The clinical literature increasingly indicates that cardiovascular risk factors and cardiovascular disease (CVD) are more common among individuals with posttraumatic stress disorder (PTSD). Depression also poses a risk for CVD and is often comorbid with PTSD. Research to date has not established whether PTSD is associated with additional CVD risk beyond the risks associated with comorbid depression. The authors examined relationships of lifetime PTSD and depression with high blood pressure in data from the US National Comorbidity Survey. They divided participants into 4 mutually exclusive diagnostic groups: (1) PTSD history and no depression history, (2) PTSD and depression history, (3) depression history and no PTSD history, and (4) no history of mental disorder. Hypertension prevalence was higher for the PTSD, no depression and PTSD plus depression groups compared with the depression only and no mental disorder groups. PTSD appears to be related to hypertension independent of depression. This may partially explain elevated rates of CVD in PTSD patients.

Although a growing literature associates depressive symptoms with cardiovascular disease (CVD), the mechanisms underlying this association have not been clearly determined. The cardiovascular reactivity (CVR) hypothesis suggests that chronically elevated CVR during psychological distress can confer disease risk via vascular alterations. This investigation is a quantitative review of studies that evaluated the association of depressive symptoms with CVR. A total of 60 hypotheses were tested: 21 tests involved systolic blood pressure (SBP), 21 involved diastolic blood pressure (DBP), and 18 involved heart rate (HR). The aggregate effect size for the relation between depressive symptoms and HR reactivity was moderate (d = 0.37); aggregate effect sizes were small for SBP reactivity (d = 0.13) and DBP reactivity (d = 0.17). Effect sizes involving SBP reactivity were homogenous, whereas effect sizes involving DBP and HR reactivity were higher for studies that examined participants with CVD. These findings provide partial support for the associations of depressive symptoms with CVR.

The literature suggests gratitude is associated with positive youth development. The current study examined the relationship between gratitude and protective/risk factors among African American youth. Adolescents (N = 389; 50.4% males) ages 12 – 14 completed measures of gratitude (moral affect and life-orientation), protective factors (e.g., academic and activity engagement, family relationship), and high-risk behaviors (e.g., sexual attitudes and behaviors, drug/alcohol use). Results indicated greater moral affect gratitude was the only variable significantly associated with greater academic interest, better academic performance, and more extra-curricular activity engagement. Greater moral affect and life-orientation gratitude both significantly correlated with positive family relationship. Greater life-orientation gratitude was the only variable significantly associated with abstinence from sexual intimacy, sexual intercourse, likelihood of engaging in sex during primary school, and abstinence from drug/alcohol use. The findings suggest that moral affect gratitude may enhance protective factors while life-orientation gratitude may buffer against high-risk behaviors among African American youth.

Recently, modified directly observed therapy (MDOT) has emerged as a promising intervention to address nonadherence for hard-to-reach populations infected with HIV. To date, there are no existing data on MDOT focusing exclusively on African Americans. The present study sought to determine the feasibility of MDOT among 31 HIV-seropositive African American substance users in the South. An outreach worker observed the participants' medication intake 5 days per week (once per day) for a period of 3 months (intensive phase). This phase was followed by a transition phase of 3 months during which the frequency of MDOT was gradually tapered from 5 days to once weekly. Assessments to gather demographic information, HIV risk behaviors, substance use, depression, and medication adherence were conducted at baseline, 3 months, and 6 months. Results indicated that more participants adhered to their medication regimen and had viral loads of less than 400 copies per milliliter at 3 and 6 months compared to baseline. Participants reported significantly less depressive symptoms at the 6-month assessment compared to baseline and 3 months. With regard to acceptability, 95% of participants indicated they liked having the outreach visits, 100% reported MDOT helped them take their medications, and only 5% felt MDOT was a violation of privacy. These results suggest MDOT is feasible among African American substance users in the South and a larger controlled study of MDOT with this population is warranted.

The purpose of this study was to examine the current practices of family practice (FP) providers and their allied staff with regard to routine HIV testing in Rhode Island (RI) and Mississippi (MS). Anonymous experimenter-derived surveys were mailed to both groups of providers in 2002. The questionnaire contained five questions about their current practices and attitudes toward HIV testing as well as patient demographics. Five hundred twenty-one questionnaires were sent to American Academy of Family Practitioners (AAFP) members in RI and MS and to FPs with listings in the phone book in RI. The response rate was 52% in RI and 41% in MS. The vast majority of providers (93%) tested their high-risk patients for HIV, but less tested pregnant (57%) and other sexually active (37%) patients. The FPs in this survey wanted HIV testing to be done in the primary care setting, yet only 7% recommended HIV testing to their sexually active patients aged 18-50 in the previous year. In order not to stigmatize any specific risk group, nor to miss any patients who are unable to be identified as being "at high risk," routine testing in the primary care setting should be encouraged.