, 2010-2015(Oxford University Press, 2023) Crockett, Kaylee B.; Schember, Cassandra O.; Bian, Aihua; Rebeiro, Peter F.; Keruly, Jeanne; Mayer, Kenneth; Mathews, Christopher; Moore, Richard D.; Crane, Heidi; Geng, Elvin; Napravnik, Sonia; Shepherd, Bryan E.; Mugavero, Michael J.; Pettit, April C.; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesBackground: Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Methods: Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. Results: Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Conclusions: Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.Publication Metadata only The role of social support on cognitive function among midlife and older adult MSM(Lippincott Williams & Wilkins, 2023) Henderson, Emmett R.; Haberlen, Sabina A.; Coulter, Robert W. S.; Weinstein, Andrea M.; Meanley, Steven; Brennan-Ing, Mark; Mimiaga, Matthew J.; Turan, Janet M.; Teplin, Linda A.; Egan, James E.; Plankey, Michael W.; Friedman, M. Reuel; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesObjective:This study examines the association between social support and cognitive function among midlife and older MSM living with or without HIV.Design:We analyzed longitudinal data from participants enrolled from October 2016 to March 2019 in the Patterns of Healthy Aging Study, a substudy of the Multicenter AIDS Cohort Study. Methods: We conducted a cross-sectional analysis to estimate the association between social support and three measures of cognitive function [Trail Making Test (TMT) Part A, TMT Part B to A ratio, and Symbol Digit Modalities Tasks (SDMT)]. We also used linear mixed-effects models to estimate the association between baseline social support and cognitive function across four subsequent time points. We evaluated a multiplicative interaction term between baseline social support and time, in order to determine whether cognitive trajectories over time vary by baseline social support. Results: Social support was associated with lower TMT Part A scores at baseline and over the subsequent 2 years, indicating better psychomotor ability. Social support was associated with higher SDMT scores at baseline and across 2 years, indicating better information processing. We observed no association between social support and TMT B to A ratio at baseline or across 2 years, indicating no effect on set-shifting ability. Longitudinal cognition outcome trajectories did not vary by the level of baseline social support. Conclusion: Social support and cognitive function were associated in this sample over a short time period. Further research should explore causal relationships over the lifespan.Publication Metadata only Living with HIV during Covid-19: knowledge and worry about Covid-19, adherence to Covid-19-related precautions, and HIV health outcomes(Routledge, 2023) Nemli, Salih Atakan; Yigit, Ibrahim; Agrali, Burcu; Gokengin, Deniz; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesThe Covid-19 pandemic has been profound impacts on mental and physical health of individuals with chronic diseases. Thus, it is important to understand the effects of the Covid-19 pandemic on people living with HIV. We aimed to assess the association between Covid-19-related knowledge and worry, HIV-related health practices and outcomes, and adherence to precautions related to Covid-19, and possible associations of these factors with HIV treatment outcomes (ART adherence and viral load). A cross-sectional survey was conducted between October 2020 and February 2021 among 291 PLWH at two large university hospital HIV clinics in Izmir, Turkey. Additionally, the most recent HIV-RNA load, CD4 count was recorded using medical records. Logistic regression analyses were performed to determine predictors of self-reported adherence to COVID-19-related precautions, ART adherence and undetectable viral load. Covid-19-related worry, Covid-19-related knowledge, and ART adherence were significant predictors of adherence to Covid-19-related precautions. Furthermore, adherence to Covid-19-related precautions was a significant predictor of both ART adherence and undetectable viral load. Findings provide a unique aspect of the interrelations of Covid and living with HIV. Since health behaviors and outcomes for Covid-19 and HIV seem to be interrelated, treatment practices and interventions that address these simultaneously may enhance their efficacy.Publication Metadata only Cognitive prescriptions for reducing dementia risk factors among Black/African Americans: feasibility, acceptability, and preliminary efficacy(Routledge Journals, Taylor & Francis Ltd, 2023) Fazeli, Pariya L.; Hopkins, Cierra; Vance, David E.; Wadley, Virginia; Li, Peng; Wang, Danny H. H.; Bowen, Pamela G.; Clay, Olivio J.; Department of Psychology; Turan, Bülent; Department of Psychology; College of Social Sciences and HumanitiesObjectives: Black/African Americans (B/AAs) have double the risk of Alzheimer's disease and related dementia than Whites, which is largely driven by health behaviors. This study examined the feasibility, acceptability, and preliminary efficacy of a pilot randomized clinical trial of an individualized multidomain health behavior intervention among middle-aged and older B/AAs (dubbed Cognitive Prescriptions [CogRx]). Design: Thirty-nine community-dwelling B/AA participants aged 45-65 without significant cognitive impairment were randomized to one of three groups: CogRx, Psychoeducation, or no-contact control. The Psychoeducation and CogRx groups received material on dementia prevalence, prognosis, and risk factors, while the CogRx group additionally received information on their risk factor profile across the five CogRx domains (physical, cognitive, and social activity, diet, sleep). This information was used for developing tailored 3-month goals in their suboptimal areas. Results: The CogRx program had high retention (all 13 CogRx participants completed the 3-month program and 97% of the full sample completed at least 1 follow-up) and was well-received as exhibited by qualitative and quantitative feedback. Themes identified in the positive feedback provided by participants on the program included: increased knowledge, goal-setting, personalization, and motivation. The Covid-19 pandemic was a consistent theme that emerged regarding barriers of adherence to the program. All three groups improved on dementia knowledge, with the largest effects observed in CogRx and Psychoeducation groups. Increases in cognitive, physical, and overall leisure activities favored the CogRx group, whereas improvements in sleep outcomes favored Psychoeducation and CogRx groups as compared to the control group. Conclusion: The CogRx program demonstrated feasibility, acceptability, and preliminary efficacy in increasing dementia knowledge and targeted health behaviors. Further refinement and testing of the implementation and effectiveness of similar person-centered dementia prevention approaches are needed on a larger scale in diverse populations. Such findings may have implications for clinical and public health recommendations.