Caffeine Intake and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living with HIV in the Miami Adult Studies on HIV Cohort

Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH.

Graduate program culture and intention to persist: Working adults in cohort and non-cohort programs

Cohort programs have been instituted at many universities to accommodate the growing number of mature adult graduate students who pursue degrees while maintaining multiple commitments such as work and family. While it is estimated that as many as 40–60% of students who begin graduate study fail to complete degrees, it is thought that attrition may be even higher for this population of students. Yet, little is known about the impact of cohorts on the learning environment and whether cohort programs affect graduate student retention. Retention theory stresses the importance of the academic department, quality of faculty-student relationships and student involvement in the life of the academic community as critical determinants in students' decisions to persist to degree completion. However, students who are employed full-time typically spend little time on campus engaged in the learning environment. Using academic and social integration theory, this study examined the experiences of working adult graduate students enrolled in cohort (CEP) and non-cohort (non-CEP) programs and the influence of these experiences on intention to persist. The Graduate Program Context Questionnaire was administered to graduate students (N = 310) to examine measures of academic and social integration and intention to persist. Sample t tests and ANOVAs were conducted to determine whether differences in perceptions could be identified between cohort and non-cohort students. Multiple linear regression was used to identify variables that predict students' intention to persist. While there were many similarities, significant differences were found between CEP and non-CEP student groups on two measures. CEP students rated peer-student relationships higher and scored higher on the intention to persist measure than non-CEP students. The psychological integration measure, however, was the strongest predictor of intention to persist for both the CEP and non-CEP groups. This study supports the research literature which suggests that CEP programs encourage the development of peer-student relationships and promote students' commitment to persistence.