Minority stress, masculinity, and social norms predicting gay men's health risk behaviors.

The authors examined the contributions of the minority stress model, traditional masculine gender roles, and perceived social norms in accounting for gay men's use of alcohol, tobacco, illicit drugs, and risky sexual practices. Three hundred fifteen gay men recruited from listserv communities completed measures assessing internalized homophobia, stigma, antigay physical attack, masculinity, and perceptions of normative health behaviors, along with health risk behaviors of alcohol use, illicit drug use, smoking, and high-risk sexual behaviors. Pearson correlations supported several hypotheses; social norms and masculinity variables were significantly related to health risk behaviors. Four multiple regression analyses indicated that masculinity and perceptions of social norms predicted health risk behaviors. Additionally, a significant interaction was found between minority stress and perceptions of social norms. The clinical implications of the findings, limitations, and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Widowhood and illness: A comparison of social network characteristics in France, Germany, Japan, and the United States.

This study examined social network characteristics of adults aged 70 to 90 years in relation to widowhood and illness in France, Germany, Japan, and the United States. Participants were drawn from representative samples from each of the 4 countries (total N?=?1,331). Resource deficit profiles based on whether respondents were widowed, ill, both, or neither were directly related to social network characteristics for German and Japanese adults, were differentially related by gender and age for French adults, and were not related to social networks of Americans. Country, gender, and age differences in total network size, proportion of close network members, and frequency of contact with network members are reported. Similarities and differences found in the associations between normative late-life deficits and social network characteristics in the 4 countries point to the importance of investigating sociocultural factors that mediate the impact of resource loss and afford life quality in very old age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma, social risk, and health policy: Public attitudes toward HIV surveillance policies and the social construction of illness.

Data from a 1999 national telephone survey with a probability sample of English-speaking US adults (N=1,335) were used to assess how support for HIV surveillance policies is related to AIDS stigma and negative attitudes toward groups disproportionately affected by the epidemic. Anonymous reporting of HIV results to the government was supported by a margin of approximately 2-to-l, but name-based reporting was opposed 3-to-l. Compared with other respondents, supporters of name-based surveillance expressed significantly more negative feelings toward people with AIDS, gay men, lesbians, and injecting drug users. More than one third of all respondents reported that concerns about AIDS stigma would affect their own decision to be tested for HIV in the future. Implications for understanding the social construction of illness and for implementing effective HIV surveillance programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reframing HIV prevention for gay men in the United States.

The HIV epidemic in the United States has affected at least two generations of gay men. Despite numerous efforts to intervene on this public health crisis, HIV infections continue to escalate, especially among young men. This condition is compounded by an ever-growing number of gay men who are aging and living with HIV. We must enact an innovative and proactive vision and framework for HIV prevention that moves us beyond the undertakings rooted in social–cognitive paradigms that have informed this work for the past 25 years. A new framework for HIV prevention must give voice to gay men; must consider the totality of their lives; must delineate the underlying logic, which directs their relation to sex and HIV; and must concurrently respect their diverse life experiences. This approach should be rooted in a biopsychosocial paradigm, should be informed by both theory and practice, and should be directed by three theoretical lenses—a theory of syndemics, developmental theories, and contextual understandings of HIV disease. Taken together, these elements are a call to action for research and practice psychologists who are working to improve the lives of gay men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamical evolutionary psychology: Individual decision rules and emergent social norms.

A new theory integrating evolutionary and dynamical approaches is proposed. Following evolutionary models, psychological mechanisms are conceived as conditional decision rules designed to address fundamental problems confronted by human ancestors, with qualitatively different decision rules serving different problem domains and individual differences in decision rules as a function of adaptive and random variation. Following dynamical models, decision mechanisms within individuals are assumed to unfold in dynamic interplay with decision mechanisms of others in social networks. Decision mechanisms in different domains have different dynamic outcomes and lead to different sociospatial geometries. Three series of simulations examining trade-offs in cooperation and mating decisions illustrate how individual decision mechanisms and group dynamics mutually constrain one another, and offer insights about gene-culture interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group identification as a moderator of the relationship between perceived social norms and alcohol consumption.

Previous research has shown that social norms are among the strongest predictors of college student drinking. Among college students, perceiving that others drink more heavily than themselves has been strongly and consistently associated with heavier drinking. Research has also shown that the more specifically others are defined, the stronger the association is with one's own drinking. In the current research, we evaluated whether group identification as defined by feeling closer to specific groups moderates the associations between perceived drinking norms in the group and one's own drinking. Participants included 3,752 (61% female) students who completed online assessments of their perceived drinking norms for 4 groups of students on their campus and identification with each group and participants' own drinking behavior. Results indicated that greater identification with same-sex students, same-race students, and same-Greek-status students was associated with stronger relationships between perceived drinking norms in the specific groups and own drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sorting through chickens and eggs: A longitudinal examination of the associations between attitudes, norms, and sexual risk behavior.

Objective: Health behavior theories posit that health-relevant attitudes, beliefs, and behavioral skills drive subsequent actions people take to protect themselves from health threats. Within the realm of HIV-related sexual risk behavior, much of the research in support of this notion is cross-sectional, rather than longitudinal, particularly in studies of gay and bisexual men. Other psychological theories (e.g., self-perception or cognitive dissonance theories) suggest that the opposite could be true—that health-relevant attitudes and beliefs might change as a function of previous risk or precautionary behavior. Appreciating the complex nature of these associations is essential for modifying theory and developing appropriate interventions. Design: Using longitudinal data from gay and bisexual men (n = 1465), we used structural equation modeling to examine three possibilities—that perceived norms and attitudes about sexual risk would be (a) related to unprotected anal intercourse cross-sectionally, (b) related to unprotected anal intercourse at a subsequent time point, and/or (c) predicted from previous instances of unprotected anal intercourse. Results: Safe-sex norms and attitudes were related to unprotected anal intercourse cross-sectionally, but did not predict unprotected sex longitudinally. Rather, perceived norms and attitudes changed as a function of previous risk behavior. Conclusions: These results raise the possibility that modified theoretical models might be necessary to adequately describe sexual risk behavior among gay and bisexual men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

Objective: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. Design: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. Main Outcome Measures: Rates of unprotected anal intercourse in the previous 3 months. Results: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. Conclusions: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related quality of life in bereaved HIV-positive adults: Relationships between HIV symptoms, grief, social support, and Axis II indication.

Objective: This study evaluated a model of the impact of borderline and antisocial personality disorder indications on HIV symptoms and health-related quality of life (HRQoL) in AIDS-bereaved adults, accounting for grief severity, social support, and years since HIV diagnosis. Design: Structural equation modeling was used to test the proposed model in a sample of 268 HIV-seropositive adults enrolled in an intervention for coping with AIDS-related bereavement. Main Outcome Measures: Functional assessment of HIV infection, HIV symptoms. Results: The proposed model demonstrated excellent fit with study data and all hypothesized paths were supported. Personality disorder indication was directly related to HIV symptoms and HRQoL and indirectly related through both social support and grief severity. Social support was negatively related to HIV symptoms and positively related to HRQoL, while grief severity was positively related to HIV symptoms and negatively related to HRQoL. Finally, HIV symptoms had a direct negative relationship with HRQoL. Conclusion: Personality disorders have a direct negative effect on HIV symptoms and HRQoL and indirect effects through grief severity and social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting adolescent eating and activity behaviors: The role of social norms and personal agency.

Guided by the theory of planned behavior, this 2-week longitudinal study examined health behaviors in a sample of 279 adolescents. Social norms and perceived behavioral control (PBC) were tested as predictors of self-reported intentions and behaviors in 2 domains, eating and physical activity. Differentiating, as opposed to aggregating, parent and peer norms provided unique information. For PBC, the authors distinguished global causality beliefs from self-related agency beliefs and intraself (effort, ability) from extraself (parents, teachers) means. Intraself agency beliefs strongly predicted healthy intentions, whereas intraself causality beliefs had a negative influence. Patterns differed somewhat across behaviors and gender. Results highlight theoretical issues and provide potential targets for research on health promotion programs for youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Agreement between prospective interactive voice response telephone reporting and structured recall reports of risk behaviors in rural substance users living with HIV/AIDS.

Sound measurement of risk behaviors is essential to guide tailored risk reduction strategies as HIV infection patterns shift toward rural minorities, particularly in the southeastern United States where HIV disease remains highly stigmatized. Interactive Voice Response (IVR) systems appear to enhance reports of sensitive behaviors and can support telehealth applications to extend the reach of care in rural, underserved areas. This study evaluated the feasibility and data quality of an IVR telephone reporting system with rural substance users living with HIV/AIDS. Community-dwelling patients were recruited from a nonprofit HIV medical clinic in rural Alabama (N = 35 men, 19 women). Participants engaged in daily IVR reporting of substance use and sexual practices for up to 10 weeks. IVR reports were compared with retrospective Timeline Followback (TLFB) interview reports for the same period. IVR and TLFB reports showed good to excellent agreement for summary measures of alcohol consumption and sexual activity. Agreements for illicit drug use reports were less satisfactory. Reports of monetary spending on alcohol and drugs were significantly higher on the IVR. Most individuals showed good agreements for reports of day-to-day alcohol and drug use and sexual practices. The study established the utility of IVR assessment with rural, disadvantaged adults living with HIV/AIDS who are priority targets for risk reduction interventions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The relationship between level of disability, psychological problems, social activity, and social networks.

Objective: To test a theoretical model on the relationship between level of disability, psychological problems, social activity, and social networks. Study Design: A repeated cross-sectional study included in 2 representative studies in the general population in Norway. Structural equation modeling was applied to test different models. Results: Activity limitations contribute to the prediction of psychological problems and level of social activity over time, whereas the reverse effects were not demonstrated. However, cross-sectional associations between psychosocial variables and activity limitations were found. Conclusions: The study confirms that activity limitations predict level of psychosocial problems. Although the reverse longitudinal effect from psychosocial problems on activity limitations was not demonstrated, short-term effects cannot be ruled out with the current study design. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social norms, arbitrariness of frustration, and status of the agent of frustration in the frustration-aggression hypothesis.

Some of the conditions under which frustration will produce aggression are further specified. Pastore's work with the role of arbitrariness in the frustration-aggression hypothesis is considered, in addition to two other variables, the effect of social norms, and the social position of the agent of frustration. Based on a sample of 60 college women, less aggression appears when (1) the instructions are designed to stress ideal behavior, (2) the situation is non-arbitrary, (3) the agent of frustration is an authority figure rather than a peer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social Support, Positive States of Mind, and HIV Treatment Adherence in Men and Women Living With HIV/AIDS.

Numerous studies have linked social support to better medication adherence among illness groups, but few have examined potential mechanisms for this relationship. Relationships were examined between social support, depression, positive states of mind (PSOM), and medication adherence among HIV positive men who have sex with men (n = 61) and women (n = 29) on highly active antiretroviral therapy. Depression and PSOM were evaluated as potential mediators of the relationship between support and adherence. Cross-sectional data showed that greater social support and PSOM related to better adherence whereas higher depression scores related to nonadherence. PSOM partially mediated the relationship between social support and adherence. PSOM may be an important mechanism through which social support is related to better medication adherence in this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing a social-cognitive model of HIV transmission risk behaviors in HIV-infected MSM with and without depression.

Objective: Social-cognitive models have been used to explain health risk behaviors in numerous populations, including people with HIV. However, these models generally do not account for the influence of clinically significant psychological problems such as major depression. Design: This study examined whether a social-cognitive model would explain recent sexual transmission risk behavior among sexually active HIV-infected men who have sex with men (MSM) who meet or do not meet screening criteria for major depression. Main Outcome Measures: Participants (n = 403) completed self-report assessments of negative expectancy, social models, and self-efficacy (SE) related to condom use, as well as recent STRB and a screening measure for major depression. Multiple group modeling was used to examine whether condom use SE explained associations of negative expectancy and social models for condom use with recent STRB among participants who screened positive (n = 47) or negative (n = 356) for major depression. Results: The multiple group model fit the data well (χ2(36) = 30.55, p = .73; CFI = 1.00; RMSEA