Obesity and the built environment

Biological, psychological, behavioral, and social factors are unable to fully explain or curtail the obesity epidemic. The goal of this paper is to provide a review of research on the influence of the built environment on obesity. Studies were evaluated with regard to their methods of assessing the environment and obesity, as well as to their effects. Methods used to investigate the relationships between the built environment and obesity were found to be dissimilar across studies and varied from indirect to direct. Levels of assessment between and within studies varied from entire counties down to the individual level. Despite this, obesity was linked with area of residence, resources, television, walkability, land use, sprawl, and level of deprivation, showing promise for research utilizing more consistent assessment methods. Recommendations were made to use more direct methods of assessing the environment which would include specific targeting of institutions thought to vary widely in relation to area characteristics and have a more influential effect on obesity-related behaviors. Interventions should be developed from the individual to the neighborhood level, specifically focusing on the effects of eliminating barriers and making neighborhood level improvements that would facilitate the elimination of obesogenic environments

Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others

Description and Demonstration of Cognitive Behavioral Therapy to Enhance Antiretroviral Therapy Adherence and Treat Depression in HIV-Infected Adults

There are an estimated 1.1 million individuals living with HIV/AIDS in the United States. In addition to the various medical comorbidities of HIV infection, depression is one of the most frequently co-occurring psychiatric conditions among HIV-infected individuals. Furthermore, depression has been found to be associated with nonadherence to antiretroviral therapy (ART), as well as HIV disease progression. Cognitive behavioral therapy (CBT) has repeatedly been found to effectively treat depression in adult populations, and CBT for adherence and depression (CBT-AD) is an effective treatment for improving depressive symptoms and medication adherence in the context of various chronic health conditions, including diabetes and HIV-infection. This paper provides a description of the CBT-AD approach to treat depression and ART adherence in HIV-infected adults, which we have developed and tested in our clinic, and for which detailed therapist and client guides exist. To augment the description of treatment, the present article provides video component demonstrations of several core modules that highlight important aspects of this treatment, including Life-Steps for medication adherence, orientation to CBT-AD and psychoeducation, and suggestions for adaptation of core CBT modules for HIV-infected adults. Discussion of video demonstrations highlights differences in patient presentations and course of treatment between HIV-infected adults receiving CBT-AD and HIV-uninfected adults receiving traditional CBT for depression. This description and the accompanying demonstrations are intended as a practical guide to assist therapists wishing to conduct such a treatment in the outpatient setting. •We demonstrate CBT for adherence and depression (CBT-AD) for HIV-infected adults.•We present video role-plays of various components of CBT-AD with diverse patients.•We describe commonalities and differences between CBT-AD and traditional CBT.•We describe common patient presentations for HIV-infected adults with depression