Browsing by Author "Smith, Nathan Grant"
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Item Addressing Sexual Health among Black College Women: Results of a HIV-Prevention Intervention Group Pilot Randomized Control Trial(2016-05) Averette, Cedrina K.; Coleman, M. Nicole; Smith, Nathan Grant; Carmack, Chakema C.; Williams Jennings, ShearaThe HIV/AIDS epidemic continues to affect the lives of many, with African American women being uniquely at risk when compared to women from other racial groups. Black/African American women have a higher proportion of cases at all stages of the virus (CDC, 2016a). The primary form of HIV contraction among this group is by way of heterosexual contact with an at-risk sexual partner. However, Black women may not be fully aware of the potential risks inherit in their sexual relationships. The epidemic calls for approaches, resolutions, and interventions to stop the spread and increase of diagnoses among African American heterosexual women. The primary purpose of this study was to test the feasibility and acceptability of a group-based HIV-prevention intervention for young African American college women (ages 18 to 29). Using the theoretical foundations of Social Cognitive Theory (SCT) and the Theory of Gender and Power (TGP), the intervention educated participants about HIV-related information and transmission, taught communication skills related to assertive expression of safer sex practices, and addressed the unique intrapersonal, interpersonal, and contextual factors that impact Black college women. The intervention was culturally specific, gender appropriate, educational, and engaging. In the pilot study, participants were randomly assigned to either an experimental intervention condition or a no-attention control condition. Data on primary and secondary variables were collected at baseline and two months post-intervention to test the main hypothesis that the pilot study was feasible and acceptable among the target population. It was expected that the study would demonstrate that the intervention could be successfully carried out and be undertaken on a larger scale in the future. It was also hypothesized that a pilot version of a sex-risk reduction intervention that is gender-appropriate, culturally-relevant and skill-building would show a trend of increased consistent condom use, condom use self-efficacy, sexual communication, sexual relationship power, condom use intentions, and HIV knowledge (secondary measures) compared to the no-attention control group condition. Quantitative data were analyzed using descriptive statistics. Measures of mean and variance including standard deviations (SD) and ranges were used to describe the full range of data at baseline and at follow-up across two conditions and at two time points. The outcome data for this study were analyzed using the Statistical Package for the Social Sciences (SPSS/Mac version 23.0 for IBM PC/MAC and PS/2, SPSS, Inc., Armonk, NY, 2015). Qualitative data in the form of participant and facilitator feedback were used to analyze intervention feasibility and acceptability. The findings of this pilot study suggest that the delivery of a theoretically-based and culturally-relevant intervention is feasible within a university college setting and that the content of the intervention was accessible to participants. Additionally, there was an overall trend in increased condom use rate regardless of condition placement. In addition, intervention participants reported increased condom use self-efficacy, intention to practice safer sex, relationship control, decision-making dominance and HIV knowledge at follow-up.Item An Examination of Moral Injury, Moral Emotions, and Adult Attachment in the Prediction of PTSD for Male Veterans(2016-08) Bannister, Jenny; Lopez, Frederick G.; Alfano, Candice A.; Burridge, Andrea Backscheider; Menefee, Deleene S.; Smith, Nathan GrantIndividuals within the U.S. military frequently experience posttraumatic stress disorder (PTSD); however, not all combat veterans develop PTSD. Attachment theory is a valuable framework for understanding potential vulnerabilities, since there is an inverse relationship between attachment security and PTSD symptom severity. Although attachment insecurity is related to PTSD severity, additional variables that explain this relationship remain unexplored. Moral injury, defined as events in combat that conflict with moral beliefs, may help to explain this relationship, as moral injury is posited to be understood using stable, internal attributions about the self and others. Litz and colleagues (2009) posited a causal model to explicate moral injury, including shame-proneness and guilt in the prediction of PTSD re-experiencing and avoidance/emotional numbing symptom severity. Their model is theoretical and has not been empirically examined. The primary objective of this study was to evaluate the interrelationships of moral injury to selected constructs and to evaluate portions of predictions within the Litz et al. model using DSM 5 criteria for PTSD. A secondary objective was to evaluate a portion of the Litz et al. model. Collectively, the linear relationships were predominantly consistent with the Litz et al. model. A few exceptions were found, including: (a) a significant relationship between moral injury and PTSD hyper-vigilance and (b) no relationship between attachment avoidance and moral injury. The proposed portion of the Litz et al. model that was tested did not fit the data. However, guided by theory and the modification indexes, an acceptable model was found. Collectively, the results indicate that models of fear-based conditioning are pertinent to the experience of moral injury. The role of attachment within the meaning making process of moral injury remains unclear and was likely temporally misspecified within the Litz et al. model. Limitations are discussed and future directions are provided, including highlighting the importance of future longitudinal research for examining moral injury, adult attachment, and post-trauma psychopathology.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 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 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 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 Examining Racial Microaggressions from an Attachment Theory Framework: Contributions of Attachment Security, Defensive Self-Esteem, and Ethnic-Racial Identity as a Product of Ethnic-Racial Socialization(2016-08) Thind, Navneet Kaur; Lopez, Frederick G.; Coleman, M. Nicole; Smith, Nathan Grant; Acitelli, Linda K.The experience of racial microaggressions negatively influences mental health in individuals. However, to date, little is known about individual differences that may contribute to an individual's experience of racial microaggressions. Attachment Theory (Ainsworth, 1969; Bowlby 1982/1969), which incorporates developmental and relational perspectives, may serve as an appropriate framework for examining such contributions. Thus, the present study was guided by Racial Microaggressions Theory (Sue et al., 2007) and Attachment Theory. Supported by results of a pilot study, the present study proposed to test two models that included attachment-related constructs, the constructs of defensive self-esteem, and ethnic-racial self-esteem to better explain the relationships between attachment and the perception of racial microaggressions in racially diverse students from the University of Houston. The models were slightly modified as the proposed models were not supported. Results of the modified models for the overall sample suggested direct and indirect relationships between attachment-related variables, defensive self-esteem, ethnic-racial self-esteem, and racial microaggressions indicating that these variables contribute to an individual's perception and experience of racial microaggressions. The results imply the appropriateness of Attachment theory as a framework to use when understanding individual experiences of racial microaggressions. Thus, clinical implications include using theory-guided interventions with individuals experiencing race-related distress are discussed. Limitations of the present study and future directions for research are also indicated.Item Examining the Role of Media Influence and Parental Involvement in the Sexual Socialization of African American Adolescent Girls(2016-08) Hill, LaWanda; Coleman, M. Nicole; Horn, Catherine L.; Smith, Nathan Grant; Carmack, Chakema C.There are disparate rates of sexually transmitted infections (STIs) and unplanned teenage pregnancies among African American adolescent girls in comparison to other ethnic female peers (CDC, 2011). The literature has demonstrated that endorsement of permissive sexual attitudes promoted by the media have explanatory value in negative sexual health outcomes (Ward & Rivadeneyra, 1999; Ward & Friedman, 2006), while parents, namely mothers/female caregivers, are cited to be health promoting sexual socialization agents (DiIorio, Pluhar & Belcher, 2003). The literature is limited, however, in providing a comprehensive understanding of both media influence and parental involvement in the process of sexual socialization among African American adolescent girls. Thus, the purpose of this study was to bridge theoretical and methodological gaps in the current literature by addressing the aforementioned limitation. This was accomplished by specifically exploring Black-oriented television exposure rates, television and music video viewing motives, parent-adolescent communication about sexuality, process of sexual communication and the sexual attitudes of a heterogonous sample of African American adolescent girls between the age of 13 and 18. These variables were explored among 174 self-identified African American adolescent girls (M age = 15.61 years; SD= 1.50) sampled from 13 states within the United States. Participants were recruited through social media, non-profit organizations, churches, and public and charter schools throughout several states and administered the following measures: Viewing Motives Scale (Ward & Friedman, 2006), Sexual Communication Scale (Somers & Caniverz, 2003), Process of Sexual Communication Scale (Miller, Kotchick, Dorsey, Forehand, & Ham, 1998), and Brief Sexual Attitudes Scale (Hendrick, Hendrick, & Reich, 2006). In order to assess overall weekly television and Hip Hop music videos media consumption and Black-oriented television exposure, an adaption of Ward’s (2002) measure of Media Exposure Scale was utilized. Means and standard deviations and bivariate correlations among primary variables were examined. Additionally, frequencies were derived to provide descriptive information of the sample’s overall weekly television and Hip Hop music video consumption and favorite genre of television. Analysis revealed overall high rates of Black-oriented television exposure among adolescent participants with both entertainment and learning viewing motives. Additionally, little conversation about sexuality occurred among adolescents and their mother/female caregiver and conversation that did occur was restricted and narrow in scope. However, despite the high rates of Black-oriented television exposure and infrequent and limited conversations about sexuality, participants in this study did not endorse permissive sexual attitudes that are associated with risky sexual behaviors. Furthermore, neither media influence nor parental involvement was significant predictors of sexual attitudes among this sample. The implications of findings are discussed in terms of future research endeavors.Item Exploring Psychological Well-being in College Students: Examining the Role of Sexual Orientation in Development(2015-08) Lukingbeal, Patrick; Fan, Weihua; Olenchak, F. Richard; Horn, Catherine L.; Smith, Nathan Grant; Riedel, BrianThis study explored the role that sexual orientation played in psychological well-being amongst college undergraduates. An increasing amount of research has examined the mental health and stressors of college students and how well-being is affected (Wood, 2012; Keyes, Eisenberg, Perry, Dube, Kroenke & Dhingra, 2011). In addition, research has shown that lesbians, gays and bisexuals (LGB) are likely to report lower well-being and higher rates of mental health issues (Gates, 2014; McLauglin, Hatzenbuehler, Xuan & Conron, 2012; Oswalt & Wyatt, 2011). The study sought to merge these contexts to understand how well-being is affected by someone identifying as heterosexual or LGB while in college. This merger should clarify some of the gaps of the two previous literature bodies – and provide administrators a better understanding of the well-being of LGB college students. This study was guided by four research questions: 1. Does psychological well-being differ between gay, lesbian and bisexual (LGB) identified college students and heterosexual (male and female) identified college students? 2. How may psychological well-being differ among gay and bisexual men and lesbian and bisexual women in college communities? 3. How applicable and useful is the Ryff Scale of Psychological Well-being (RPWB) for LGB college students? 4. What sort of stressors do LGBs face while in college? A mixed methods design was used to examine these research questions. A quantitative approach was used for the first two research questions. The Ryff Scale of Psychological Well-being (RPWB) was given to participants to measure psychological well-being (Ryff, 1989). Based on the positivist psychology movement, the RPWB measured six operationalized dimensions of well-being: self-acceptance, positive relations with other people, autonomy, environmental mastery, purpose in life and personal growth. On the RPWB, participants received an overall score for well-being as well as a score for each of the six dimensions. On research question one, results indicated that there was not a significant difference found in the overall score on the RPWB between LGB college students and heterosexual male and female college students. When comparing across the six dimensions of RPWB, it was found that LGB participants scored higher than heterosexual males on the personal growth subscale. For research question two, there was no significant difference found among gay and bisexual males and lesbian and bisexual females on the overall score or six subscales of the RPWB. The second part of the study used qualitative observation through semi-structured focus groups to answer the third and fourth research questions. Data analysis was informed by two qualitative methods: Braun and Clarke (2006) and Carspecken (1996). The findings indicated that LGB students employed an “open” – but not too open mentality around their orientation, choosing to take on or discard part of their identity depending on the situation. Participants emphasized self-preservation strategies in an effort to protect their own well-being in uncomfortable social, academic or professional arenas. Students often found themselves educating their family, friends and professional networks – which based on the relationship, could either be embraced or cause frustration. Finally, participants felt their struggle with their sexual orientation might have translated into a source of strength and personal development that heterosexuals do not experience. Resources in higher education must be positioned to provide programs and services that are welcoming and inclusive of LGB people. As the literature will show, LGB participants faced stigma, misinformation, as well as homophobia and biphobia. However, findings from this study indicate that the collegiate experience may prove useful in the development of LGB students – providing safer environments, tight-knit social relationships, and readily available professional support.Item Exploring the Interrelationships Among College Students' Attachment Orientations, Sexual Motives, and Sexual Risk-Taking(2018-08) Powell, Elisabeth; Lopez, Frederick G.; Smith, Nathan Grant; Wiesner, Margit F.; Frankel, Leslie A.; Parrish, Danielle E.Background: The sexual risk taking behaviors and attitudes of college students are important phenomena to examine due to the potential for negative outcomes, including contraction of STIs or unintended pregnancy. Purpose: As most of the current research on college students’ sexual behaviors has been descriptive and atheoretical, this investigation conducted an attachment theory-guided study of the interrelationships among their adult attachment orientations (i.e., relative levels of attachment avoidance and attachment anxiety), sociosexual orientation (i.e., domain-specific perspectives on uncommitted sex, which varies from restricted to unrestricted), sexual motives, and their sexual risk behaviors (e.g., frequency of condomless sex and casual sex). Methods: Six-hundred and thirty undergraduate students between the ages of 18 to 24 at the University of Houston participated in this study by completing online measures assessing adult attachment, sociosexual orientation, sexual motives, and sexual risk behaviors. Results: Findings indicated that insecure attachment (i.e., high levels of attachment avoidance and attachment anxiety) was related to some, but not all, aspects of sexual risk-taking behaviors, and also related to a less restricted sociosexual orientation in some domains. Additionally, there was evidence of an indirect effect of adult attachment orientations on sexual risk behaviors and attitudes through theoretically-expected sexual motives. Lastly, participants’ gender moderated the indirect effects of sexual motives in explaining the relationship between attachment anxiety and one sexual risk behavior (i.e., use of alcohol prior to sex). Conclusion: Adult attachment orientation influences motives for engaging in sex, attitudes towards sex, and participation in sexual risk behaviors. Several important implications of these findings for future research and clinical practice are discussed.Item General Anxiety Disorder Symptoms and Alcohol Use Among Female College Students: A Moderated Mediation Model Using Alcohol Coping Motives and a History of Lifetime Sexual Assault(2023-08) Desrochers, Madeleine T.; de Dios, Marcel A.; Arbona, Consuelo; Smith, Nathan Grant; Schwartz, JonBackground: Previous studies have linked sexual assault with drinking behaviors. There are several psychosocial factors that contribute to a woman’s experience during and after a sexual assault. However, there is limited research examining the relationship between women’s sexual assault history, general anxiety disorder symptoms, and the use of alcohol as a form of coping. Examining such psychosocial factors and their unique impact may provide findings that can inform prevention and intervention efforts for young adult college women. Purpose: The current study examined the moderating role that sexual assault history may have on the mediational relationship of drinking coping motives on the relationship between general anxiety disorder (GAD) symptoms and alcohol use. Methods: A sample of 147 young adult female college students, who identified as regular alcohol users, completed an online survey which included measures of GAD symptoms, sexual assault history, alcohol drinking motives and alcohol use days. A series of OLS models tested a moderated mediation model. Results: The hypothesized moderated mediation model was not confirmed by the data. A post-hoc alternative mediation model revealed drinking to cope motives to be a significant mediator of the association between sexual assault history and drinking days. Discussion: Both sexual assault history and drinking to cope motives significantly predicted 30-day alcohol use. Age, relationship status, and sorority status were found to be significantly associated with the variables of interest. Results were discussed in relation to the existing literature and potential implications.Item Mental Health Help-Seeking in South Asian American Muslims: The Role of Cultural Beliefs, Attitudes, and Knowledge(2018-08) Damani-Khoja, Nadia; Smith, Nathan Grant; Nutt, Roberta L.; Hassett, Kristen S.; Obasi, Ezemenari M.Background: Islam is one of the fastest growing religions in the U.S. It is imperative for mental health researchers and clinicians to learn about group differences among South Asian American Muslims to avoid misconceptions and stereotypes. Purpose: This study examined if there are differences in (a) cultural beliefs, attitudes, and knowledge and familiarity towards formal mental health help between three South Asian Muslim groups—Sunni, Shia, and Ismaili—controlling for the effects of age and generational status; (b) cultural beliefs, attitudes, and knowledge and familiarity between men and women; and (c) preferences towards seeking formal (physicians, mental health professionals) versus informal (family, friends, and religious leaders) mental health resources based on Muslim group. Method: Participants included 252 South Asian American Muslims. Measures included demographics, the Cultural Beliefs about Mental Health Problems scale, the Attitudes Towards Seeking Formal Mental Health Services scale, the Knowledge About and Familiarity with Formal Mental Health Services scale, and an author-generated measure of preferences towards formal versus informal mental health resources. Results: A one-way between-groups MANCOVA, controlling for age and generational status, was conducted. Sunnis endorsed the most traditional cultural beliefs, compared to Shias and Ismailis. Shias endorsed the least positive attitudes and the least knowledge and familiarity, compared to both Sunnis and Ismailis. Women endorsed more positive attitudes and knowledge and familiarity than men but there were no significant differences for cultural beliefs. Shias preferred reaching out to informal support first while both Sunnis and Ismailis preferred reaching out to formal support. Conclusion: Results suggest that mental health help seeking in South Asian American Muslims is complex, especially when it comes to cultural beliefs, and can have implications for engagement in seeking formal services. Clinical implications are discussed and suggestions for future research provided.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.Item #NoFilter: Examining the Relationship Among Online Photo Manipulation and Mental Health Variables of African American Women(2019-05) Long, Amanda; Coleman, M. Nicole; Smith, Nathan Grant; Schwartz, Jonathan P.; Williams Jennings, ShearaBackground: The way in which media images are being presented to the public has transformed within the last 15 years as more individuals are gaining internet access and using online social networking sites as a primary tool to communicate societal expectations of beauty. Users also help maintain these expectations by posting personal images that reflect similar ideas. Photo-based activities such as posting “selfies” (photos one takes of oneself) or “usies” (photos of oneself that includes others) have shown a correlation with women endorsing greater thin ideal internalization, self-objectification, and drive for thinness. Purpose: There is minimal research that explores how engagement in specific online activities can help perpetuate beliefs about cultural standards of beauty. Current research only examines the impact of usage habits (i.e., duration/frequency) among samples of predominately white women. Considering the increasing popularity of social media, it is important to explore the relationship between exposure and engagement in specific social networking activities and body dissatisfaction among Black women. As a result of an absence of literature that examines the impact of specific entities or activities of social media on body image concerns, this study posed the following research question: What is the relationship among engagement in photo-related activities, including photo investment and photo manipulation, body dissatisfaction, appearance anxiety, appearance comparison, and skin color satisfaction among a sample of Black women? Methods: This study recruited 333 Black women between the ages of 18 and 34 years old that reported having an Instagram or Facebook account. Participants completed a selfreported survey, and four multiple regressions analyses were conducted with photo investment and photo manipulation as the predictor variables and Body Dissatisfaction, appearance anxiety, online physical appearance comparison, and skin color satisfaction as the criterion variables. Results: Photo investment and photo manipulation appeared to make unique and distinct contributions in the various domains of appearance related concerns among a sample of Black women. These findings support the notion that having more investment in the types of photographs that are posted along with modifying pictures prior to posting actually contributes to a cyclical process that helps to maintain dissatisfaction with one’s body.Item Personalized Feedback to Reduce HIV Transmission Risk Behavior among Young, Gay Males(2018-12) Jardin, Charles Benjamin; Zvolensky, Michael J.; Neighbors, Clayton; Smith, Nathan Grant; Vujanovic, Anka A.; Viana, Andres G.Transmission of HIV disparately impacts young men who have sex with men (YMSM). Few efficacious individual-level interventions exist to reduce HIV risk among YMSM. The objective of the present study was to develop and test the initial acceptability and feasibility of an internet-based intervention utilizing personalized normative feedback to reduce sexual HIV-related risk behavior and alcohol use, as well as increase health-protective behaviors among YMSM. Guided by the Prototype Willingness Model, the personalized feedback intervention (PFI) sought to modify perceived social norms and risk prototype favorability to reduce risk for HIV. The final sample consisted of 58 YMSM, 54 of whom were randomized to either the PFI (n = 28) or a sexual health education control group (n = 26). Following the treatment, participants completed surveys at post-intervention and at one-month follow-up. Analyses tested the main effect of treatment group, as well as the interaction effect of treatment group by treatment dose. Results demonstrated the PFI led to reductions in some, but not all, risk behaviors and behavioral norms. Across both treatment conditions, study participants evidenced reductions in four out of six risk behaviors, suggesting that both the PFI and the active control may have been useful in reducing risk. No differences were observed between the treatment conditions for treatment acceptability, intentions to use HIV prevention methods, and self-efficacy factors. The PFI developed was feasible and acceptable to the sample and its preliminary efficacy supported the use of personalized normative feedback interventions among YMSM. As such, this PFI may help in meeting the critical need, recognized by the Center for Disease Control and Prevention and the National Institutes of Health, for the development of cost-effective interventions tailored to the strengths and vulnerabilities of specific sexual minority populations.Item Project PRIDE: A Cognitive-Behavioral Group Intervention to Reduce HIV Risk Behaviors Among HIV-Negative Young Gay and Bisexual Men(2016) Smith, Nathan Grant; Hart, Trevor A.; Moody, Cherie; Willis, Amy C.; Anderson, Marie Faaborg; Blais, Martin; Adam, BarryYoung gay and bisexual men are at increased risk for HIV infection. Research suggests that the stress associated with being a stigmatized minority is related to negative mental health outcomes, substance use, and condomless sex. However, interventions aimed at reducing HIV risk behaviors in young gay and bisexual men have failed to address these important variables. The purpose of the present paper is to assist cognitive and behavioral therapists who work with young gay and bisexual men to conduct therapy for stress management and HIV prevention. This paper provides an overview of the research on stress and coping among gay and bisexual men and its relation with condomless sex among young gay and bisexual men. The treatment described here integrates minority stress theory (e.g., Meyer, 2003) and stress and coping theory (e.g., Lazarus, 2000) in a small group counseling framework that uses psychoeducation, cognitive reframing, and role-plays to help young gay and bisexual men to manage stress, reduce substance use, and reduce condomless sex. The application of empirically-supported theory and a combination of cognitive and behavioral techniques to reduce both psychological distress and HIV risk behavior for young gay and bisexual men is illustrated using three case examples. The present treatment may help therapists working with young HIV-negative gay and bisexual men who engage in condomless sex and who wish to remain HIV-negative by decreasing their HIV risk behavior.Item Project QTMINDS: Queer and Trans Mending of Inflexibility when facing Non-Affirmation, Discrimination, & Stigma(2023-05-16) Soltis, Dani; Smith, Nathan Grant; Allan, Blake A.; Kim, Han Joe; Winderman, Katherine E.Background: Sexual and gender minorities (SGM) in the United States are faced with a unique historical moment in the 2020s. Changes in sociocultural unrest and discriminatory legislation have made identifying as lesbian, gay, bisexual, transgender, queer (LGBTQ) or other SGM identities increasingly fraught. Purpose: Grounded in the context of the current political landscape, the following set of studies revolved around a central question: does having a psychologically flexible worldview help SGM people navigate the stress and strain of this sociopolitical moment and, more broadly, does psychological flexibility serve a protective function for these populations when coping with sexuality and gender specific marginalization stress? Methods: Manuscript 1 explored these questions by focusing on people with diverse sexual identities and assessed psychological inflexibility’s mediating role in the relationship between sexual orientation marginalization stressors and psychological distress outcomes, including anxiety, depression, and suicidal ideation. Participants were recruited via listservs of related professional organizations, through a university research participation system, and through posts on social media, resulting in a sample of 412 participants who met eligibility criteria. Manuscript 2 focused on people with diverse gender identities and explored psychological flexibility’s mediating role in the relationship between gender-related marginalization stressors and gender dysphoria. The same methods used in study 1 were used to recruit a sample of 187 participants who met criteria for study 2. The third and final manuscript is a qualitative, thematic analysis study that focused on the present moment by examining resilience narratives for those identifying as transgender or gender diverse during the current push for anti-trans legislation and messages. Semi-structured interviews were analyzed to assess what role psychological flexibility has in the strategies currently used by transgender and gender diverse people in a time when they are the direct targets of anti-trans sentiments. Participants in studies 1 and 2 were provided the option to participate in study 3 if they met criteria. Along with this method and social media posts, 8 participants were recruited for the semi-structured interviews. Results: Manuscript 1 found expected results, in that psychological inflexibility partially mediated the relationship between marginalization stress for those with diverse sexual orientations and psychological distress. The results of manuscript 2 were less clear, suggesting a more nuanced relationship of psychological flexibility in association to gender-related marginalization stress and gender dysphoria. Lastly, manuscript 3 uncovered the variety of stressors transgender and gender diverse are experiencing in the face of anti-trans movements as well as the ways that psychologically flexible approaches (as well as others such as community and identity pride) provided positive coping and resilience. Implications: Findings suggest that counseling psychologists can empower those of diverse sexual orientations and gender identities in their spheres with psychological flexibility interventions, particularly when their experiences of marginalization stress may translate into anxiety or mood symptoms. However, more work must be done to see if psychological flexibility interventions are useful for those coping with gender dysphoria.Item Psychological Inflexibility as a Mediator for the Relationship between Overall Perceived Stress and Postpartum Depressive Symptomology among New Mothers with Infants in Neonatal Intensive Care(2021-08) Wong, Jasmin Prudon; Smith, Nathan Grant; Chen, Ann; Sampson, McClain M.; Villarreal, Yolanda R.Background: Pregnancy and childbirth are often viewed as blissful events, although they can be emotionally and physically stressful for women. Mothers with infants in the NICU are at an elevated risk for clinically-significant levels of postpartum anxiety and depression, due to higher rates of negative emotional states. Women who are psychologically inflexible may engage in experiential avoidance, living less in the here-and-now, and may experience less value-driven behavior. Over time, this avoidant response style may have considerable consequences on their well-being and contribute to pathological outcomes. Purpose: The present study was a secondary analysis that examined longitudinally the mediating effect of psychological inflexibility on the relationship between NICU overall perceived stress and postpartum depression (PPD) among mothers with an infant in the NICU. Methods: The parent study, entitled Baby’s Breath II Project, consisted of 360 mothers with infants in the NICU, yet after excluding participants with missing data on the Acceptance and Action Questionnaire-II, the final sample size was 207. Participants completed the following self-report measures: NICU overall perceived stress (PSS: NICU; The Parental Stressors Scale), Psychological Inflexibility (AAQ-II: The Acceptance and Action Questionnaire-II), and Postpartum Depressive Symptoms (CES-D: Center for Epidemiologic Studies Depression Scale). An exploratory path analysis and two mediation models were conducted to examine the relationships among these variables across different time points. Results: Participants identified predominately as African American (61.4%) with 34.78% of participants reporting an average household income totaling less than $15,000 annually. Findings revealed no mediation effects, though the effect of NICU overall perceived stress on PPD symptoms at follow-up 1 was found to be significant (β = 0.128, p < .01). As noted, no indirect effects were statistically significant. Conclusion: Results showed that parents maintained psychological flexibility regardless of the parental stress experienced because of the NICU environment. Mothers who endorsed psychological inflexibility 2 weeks post-partum maintained post-partum depressive symptoms through follow-up 1 (2 months) and follow-up 2 (5 months). Lastly, mothers who endorsed depressive symptoms 2 months post-partum continued to endorse symptoms 5 months post-partum. It is important to develop interventions specifically to address the mental health of mothers with infants in the NICU and such interventions should be offered routinely in all NICUs.Item PTSD Symptom Severity and Emotion Regulation in Acute-Care Psychiatric Inpatients: Associations with Suicidality(2017-05) Martin, Colleen; Day, Susan X.; Vujanovic, Anka A.; Smith, Nathan Grant; Reitzel, Lorraine R.; McPherson, Robert H.Trauma and posttraumatic stress disorder (PTSD) have been positively associated with both suicidality (suicidal ideation and attempts) and difficulties with emotion regulation in various samples (e.g., sexual assault victims, combat veterans, college students, community samples). The association between PTSD and suicidality in a psychiatric inpatient setting has a limited research base of approximately 5 studies, and no study to date has examined the role of emotion regulation difficulties in the association of PTSD and suicidality. The present study aimed to address these gaps in the extant literature by examining the main and interactive effects of PTSD symptom severity and emotion regulation in regard to suicidality among trauma-exposed acute-care psychiatric inpatients. It is hypothesized that 1) PTSD will be significantly related to greater levels of suicidality, 2) greater difficulties in emotion regulation will be significantly related to greater levels of suicidality, and 3) the interaction of PTSD and emotion regulation difficulties will be significantly related to greater levels of suicidality. Participants were comprised of 120 adults in a psychiatric inpatient setting. Hierarchical linear and logistic regression analyses were used to examine the main and interactive effects of PTSD and emotion regulation difficulties with four outcomes of suicidality. PTSD symptom severity (ß = .30, p = .02) had a main effect on self-reported suicidal ideation. Difficulties in emotion regulation (p = .01) and number of traumatic life events (p = .002) had significant main effects in predicting suicide as the reason for current admission. An interactive effect of PTSD symptom severity and difficulties in emotion regulation existed for self-reported suicidal ideation (ß = .24, p < .001) in that high levels of both of these variables resulted in the highest level of self-reported suicidal ideation. For individuals with heightened emotion regulation difficulties, the association between PTSD symptom severity and self-reported suicidal ideation was significant whereas with less emotion regulation difficulties it was non-significant. Limitations (e.g., measurement) and future directions (e.g., implementing causal and longitudinal designs) are discussed.