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BACKGROUND: Despite numerous published reports, there is no consensus in the literature as to whether the surgical repair of the pectus excavatum improves cardiovascular function. As a result, it has been suggested that correction should be considered a cosmetic procedure, and therefore, many health insurance companies have questioned whether the repair of the pectus excavatum improves cardiovascular function and thus are reluctant to authorize the procedure. The purpose of this study was to apply metaanalysis methodology to generate a quantitative synthesis of the effects of surgical repair on cardiovascular function and to test the hypothesis that surgical repair of the pectus excavatum results in significant improvements in cardiovascular function. METHODS: Studies were retrieved via computerized literature searches, cross-referencing from original and review articles, and a review of the reference list by a recognized authority in the area of pectus excavatum repair. The inclusion criteria were as follows: (1) reporting quantitative measures of preoperative and postoperative cardiovascular function; (2) published in the English language; (3) indexed between January 1960 and May 2005; (4) reporting the duration between which preoperative and postoperative assessments were conducted; and (5) describing the cardiovascular assessment procedures. RESULTS: A comprehensive search of the literature identified eight studies that met all of the inclusion criteria. These studies, representing 169 pectus excavatum patients, were used for the metaanalysis. Random-effects modeling yielded a mean weighted effect size (ES) for cardiovascular function that was statistically significant (ES, 0.59; 95% confidence interval, 0.25 to 0.92; p = 0.0006). CONCLUSIONS: The findings of the present study indicated that surgical repair of the pectus excavatum significantly improves cardiovascular function and contradicts arguments that surgical repair is primarily cosmetic yielding minimal physiologic improvement. [ABSTRACT FROM AUTHOR]

The authors assessed factors that motivate individuals to report negative human immunodeficiency virus (HIV) antibody test results, although they had never been tested. In particular, they investigated sexual intimacy motives associated with the needs for affiliation, sex, and dominance as contributing factors for faulty disclosures. Participants were 246 sexually active heterosexual students. Overall, 21% of the sample had been tested for HIV, and most individuals disclosed their results to intimate partners. Of the entire sample, 5% had previously told an intimate sexual partner they were HIV-negative, although they had not been tested. HIV testing and perceptions of partner deceptions with reference to primary prevention efforts and applications are explored. [ABSTRACT FROM AUTHOR]

An assessment of the effects of HIV/AIDS patients' empowered behaviours on the patient-provider relationship was undertaken. Participants were 50 HIV-positive women ranging in age from 23 to 48 years, with 60% of the sample African American, 24% Latina, 6% White and 10% mixed/other race. Descriptive and canonical correlation analyses were used to investigate the interrelationships between patients' empowered behaviours and self-reported interactions with their providers. Positive associations were noted between patients' medical decision-making involvement and patient-provider interactions. Patients reporting greater decision-making involvement, had higher levels of communication with their providers, and received more information and positive affect from their providers. Health care providers of HIV-positive women are encouraged to cultivate empowered behaviours in their patients. [ABSTRACT FROM AUTHOR]

Objective: The current study applied survival analysis to examine factors associated with nondisclosure of human immunodeficiency virus (HIV) serostatus among mothers living with HIV (MLH) who had participated in a cognitive-behavioral intervention to disclose their HIV status to their children., Method: Data were utilized from MLH in the intervention arm of the teaching, raising, and communicating with kids (TRACK; Schulte et al., 2021) trial focusing on serostatus disclosure/nondisclosure across four time points (baseline, 3, 9, and 15 months). MLH ( M age = 39.4) resided in California or Georgia and identified as Latina (33%), Black (54%), White (5%), or multiracial (8%). Physical, mental health, and psychosocial measures from the 3-month assessment were used to predict nondisclosure applying Cox regression survival analysis., Results: Nondisclosure was associated with MLH reporting better physical and mental health, less conflict with their child, better cohesion within their families, and less perceived stigma. MLH reporting better physical functioning were 58% less likely to disclose compared to those reporting physical limitations (hazard ratio [HR] = 0.42). Those reporting lower levels of disclosure self-efficacy were 59% less likely to disclose than those reporting higher levels (HR = 2.47); by 67 weeks into the study, the nondisclosure rate was 56% for those reporting lower self-efficacy compared to 24% for those reporting higher self-efficacy., Conclusions: Addressing the inclination not to disclose when the MLH is feeling healthy may be an aspect to incorporate into future interventions. Furthermore, improving disclosure self-efficacy to a high level appears to be a critical component to intervention success. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

HIV remains prevalent, stigmatized, and requires parents to decide whether and how to disclose to their serostatus to their children. Teaching Raising And Communicating with Kids (TRACK), an intervention to support maternal disclosure of HIV status to children, demonstrated efficacy through a pilot and a full-scale multisite trial. In response to the limited availability of best practices for conducting multisite research and recognizing the importance of identification of key intervention components, the current manuscript presents the traditional elements of an implementation paper along with secondary data analyses to identify drivers of the intervention's effects. Black, Latinx, and White mothers living with HIV (mean age = 39.27, SD = 7.89) and their children (51% female, mean age = 9.65, SD = 2.48) were recruited in Southern California and Atlanta (N = 176 dyads). Following baseline assessments, half were randomized to the intervention. Follow-up assessments occurred at 3, 9, and 15 months. Implementation and quality assurance protocols revealed the need for a broad range of recruitment and retention strategies, ongoing assessment of participants' psychological distress, and joint initial training of study personnel with ongoing supervision. Based on linear growth modeling, key intervention components (i.e., parent-child communication, positive parent involvement and reinforcement, family routines) significantly contributed to disclosure self-efficacy, the primary intervention target. Lessons learned emphasized the need to balance fidelity to the research protocol with strategies for managing site-based differences and the importance of including all key intervention components for future implementation at clinical or community-based sites., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Maternal illness is a stressor that can disrupt family processes and contribute to negative child outcomes, and researchers have considered family variables that mediate or moderate the maternal illness-child outcome relationship. Through reliance on a diverse sample (ethnically and racially, as well as geographically), the current study expands prior literature with a focus on parent-child conflict. Specifically, associations between aspects of HIV positive mothers' illness and mother-child conflict were explored. One goal of the study was to determine if there were direct or indirect associations with aspects of mothers' HIV and mother-child conflict. HIV-positive mothers ( N = 136) provided CD4 count and completed measures assessing their perceived level of physical functioning, depressive symptoms, HIV health-related anxiety, and mother-child conflict with their healthy school-age children. Path analysis considered the pattern of relationships across variables. Results showed maternal vitality and depressive symptoms were directly associated with mother-child conflict. CD4 cell count and health-related anxiety operated indirectly through maternal depressive symptoms. Mediation analyses further assessed the influence of maternal CD4 cell count on mother-child conflict behavior; results indicated an indirect effect was mediated by vitality. HIV health-related anxiety and vitality separately showed indirect effects on mother-child conflict, mediated by maternal depressive symptoms. These findings are the first to focus on mother-child conflict among children affected by maternal HIV and highlight the need for screening and intervention to address depressive symptoms among HIV-positive mothers.

Anxiety symptoms related to health are often present in populations coping with chronic illness, and among women living with HIV (WLWH), anxiety has been linked to a range of negative outcomes. This paper describes the validation of a four-item instrument designed to measure health-related anxiety (HRA) in WLWH by assessing the impact of thinking about HIV status and health on difficulty sleeping, lack of appetite, reduced desire to socialize, and difficulty concentrating at school or work. The scale was administered to 238 adult WLWH across three studies. Exploratory factor analysis revealed a one-factor solution; multi-group confirmatory factor invariance analyses supported the single factor model. For construct and criterion validity, correlations between the HRA scale and validated instruments measuring psychological, psychosocial, and physical distress were as predicted. Results support the validity of the HRA scale among WLWH as a brief measure of anxiety related to HIV status and health., (© 2018 Wiley Periodicals, Inc.)

Mothers living with HIV (MLWH) experience stressors inherent to parenting, often within a context characterized by poverty, stigma, and/or limited social support. Our study assessed the relationship between parenting stress and child perceptions of family functioning in families with MLWH who have healthy school-age children. MLWH and their children (N = 102 pairs) completed measures addressing parenting stress and perceptions of family functioning (i.e., parent-child communication, family routines, and family cohesion). We used covariance structural modeling to evaluate the relationship between these factors, with results showing greater maternal parenting stress associated with poorer family functioning outcomes (reported by both the child and the mother). Findings offer support for the parenting stress-family functioning relationship by providing the child perspective along with the maternal perspective, and point to the need for interventions aimed at minimizing the impact of maternal parenting stress on family functioning., (Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.)

A pilot study was conducted to assess the effects of the IMAGE pilot intervention (Improving Mothers' parenting Abilities, Growth, and Effectiveness) on mothers living with HIV (MLH). Based on Fisher and Fisher's IMB model [1992. Changing AIDS risk behavior. Psychological Bulletin, 111, 455-474], the intervention focused on self-care and parenting behavior skills of MLH that affect maternal, child, and family outcomes. A randomized pre-test-post-test two-group design with repeated assessments was used. MLH (n = 62) and their children aged 6-14 (n = 62; total N = 124) were recruited for the trial and randomized to the theory-based skills training condition or a standard care control condition. Assessments were conducted at baseline with follow-ups at 3, 6, and 12 months. Maternal, child, and family outcomes were assessed. Results show significant effects of the intervention for improving parenting practices for mothers. The intervention also improved family outcomes, and showed improvements in the parent-child relationship. IMAGE had a positive impact on parenting behaviors, and on maternal, child, and family outcomes. Given MLH can be challenged by their illness and also live in under-resourced environments, IMAGE may be viewed as a viable way to improve quality of life and family outcomes.

The purpose of this 15-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent career readiness and externalizing behaviors. Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning and depression) and child/adolescent outcomes (e.g., career readiness, conduct disorder, drug use, sexual behaviors, parent attachment and youth autonomy) were assessed over 20 time-points. Individual growth and GEE logistic regression models showed lower variability in maternal viral load was positively associated with better career readiness and parent attachment among adolescent/young adults. Externalizing behaviors (conduct disorder, alcohol and crystal methamphetamine use) were positively associated with maternal depression. Adolescent coping efficacy was shown to be a protective factor when applied to models on career readiness. Stability in MLH health positively affects children's career readiness over time, particularly career planning and career choices. The finding that adolescent coping efficacy may act as a protective factor against poor career planning has important implications for developing interventions to assist children in coping with parental HIV., Competing Interests: Declaration of Conflicting Interests The authors declare that there is no conflict of interest.

The purpose of this study was to examine a model of the relationships between parenting deficits and skills, along with child outcomes, in a sample of mothers living with HIV (MLH) and their 6 to 14 year old children. Sixty-two MLH (61% Latina, 26% black, 3% white, & 10% multiracial) and their well children (age 6 - 14) were recruited from the greater Los Angeles, California, region to participate in an intervention (IMAGE: Improving Mothers' parenting Abilities, Growth, and Effectiveness) designed to assist MLH with parenting and self-care skills. Constructs examined included parenting deficits, parenting skills, and child outcomes. Covariance structural modeling was used for the analyses. Covariance structural modeling confirmed the hypothesized set of construct associations. As predicted, fewer parenting deficits were associated with better parenting skills, which, in turn, were associated with better child outcomes. This study delineated further the parenting issues with which MLH struggle, providing information on the interventions needed for this population. MLH who have little confidence they can enact parenting skills and limited knowledge of basic parenting practices appear to be less likely to provide family routines consistently, monitor their children, or to engender family cohesion or a close parent-child relationship. Such parenting skills were found to be associated with child functioning.

Past research has shown that young children affected by maternal HIV present with elevated stress/anxiety and negative well-being. This pilot intervention for children aged 7-14 affected by maternal HIV targeted improving positive child-mother communication, improving HIV/AIDS knowledge and reducing anxiety (especially related to transmission), and lessening feelings of stigma. Each of the three child intervention sessions included behavioral skills training and a themed craft exercise; mothers attended an open discussion group while the children attended their sessions. Study participants were 37 child-mother pairs. The study design was a randomized two-group pretest-posttest experimental design. The intervention sessions were audiotaped for transcription. Results showed significant decreases in anxiety and worry for children in the intervention group, and increases in happiness and knowledge regarding HIV/AIDS transmission. Intervention group mothers reported greater social support. Qualitative findings for the intervention group children and mothers also support these findings. Early intervention reduces child stress, and may affect longer-term outcomes., (© The Author(s) 2013.)

A longitudinal assessment was undertaken of young adolescents' psychosocial outcomes affected by maternal HIV/AIDS, focusing on both parent-child psychosocial ties and peer relationships. Data were taken from the Parents and Children Coping Together study (PACT), a 15-year study assessing mothers with HIV/AIDS and their well children every 6 months. Families (N = 118) who participated in PACT II and PACT III are included in the current analyses, who were assessed every 6 months for 36 months in PACT II, and every 6 months for 18 months in PACT III (providing 11 time points of data across 8 years). Growth curve modeling was applied to assess the associations of maternal health on adolescent psychosocial outcomes. In terms of their relationship with their mother living with HIV (MLH), adolescent psychosocial functioning was negatively impacted by maternal illness, specifically viral load count and vitality levels, while several indicators of increased maternal illness (including viral load, vitality, illness symptoms, health-related anxiety) predicted less attachment with peers. In addition, MLH increased illness was associated with more adolescent autonomy.

Purpose: The purpose of this 12-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent well-being and behavioral outcomes, extending an earlier published account., Methods: Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS, who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning, and depression) and child/adolescent outcomes (e.g., depression, anxiety/worry, aggression, and self-concept) were assessed over 16 time points., Results: Using growth curve modeling, results show a negative effect of maternal health status on child/adolescent outcomes, including child/adolescent depression, anxiety/worry, aggression, and self-concept. Interaction effects within the growth models suggest younger children are more impacted by poor maternal health than are older children/adolescents., Conclusions: This is the first study to follow a cohort of children of mothers living with HIV/AIDS over such an extended age range, through late adolescence/early adulthood, to determine the impact of maternal health status throughout the entire developmental period., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Adolescent children of mothers with HIV face a host of stressors that place them at increased risk for poor outcomes. Using covariance structure analysis, this study examines adolescent risk outcomes and their relationships to maternal health, as well as the potentially protective factors of family environment and self-competence. The final model indicated that poor maternal health was negatively related to a protective family environment, which in turn was negatively related to adolescent risk outcomes. A protective family environment was also positively related to adolescent self-competence, which was negatively related to adolescent risk outcomes. Implications of the study are discussed, including how these findings can influence interventions aimed at reducing the risk for poor outcomes among adolescent youth with HIV-infected mothers.

Objective: The Teaching, Raising, And Communicating with Kids (TRACK) program was a longitudinal pilot-trial intervention designed to assist mothers living with HIV (MLHs) to disclose their serostatus to their young children (age 6-12 years)., Method: MLH and child dyads (N = 80 dyads) were recruited and randomized to intervention or control; the intervention group had 3 individual sessions and 1 follow-up phone call. The sessions focused on preparing MLHs for disclosure through behavioral exercises using Derlega's model (V. J. Derlega, B. A. Winstead, K. Greene, J. Serovich, & W. N. Elwood, 2004) of HIV disclosure. Both MLHs and their child were assessed across multiple time points (baseline, 3, 6, and 9 months) regarding disclosure of HIV status, and specific outcome variables (i.e., relationship context, mother's health, child's mental health, and family outcomes)., Results: MLHs in the intervention group were 6 times more likely to disclose their HIV status than those in the control group (OR = 6.33, 95% CI [1.64, 24.45]), with 33% disclosing in the intervention group compared with 7.3% in the control group. MLHs in the intervention group showed increases in disclosure self-efficacy across time, increased communication with their child, and improvement in emotional functioning. Children of MLHs in the intervention group exhibited reductions in depression and anxiety, and increases in happiness., Conclusions: TRACK was found to be successful in helping MLHs disclose their HIV status to their children, with positive outcomes noted for both MLHs and their children., ((c) 2011 APA, all rights reserved.)

Parental HIV infection has been associated with negative outcomes for children, and parenting skills appear to be one mechanism operating in that association. The present study focuses on the relations between maternal stress, parenting, and child functioning among families where the mother is living with HIV. Sixty-nine mothers with at least one child between six and 12 years old completed questionnaires at the baseline assessment of an intervention designed to facilitate maternal disclosure of HIV status. Respondents were assessed using multiple measures of stress/anxiety, parenting skills, and child outcomes, including the Parenting Stress Index, the RAND Mental Health Inventory, the Family Routines Questionnaire, and the Child Behavior Checklist. Covariance structural modeling was used to assess the variable relationships, with latent constructs created for maternal anxiety/stress, parenting skills, and child problem behaviors (both direct and indirect effects were evaluated, with a model-based bootstrap used to verify model stability). Results demonstrated that maternal stress was negatively associated with a broad range of parenting skills, and that parenting skills were negatively associated with child problem behaviors. Mothers living with HIV who are anxious about their own health and functioning, and who were more stressed in their parental role, were more likely to exhibit poorer parenting skills - specifically to engage children less frequently in family routines (e.g., eating meals together, having a bedtime routine), poorer parent-child communication, and poorer and less consistent parenting discipline. Not uncommonly, mothers living with HIV experience a range of stressors above and beyond those related to their illness (e.g., poverty, residence in high risk and low resource communities, discrimination). Results demonstrate the need for interventions designed to decrease maternal stress and enhance parenting skills for families affected by HIV.

The impact of maternal HIV and family variables on sexual behaviors of early and middle adolescents was investigated. Data were collected from 118 pairs of HIV-positive mothers and their uninfected early/middle adolescents across four time-points. Descriptive analyses show the prevalence of sexual behaviors in this sample was significantly lower than rates in a comparable sample of adolescents who participated in the Youth Risk Behavior Surveillance System. Multivariate longitudinal analysis using GEE logistic regression showed adolescent sexual behavior was more likely to occur with adolescent alcohol use, lack of parental monitoring, and poorer physical functioning of HIV+ mothers.

The influence of parenting skills on adolescent outcomes among children affected by maternal HIV/AIDS (N = 118, M age = 13) was investigated. Among families with more frequent family routines, over time adolescents showed lower rates of aggression, anxiety, worry, depression, conduct disorder, binge drinking, and increased self-concept. Among families with higher levels of parental monitoring, adolescents showed significant declines in anxiety and depression, conduct disorder, and binge drinking, along with increased self-concept. Mothers' level of illness was associated with parenting. Greater variability in parental monitoring resulted in higher levels of problem behaviors.

The current study assessed the efficacy of selected variables from the Parents and children Coping Together (PACT) model, which was designed to predict maternal HIV effects on child/adolescent outcomes. Data from two longitudinal studies applying PACT measures were utilized, encompassing a seven-year assessment timespan for HIV-infected mothers and their children. Both maternal and child-based measures were evaluated, and a sequential longitudinal design was adopted. Structural equation modeling using FIML was performed to assess the proposed model. Results show the PACT model was viable in predicting child/adolescent outcomes of self-concept and depression. Study implications are discussed, including the influences of maternal factors on child's self-concept and depression, and a reconsideration of the affect of family cohesion on child/adolescent outcomes.

Resiliency was investigated among well children 6-11 years of age (N = 111) whose mothers are living with AIDS or are HIV symptomatic to determine if mother's HIV status was a risk factor that could effect child resiliency, as well as investigate other factors associated with resiliency. Assessments were conducted with mother and child dyads over four time points (baseline, 6-, 12-, and 18-month follow-ups). Maternal illness was a risk factor for resiliency: as maternal viral load increased, resiliency was found to decrease. Longitudinally, resilient children had lower levels of depressive symptoms (by both mother and child report). Resilient children also reported higher levels of satisfaction with coping self-efficacy. A majority of the children were classified as non-resilient; implications for improving resiliency among children of HIV-positive mothers are discussed.

The use of deception in association with sexual encounters may take many forms, ranging from outright lies to more subtle, evasive manipulations. To address such deceptions, a behavior-based sexual deception scale was developed utilizing social exchange theory. Participants were 267 individuals associated with two large universities who were surveyed regarding different aspects of their sexual deceptive behaviors. In addition, items addressing sexually related behaviors and attitudes were assessed for validation purposes. Principal components analysis identified three components of sexual deception, labeled Blatant Lying, Self-Serving, and Avoiding Confrontation. Confirmatory factor analysis verified the resulting structure, and promising validity was noted. In general, those using any of these deceptions reported more sexual partners and one-night stands. Those telling blatant lies to have sex were more likely to report greater needs for sex, while those using self-serving lies or having sex to avoid confrontation experienced greater worry about partner loss. Men were more likely to use blatant lies to have sex, while women were more likely to have sex to avoid confrontation. Results support sexual deception as an exchange process, with sex for pleasure and positive relationship outcomes acting as rewards, and unwanted sex and deception consequences as costs. Implications for health interventions and primary prevention applications are discussed.

The purpose of this study was to use a meta-analytical technique to examine the efficacy of surgical repair of pectus excavatum on pulmonary function. Studies were retrieved via computerized literature searches, cross-referencing from original and review articles. Inclusion criteria were as follows: (1) reporting quantitative measures of preoperative and postoperative pulmonary function; (2) published in the English language; (3) indexed between January 1960 and September 2005; (4) reporting the duration between which preoperative and postoperative assessments were conducted; and (5) describing the pulmonary assessment procedures. The titles and abstracts of potentially relevant articles were reviewed to determine whether they met the criteria for inclusion. Twelve studies representing 313 pectus excavatum patients met the inclusion criteria and were used for the meta-analysis. Random-effects modeling yielded a mean weighted effect size (ES) for pulmonary function which was statistically nonsignificant (ES=0.08, 95% CI=-0.20 to 0.35; P=0.58). The findings of the present study indicated that surgical repair of pectus excavatum does not significantly improve pulmonary function. These findings, however, may be a result of testing pulmonary function under conditions in which pectus excavatum does not manifest itself.

This study was conducted in order to help determine the key factors that predict adherence to antiretroviral medications. A total of 115 HIV/AIDS patients who were having trouble adhering to their antiretroviral regimens completed face-to-face interviews in which adherence levels, medication side effects, mental health, social support, patient-provider relationship characteristics, substance use and health anxiety were assessed. Three measures of adherence were used: adherence over the past three days, adherence over the past week, and adherence over the past month. Logistic regression analyses indicated strongest prediction of three-day adherence, with mental health, social support, patient-provider relationship characteristics and side effects contributing to prediction. Past week adherence was associated with age and social support measures, and showed a marginal association with side effects. Past month adherence was less strongly predicted, with social support and alcohol use contributing to prediction. Thus, a variety of factors were found to determine adherence, and implications of the findings for adherence models and interventions are discussed.

An earlier pilot study found that US DHHS guidelines for antiretroviral treatment were not being successfully implemented (Mann et al., 2000). A brief and inexpensive intervention (visual aid checklist) was developed with the assistance of HIV-expert physicians in order to aid HIV/AIDS health care providers' and their patients' decisions about antiretroviral therapy. The visual aid checklist consisted of a two-page coloured diagram and explanation of key concepts (T-cell, viral load and resistance) and a checklist of the benefits and risks of antiretroviral therapy. Twenty adult HIV-positive subjects and eight health care providers were studied. Ten subjects were observed with their providers without the intervention being used, and then ten subjects were observed with the intervention. A pre-/post-test format was used to assess the patients' antiretroviral knowledge, patient-provider discussion of the DHHS guidelines, and provider satisfaction with the intervention. No differences in baseline HIV knowledge were found between the two groups. Results showed that patients in the intervention condition had greater knowledge of the benefits and risks of antiretroviral therapy than patients in the control condition. Providers reported that the intervention was useful in aiding and encouraging communication as well as conveying knowledge.

A small pilot trial of a multicomponent (behavioral strategies, simplified patient information, and social support) and multidisciplinary (cognitive-behavioral therapy and nursing) medication adherence intervention was conducted for HIV-infected adults prescribed antiretrovirals. Patients (N = 33) were randomly assigned to the intervention condition or standard care. Compared to the control group, patients in the intervention condition had significantly higher self-efficacy to communicate with clinic staff (p = .04) and to continue treatment (p = .04), were significantly more likely to be using behavioral and cognitive strategies (p = .01 and p = .04), reported significantly higher life satisfaction (p = .03), reported significantly increased feelings of social support (p = .04), and showed a trend toward an increase in taking their medications on schedule (p = .06). The intervention, however, did not appear to affect health-related anxiety or to significantly improve adherence to dose. Implications for future intervention planning are discussed.

There has been little work assessing the psychological condition of mothers living with HIV, their home life, and how these women function as caretakers with a chronic illness. In this study, interviews were conducted with 135 HIV symptomatic or AIDS diagnosed mothers of young, well children aged 6-11. White mothers were less likely to be severely ill (CD4 counts of <500) than all other race/ethnic groups. The mean level of depression was elevated among this sample, and was associated with poorer cohesion in the family, and with poorer family sociability. Depression also was associated with the mothers being less able to perform tasks that they typically do; children of more depressed mothers had increased responsibilities for household tasks.

The present study compared bereavement responses of 325 monozygotic (MZ) and 176 dizygotic (DZ) adolescent and adult twins following the loss of their co-twins. A subset of twins completed the Grief Experience Inventory using a retrospective time frame, while a second subset completed it using a current time frame. It was hypothesized that MZ twins (in both retrospective and current groups) would report higher levels of grief-related behavior than DZ twins, consistent with Hamilton's (1964) concept of inclusive fitness. Discriminant function and profile analyses yielded supportive findings, but only for the retrospective MZ and DZ twin comparisons. Females in both groups expressed higher levels of bereavement-related behavior than males. Findings are discussed with reference to theoretical aspects of grief and mourning.

An assessment of HIV/AIDS patients' involvement in antiretroviral treatment decisions with their health care providers was undertaken. Four focus group interviews were conducted with HIV-positive individuals (N = 39) who were receiving antiretroviral medications at the time of the study. Participants ranged in age from 33 to 54 years, 69% were male, with 44% African-American, 39% White and 12% Latino/other race. Qualitative analyses were used to uncover patterns of patient involvement with their health care providers. Transcripts revealed four primary themes regarding patients' participation with providers in antiretroviral treatment decision making: (1) joint decision making between patients and providers, (2) patients taking control of their drug treatment decisions, (3) initial passivity followed by increased involvement, and (4) patients as knowledge gatherers (revealing where patients get treatment information). HIV/AIDS patients were generally active in making treatment decisions with their providers, garnering information about antiretroviral treatments from a variety of sources including peers, family members, health professionals and the media. Patient passivity in decision-making involvement was found only after initial HIV-positive diagnosis. Implications for patients' apparent empowered position are discussed.

Validated the interrelatedness of depression and anxiety in young children by testing four latent factor models: dual construct, unrelated; dual construct, correlated; single construct; and second-order or higher order analysis to test that depression and anxiety are primary constructs under the higher order factor of general affective distress. Children (N = 86) were ages 6 to 11, with mothers who were HIV-symptomatic or diagnosed with AIDS. Depression and anxiety measures included the Children's Depression Inventory (Kovacs, 1992), selected items from the Dominic-R (Valla, Bergeron, Berube, Gaudet, & St-Georges, 1994), and the Revised Children's Manifest Anxiety Scale (Reynolds & Richmond, 1985). Structural equation modeling was used to test the models. Model 2 (dual construct, correlated) fit the data better than did Models 1 and 3; results for the higher order model were identical to Model 2, suggesting the higher order model is equivalent to the dual-construct model.

Objective: An examination of gender differences in alcohol-impaired driving., Method: Attitudes, perceptions and behaviors concerning drinking and driving were compared for male and female California drivers in three random-digit-dialing telephone survey interviews from 1983, 1986 and 1994 (survey response rates of 58%, 52% and 49%, respectively). A moral reasoning framework was applied to account for observed gender differences., Results: Gender differences were examined within aggregate data from the 1983 and 1986 surveys (n = 291), and within the 1994 survey data (n = 608). Self-reported drinking-driving violations showed a substantial decline for both men and women across the survey periods (although violations remained much higher for men), paralleling the well-documented drop in alcohol-related traffic crashes during this time span. Men and women responded equally to the threat of punishment from the legal system (threat of arrest, jail, loss of license, fine, increased insurance), but women were much more responsive to social and internal controls (perceived disapproval from friends, feelings of guilt, violation of a moral standard)., Conclusions: These gender differences suggest that women may play an important role in strengthening broad social and moral constraints regarding alcohol-impaired driving. Implications of these findings to deterrence, the effects of sanctions, and social change are discussed.

Variations in sexual risk acts and the social-cognitive mediators of sexual acts were examined among young homosexual, bisexual, and heterosexual males and females (N = 478; 13-21 years of age) from four community-based agencies in New York City, San Francisco, and Los Angeles (29% African American, 36% Latino, 36% White/other). The prevalence and frequency of sexual risk acts varied be gender but were similar across youth of different sexual orientations, ethnicities, and ages. Condom use and the social-cognitive mediators of risk varied by sexual orientation and gender. Homosexual youths reported a gap between their positive attitudes toward HIV prevention and their skills to implement safer sex acts, particularly under social pressure. Bisexual youths appeared at greatest risk; their reports of sexual risk were the highest, yet their perceived risk for HIV was relatively low and skills and knowledge were moderate (relative to their peers). Heterosexual youths appear at high risk for HIV based on reports of low rates of condom use and HIV-related beliefs and attitudes. However, heterosexual youths demonstrated the highest level of condom skills. The number of sexual partners was not associated with any HIV-related social cognitive mediator, suggesting that alternative theoretical models must be proposed for partner selection. Longitudinal research with similar subgroups of youths is needed.

Objective: This research was designed to provide information on the legal and social forces that influence change in control of alcohol-impaired driving., Method: Attitudes, perceptions and behaviors concerning drinking and driving for California drivers in 1994 (n = 608) were compared to similar information collected from California drivers in 1983 and 1986 (n = 291) through random-digit-dialing telephone interviews., Results: Self-reported drinking-driving violations showed a substantial decline, paralleling the well-documented drop in alcohol-related traffic crashes during this time span. A large reduction in drinking before driving was reported for all age groups, men and women, and for both heavy drinkers and light drinkers. There was evidence of an increase in the levels of both general deterrence and general prevention. Increased external control was reflected in greater knowledge of drinking-driving laws and trends toward an increased expectation that violations would be followed by unpleasant consequences. Strong gains in creating a social norm for control of alcohol-impaired driving were indicated by perceptions that friends and relatives were more likely to disapprove of driving after drinking, observations of more control of drinking by drivers at occasions where alcohol is served and an increase in the view that it is morally wrong to drive after heavy drinking., Conclusions: California has made substantial progress in efforts to control alcohol-impaired driving, through increases in both general deterrence (fear of punishment) and general prevention (moral inhibitions and socialization of preventive habits), especially the latter.

Two studies examined whether individualism (orientation toward one's own welfare), collectivism (orientation toward the welfare of one's larger community), and familism (orientation toward the welfare of one's immediate and extended family) are distinct cultural values predicted by race/ ethnicity. The 3 constructs proved to be separate dimensions, although collectivism and familism were positively correlated. In Study 1, persons of color scored higher on collectivism and familism than did Anglos. No differences emerged for individualism. Also, persons of color scored higher than Anglos on racial/ethnic identity, which in turn was a positive predictor of all 3 cultural values. In Study 2, we replicated the group differences on collectivism and familism for men but not for women.

To evaluate the distribution of the human immunodeficiency virus type 1 (HIV-1) epidemic among California women, we analyzed HIV-1 seroprevalence and risk factors among women attending sexually transmitted disease (STD) clinics in 21 local health jurisdictions. Using standardized protocols developed by the Centers for Disease Control, we tested unlinked serum specimens from women attending participating STD clinics in 1989. We analyzed demographic characteristics, HIV risk exposure groups, and results of HIV-1 antibody testing on 17,210 specimens with an overall HIV-1 seroprevalence of 0.57%. Seroprevalence rates were highest for African-American women, women 25 to 29 years of age, injection drug users, and women attending STD clinics in San Francisco. After multiple logistic regression analysis, HIV-1 seropositivity remained highest for these four groups. The rate of HIV-1 infection among women attending STD clinics in California underscores the continued need to make HIV counseling and testing an integral component of routine services for women being evaluated for, or presenting with, sexually transmitted diseases.

The incidence of acquired immunodeficiency syndrome (AIDS) is increasing among California heterosexuals and children. To assess human immunodeficiency virus (HIV)-1 infection in childbearing women, we conducted a blinded serosurvey of newborns. Dried blood specimens taken from 99% of California births during the third quarter of 1988 (n = 135,808) and linked only to maternal demographic categories were tested for HIV-1 antibody by enzyme immunoassay and confirmed by Western blot. Period prevalence of HIV-1 infection was 7.4 per 10,000 childbearing women. Prevalence was highest for Black women and was also elevated for Hispanic and San Francisco Bay Area women. Findings suggest that California Hispanic women will make up an increasing proportion of new AIDS cases.