No abstract

This study is a 6-month follow-up of a randomized pilot evaluation of standard one-session treatment (OST-S) versus culturally-adapted OST (OST-CA) with phobic Asian Americans. OST-CA included seven cultural adaptations drawn from prior research with East Asians and Asian Americans. Results from 1-week and 6-month follow-up show that both OST-S and OST-CA were effective at reducing phobic symptoms compared to self-help control. Moreover, OST-CA was superior to OST-S for several outcomes. For catastrophic thinking and general fear, moderator analyses indicated that low-acculturation Asian Americans benefitted more from OST-CA than OST-S, whereas both treatments were equally effective for high-acculturation participants. Although cultural process factors (e.g., facilitating emotional control, exploiting the vertical therapist-client relationship) and working alliance were predictive of positive outcomes, they did not mediate treatment effects. This study offers a potential model for evaluating cultural adaptation effects, as well as the mechanisms that account for such effects.

Objective: To assess the effects of a 50% discount on low-energy density (ED) fruits and vegetables (F&V), bottled water, and diet sodas on shoppers' purchasing, food intake, and body weight. Design and Methods: A randomized, controlled trial was conducted at two Manhattan supermarkets, in which a 4-week baseline period (no discounts) preceded an 8-week intervention period (50% discount), and a 4-week follow-up period (no discounts). Twenty-four hour dietary recall, as well as body weight and body composition measures were obtained every 4 weeks. Participants (n 5 47, 33f; 14m) were overweight and obese (BMI 25) shoppers. Results: Purchasing of F&V during intervention was greater in the discount group than in the control group (P < 0.0001). Purchasing of these items by the discount group relative to the control group during follow-up was reduced from intervention (P 5 0.002), but still remained higher than during baseline (P 5 0.01), indicating a partially sustained effect. Intake of F&V increased from baseline to intervention in the discount group relative to the control group (P 5 0.037) and was sustained during follow-up. Body weight change did not differ significantly between groups, although post hoc analysis indicated a change within the discount group (21.1 kg, P 5 0.006) but not within the control group. Conclusions: Discounts of low-ED F&V led to increased purchasing and intake of those foods.

Hispanic children in the United States are disproportionately affected by obesity. The role of acculturation in obesity is unclear. This study examined the relation between child obesity, dietary intake, and maternal acculturation in Hispanic children. We hypothesized that children of more acculturated mothers would consume more unhealthy foods and would have higher body mass index (BMI) percentiles. A total of 209 Hispanic mothers of children aged 2-4 y (50% female, 35.3 ± 8.7 mo, BMI percentile: 73.1 ± 27.8, 30% obese, 19% overweight) were recruited for an obesity prevention/reversal study. The associations between baseline maternal acculturation [Brief Acculturation Rating Scale for Mexican Americans-II (Brief ARSMA-II)], child BMI percentile, and child diet were examined. Factor analysis of the Brief ARSMA-II in Puerto Rican mothers resulted in 2 new factors, which were named the Hispanic Orientation Score (4 items, loadings: 0.64-0.81) and U.S. Mainland Orientation Score (6 items, loadings: -0.61-0.92). In the total sample, children who consumed more noncore foods were more likely to be overweight or obese (P < 0.01). Additionally, children of mothers with greater acculturation to the United States consumed more noncore foods (P < 0.0001) and had higher BMI percentiles (P < 0.04). However, mothers with greater Hispanic acculturation served fewer noncore foods (P < 0.0001). In the Puerto Rican subgroup of mothers, Puerto Rican mothers with greater acculturation to the United States served more noncore foods (P < 0.0001), but there was no association between acculturation and child BMI percentile in this subgroup. These mothers, however, served fewer sugar-sweetened beverages (P < 0.01) compared with non-Puerto Rican mothers, and this may have negated the effect of noncore food consumption on BMI percentile. These data suggest a complex relation between acculturation, noncore food consumption, and child BMI percentile in Puerto Rican and non-Puerto Rican Hispanic children.

Health disparities in access to antiretroviral therapy (ART) as well as the demands of long-term medication adherence have meant the full benefits of HIV treatment are often not realized. In particular, food insecurity has emerged as a robust predictor of ART non-adherence. However, research is limited in determining whether food insecurity uniquely impedes HIV treatment or if food insecurity is merely a marker for poverty that interferes more broadly with treatment. This study examined indicators of poverty at multiple levels in a sample of 364 men and 157 women living with HIV recruited through an offering of a free holiday food basket. Results showed that 61% (N = 321) of participants had experienced at least one indicator of food insecurity in the previous month. Multivariate analyses showed that food insecurity was closely tied to lack of transportation. In addition, food insecurity was associated with lacking access to ART and poor ART adherence after adjusting for neighbourhood poverty, living in an area without a supermarket (food desert), education, stable housing, and reliable transportation. Results therefore affirm previous research that has suggested food insecurity is uniquely associated with poor ART adherence and calls for structural interventions that address basic survival needs among people living with HIV, especially food security.

Tangible support is amenable by interventions such as building and strengthening supportive networks and paraprofessional services. Socially supportive interventions should be considered critical in efforts to decrease HIV health disparities among transgender women.

Household food insecurity was not associated with child BMI percentile in this study. Dietary intake patterns of children from food-insecure households were not different compared to those from food-secure households.

HIV infection is concentrated in populations living in poverty. We examined the overlapping and independent effects of multiple poverty indicators on HIV-related health status. Because substance use can create competing survival needs when resources are limited, we also sought to objectively measure expenditures on food relative to alcohol and tobacco products. To achieve these aims, 459 men and 212 women living with HIV infection in Atlanta, GA completed measures of socio-demographic and heath characteristics as well as multiple indicators of poverty including housing stability, transportation, food insecurity, and substance use. Participants were given a $30 grocery gift card for their participation and we collected receipts which were coded for alcohol (beer, wine, liquors) and tobacco purchases. Results showed that participants with unsuppressed HIV replication were significantly more likely to experience multiple indicators of poverty. In addition, one in four participants purchased alcohol or tobacco products with their gift cards, with as much as one-fourth of money spent on these products. A multivariable logistic regression model showed that food insecurity was independently associated with unsuppressed HIV, and purchasing alcohol or tobacco products did not moderate this association. Results confirm previous research to show the primacy of food insecurity in relation to HIV-related health outcomes. Competing survival needs, including addictive substances, should be addressed in programs that aim to alleviate poverty to enhance the health and well-being of people with HIV infection.