The influence of neurocognitive impairment, alcohol and other drug (AOD) use, and psychosocial factors on antiretroviral treatment adherence, service utilization and viral load among HIV-seropositive adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p<0.01) at 6 months, but not 3 months, post-intervention. Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

On Record: Soundscapes as Metaphor and Physical Manifestation of Memory in Early Holocaust Novels and Contemporary Criticism

This thesis compares two perspectives on the production of Holocaust memory: a novel that leads up to The Holocaust in Britain and one that reflects the hindsight perspective of a liberator in the Soviet Union. The novels are Virginia Woolf’s BETWEEN THE ACTS and Vasily Grossman’s LIFE AND FATE. The analysis offers a locus of analysis for the diasporic literary energy created by the catastrophe in the 20th and 21st centuries. The project offers a theorized standpoint on the role of literature on official historical archives. Proposing a method through which contemporary readers can engage the diasporic event of The Holocaust, the project adopts both the extended metaphor and literal expression of soundscapes. Soundscapes encompass the immaterial processes of memorialization and the literal sonic textures developed in Holocaust novels. The critical perspective incorporates contemporary notions of narratology, archival practices, and cultural manifestations of language into the notion of literary ethnomusicology.

The Effect of Osteoporosis Education on Calcium Intake and Physical Activity in a Group of Community-Dwelling Black Older Adults

The unprecedented increase in the number of older adults is expected to increase the burden of osteoporosis on the individual and society. Blacks have been understudied in osteoporosis prevention education research. Although the risk of osteoporosis is low in this population, its consequences are significant. This study employs a two-group experimental design (experimental and wait-list control groups) to evaluate the effect of an osteoporosis education on two osteoporosis prevention behaviors (OPBs) – calcium intake (CI) and physical activity (PA), in a group of community-dwelling Black older adults, 50 years and older resident in South Florida. A final sample of 110 (mean age 70.15 years), 90% female and 10% male completed a battery of questionnaires at two assessment periods. The experimental group participated in six weekly education program sessions immediately following baseline assessment, and the wait-list control group received the education following end of program assessment by all participants. The weekly educational sessions were conducted in social settings (church or senior center) employing constructs of the Revised Health Belief Model. The sessions focused on improving CI; osteoporosis knowledge (OKT), self-efficacy (SE), health beliefs (HB) and PA. Findings revealed significantly greater increase in reported CI (M = 556 mg, Wilks’ λ = .47, F(1,108)=122.97, p< .001, η2=.53), OKT (p< .001), and SE (p< .001) among participants in the experimental compared to the wait-list control group. There was no significant difference between the two groups for PA and most of the HB subscales. OKT and SE were the best predictors of CI, while perceived barrier was a predominant factor predicting PA. Over the study period, a change in SE was the only variable related to changes in both OPBs. Attrition rate was lower than expected, which can be attributed to the settings utilized for the study. These findings support the importance of utilizing a familiar social setting. These results suggested the effectiveness of a program offered in multiple short sessions among this underserved minority population to improve OKT and SE resulting in a change in OPBs (increase in CI). However, there is need to explore alternative strategies to improve PA in this population group.

Diet Self-efficacy and Physical Self-concept of College Students at Risk for Eating Disorders

Background: Both eating disorders and body image dissatisfaction affect a high proportion of college students. Self-esteem and self-efficacy may be protective factors for eating disorders. The aim of this study was to evaluate diet self-efficacy, the confidence to maintain or lose weight, and its association with physical selfconcept using data from an online survey of health literacy, body image, and eating disorders. Study Population and Methods: This cross-sectional study collected online survey data from college students within the United States. The inclusion criteria allowed for 1612 college students, ages 17-35 years (597 males, 1015 females) belonging to the following racial/ethnic categories: Black (187); White, non-Hispanic (244), Hispanic (1035), and other (146). Specifically, the study aimed to examine (a) whether and to what degree diet self-efficacy and physical self-concept were associated with risk of eating disorders; (b) the interaction of gender by ethnicity on diet self-efficacy, physical self-concept and risk of eating disorders; and, (c) the relationship of diet self-efficacy with physical self-description and body mass index (BMI) in college students. Results:Low diet self-efficacy was associated with a lower score on physical self-concept (B = −0.52 [−0.90, −0.15], P = 0.007). Males had a higher physical self-concept as compared to females (B = 14.0 [8.2, 19.8], P Conclusion: College students in this study who had a poor body image were less confident with diet control. Poorer body image and low diet selfefficacy were associated with higher BMI. These findings suggest lifestyle management interventions may be of value to improve physical self-concept and lower risk of eating disorders for college students.

Further evidence for the relationship between eating frequency, body mass index, and physical activity

The relationship between the frequency of eating, physical activity and Body Mass Index (BMI) was investigated. Seventy five women, aged 24 to 55, were recruited from Florida International University. Via interview, subjects provided information regarding demographics and habitual eating frequency over 24-hours, and completed both the Baecke Questionnaire of Habitual Physical Activity and the Health Insurance Plan of New York Questionnaire on Physical Activity. Pearson correlations and partial correlation coefficients were used to assess the relationship between eating frequency, physical activity, age, and BMI. Results revealed significant positive correlations between eating frequency and total physical activity scores, and leisure time physical activity scores, but not between eating frequency and physical activity on the job. Partial correlations suggest that there may be an effect of eating frequency on BMI both through an effect on physical activity and through another mechanism. These results suggest that more frequent eaters tend to be more physically active, which may partially explain why lower body weights is associated with more frequent eating.

Knowledge and perceptions of domestic violence services among women in Ghana

Support services are important to the mental and physical well-being of survivors of intimate partner violence. However, researchers and service providers note that survivors seldom report violence to formal domestic violence services in Ghana. Despite calls from service providers for Ghanaians to report domestic violence, few studies have focused on women’s knowledge and perceptions of formal domestic violence services in Ghana and how these perceptions influence their help-seeking behaviour. This thesis presents qualitative findings on Ghanaian women's knowledge and perceptions of formal domestic violence services. Also, challenges to service delivery are explored. Results revealed that awareness among respondents of available services was low. Additionally, most respondents had negative perceptions of these formal services. This study demonstrates that more educational campaigns need to be carried out to raise awareness among Ghanaians on domestic violence and the formal interventions available in the country. Additionally, service providers and policy makers must formulate programmes and policies that are better suited to the uniqueness of the Ghanaian situation.