Month: August 2014

Social Stigma Hinders HIV Interventions for African Americans

By Beth Krane

Social Stigma CollageThe level of esteem that Whites hold toward African Americans is linked to the impact of behavioral HIV interventions for African Americans, according to a recent study co-authored by CHIP Principal Investigator (PI) Blair T. Johnson.

While previous research has shown that people who perceive more bias experience poorer mental and physical health, access healthcare less often, and have higher mortality rates, this study breaks new ground because it evaluates the health effects of actual attitudes of Whites’ toward African Americans. The study, published in the journal Social Science & Medicine (DOI: 10.1016/j.socscimed.2013.06.028), also is novel because it examines how the interplay between individual and social variables affects the success of HIV interventions.

“The present research provides support for an influence of structural stigma on the efficacy of interventions for bringing about behavior change, highlighting the role of stigma in the environment in perpetuating health disparities,” wrote Johnson, a UConn professor of social psychology.

Johnson’s team also examined the effects of the level of racial residential segregation in communities and found HIV prevention trials had more success in communities where Whites and African Americans live less segregated from each other and less success with greater segregation.

The study took advantage of a meta-analysis Johnson and his team had published in 2009 in the Journal of Acquired Immune Deficiency Syndromes (JAIDS). This earlier effort used features of the studies themselves in order to try to understand why interventions sometimes succeed and other times fail, but did not examine any community-level variables. The newer effort added information drawn from benchmark polls and economic databases and enabled Johnson’s research team to look at how Whites’ attitudes toward African Americans and levels of racial segregation jointly influenced outcomes in 70 studies conducted between 1988 and 2005. The studies took place at 50 different sites and involved a total of 40,000 participants, the majority of whom were African American.

The main results of the study were:

  • Interventions to increase African Americans’ condom use were more successful when Whites’ attitudes toward African Americans were more positive or when racial segregation was low. Conversely, such interventions failed when attitudes were negative or segregation was high.
  • The two social or structural factors interacted: Interventions improved condom use only when Whites’ attitudes were positive and racial segregation was low.
  • In communities where Whites had more positive attitudes toward African Americans, intervention participants improved their condom use over time, compared to individuals in control groups, but in communities with more negative attitudes, there was no improvement over time, on average.

The negative effects of Whites’ attitudes remained even controlling for variables examined in the original meta-analysis, such as study participant characteristics (e.g., gender and HIV status) and intervention characteristics (e.g., provision of skills training). The effects also held up controlling for community-level characteristics such as levels of education and poverty.

“The stress experienced by African Americans in more negative environments appears to hinder intervention participants’ ability to adopt new, safer, health behaviors,” said CHIP Affiliate Allecia Reid, an assistant professor of psychology at Colby College and lead author of the study.

One approach that buffered study participants from the effects of negative attitudes and high levels of segregation was tailoring intervention content to the values and needs of study participants, perhaps because tailoring helps to reduce African Americans’ mistrust of intervention providers or because tailored interventions are more likely to provide needed skills to cope with the stresses caused by experiencing prejudice and discrimination, Johnson said.

The detrimental effects of Whites’ attitudes on the efficacy of interventions was even more pronounced for African American adolescents, with HIV interventions for this target population failing, on average, in communities with negative attitudes.

“Adolescents may feel the effects of discrimination more acutely because they are still forming their sense of identity and integrating external evaluations into their self-identity,” Johnson said.

For this study, information about Whites’ attitudes toward African Americans was drawn from the American National Election Studies (ANES). The researchers matched the location and year of the studies included in the meta-analysis to the location and year of the ANES studies. Residential segregation was approximated using dissimilarity scores, which reflect the proportion of African Americans who would have to move into different census tracts to obtain even distribution of African Americans across a metropolitan area.

The current study uses a multi-level or structural approach developed by Johnson’s Systematic Health Action Research Program (SHARP). The Network Individual Resource model, a 2010 publication that resulted from the work of 14 scholars led by Johnson, situates behavior in the web of interactions between individuals and their networks, highlighting how the exchange of resources may increase or decrease risk across the lifespans of the individuals and the networks. The model has fared well in empirical tests and was highlighted in a review of multi-level approaches in an article published in July in AIDS.

These research findings may have implications for the success of other behavior change interventions focused on reducing health disparities experienced by African Americans, such as those focused on obesity and diabetes, the authors note.

“Members of stigmatized networks must cope day to day with other networks that often present challenges due to prejudice and discrimination; therefore, it is logical that members of networks living in communities marked by greater stigma will have more difficulty incorporating new health habits whether it relates to HIV risk, physical activity, or nutrition,” Johnson noted.

“It would not surprise me if the effects we found with HIV risk are even larger for some other health behaviors.”

Along with Johnson and Reid, John F. Dovidio, and Estrellita Ballester are co-authors of the article; Johnson took the senior, last, author position. Dovidio, of Yale University, is a CHIP affiliate. Ballester and Reid are both baccalaureate graduates of the psychology department at UConn; they are also former CHIP full-time employees working for SHARP prior to pursuing graduate studies elsewhere.

CHIP PI Deborah Fein Featured in New York Times Magazine

CHIP Principal Investigator and Board of Trustees Distinguished Professor of Psychology Deborah Fein was featured prominently in an in-depth piece in the New York Times Magazine for her work on autism with CHIP Affiliate Inge-Marie Eigsti and others in the Department of Psychology.

The piece was entitled,”The Kids Who Beat Autism,” and is excerpted below:

In the last 18 months, however, two research groups have released rigorous, systematic studies, providing the best evidence yet that in fact a small but reliable subset of children really do overcome autism. The first, led by Deborah Fein, a clinical neuropsychologist who teaches at the University of Connecticut, looked at 34 young people, including B. She confirmed that all had early medical records solidly documenting autism and that they now no longer met autism’s criteria, a trajectory she called “optimal outcome.” She compared them with 44 young people who still had autism and were evaluated as “high functioning,” as well as 34 typically developing peers.

CHIP Researchers at Forefront of HIV Communication Research

By Beth Krane

JAIDS supplement 2014An interdisciplinary research team from UConn’s Center for Health, Intervention, and Prevention (CHIP) played a significant role in a special issue of the Journal of Acquired Immune Deficiency Syndromes (JAIDS), which was released recently and highlighted at the biannual International AIDS Conference in Melbourne, Australia in July. A press conference took place to promote the special issue at the National Press Club in Washington, DC.

CHIP Principal Investigator (PI) and Professor of Social Psychology Blair T. Johnson and members of his Systematic Health Action Research Program (SHARP) authored or co-authored four of the 13 journal articles focused on health communication and its essential role in HIV prevention and treatment. Johnson also contributed to the project, sponsored by John Hopkins University’s Bloomberg School of Public Health’s Health Communication Capacity Collaborative (HC3), from its formative stages as a member of an expert panel convened by HC3 last year.

JAIDS Collage“We’re calling attention to when and how the message matters,” Johnson said. “The communication piece of HIV interventions is often taken for granted. The assumption is that the message is always the same – ‘safe sex.’  Although advances in medicine are helping to stem the toll of AIDS in countries that can afford to distribute the medicines, it is clear that enacting safer behavior will always be critical to improving public health.”

The JAIDS supplement highlights the value of communication in changing human behavior, whether through medical or psychosocial interventions, Johnson said. A common theme in the articles his teams authored is that researchers, both of original studies and of meta-analyses, should consider the complexities of their topics in more detail. The authors suggest they do so by looking at the effects of specific elements of content, communicating more precisely about their processes and findings, and examining the influence of multiple social structures on the success of interventions.

“We provide guidance to researchers and reviewers that can help them make research more efficient. Doing so, in turn, should make it easier to replicate their work in other settings and to translate it into practice,” said Johnson, whose SHARP research team has been funded continuously by the National Institute of Mental Health (NIMH) for the past 19 years.

“Ultimately, public health research should clean up tremendously and people’s health should improve as a result.”

All of the articles in the JAIDS special issue are open-access.

1. Effectiveness of Mass Media Interventions on HIV Prevention 1986 – 2013: A Meta-Analysis

Link to article

This article presents the first global meta-analysis of the effectiveness of mass media campaigns for HIV prevention.

Mass media campaigns were significantly associated with increases in condom use and HIV transmission and prevention knowledge, the authors’ review of both published and unpublished reports found. Increases in condom use were greater following longer campaigns and in countries lower on the Human Development Index (HDI), which compares countries based on factors such as life expectancy, education, and income. Increases in transmission knowledge were more significant when there was greater campaign exposure, for more recent campaigns, and in countries lower on the HDI.

One factor that positively impacted condom use was when the campaign messages were carefully tailored to their target populations. Campaigns including both transmission and prevention information also positively affected condom use.

“It is profound to see that mass media campaigns can have such a large effect in countries lowest on the Human Development Index, where the need is greatest. The results are promising because it shows mass media campaigns are an effective way to go to scale – taking interventions to large numbers of people in the places most in need,” said UConn Professor of Communication Sciences Leslie Snyder, a CHIP PI and a co-investigator on Johnson’s SHARP grant. Snyder is co-author of two of the supplement articles.

The differential impact between nations scoring higher and lower on the HDI may be because of reduced “media clutter” in less developed nations and due to differences in HIV incidence rates and perceived risk, Snyder said.

Co-Editor of the special issue is David R. Holtgrave, who is Professor, Department Chair, and Co-Director of the HC3 program. Dr. Holtgrave remarked that this “paper is a very important and careful systematic review… It provides a comprehensive, up-to-date summary of the impact of these interventions and helps us to understand the social factors that set the stage to make such behavior change programs work most effectively.”

2. Effects of Behavioral Intervention Content on HIV Prevention Outcomes: A Meta-Review of Meta-Analyses

Link to article

Past meta-analyses of HIV prevention interventions have examined the effectiveness of interventions for various target populations and they have examined the success of different modes for delivering the interventions, but surprisingly few have focused on many, if any, dimensions of intervention content, Johnson said.

“The meta-analyses focused more on whether the interventions worked and for whom than why,” he said.

In this meta-analysis of past HIV intervention meta-analyses, Johnson’s team found two intervention content dimensions significantly related to risk reduction: skill provision and motivational enhancement.

Past HIV prevention meta-analyses have not coded behavior change techniques (BCTs), essentially the mechanisms of change, in the intervention. However, a recently developed BCT taxonomy allows more detailed examination of the interacting components of an intervention, he said.

“The taxonomy is a virtual periodic table of the elements that go into making communication-based interventions successful,” the authors note. They exhort researchers to incorporate the taxonomy into both their original studies and their meta-analyses in the future.

3. Enhancing Reporting of Behavior Change Intervention Evaluations

Link to article

This article addresses four practices contributing to suboptimal reporting of behavior change interventions and encourages researchers to follow recently developed international standards for what information to include in social science journal articles.

The four practices are: 1. Lack of availability of detailed descriptions of interventions and their implementations, 2. Omission of content from active control groups, 3. Lack of availability of detailed process evaluations and 4. Lack of replication to other contexts.

For example, the authors note that “a substantial portion of the science of behavior change is being lost each year” because of lack of attention being paid to supplemental information available in some HIV intervention manuals, which the U.S. Centers for Disease Control and Prevention (CDC) make available through a program to disseminate best evidenced-based interventions, and because social scientists do not make enough efforts to make such materials available to each other apart from formal programs such as the CDCs.

The importance of paying attention to the content active control groups are receiving is stressed in several of the CHIP articles. In this article, the authors estimate the effects of some interventions could be up to two times greater or four times smaller if control group content were given greater attention.

4. Health Behavior Change Models for HIV Preventions and AIDS Care: Practical Recommendations for a Multi-Level Approach

Link to article

“Despite increasing recent emphasis on the social and structural determinants of HIV-related risk behavior, empirical research and interventions lag behind, partly because of the complexity of social-structural approaches,” the authors of this article note.

This article compares four multi-level approaches. One of these is the Network Individual Resource model, a 2010 publication that resulted from the work of 14 scholars led by Johnson. This model situates behavior in the web of interactions between individuals and their networks, highlighting how the exchange of resources may increase or decrease risk. The model has fared well in empirical tests. Indeed, the finding that mass media campaigns succeed better in poorer nations supports one of the model’s predictions.

He article reviewing multi-level approaches also provides an extensive list of variables associated with behavior and behavior change on the individual-structural spectrum for researchers’ consideration. The authors also discuss challenges associated with designing research to take into account such complexities and they identify starting points for doing so.

Of note, the researchers recommend assembling an interdisciplinary team and recommend the appropriate disciplines to address different levels of the individual-structural spectrum. While encouraging researchers to embrace the complexities of their research topics, the authors also caution them to limit themselves to limit themselves to two such factors in any one research endeavor.

* * *

UConn-affiliated authors of the articles are: Tania B. Huedo-Medina (Allied Health Sciences), Blair T. Johnson (Psychology), Jessica M. LaCroix (Psychology), and Leslie B. Snyder (Communication), all of whom are CHIP affiliated. Other authors with CHIP affiliations include Charles Abraham (Exeter University, UK) and Marijn de Bruin (Aberdeen University, UK). Michelle Kaufman (HC3 program, Johns Hopkins), who completed her Ph.D. work under the supervision of Prof. Seth C. Kalichman at UConn, was lead author on the article reviewing multi-level theories.

CHIP Principal Investigators in the Spotlight

CHIP PI Linda Pescatello was featured in a Hartford Courant article, titled, “Do Our Genes Influence How We Respond To Exercise?” on August 1st, along with CHIP Affiliate Beth A. Taylor, CHIP Graduate Student Affiliate Garrett Ash, Amanda Zaleski, and CHIP Graduate Student Lauren Lamberti. The article describes the team’s efforts to raise money for their exercise genomics project, “A Prescription for Health and Fitness Based on Your Genes,” through the crowdfunding platform Experiment.com. The project has until August 14th to meet a funding target of $6,000. So far, they have raised $5,029 with the help of 57 backers. An excerpt from the Courant piece:

Through Experiment’s platform, Dr. Linda Pescatello and their team are sharing progress reports in real-time. When backers give money to the project, they receive behind-the-scenes access to research updates, and recognition in the published results.

If fully funded, the researchers will analyze stored blood samples from the people that have previously completed their exercise studies. They will use the new technology of deep gene sequencing to find genes that predict who responds and who does not respond to exercise as antihypertensive lifestyle therapy. Their findings may enable them to create personalized exercise prescriptions to maximize the blood pressure lowering effects of exercise for people with hypertension.

CHIP PI Blair Johnson was quoted in an article in the Science Speaks blog, titled, “In treatment as prevention era, health communication plays new and critical role“:

“You don’t have to hit people over the head to get behavior change,” Blair Johnson, a professor of psychology at the University of Connecticut at Storrs said. He presented findings from a Meta-Review of Meta-Analyses of the effects of behavior intervention on HIV prevention outcomes. While efforts to change sexual behavior are among the least successful, the review found, many interventions are effective. That includes instruction on condom use for adolescents, which did not increase the odds those teenagers would be sexually active, Johnson noted, “instead it had the opposite effect.”