Psychological Distress, Drug Use, Sexual Risks and Medication Adherence among Young HIV-Positive Black Men Who Have Sex with Men: Exposure to Community Violence Matters

In the USA, Black males are disproportionately affected by community violence and HIV. The aim of this study was to assess whether exposures to community violence are related to psychological distress, drug use, sexual risk behaviors, and medication adherence among a sample of HIV-positive young Black men who had sex with men (YBMSM). Data are from 98 YBMSM ages 18–29 years recruited from Chicago who completed measures on demographics, exposures to community violence, psychological distress, drug use, condomless anal intercourse, and medication adherence. Rates of exposure to community violence were high and youth reported victimization and witnessing numerous types of violence in their lifetime. In adjusted logistic regression analyses, models indicate that YBMSM reporting higher levels of exposure to community violence had significantly higher rates of condomless anal intercourse in the previous 6 months (AOR: 5.33, 95%CI: 1.38–20.55). Additionally, exposure to community violence was positively associated with psychological distress, hard drug use, and use of marijuana as a sex drug. Adherence to HIV antiretroviral medication was negatively associated with community violence (AOR: 0.36, 95%CI: 0.13–0.97). Rates of exposure to community violence are especially high in urban communities. Overall findings suggest that treatment, intervention, and programmatic approaches that include initiatives to address exposure to community violence might correlate with better health-related outcomes for HIV-positive YBMSM

Pathways Linking Family Stress to Youth Delinquency and Substance Use: Exploring the Mediating Roles of Self-Efficacy and Future Orientation

African American adolescents in poorer neighborhoods experience significant sanctions related to drug use and delinquency. Parental stress (i.e. substance use, mental distress, and incarceration) is associated with youth drug use and delinquency. We examined whether high self-esteem and positive future orientation mediated parental stress and youth substance use and delinquency. Demographic, family stress, future orientation, self-esteem, and drug use data were collected from 578 youths. Major findings indicated that self-esteem mediated the relationship between family stress and both drug use and delinquency. Future mediated the relationship between family stress and delinquency. Resiliency factors may promote positive development for low-income youth

Mechanisms Linking Violence Exposure and School Engagement among African American Adolescents: Examining the Roles of Psychological Problem Behaviors and Gender

This study examines whether the relationship between violence exposure and school engagement is mediated by psychological problem behaviors and whether such relationships are gendered. Five hundred and sixty-three high school African American adolescents (ages 13-19 years) completed questionnaires that assessed two types of violence exposure (community violence and marital conflict), psychological problem behaviors (e.g., posttraumatic stress disorder symptoms, anxiety, withdrawal, and aggressive behaviors), and school engagement (i.e., student-teacher connectedness and grade point average [GPA] obtained from school records). For male adolescents, psychological problem behaviors collectively mediated the relationship between community violence exposure and student-teacher connectedness. For female adolescents, both community violence and marital conflict exposure were negatively related to both GPA and student-teacher connectedness via aggressive behavior. Findings suggest that the differential impact of type of violence exposure and its sequela based on gender should be considered when addressing low school engagement among African American youth

Involvement in the Juvenile Justice System for African American Adolescents: Examining Associations with Behavioral Health Problems

While researchers have found that African American youth experience higher levels of juvenile justice involvement at every system level (arrest, sentencing, and incarceration) relative to their other ethnic counterparts, few studies have explored how juvenile justice involvement and number of contacts might be correlated with this broad range of problems. A convenience sample of 638 African American adolescents living in predominantly low-income, urban communities participated in a survey related to juvenile justice involvement. Major findings using logistic regression models indicated that adolescents who reported juvenile justice system involvement versus no involvement were 2.3 times as likely to report mental health problems, substance abuse, and delinquent or youth offending behaviors. Additional findings documented that the higher the number of juvenile justice system contacts, the higher the rates of delinquent behaviors, alcohol and marijuana use, sex while high on drugs, and commercial sex. These findings suggest that identifying and targeting youth who have multiple juvenile justice system contacts, especially those in low-resourced communities for early intervention services, may be beneficial. Future research should examine whether peer network norms might mediate the relationships between juvenile justice involvement and youth problem behaviors

A Longitudinal Analysis of Antiretroviral Adherence among Young Black Men Who Have Sex with Men

Purpose: Young black men who have sex with men (YBMSM) experience poorer antiretroviral therapy (ART) medication adherence relative to their white counterparts. However, few studies have longitudinally examined factors that may correlate with various classifications of ART adherence among this population, which was the primary aim of this study. Methods: Project nGage was a randomized controlled trial conducted across five Chicago clinics from 2012 to 2015. Survey and medical records data were collected at baseline and 3- and 12-month periods to assess whether psychological distress, HIV stigma, substance use, family acceptance, social support, and self-efficacy predicted ART medication adherence among 92 YBMSM ages 16–29 years. Results: Major results controlling for the potential effects of age, education level, employment, and intervention condition indicated that participants with high versus low medication adherence were less likely to report daily/weekly alcohol or marijuana use, had higher family acceptance, and exhibited greater self-efficacy. Conclusions: These findings identity important factors that can be targeted in clinical and program interventions to help improve ART medication adherence for YBMSM

A Synthesis of 20 Years of Research on Sexual Risk Taking among Asian/Pacific Islander Men Who Have Sex with Men in Western Countries

Over the past two decades, there has emerged a body of literature documenting a number of risk factors associated with Asian/Pacific Islander men who have sex with men’s unsafe sexual behaviors. This study aims to systematically review existing empirical studies and synthesize research results into a social–ecological framework using a mixed research synthesis. Empirical research articles published in peer-reviewed journals between January 1990 and June 2013 were identified in six databases, including PubMed, Ovid MEDLINE, PsycINFO, Social Work Abstract, CINAL, and Web of Knowledge. Both quantitative and qualitative studies were included. Two analysts independently reviewed the articles, and findings were organized on a social–ecological framework. Twenty-two articles were included in the analysis; among these 13 were quantitative, 8 were qualitative, and 1 was mixed-methods research. Results indicated that demographic characteristics, psychological resources, behavioral patterns, relationships with family and friends, dynamics with romantic or sexual partners, community involvement, culture, discrimination, and institutional factors were related to unprotected anal intercourse. This article presents a critique of this literature and discusses implications for future research with this population. It concludes with prevention/intervention initiatives based on review findings

The use of antibiotics in the treatment localized juvenile periodontics

Thesis (M.Sc.D.)--Boston University, Henry M. Goldman School of Dental Medicine, 1999 (Periodontology and Oral Biology).Includes bibliographical references (leaves 67-78).Treatment studies of Localized juvenile periodontitis (LJP) have revealed a direct relationship between the elimination of Actinobacillus actinomycetemcomitans (A.a.) from the deep pocket epithelium, and disease cessation. To evaluate the successful treatment outcome in LJP patients, we compared pre and post treatment levels in A.a. in this patient population to treatment outcome. Ten LJP patients were randomly divided into two groups, with one group receiving antibiotic therapy (a combination of metronidazole and amoxicillin) and the other receiving no antibiotic. Both groups received full polymorphonuclear leukocyte (PMN) chemotaxis evaluation, microbiologic screening, oral hygiene instruction (OHi) and full mouth scaling and root-planing (S/RP) prior to surgical therapy. The surgical protocol included open flap debridement without resective or regenerative therapy. Using the DNA checkerboard method A.a. levels were measured, from samples obtained before and after treatment. The findings demonstrate that A.a. serotype b was the dominant strain throughout the clinical trial and all the patients n=10 (100%) expressed depressed PMN chemotaxis at baseline and at 24-months. The sites surgically treated yielded a mean probing depth reduction of 1.48mm (antibiotic) and 0.66mm (non-antibiotic) respectively. The treatment groups responded well to therapy and there was no statistical difference between both groups. The study suggests that LJP cases respond positively to therapy and that the judicious use of antibiotic therapy can provide improvement

Community Violence Exposure and Adolescent Delinquency: Examining a Spectrum of Promotive Factors

This study examined whether promotive factors (future expectations, family warmth, school attachment, and neighborhood cohesion) moderated relationships between community violence exposure and youth delinquency. Analyses were conducted using N = 2,980 sixth to eighth graders (Mage = 12.48; 41.1% males) from a racially, ethnically, and socioeconomically diverse sample. After controlling for demographic factors, delinquency was positively associated with community violence exposure and inversely associated with each of the promotive factors. When interaction effects between all promotive factors and community violence exposure were examined simultaneously, only future expectations moderated the relationship between community violence exposure and delinquency. Specifically, community violence exposure had a weaker association with delinquency for youth reporting high versus low levels of future expectations. Results indicate that while promotive factors from family, school, and neighborhood domains are related to lower rates of delinquency, only future expectations served as a protective factor that specifically buffered youth from the risk effects of community violence exposure

Testing Three Pathways to Substance Use and Delinquency among Low-Income African American Adolescents

Objective Mounting literature suggests that parental monitoring, risky peer norms, and future orientation correlate with illicit drug use and delinquency. However, few studies have investigated these constructs simultaneously in a single statistical model with low income African American youth. This study examined parental monitoring, peer norms and future orientation as primary pathways to drug use and delinquent behaviors in a large sample of African American urban adolescents. Methods A path model tested direct paths from peer norms, parental monitoring, and future orientation to drug use and delinquency outcomes after adjusting for potential confounders such as age, socioeconomic, and sexual orientation in a sample of 541 African American youth. Results Greater scores on measures of risky peer norms were associated with heightened risk of delinquency with an effect size that was twice in magnitude compared to the protective effects of future orientation. Regarding substance use, greater perceived risky peer norms correlated with the increased likelihood of substance use with a standardized effect size 3.33 times in magnitude compared to the protective effects of parental monitoring. Conclusions Findings from this study suggest that interventions targeting risky peer norms among adolescent African American youth may correlate with a greater impact on reductions in substance use and delinquency than exclusively targeting parental monitoring or future orientation

Marijuana Use among Young Black Men Who Have Sex with Men and the HIV Care Continuum: Findings from the uConnect Cohort

Background: Young Black men who have sex with men (YBMSM) are at highest risk for HIV seroconversion in the United States. Successful movement through the HIV care continuum is an important intervention for limiting onwards HIV transmission. Objective: Little data exists on how substances most commonly used by YBMSM, such as marijuana, are related to the HIV continuum, which represents the primary aim of this study. Methods: A cohort of YBMSM (n = 618) was generated through respondent-driven sampling. Frequency of marijuana use and marijuana use as a sex-drug were assessed across the HIV care continuum using weighted logistic regression models. Results: Study participants reported more intermittent marijuana use (n = 254, 56.2%) compared to heavy use (n = 198, 43.8%). Our sample contained 212 (34.3%) HIV seropositive participants of which 52 (24.5%) were unaware of their HIV positive status. Study participants who were heavy marijuana users were more likely to be unaware of their HIV seropositive status (AOR: 4.18; 95% CI 1.26, 13.89). All other stages in the care continuum demonstrated no significant differences between those who use marijuana intermittently or heavily or as a sex-drug and nonusers. Conclusions: YBMSM who used marijuana heavily were more likely to be HIV-positive unaware than those who never used marijuana. Findings were inconclusive regarding the relationships between marijuana use and other HIV care continuum metrics. However, knowledge of ones’ HIV status is a critical requirement for engaging in care and may have implications for onwards HIV transmission