Browsing by Author "Reitzel, Lorraine R."
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Item Anxiety Sensitivity and Fast-Food Ordering Habits Among African-American Adults(2020-09-29) Nitturi, VijayBackground: African American adults experience high rates of overweight/obesity, which is linked to chronic diseases and is exacerbated by fast-food consumption. Anxiety sensitivity, a relatively stable fear of anxiety-related sensations, has been linked to high caloric intake. Here, we examine whether anxiety sensitivity is associated with fast-food ordering habits within an African American convenience sample. Methods: Of 124 adults (79.4% women; Mage=49.3±11.6; 84.8% overweight/obese), 107 (86.3%) reported eating from a fast-food restaurant in the last month. Participants completed the Anxiety Sensitivity-Index 3, which has a total score and physical, cognitive, and social concerns subscales. Investigator-generated items were frequency of ordering “supersized” quantities of fast-food (e.g., cheeseburgers, fries), and healthy items (e.g., salads, oatmeal, yogurt), respectively, from “never” to “always.” Covariate-adjusted ordinal logistic regression models were used to assess relations between measures of interest. Results: Anxiety sensitivity (total and physical concerns) was associated with greater odds of more frequently ordering supersized unhealthy fast-food; and anxiety sensitivity (total and cognitive concerns) was associated with lower odds of more frequently ordering healthy items from fast-food restaurants. Conclusions: Results suggest that adults with greater anxiety sensitivity may engage in fast-food ordering habits that may contribute to the overweight/obesity epidemic. Future studies should replicate results and determine the potential for anxiety sensitivity-reduction interventions to affect dietary choices that contribute to overweight/obesity. This project was completed with contributions from Lorna H. McNeill from The University of Texas MD Anderson Cancer Center.Item Anxiety Sensitivity and Sleep Problems among Homeless Adults(2017-10-12) Bhavsar, Shaili; Okamoto, Hiroe; Kendzor, Darla E.; Zvolensky, Michael J.Anxiety sensitivity (AS) is a transdiagnostic individual difference factor, reflecting amplified fear about the negative consequences of anxiety-related autonomic arousal. AS has been linked to sleep problems and serious mental/physical health conditions in the domiciled population. No previous research has examined how AS affects sleep among homeless adults who are vulnerable to health disparities and living in harsh environments that may, by their nature, compromise sleep integrity. The purpose of this study was to investigate the association between AS and sleep-related problems among homeless adults. AS was significantly associated with more days of inadequate sleep (p < 0.001), fewer hours of sleep per day (p < 0.01), unintentionally falling asleep (p ≤ 0.01) in this convenience sample of predominately male homeless adults. See Tables 1 and 2. Results suggest that AS may be a risk factor conferring additional vulnerability to sleep- related problems among homeless adults. This project was completed with contributions from Michael S. Businelle from the Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center.Item The Association of Lesbian, Gay, and Bisexual Identity Facets with Smoking Dependence Motives(Nicotine & Tobacco Research, 2018-02-07) Smith, Nathan Grant; Winderman, Kate; King, Brooke; Obasi, Ezemenari M.; Reitzel, Lorraine R.Introduction: Lesbian, gay, and bisexual (LGB) adults have higher rates of smoking than heterosexual adults. LGB individuals face unique stressors, including challenges associated with having a LGB identity. The extent to which these unique stressors are related to dependence motives in LGB adult smokers, however, has not been previously explored. The current study was conducted to redress these gaps. Methods: Participants (N=52; Mage=42.8; 55.8% Black/African American) were recruited from the local community. Identity facets were measured by the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). Dependence motives were measured by the Brief Wisconsin Inventory of Smoking Dependence Motives. Linear multiple regressions were calculated with the predictors of seven LGBIS subscales for primary and secondary dependence motives, respectively. Results: Primary dependence motives (core nicotine dependence features) were predicted by affirmation of LGB identity (β=.44). Secondary dependence motives (e.g., taste, cognitive/affective enhancement) were predicted by uncertainty of LGB identity (β=.43). Conclusions: LGB identity affirmation was associated with primary dependence motives, suggesting that a positive view of one’s sexual orientation is a risk factor for dependence. It may be that identity affirmation is related to stronger involvement with the LGB community, which has smoking-friendly norms. Identity uncertainty was associated with secondary dependence motives; this unique identity challenge may represent a stressor contributing to smoking dependence. Findings can help explain the higher rate of smoking in LGB populations and offer avenues to better tailor smoking cessation interventions.Item Associations of Subjective Social Status and Mindfulness on Readiness to Quit Smoking in Homeless Smokers(2018-10-18) Maza, ValentinaIn the United States, the prevalence of smoking among adults who are homeless is ~75%, about 5 times higher than the general adult population of the United States. It is important to identify characteristics associated with increased desire to quit smoking for intervention development and targeting. Factors associated with an increased desire to quit smoking among domiciled smokers include greater Subjective Social Status (SSS; relative ranking socially within a self-defined community) and mindfulness (awareness and connection with the present moment). However, it is unknown if these patterns generalize to homeless smokers. The current study redressed this gap in a sample of homeless adult smokers from Dallas, TX (N=161; 74.53% male). Results indicated that SSS was each independently predictive of desire to quit (ps<.01), but neither mindfulness nor the interaction between them significant. Results indicate that targeting individuals with higher SSS for cessation services within limited service settings (e.g., shelters) may be advisable. Moreover, results hint that interventions to increase community social standing may increase a desire to quit among homeless adults, but definitive conclusions await future study. Unlike findings with domiciled adults, neither mindfulness nor the combination of low SSS and low mindfulness resulted in particularly low desire to quit relative to low SSS.Item Autonomic Nervous System Reactivity and Addiction Vulnerability in the African American Community(2018-08) Cavanagh, Lucia; Obasi, Ezemenari M.; Reitzel, Lorraine R.; Coleman, M. Nicole; Smith, Nathan GrantBackground: African Americans experience disproportionate rates of morbidity and mortality with regard to drug use, but the mechanisms underlying this association remain poorly understood. Increasing evidence suggests that exposure to chronic stress and the subsequent activation of the physiological stress systems have been linked to the development of addiction. To date, no research exists that focuses on the influence of autonomic reactivity on prospective drug use among African American emerging adults. Purpose: The present study aimed to: (1) investigate the association between ANS reactivity and prospective drug use among a sample of African American emerging adults (18-25 years old) in the southwestern U.S.; (2) characterize the impact of chronic environmental stress exposure on regulatory mechanisms of the ANS; and (3) identify socially- and culturally-specific risk and resilience factors associated with physiological stress reactivity in this population. Methods: Participants (N = 277) were assessed across three different time points over a period of four-months. They completed measures of self-reported chronic and race-related stress exposure, behavioral and emotional coping styles, and past 90-day marijuana and alcohol use. They also underwent a laboratory-based stressor to derive measures of autonomic reactivity to acute stress, including heart rate (HR), heart rate variability (HRV), and skin conductance levels (SCL). Results: Higher SCL reactivity to acute stress was associated with higher rates of subsequent alcohol and marijuana use at 90-day follow-up. There was no significant association between autonomic reactivity and chronic, nor race-related stress exposure. However, there was a significant interaction effect, such that active coping moderated the relationship between race-related stress exposure and HRV reactivity to acute stress. Conclusions: These results highlight the role of ANS (dys)regulation as a putative link between environmental stress exposure and subsequent drug use vulnerability among African American emerging adults.Item Benefit Finding and Low Socioeconomic Status: Does it Buffer Against the Deleterious Effects of Chronic Stress?(2018-12) Wang, Carol; Lu, Qian; Neighbors, Clayton; Reitzel, Lorraine R.Literature has documented benefit finding, the process of deriving benefits within adverse experiences, as a valuable psychological resource for those who have undergone traumatic experiences such as cancer, terrorism, war, or sexual assault. It is unclear whether benefit finding operates in a similar manner among those who undergo chronic stress such as those from low socioeconomic (SES) backgrounds. SES is one of the most robust predictors of health. Low SES predisposes individuals to chronic stress, which over time, compromises immune functioning whereby one’s bodily responses to stressors may become maladaptive and contribute to further illness, disease, and deterioration of psychological health. Benefit finding is a potential pathway in improving psychological well-being among those low in SES. The current study examined the efficacy of a benefit finding writing intervention among low SES undergraduate students on improving psychological health and perceived control. The study also explored the impact of writing on health behaviors. It was hypothesized that benefit finding writing would improve health outcomes, and the effects would be moderated by difficulties in emotional regulation, optimism, and personality traits. The mechanisms of the impact of benefit finding writing on outcomes were explored with benefit finding, positive affect, and cognitive reappraisal as potential mediators. 178 undergraduate students who self-indicated experiencing some type of financial strain in childhood participated in the study. Participants were randomly assigned to either the benefit finding group, to write for 20 minutes three times within a week, about the perceived benefits of being from a low social class background, or the control group, to write about a mundane topic. Both groups also completed a battery of questionnaires at baseline and follow-up at two weeks and four months post-writing. Results showed no group differences in psychological well-being at the two week follow-up. The benefit finding group had lower personal mastery compared to the control group only at the two week follow-up among those with higher levels of difficulties regulating emotions. At the four month follow-up, those in the benefit finding group had lower perceived stress than those in the control group. This study adds to the current literature on benefit finding by examining its potential benefits to low SES individuals through a writing intervention. A number of limitations of the study and future directions are discussed.Item Bisexual Body Project: A Mixed Methods Approach to Understanding Bisexual Men’s Identities and Bodies(2023-08) Mercer, Andrew D; Smith, Nathan Grant; Sampson, McClain M.; Allan, Blake A.; Reitzel, Lorraine R.Background: Bisexual men are often socially misunderstood and understudied across psychological research. Their identities have largely been defined by the heteronormative and homonormative norms they violate rather than viewed as a stable, valid, and visible social identity. Rather than directly asking bisexual men themselves, the attitudes of gay and heterosexual men have often been used as proxies to understand how bisexual men feel about their bodies. Purpose: The broad purpose of this study is to disentangle bisexual men from the stigma surrounding their identities and from body-related misconceptions broadly applied to sexual minority men. Separating bisexual identities from stigma will allow a cohesive view of body image to emerge. Methods: Using convenience sampling, participants over the age of 18 who self-identify as male and bisexual were recruited to complete a mixed-methods online survey. For Study 1 and 2, 351 participants met criteria and were enrolled in the study. Manuscript 1 focused on the associations between internalized weight bias and quality of life, with particular attention given to the role appearance investment plays in moderating that relationship. Data were analyzed using multiple regression to test the moderating effect of appearance investment on the relationship between internalized weight bias and quality of life. Manuscript 2 continued exploring the moderating impact of appearance investment, this time in the context of sexual minority stressors and positive body image, via outness and body appreciation. As in Study 1, multiple regression was used to test the hypothesis that appearance investment moderates the relationship between outness and body appreciation. Manuscript 3 is a qualitative study centering bisexual men’s experiences of intersectionality and social identity in the construction of body image. Responses to three open-ended writing prompts were collected from a subset of 78 participants enrolled in Studies 1 and 2. Responses were sufficient to achieve thematic saturation. Participants were asked to evaluate their bodies by considering (a) body function, (b) body appearance, and (c) intersectionality. Results: Manuscript 1 revealed a significant negative relationship between weight bias and quality of life and a significant positive relationship between motivation salience and quality of life. Self-evaluative salience moderated the relationship between weight bias and quality of life at low and moderate levels of the moderator. Results of Manuscript 2 revealed significant positive relationships between disclosure and motivation salience on body appreciation, while concealment and self-evaluative salience showed negative associations with body appreciation. Motivation salience moderated the relationship between disclosure and body appreciation. In Manuscript 3, four themes emerged from each writing exercise. Taken together, responses to the first prompt described the body as a process, responses to the second prompt described the body as an object, and responses to the third prompt described the body as a part of a system. Implications: Findings provide a crucial step in addressing the artificial separation of body image from research on minority stress, suggesting appearance investment influences the relationship between social stressors and positive outcomes among bisexual men. Results underscore the importance of contextualizing body image, sexual orientation, minority stressors, and resilience within an individual's social location.Item Characterization of Physical Activity and its Association with Self-Rated Health among a Large Homeless Population(2018-10-18) Machkhas, TaymaBackground: Homelessness affects approximately 6 percent of the United States population, which is known to have multiple health disparities potentially affected by lack of physical activity. Here we characterize physical activity and its association with self-rated health among a large sample of homeless adults. Methods: Homeless adult participants recruited from Dallas and Oklahoma (N=711, 66.4% men, Mage = 43.6+12) self-reported quantity and frequency of physical activity in minutes using items from the Behavioral Risk Factor Surveillance System Physical Activity Questionnaire. Based on the 2008 Physical Activity Guidelines for Americans. Self-rated health was assessed with an item asking participants to rate their health in general (excellent/very good/good vs. fair/poor). Associations between variables were examined using biserial correlations adjusted for age, sex, race, education, weight status, number of months homeless, at-risk drinking, serious mental illness, smoking status, and recruitment site. Results: On average, participants reported 812.9+1459.8 minutes (13.5+24 hours) of physical activity a week and 34.2% of the sample reported fair/poor health. Physical activity was negatively associated with fair/poor health (p=.0036). Discussion: Results suggest that physical activity promotion may hold promise for improvement of overall health within an adult homeless population.Item Characterization of Sleep Inadequacy and Association with Health among Homeless Adults(2018-10-18) Lim, Hee JungBackground: Multiple health disparities, potentially affected by sleep inadequacy, are common among homeless individuals in the United States. Here, we characterize sleep inadequacy, examining its association with self-rated health (SRH) among a large sample of homeless adults. Methods: Homeless adults from Dallas and Oklahoma (N=712; 66.3% men, Mage = 43.7+12) self-reported days (of 30 days) with insufficient sleep, sleep duration (over average 24 hours), and unintentional daytime sleep (of 30 days) using individual items from the BRFSS. SRH was assessed with a single item asking participants to rate their health in general (excellent/very good/good vs. fair/poor). Associations between variables were examined using biserial correlations adjusted for age, sex, race, education, weight status, number of months homeless, at-risk drinking, serious mental illness, smoking status, and recruitment site. Results: Overall, 34.1% of the sample reported fair/poor health. Participants reported 12.6+11.2 days of insufficient sleep, 6.7+2.2 hours of sleep a night, and 5.1+8.1 days with unintentional sleep. Insufficient sleep and unintentional sleep were positively, and sleep duration was negatively, associated with fair/poor SRH (all ps <.001). Conclusions: Results suggest that attention to improving sleep for homeless individuals could potentially improve homeless health.Item Comparing diet , body mass index and perceived cancer risk in African american men and women(2018-10-18) Reuven, SeanBackground: African American men are more likely to be diagnosed with prostate cancer and are more likely to die from it compared to White men. Disparities exist in cancer risk behavior, such as obesity, red meat consumption, fruit and vegetable intake, fast food intake, and prostate cancer screening between African American and white males. There is also evidence that these behaviors differ between African American males and African American females, suggesting that there is something unique about these behaviors in men. This study examined diet and perceived cancer risk in African American men and then also compared these behaviors to that of African American women. Methods: We used data from a sample of church-going African Americans from Project CHURCH—a cohort study. Data was stratified into groups of male and female. We examined diet (e.g., red meat intake, fast food intake, fruit and vegetable daily intake, sugary drink intake), Variables used include BMI, cancer risk perception, and prostate cancer screening. Results: Of the participants (n=1,374) majority were female (75%), had finished high school (87%), reported an annual household income of $40,000 or more (75%), and were currently working (74%). Final Results are pending. This project was completed with contributions from Lorna McNeill from the M.D. Anderson Cancer Center.Item Development and Implementation of an HIV and Anxiety Management/Reduction Program (HAMRT)(2017-05) Brandt, Charles Philip; Zvolensky, Michael J.; Woods, Steven P.; Reitzel, Lorraine R.; Lu, QianThe Human Immunodeficiency Virus (HIV) is a worldwide pandemic affecting over 35 million individuals worldwide. Though revolutions in antiretroviral medications can control the virus and enable infected individuals to live full lifespans with the disease, upwards of half of all persons living with HIV/AIDS (PLWHA) are not appropriately adherent to their medication. This underadherence leads to higher than expected rates of mortality, disease spread, and increasing the financial burden on the global healthcare system. Recent research has indicated that mental health disorders, particularly anxiety, predicts poor antiretroviral medication adherence. Despite this knowledge, there have not yet been treatments developed specifically to increase medication adherence via the reduction of anxiety among PLWHA. The present study aimed to fill in this gap by developing and implementing a six-session CBT-based integrated treatment/management program for PLWHA with concurrent anxiety that impedes success of HIV management. The recruited sample included 42 PLWHA (Mage = 46.95, SD = 9.93, range = 21-61, 45.2% female) who were randomized to either an active treatment condition, or a waitlist control condition of equal length. Participants were assessed pre-randomization, at the mid-treatment time point (after three sessions for the active participants and three weeks for the control participants) and post-treatment (six sessions for active participants, six weeks for control participants). Active participants were then re-assessed at 1-, 3-, and 6-months post-treatment. Attrition was high for the active condition (i.e., 73.2%). Results indicated notable effect sizes between the active and control conditions on most outcome variables including HIV medication adherence (Partial Eta Squared = .189), anxiety symptoms (Cohen’s D = .64), anxiety sensitivity (Cohen’s D = 1.5), Depressive symptoms (Cohen’s D = .8), and multiple quality of life indices (range of Cohen’s D = .43 – 1.73). These findings are discussed in terms of the feasibility and utility of administering an anxiety-reduction therapy program specifically designed for PLWHA with HIV medication adherence difficulties.Item DHEA Reactivity to Acute Stress: Examining the Effect of Coping Styles(2022-08-17) Yan, Sandra; Obasi, Ezemenari M.; Reitzel, Lorraine R.; Smith, Nathan Grant; Carmack, Chakema C.Background: The culmination of economic and social disadvantages such as chronic exposure to systemic racism, discrimination, access to quality education, substandard housing, affordable health care, and food insecurity experienced by African Americans may result in greater susceptibility to stressors associated with the social determinants of health. Enduring exposure to these risk factors has been linked to a variety of adverse health conditions such as coronary vascular disease, obesity, diabetes, cancers, depression, cognitive impairment, age-related diseases, as well as the inflammatory and immunomodulation system in the body. Based on the adverse effects that chronic stress has on the mental and physical health of African Americans, investigations into the mechanisms associated with adaptive coping strategies may provide novel targets for prevention and intervention. Unfortunately, research on potential mechanisms of exposure to chronic stress that underlie health disparities affecting the African American community has received limited focus in the scientific literature. Purpose: This study aims to provide biomarker support for the potential effects that coping styles have on stress reactivity to acute stress during a controlled laboratory experiment. Identifying mechanisms that work toward an explanation of within-group differences in African American health disparities is both needed and informative for culturally informed prevention and intervention efforts. Methods: A metropolitan sample of African American emerging adults (N = 277) completed a battery of assessments, the Trier Social Stress Test (TSST), and provided six samples of salivary DHEA: before TSST instructions, before speech task, following the TSST, 15 min after TSST, 30 min after TSST, and 45 min after TSST. It was predicted that DHEA levels would increase in response to a controlled laboratory inducement of acute stress and individual coping strategy parameters: engagement in active coping (John Henryism), coping styles (Coping with Stressful Situations), and coping self-efficacy (Coping Self Efficacy) will affect DHEA reactivity to acute stress. Partial correlations between coping strategy parameters, Area under the Curve (AUC), and peak DHEA response (PDR) were run while controlling for age and sex. A two-level HLM was run with predictors of DHEA in acute stress included at the within-subjects level (i.e., level 1). Results: Marginally significant correlations between PDR and CISS avoidance subscale scores were found (r=-0.135, p=0.051). Avoidance coping styles (CISS_A=-1.645, t (200) =-1.89, p=0.061) was a marginally significant predictor of DHEA response during acute stress with a significant interaction also present between PDR*CISS_A (PDR*CISS_A=0.008, t (200) = 2.07, p=0.040). Conclusion: The results of this study suggest that the use of avoidance-focused coping styles may be a prime target for further investigation as a modifiable risk factor for the deleterious effects of chronic stress on the stress regulatory system. Additional research on identifying mechanisms for different indicators of HPA axis functioning in acute stress (e.g., reactivity vs. overall hormonal levels) may assist in further understanding of within-group differences in African American health disparities as well as being informative for culturally sensitive prevention and intervention efforts.Item Enablers and Inhibitors to Implementing Tobacco Cessation Interventions within Homeless-Serving Agencies: A Qualitative Analysis of Program Partners’ Experiences(2024-06-06) Martinez Leal, Isabel; Siddiqi, Ammar D.; Rogova, Anastasia; Britton, Maggie; Chen, Tzuan A.; Williams, Teresa; Casey, Kathleen; Sanchez, Hector; Reitzel, Lorraine R.Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers’ attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study’s findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.Item EXAMINING MOMENT TO MOMENT AFFECTIVE DETERMINANTS OF SMOKING RATE FOLLOWING A QUIT ATTEMPT IN A SAMPLE OF HOMELESS ADULT DAILY SMOKERS: AN ECOLOGICAL MOMENTARY ASSESSMENT STUDY(2016-05) Savoy, Elaine; Norton, Peter J.; Reitzel, Lorraine R.; Neighbors, Clayton; Businelle, Michael S.Tobacco use, mainly cigarette smoking, is a prevalent and deadly habit, and disproportionately affects homeless individuals, who have fewer resources and increased stressors compared to domiciled smokers. Despite these disadvantages, the majority of homeless smokers report a desire to quit yet little is known about how to facilitate smoking cessation among this population. Limitations of previous work includes small samples and low quit rates – even on the quit date. The current study used ecological momentary assessments (EMAs) and focused on cigarettes smoked per day (CPD) following a specific quit attempt to more effectively study smoking cessation among this group. Using the relapse prevention model to inform the hypotheses, the current study sought to examine whether moment-to-moment changes in affect [e.g., negative affect (NA), positive affect (PA), and stress] predicted changes in CPD following a specific quit attempt among a homeless sample of smokers. Participants were 67 homeless daily smokers aged >18 from a transitional shelter program in Dallas, Texas. Separate hierarchical linear modeling (HLM) on each predictor was performed to examine the associations between affective variables and CPD in covariate-adjusted analyses. Model diagnostics were run to test whether necessary model assumptions were met, then HLM was re-run on each predictor to obtain final results. Results indicated that increases in PA during the post-quit week significantly predicted fewer CPD (p=.0025). Increases in NA during the post-quit week was marginally associated with greater CPD (p=.0548). Homeless smokers may be less likely to increase their cigarette consumption during periods of greater positive affect throughout the post-quit week. Intervention programs could utilize this information as well as recent smoking cessation literature focusing on affective variables (using domiciled smoker samples) to examine the efficacy of a harm reduction approach to eventual cessation.Item Implementation of a Comprehensive Tobacco Free Workplace Program in Agencies Serving the Homeless and Vulnerably Housed(2020-09-29) Taing, MatthewAlthough there have been substantial decreases in the prevalence of cigarette smoking in the last two decades, these overall population estimates often fail to account for subpopulations, such as individuals who are homeless or vulnerably housed, that have disproportionately high smoking rates. Despite this, clinicians do not commonly address tobacco use among individuals who are homeless. Tobacco-free workplace programs, like TTTF, are evidence-based, tobacco control initiatives that may be effective in increasing capacity to address tobacco use within homeless-serving community agencies by addressing known clinician barriers to intervention by providing education, specialized training, and resources to promote and assist quit attempts. Here, we examine the outcomes of TTTF’s implementation within 4 agencies that provide housing or other services to individuals who are homeless or vulnerably housed. Pre- and post-implementation data were collected from clinicians (N=68) to assess changes in training receipt, knowledge, and intervention behaviors. Results indicated significant gains in clinicians’ receipt of training in 9 (of 9) target areas (ps≤0.0042) and a 53% knowledge gain (ps<0.0001). From pre- to post-implementation, there were mean increases in the use of the 5A’s (ask, advise, assess, assist, and arrange) and other evidence-based interventions for tobacco cessation, with significant gains seen over time in assisting residents/clients to quit, arranging follow-ups, and providing or referring for non-nicotine medications (ps≤0.0491). Overall, TTTF improved clinicians’ capacity to address tobacco use among homeless and vulnerably housed individuals and may serve as a model for tobacco control efforts in similar agencies. This project was completed with contributions from Bryce Kyburz, Teresa Williams, and Kathleen Casey from Integral Care at Austin.Item Incorporating Expressive Writing into a Personalized Normative Feedback Intervention to Reduce Alcohol Use among College Students(2016-05) Young, Chelsie Marie; Neighbors, Clayton; Lu, Qian; Woods, Steven P.; Reitzel, Lorraine R.This study combines personalized normative feedback (PNF) and expressive writing into a brief intervention to reduce drinking among undergraduates. Limitations of PNF interventions include reactance, defensiveness, and a lack of attention to and adequate processing of the information. Adding a writing component to PNF interventions may compensate for these limitations and boost intervention efficacy. The present study evaluated whether increasing cognitive processing and reducing defensiveness and reactance in response to PNF through an expressive writing task would improve the efficacy of this brief intervention tool. Participants included 244 University of Houston students who met screening criteria, correctly answered two out of three check questions, and were randomized to receive either: 1) PNF about their alcohol use; 2) expressive writing about a heavy drinking occasion; 3) PNF plus expressive writing; or 4) attention control feedback about their technology use. One month post-baseline, 169 participants completed a follow-up survey asking about their past month alcohol use and alcohol-related problems. Results revealed that the PNF plus writing condition significantly reduced drinking via the AUDIT-C and reduced alcohol-related consequences at follow-up compared to control. Further, intervention effects were moderated by factors such as readiness to change, intentions for drinking, depth of processing of the feedback, and cognitive processing language in the narratives. Findings have implications for future alcohol intervention efforts among college student drinkers.Item Investigating Parental Health-Related Quality of Life in Pediatric Type 1 Diabetes: A Social Determinants Framework(2023-12) Eshtehardi, Sahar Soror; Reitzel, Lorraine R.; Hilliard, Marisa E.; Mire, Sarah S.; Carmack, Chakema C.Background: Caring for a child with type 1 diabetes (T1D) is complex and taxing. For parents of youth with T1D, health-related quality of life (HRQOL) is an important construct to consider, representing the impact of their child’s medical condition on their own physical, emotional, mental, and social functioning. Supporting parents’ HRQOL is critical as poor parental well-being is consistently linked to poorer youth behavioral and glycemic outcomes. Social determinants of health (SDOH) – or non-medical factors closely related to health – play a vital role in an individual’s perceived HRQOL. SDOH are organized into five key domains: (1) economic stability, (2) education, (3) health and health care, (4) neighborhood and built environment, and (5) social and community context. To date, limited literature has examined how SDOH relate to experiences of parenting a child with T1D. Understanding the potential social determinants of HRQOL in parents is needed to assess the appropriateness of current supportive interventions, support the development of future interventions, and ultimately improve youth diabetes outcomes. Purpose: The three-part dissertation aimed to investigate the associations of SDOH with parental HRQOL by: (1) exploring diabetes-specific financial experiences in parents; (2) assessing potential sociodemographic differences in parents’ HRQOL; and (3) characterizing parents’ experiences with and perceptions of diabetes-specific social support. Together, these studies explored three domains of SDOH: economic stability (studies 1 & 2), health/health care (studies 1, 2, & 3), and social and community context (study 3). Methods & Results: All studies were secondary analyses of data from a larger mixed-methods study about HRQOL in people with T1D and their families. Study 1, which was previously published (Eshtehardi et al., 2020), used qualitative methods to explore perspectives on diabetes-related expenses in parents of youth with T1D (n=23). Following the principles of hybrid thematic analysis, two primary themes were generated: “Sacrifices & Hardships” and “Gratitude.” Study 2 used quantitative methods to evaluate whether there are differences in HRQOL in parents of youth with T1D (N=369, Mage=43.3±8.7, 80% female) across demographic, medical, and socioeconomic groups. Multivariate regression analyses revealed that a model inclusive of demographic (youth age), medical (HbA1c, diabetes duration, continuous glucose monitoring (CGM) use, insulin regimen), and SDOH (race/ethnicity, marital status, youth health insurance) variables significantly predicted parental HRQOL, though CGM use and HbA1c were the only variables independently associated with HRQOL in the final model. Study 3 characterized how parents (n=23) feel about and seek emotional support related to their role as a parent of someone with T1D using qualitative research methods. Data generated three major themes and nine subthemes, suggesting parents receive emotional support of different types and from various sources based on preferences at the individual, interpersonal, and community levels. Discussion: Findings suggest individual needs, experiences, and SDOH relate to parental HRQOL. Considering the intersectionality of SDOH, medical outcomes, and HRQOL, clinical approaches should emphasize universal parental HRQOL screening and tailored interdisciplinary interventional approaches. Future research is needed to advance opportunities for HRQOL equity in parents, including collecting qualitative and quantitative data on housing, environmental safety, transportation, and socioeconomic status across a larger time frame.Item Lending a Helping Hand? Examining Cultural Differences in Social Support(2015-05) Nguyen, Mai-Ly; Neighbors, Clayton; Acitelli, Linda K.; Penney, Lisa M.; Reitzel, Lorraine R.The aim of the current research was to explore the ways in which culture might influence both the recipient’s and provider’s mental affective states and their feelings towards others following social support transactions. Study 1 examined whether European American and Asian American recipients differed in terms of the likelihood in which they would request support in a given manner (implicit or explicit support seeking) and whether they would be more likely to accept and feel more supported by a specific type of social support (emotional or instrumental support) from a provider. An interaction between culture and type of support in predicting perceptions of support emerged. Results revealed that participants felt more supported after receiving instrumental support versus emotional support and that this was particularly true for European Americans. Study 2 examined whether there were differences between Asian Americans and European Americans in terms of whether they would be more likely to accept or decline a direct request for support. Further, Study 2 sought to determine whether European Americans and Asian Americans differed on internal affective states and feelings towards the recipient following a direct request for support. Overall, findings for Study 2 indicated there were no cultural differences from the provider’s perspective. However, post-hoc analyses uncovered that Asian American men may take on more traditional gender roles relative to European American men, which in turn, influences their provision of support. That is, Asian American men reported feeling more of a responsibility but less negativity towards the help seeker than European American men. Recommendations are provided in order to improve both study designs so as to better elucidate the potential cultural nuances in social support transactions.Item Minority Stress and TV Viewing Behaviors among Lesbian, Gay, and Bisexual Adults(2018-05) Winderman, Katherine; Smith, Nathan Grant; Coleman, M. Nicole; Schick, Vanessa R.; Reitzel, Lorraine R.A burgeoning body of research has examined the ways in which lesbian, gay, and bisexual (LGB) individuals consume LGB-inclusive media. Despite growing focus on this topic, no studies have explored the role of minority stress in the media consumption process among LGB adults. The present study examined the relationships between minority stressors and TV consumption behaviors (i.e., parasocial relationships and viewing frequency) among adult LGB TV viewers. Participants (N = 340) identified predominately as White (52.9%) and female (72.1%), and the largest group identified as bisexual (44.4%). Participants completed self-report measures of prejudice events (Heterosexist Harassment, Rejection, and Discrimination Scale), concealment (Sexual Orientation Concealment Scale), internalized homonegativity (Internalized Homonegativity Scale), social support (Multidimensional Scale of Perceived Social Support), LGB community connectedness (Connectedness to the LGBT Community Scale), loneliness (UCLA Loneliness Scale), viewing frequency (LGB-Inclusive Consumption Questionnaire), parasocial relationships (Revised Parasocial Interaction Scale), and depression, anxiety, and stress (Depression Anxiety Stress Scales-21). Seven multiple regressions were conducted to examine the interrelationships among these variables. Findings revealed that concealment (β = .30, p < .001), and community connectedness (β = .23, p < .001) were significantly associated with parasocial relationships. Additionally, perceived social support moderated the effect of prejudice events on viewing frequency (β = -.12, p < .05). Sexual minority viewers who reported high levels of prejudice events and low levels of perceived social support endorsed the highest levels of viewing frequency of LGB-inclusive shows. Moreover, loneliness significantly mediated the relationship between prejudice events and viewing frequency [CI = -3.90, -.26], as well as the relationship between concealment and viewing frequency [CI = -3.50, -.19]. This line of inquiry clarifies the nuanced ways in which LGB individuals consume media content, and may be informative for clinicians in understanding coping strategies for minority stress among LGB clients.Item Minority Stress as Traumatic Stress: The Relationship between Discrimination, Social Support, Posttraumatic Stress, and Alcohol Use for Bisexual Women(2019-12) King, Brooke; Smith, Nathan Grant; Reitzel, Lorraine R.; Liu, Yu; Tran, Jana K.Background: Lesbian, gay, and bisexual (LGB) individuals are at increased risk of both psychological distress (e.g., depression and anxiety) and maladaptive behaviors (e.g., alcohol use) compared to heterosexual peers. The literature linking discrimination experiences to symptoms of posttraumatic stress disorder (PTSD) suggests that sexual minority stress may serve as a form of posttraumatic stress. Studies addressing within-group differences indicate that bisexual women are more likely than other LGB people to report poor physical and psychological outcomes, which may be explained by disparities in social support and symptoms of posttraumatic stress. Purpose: The current study measured the role of social support and symptoms of posttraumatic stress as potential mediators in the relationship between discrimination experiences (anti-bisexual and sexist) and alcohol use in sample of bisexual women. Method: Participants included bisexual women over the age of 18 from an archival data set (N = 256) with measures including self-reported discrimination experiences, social support, posttraumatic symptoms, and alcohol use. Two sequential, three-path mediation path models were analyzed to examine the direct effects of anti-bisexual discrimination and sexist discrimination on alcohol use, as well as the indirect effects through social support and posttraumatic stress. Results: Path analyses were conducted to analyze the relationships between discrimination experiences, social support, PTSD symptoms, and alcohol use. Neither social support nor PTSD symptoms mediated the relationships between either anti-bisexual experiences or sexist experiences and alcohol use. Most effects were found to not be significant; however, significant bivariate relationships were found between anti-bisexual and sexist experiences, as well as between both types of discrimination experiences and PTSD symptoms. In addition, multivariate relationships were found between anti-bisexual experiences and PTSD symptoms; sexist experiences and PTSD symptoms; social support and PTSD symptoms; and sexist experiences and alcohol use. Conclusion: Anti-bisexual and sexist experiences appear linked, and both of these prejudice experiences relate to bisexual women’s reported PTSD symptoms. Future research should address the sequential relationships between these variables, as well as other psychosocial factors not explored in the present study. Clinicians are advised to conceptualize prejudice experiences as interrelated, and bisexual women clients would benefit from practice that is affirmative and trauma-informed.