The Relation between Substance Use and Medication Adherence among HIV Positive Substance Users in Residential Treatment

Poor medication adherence is problematic among HIV positive, low-income African-American substance users. Substance use has been shown to be associated with poor medication adherence, though we do not know the mechanism that underlies this relationship. Lack of positive environmental rewards and the propensity to discount delayed rewards may be possible mechanisms to explain this relationship. Using baseline data from a randomized controlled trial, we examined the relationships between substance use and medication adherence, testing both environmental rewards and delay discounting as independent mediators. There was a main effect of substance use on adherence, such that high frequency of substance use predicted poor adherence. There was also a main effect of environmental rewards on adherence, such that a lack of environmental reinforcement predicted poor adherence. This study shed light on the processes that contribute to low adherence, namely substance use and lack of environmental contingencies, and suggests important targets for intervention.

DIFFERENCES IN PSYCHOPATHOLOGY AMONG SUBSTANCE USERS IN RESIDENTIAL TREATMENT RELATED TO HIV STATUS

HIV-positive individuals engage in substance use at higher rates than the general population and are more likely to also suffer from concurrent psychiatric disorders and substance use disorders. Despite this, little is known about the unique clinical concerns of HIV-positive individuals entering substance use treatment. This study examined the clinical characteristics of clients (N=1712) entering residential substance use treatment as a function of self-reported HIV status (8.65% HIV-positive). Results showed higher levels of concurrent substance use and psychiatric disorders for HIV-positive individuals, who were also significantly more likely to meet criteria for bipolar disorder and borderline personality disorder. Past diagnoses of depression, posttraumatic stress disorder, and social phobia were also significantly more common. Study findings indicate a need to provide more intensive care for HIV-positive individuals, including resources targeted at concurrent psychiatric problems, to ensure positive treatment outcomes following residential substance use treatment discharge.

THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD’s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.

A MEMETIC/PARTICIPATORY APPROACH FOR CHANGING SOCIAL BEHAVIORS AND PROMOTING ENVIRONMENTAL STEWARDSHIP IN JALISCO, MEXICO

This dissertation addressed the issue of sustainable development at the level of individual behaviors. Environmental perceptions were obtained from people living around the biosphere reserve Chamela-Cuixmala in Jalisco, Mexico. Several environmental issues were identified by the people, such as garbage and grey water on the streets, burning plastics, and the lack of usage of recreational areas. All these issues could be addressed with a change in behavior by the villagers. Familiarization activities were conducted to gain people's trust in order to conduct a community forum. These activities included giving talks to school children and organizing workshops. Four different methodologies were generated using memetics and participation to test which would ameliorate those environmental issues identified by the people through a change in behavior. The methodologies were 1) Memes; 2) Participation and Memes; 3) Participation; 4) Neither Participation nor Memes. A meme is an idea expressed within a linguistic structure or architecture that provides it with self-disseminating and self-protecting characteristics within and among the minds of individuals congruent with their values, beliefs and filters. Four villages were chosen as the treatments, and one as the control, for a total of five experimental villages. A different behavior was addressed in each treatment village (garbage, grey-water, burning plastics, recreation.) A nonequivalent control-group design was established. A pretest was conducted in all five villages; the methodologies were tested in the four treatment villages; a posttest was conducted on the five villages. The pretest and posttest consisted in measuring sensory specific indicators which are manifestations of behavior that can either be seen, smelled, touched, heard or tasted. Statistically significant differences in behavior from the control were found for two of the methodologies 1) Memes (p=0.0403) and 2) Participation and Memes (p=0.0064). For the methodologies of 3) Participation alone and 4) Neither, the differences were not significant (p=0.8827, p=0.5627 respectively). When using memes, people's behavior improved when compared to the control. Participation alone did not generate a significant difference. Participation aided in the generation of the memes. Memetics is a tool that can be used to establish a linkage between human behavior and ecological health.