Faculty Bibliography

Cross-sectional analyses of 904 diverse men and women aged 50 years and older living with HIV in New York City were conducted to examine the unique experiences and needs of aging HIV-positive individuals. Using Minority Stress Theory and Syndemic Theory as guiding paradigms, the authors documented the mental health burdens of the sample with regard to depression, loneliness, and diminished psychological well-being and examined how multiple-minority status and HIV-related stigma explained these burdens. Mediation modeling demonstrated that the effects of minority stressors on mental health burden were mediated by HIV-related stigma. The mediation was significant for the overall sample and for the male subsample. Results suggest that to fully address the mental health burdens experienced by aging HIV-positive individuals, we must continue to address mental health burdens directly, and at the same time, look beyond the psychiatric symptoms to address the structural inequities faced by individuals based on their multiple-minority status.

Stigma can be harmful to drug users, particularly those in need of treatment. Beliefs and opinions about drug use may influence how individuals view or treat drug users, so research was needed to examine whether specific beliefs and opinions are related to stigma towards users. A sample of 531 adults was assessed to examine how stigmatization relates to specific beliefs and opinions about drug use. Eighty percent of the sample reported lifetime use of an illicit drug. While controlling for demographic characteristics, lifetime drug use and exposure to users, stigmatization towards users more than doubled the odds of reporting that addiction is a choice, and more than tripled the odds for reporting that marijuana and heroin are equally dangerous. Stigmatization, however, lowered the odds of reporting that drugs would be okay to use if legal. Individuals who stigmatize drug users may be under-educated about drug use; however, such individuals appear to be at low risk for use. Beliefs and opinions guided by misinformation may negatively affect users, so public health efforts are needed to educate individuals about drug use and addiction in an objective manner, and treat use as more of a health behavior and less of a moral behavior.

OBJECTIVE:To evaluate the impact of an early childhood, family-centered, school-based intervention on children's kindergarten academic achievement.METHODS:This was a cluster (school) randomized controlled trial with assessments from pre-kindergarten (pre-k) entry through the end of kindergarten. The setting was 10 public elementary schools with 26 pre-k classes in 2 school districts in urban disadvantaged neighborhoods serving a largely black, low-income population. Participants were 1050 black and Latino, low-income children (age 4; 88% of pre-k population) enrolled in 10 schools over 4 years. Universal intervention aimed to promote self-regulation and early learning by strengthening positive behavior support and effective behavior management at home and school, and increasing parent involvement in education. Intervention included after-school group sessions for families of pre-k students (13 2-hour sessions; co-led by pre-k teachers) and professional development for pre-k and kindergarten teachers. The outcome measures were standardized test scores of kindergarten reading, writing, and math achievement by independent evaluators masked to intervention condition (primary outcome); developmental trajectories of teacher-rated academic performance from pre-k through kindergarten (secondary outcome).RESULTS:Relative to children in control schools, children in intervention schools had higher kindergarten achievement test scores (Cohen's d = 0.18, mean difference = 2.64, SE = 0.90, P = .03) and higher teacher-rated academic performance (Cohen's d = 0.25, mean difference = 5.65, SE = 2.34, P = .01).CONCLUSIONS:Early childhood population-level intervention that enhances both home and school environments shows promise to advance academic achievement among minority children from disadvantaged, urban neighborhoods.

INTRODUCTION AND AIMS: Illicit drug use is a stigmatised behaviour; therefore, users tend to experience rejection and remain secretive about use. However, stigma-related rejection and secrecy can adversely affect those who reject abstinence. This study aimed to modify measures to assess these concepts with regard to illicit drug use and examine how they relate to use of various drugs and associated perception of public stigma. DESIGN AND METHODS: An Internet-based convenience sample (n = 700) was surveyed to pilot items modified from previous scales in order to assess these concepts with regard to drug use. As perceived rejection and secrecy are related and potentially overlapping constructs, exploratory factor analysis was conducted to examine the underlying structure of items previously used to assess these concepts. These variables were examined in relation to sociodemographic characteristics, perceived public stigma and use of various drugs (marijuana, powder cocaine, ecstasy and nonmedical use of opioids and prescription stimulants). RESULTS: After factor reduction, perceived rejection and secrecy loaded as two distinct, but related concepts. These modified measures had moderate to high internal consistency and both concepts were positively related to perceived public stigma and use of various drugs. DISCUSSION AND CONCLUSIONS: This pilot study demonstrated validity evidence for these measures and results suggest that illicit drug use and associated stigma are related to increased feelings of rejection and secrecy in users. Research is needed to examine whether stigma towards users serves as a deterrent to use because rejection and secrecy are associated with adverse psychosocial outcomes.

The stigma associated with illegal drug use is nearly universal, but each drug is associated with its own specific level of stigma. This study examined level of stigmatization towards users of various illegal drugs and determined what variables explain such attitudes. A sample of emerging adults (age 18 to 25) was surveyed throughout New York City (N = 1021) and lifetime use, level of exposure to users, and level of stigmatization was assessed regarding use of marijuana, powder cocaine, Ecstasy, and nonmedical use of opioids and amphetamine. Bivariate and multivariate analyses were conducted to examine predictors of stigmatization towards each drug. Results suggest that non-illegal drug users reported high levels of stigmatization towards users of all drugs, but lifetime marijuana users reported significantly lower levels of stigmatization towards users of all harder drugs. This may suggest that once an individual enters the realm of illegal drug use, stigmatization towards use of harder drugs decreases, potentially leaving individuals at risk for use of more dangerous substances. Since stigma and social disapproval may be protective factors against illegal drug use, policy experts need to consider the potential flaws associated with classifying marijuana with harder, more dangerous drugs.

This study established validity evidence for scales that assess perceived public stigma and stigmatization of illicit drug use. These concepts were measured with respect to five commonly used drugs: marijuana, powder cocaine, ecstasy, and nonmedical use of opioids and amphetamine. Data were collected from a diverse sample of 1,048 emerging adults in New York City in 2009. Exploratory and confirmatory factor analyses suggested two distinct factors, which were inversely related to exposure to users and recent use of each drug. These measures demonstrated good criterion, construct, and incremental validity and effectiveness in analyzing predictors of use. Study limitations were discussed

OBJECTIVE: Ephedrine is not only efficacious in the treatment of numerous ailments, but also has a long history of misuse. Research was needed to examine ephedrine policy over time in order to determine potential regulatory flaws that allowed misuse to continue. METHODS: This review is based on primary literature derived from systematic searches of historical and scientific archives, as well as grey literature. RESULTS: Ephedrine managed to pass through numerous regulatory loopholes within seventy years. Despite warnings of misuse over the latter half of the century, ephedrine, and its herbal source, ephedra, were regulated in a piecemeal fashion and remained easily available to the public. Health authorities have struggled to control ephedrine, as an amphetamine 'look-alike,' as a methamphetamine precursor, as a dietary supplement, and as a medication. Despite being a potentially dangerous stimulant, under-regulation was perhaps more problematic than the substance itself. CONCLUSIONS: Tighter control of all ephedrine products, drugs and dietary supplements alike, might have prevented adverse outcomes and allowed this substance to remain available in a safer manner. Stringent regulation of all ephedrine products is necessary to prevent misuse and to protect the public's health

The purpose of the analyses was to examine the associations between methamphetamine and other club drug use with sexual risk taking across time in cohort of gay and bisexual men. Data were collected from a community-based sample. Assessments of unprotected anal intercourse with casual partners, and use of methamphetamine and other illicit drugs, were assessed at baseline, and at 4-month intervals over the course of a year, and were analyzed using hierarchical linear modeling. Methamphetamine use was related to the frequency of unprotected insertive and receptive intercourse with both HIV-positive and status unknown casual partners across time. The association between methamphetamine use and unprotected acts also was more pronounced for HIV-positive participants. These findings suggest that methamphetamine, and unprotected anal intercourse are co-occurring risk behaviors, that potentially heighten the risk of HIV transmission among gay and bisexual men. HIV prevention and intervention should concurrently target both these behaviors

Based on quantitative data describing a sample of 300 HIV seropositive gay and bisexual men living in New York City who were on antiretroviral drug therapy, variables of interest were collapsed into 4 latent constructs-SES (including health care provision), psychological states, drug use impairment, and HIV treatment adherence-and structural equation modeling was used to test the relations among them. Our model indicated a complex interplay between socioeconomic factors, drug use impairment, psychological states, and adherence. It is imperative for counselors and clinicians working with this population to understand the complex relationships between cultural, social, and psychological realities and adherence to HIV antiviral medications and to develop effective socially relevant and culturally nested interventions.