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This study, using scenarios, examined the impact of two kinds of cause-related marketing (CRM) efforts (a traditional donation of a portion of sales to a related cause and a more strategic one-for-...

Purpose The purpose of this study was to examine the importance of rural location in the likelihood of adolescent drunk driving and riding in a vehicle with a driver under the influence while controlling for a variety of student-, school-, and county-level factors. Methods Data from the 2013 Georgia Student Health Survey (GSHS) II (a statewide assessment of student health in public school students in Georgia) were analyzed using multilevel binary regressions to examine rural-urban differences in prevalence of driving under the influence (11th and 12th graders only; n = 114,907) and riding with a driver under the influence (9th -12th graders; n = 258,610), controlling for school-level race, gender, and income, in addition to county-level education level, unemployment, alcohol use, and smoking. Findings Across geographies, students were twice as likely to report riding with a driver under the influence (10.32%) as driving under the influence (4.16%). While both outcomes were more likely among rural adolescents in unadjusted analyses, in adjusted analyses, rural adolescents were not significantly more likely to drive under the influence (ORadj = 1.19; P = .055), but they were significantly more likely to ride with a driver under the influence (ORadj = 1.18; P = .002). Conclusions Our findings suggest that riding with a driver under the influence rather than driving under the influence may be a more pressing public health issue for adolescents in rural areas. Future research focused on the formative work necessary to build novel, culturally tailored interventions should be conducted to minimize the associated substantial burden of motor vehicle deaths within rural adolescents.

The developmental transition from adolescence to adulthood, a period of time known as emerging adulthood, is marked by great personal growth and interpersonal maturation (Arnett, Emerging adulthood: The winding road from the late teens through the twenties, Oxford University Press, New York, 2004). Risk-taking behaviors are seen as a significant impediment to positive development during emerging adulthood. However, few researchers have examined how underlying cognitive processes contribute to the development and exacerbation of risk-taking behaviors at this time. In the current study, we examined the multivariate associations between early maladaptive schemas (disconnection and rejection, impaired autonomy, impaired limits, other-directedness, overvigilance, and inhibition) and expected involvement in five indices of risky behaviors for college women (n = 341) and college men (n = 143). Gender-specific patterns emerged in the prediction of different risk-behavior indices. Early maladaptive schemas accounted for 24% of the variance in men’s anticipated engagement in risky sexual behavior (vs. 9% of women’s). Early maladaptive schemas accounted for 20% of the variance in women’s anticipated engagement in both academic/work and illegal/aggressive risky behaviors (vs. 11 and 9% of men’s). In addition, unique schema domains differentially predicted variance in risky sexual, illicit drug use, heavy drinking, and aggressive/illegal risk behavior for each gender. Gender-sensitive and schema-specific prevention efforts for different types of risky behaviors, often present during emerging adulthood, may be warranted.

Given their critical gatekeeper function regarding naloxone access in rural areas, the purpose of the current study was to examine rural pharmacists’ knowledge and attitudes regarding naloxone use and access (Georgia, 2019), all 364 rural community pharmacies in Georgia were contacted using “secret shopper” methodology and asked about the availability, accessibility, and use of naloxone. A script provided specific questions for data collection. Callers recorded general notes about the call, including the dispositions and impressions of the pharmacists. Thematic analysis was conducted to identify key themes. Rural pharmacists exhibited two classes of attributes: Active Facilitators and Passive Hindrances. Active facilitators supported callers in their search for naloxone, but passive hindrances discouraged callers in a way that was not perceived to be malicious or intentional. Three types of active facilitators emerged: positive approach, helpful suggestions, and knowledgeable and informed. Two types of passive hindrances emerged: negative attitudes and insufficient knowledge. Community pharmacies are sometimes the only formal healthcare access point in rural communities. It is vital for pharmacists to be active facilitators of naloxone access for maximized public health impact. Specific interventions are needed to increase the ability of rural pharmacists to support access to naloxone.

The Disparities Elimination Summer Re­search Experience (DESRE) was created to provide hands-on health equity research training opportunities to undergraduate and graduate students, particularly those from backgrounds underrepresented in bio­medical research. Funded by NIH’s National Institute on Minority Health and Health Dis­parities, a total of 22 students participated in 4 annual cycles of an intensive, 6-week, full-time, residential research training program consisting of didactics, community immer­sion experiences, peer mentoring, ethics training, and hands-on health disparities research. Demand for the program was high; by the 4th year of implementation, more than 500 applications were received for the cohort’s six slots. More than half of DESRE participants came from minority-serving institutions and/or identified as a member of a minority group. Students reported a significant increase in self-reported compe­tency across all of the program’s 26 learning objectives from pre- to post-assessment. Further, the program had a 77% success rate in promoting a career in biomedical research and/or health disparities elimina­tion, including 100% of minority participants either entering a graduate program and/or entering careers focused on health equity. Key success factors and lessons learned are discussed. Ethn Dis.2020;30(1):47-54; doi:10.18865/ed.30.1.47

The purpose of this study was to compare psychological well-being among transgender women, transgender men, genderqueer/nonbinary individuals, and their cisgender sexual minority counterparts. A total of 2,932 gender and sexual minority individuals participated in the online study. While controlling for age, race/ethnicity, employment status, education, and relationship status, there was significant variation between gender minority subgroups in depression (p < 0.001); anxiety (p = 0.003); stress (p = 0.004); perceived social support (p < 0.001); self-esteem (p = 0.031); self-perceived need for mental health care (p < 0.001); family history of mental illness (p = 0.003); personal history of mental health concerns (p = 0.003); and being in recovery (p = 0.004). Overall, transgender women had the poorest psychological well-being across the majority of variables. In contrast to their transgender peers, genderqueer/nonbinary–identified individuals did not significantly differ from their cisgender sexu...

The use of addictive substances by adolescents is a major public health concern; however, rural vs. urban variations are poorly understood. The purpose of the current study was to examine rural-urban differences in the prevalence of recent use of 11 substances in grades 6–12 in a statewide sample of students from the Georgia Student Health Survey II (n = 513,909). We found that rural-urban differences in substance use depend largely upon grade level, with rural middle school students demonstrating higher rates of alcohol, smoking tobacco, and chewing tobacco use, and urban high school students demonstrating higher rates of illicit drugs.

The goal of the current study was to investigate the association of experiences of bullying with 17 individual risk behaviors in a large, non-clinical sample of middle and high school students. Data were analyzed from the 2013 Georgia Student Health Survey II, administered to 6th–12th grade students in all public schools in Georgia (n = 513,909). Bullied students reported higher levels of engagement in every risk behavior investigated, with the largest connections related to safety-related absenteeism (OR 25.4, p

The purpose of this paper was to (1) examine the rates of elevated depression symptoms among a sample of rural Federally Qualified Health Center (FQHC) patients with chronic disease and (2) determine if an inability to afford general prescription medications within the past 12 months is a significant predictor of depression symptoms among these patients. These data came from Project EDUCATE, an ongoing five-year study designed to be a large-scale, multifocal examination of the needs and experiences of rural FQHC patients with hypertension and/or diabetes. A total of 497 rural FQHC patients completed surveys (including a series of psychosocial questions, the Multigroup Ethnic Identity Measure and the Center for Epidemiologic Studies Depression scale) as part of phase one of the project; 438 of these with complete data are included in the current analytic sample. Results revealed that 53.0% of the sample screened positive for depression, and over half of those who screened positive reported not being able to afford their prescription medications at least once within the past 12 months (51.3% vs. 26.3% non-depressed). Further, even after controlling for age, ethnic identity attachment, sex, education level, employment status, income, insurance status, recent inability to afford needed medical care, hypertensive status, mental health diagnosis, and family history of mental illness, patients who could not afford to fill their prescriptions in the past 12 months were 2.6 times as likely to screen positive for depression (ORADJ = 2.476, p = 0.002) as those who could afford their medications. Overall, results of this study suggest that, among rural patients diagnosed with chronic disease, depressive symptomatology may be alarmingly high and an inability to afford medications may be an important risk factor for depression symptoms. These results highlight the need for increased attention to prescription medication affordability among rural patients with chronic disease in order to reduce the risk of comorbid depression.

The purpose of this study was to compare rates of elevated levels of depression, anxiety, and stress among six different lesbian, gay, bisexual, and transgender (LGBT) subgroups (cisgender lesbians, cisgender gay males, cisgender bisexual females, cisgender bisexual males, transgender females, and transgender males). A total of 2,702 LGBT-identified individuals participated in the online study. While controlling for other demographic factors, rates of elevated levels of depression (p < 0.001), anxiety (p = 0.015), and stress (p < 0.001) all varied significantly between LGBT subgroups. Post-hoc examinations of pairwise differences revealed substantial and unexpected variations, highlighting the importance of separately examining LGBT subgroups when considering mental health outcomes.

The purpose of the current study was to examine rural lesbians’ experiences of psychological distress and barriers to mental healthcare compared with their nonrural counterparts. A geographically diverse sample of 716 lesbians from across the United States participated in an online study. Results revealed that compared with their nonrural counterparts, rural lesbians experience higher levels of psychological distress. In addition, after controlling for age, race, and education level, rural lesbians were also more likely to report the following barriers to needed mental healthcare: (1) a lack of coverage/financial limitations, (2) a limited availability of providers in their area, and (3) avoidance of care due to fears of discrimination/unfair treatment by a provider. Rural lesbians appear to face greater mental health related vulnerabilities. Implications for research and clinical practice are discussed.

Current recruitment strategies to reach lesbian, gay, bisexual, and transgender (LGBT) groups typically yield highly localized, mostly urban samples. Online recruitment strategies hold much promise for engaging rural and other underrepresented LGBT individuals in health research, but little research has been conducted examining the relative strengths of differing online recruitment methods. The purpose of the current study was to explore the effectiveness of both email and Craigslist recruitment to access rural sexual and gender minorities, and to examine if individuals across modalities differ significantly from each other with regards to demographic and psychosocial characteristics. Participants for the study were recruited through two sequentially implemented online convenience sampling recruitment methods: listserv based and Craigslist based. Participants completed an online battery assessing demographic characteristics, disclosure of sexual orientation/gender identity, health behaviors, and various psychosocial characteristics. A total of 3279 LGBT-identified individuals were recruited, 980 through Listservs and 2299 through Craigslist. Participants came from all 50 US states and nearly 30 % reported living in a rural area. When comparing the Listserv and Craigslist recruits, the groups differed on nearly every demographic and psychosocial characteristic assessed, ranging from racial/ethnic diversity to levels of psychological distress. Online recruitment strategies are feasible for accessing both rural and urban LGBT populations, and are highly effective at doing so. These strategies yield samples with remarkable diversity geographically, demographically, and psychosocially. In addition, similar to comparisons between in-person and online recruitment, samples recruited through different online methods significantly differ from each other in demographic and psychosocial characteristics.

The bisexual community may face unique barriers to health care that affect mental health outcomes; however, previous research has not specifically compared bisexual and gay men and women on these factors. This study explored differences between bisexual and gay men and women in barriers to care and psychological distress among a sample of 2,500 bisexual and gay men and women recruited online. Bisexual men and women were more likely to report barriers to care ranging from limited availability of providers to less comfort discussing their sexual orientation with their provider. Differences in specific mental health outcomes centered on sexual orientation, but not gender. Bisexual women reported the highest levels of depression, stress, and anxiety, and bisexual men reported higher levels of anxiety than gay men and gay women. Findings suggest that the sociocultural pressures affecting barriers to care and psychological distress may be disproportionately affecting bisexual individuals, even more so than prev...

Although the majority of lesbians reside in urban areas, lesbian couples significantly outnumber partnered gay men in rural communities and are an important part of the rural demographic landscape. However, being present does not mean lesbians are fully embraced within rural culture. Rural culture i

The goal of the current study was to explore the impact of CRM on Millennials’ overall perceptions of companies and likelihood of purchasing from a company and if this is impacted by the type of product and the donation style used in the campaign. The average number of CRM campaigns accurately identified was low (H1), with 76.2% of the sample identifying half or fewer of the six campaigns correctly and no participants correctly identifying all six. A regression examining the impact of hours spent per week on social media on number of correctly identified CRM campaigns revealed a significant relationship (B = 0.190, F = 4.494, p = 0.030), indicating that for every additional five hours per week spent on social media, an individual can be expected to correctly identify one additional CRM campaign. The most-recognized campaign was TOMS, which has the purest “one-for-one” style of CRM of all the campaigns examined.

Objectives We explored the extent to which discrepancy between motivation for weight loss and exercise is related to obesity among rural patients with chronic disease, and identified the psychosocial correlates of this discrepancy. Methods 497 patients with diabetes and/or hypertension were recruited from a network of Federally Qualified Health Centers in the rural South and completed a battery of assessments. Results Most persons in the sample (83.1%) were overweight and 65.0% were obese. For motivation for change, 70.8% reported being in the Action stage or higher for weight loss, whereas only 24.9% reported being in the Action stage or higher for motivation for exercise. When controlling for age, education level, income, sex, and race/ethnicity, individuals who were motivated for weight loss but not exercise were twice as likely to be obese (p = .005). Race and sex were significantly associated with this discrepancy, with African-American patients 1.7 times as likely (p = .05) and women 2.3 times as likely to be discrepant (p = .001). Conclusions Findings underscore the importance of focusing not simply on weight loss among rural patients with chronic disease, but rather to incorporate specific activities designed to build simultaneous motivation for engaging in exercise.

Introduction Previous research has consistently demonstrated that, in comparison to their cisgender heterosexual counterparts, lesbians face a multitude of women's healthcare-related disparities. However, very little research has been conducted that takes an intersectionality approach to examining the potential influences of rural-urban location on the health-related needs and experiences of lesbians. The purpose of this study was to quantitatively compare rural and urban lesbians' access to women's health care, experiences with women's healthcare providers (WHCPs), and preventive behavior using a large, diverse sample of lesbians from across the USA. Methods A total of 895 (31.1% rural and 68.9% urban) lesbian-identified cisgender women (ie not transgender) from the USA participated in the current online study. As part of a larger parent study, participants were recruited from across the USA through email communication to lesbian, gay, bisexual, and transgender (LGBT)-focused organizations and online advertisements. Participants were asked to complete a series of questions related to their women's healthcare-related experiences and behaviors (ie access to care, experiences with WHCPs, and preventive behavior). A series of χ2 analyses were utilized in order to examine rural-urban differences across dependent variables. Results An examination of sexual risks revealed that relatively more rural lesbians reported at least one previous male sexual partner in comparison to the urban sample of lesbians (78.1% vs 69.1%, χ2(1, N=890)=7.56, p=0.006). A similarly low percentage of rural (42.4%) and urban (42.9%) lesbians reported that they have a WHCP that they see on a regular basis for preventive care. In terms of experiences with WHCP providers, relatively fewer rural lesbians indicated that their current WHCP had discussed/recommended the human papillomavirus (HPV) vaccination in comparison to urban lesbians (27.5% vs. 37.2%; χ2 (1, N=796)=7.24, p=0.007). No other rural-urban differences in experiences with WHCPs emerged - few rural and urban lesbians had been asked about their sexual orientation by their WHCP (38.8% and 45.0%, respectively), been provided with appropriate safe-sex education by their WHCP (21.4% and 25.3%), had their last HIV/sexually transmitted infection screening instigated by their WHCP (if applicable; 15.7% and 19.5%), and reported that their WHCP seems knowledgeable about lesbian health concerns (56.5% vs 54.6%). In terms of preventive behavior, significantly fewer rural lesbians aged 40 years or more had received a mammogram in the past 3 years (63.2% vs 83.2%; χ2(1, N=163)=8.36, p=0.004) when compared to their urban counterparts. No other significant rural-urban differences in preventive behaviors emerged. A similarly low percentage of rural and urban lesbians indicated that they have received the HPV vaccination (22.8% and 29.0%, respectively) and/or have had a HIV/STI screening (43.0% and 47.8%), Pap test (62.0% and 64.5%) or breast exam (59.2% and 62.8%), in the past 3 years. Conclusions The current findings highlight that rural lesbians in the USA, in comparison to urban lesbians, may experience elevated health risks related to being more likely to have at least one previous male sexual partner, less likely to be recommended the HPV vaccination by a WHCP, and, for those 40 or older, less likely to receive routine mammogram screenings. Furthermore, rural lesbians appear to engage in similarly low rates of HPV vaccination and regular HIV/STI screenings, Pap tests, and clinical breast exams as their urban counterparts. Given the increased cervical and breast cancer risks associated with rural living, the current findings underscore the dire need for health promotion efforts aimed at increasing rural lesbians' engagement in routine pelvic and breast exams.

Only a handful of empirical investigations have identified culturally salient markers of suicide risk within samples of African American young adults. To address this gap, our study examined the intercorrelations among cultural congruity, defectiveness schemas, and multiple indices of suicide risk for African American ( n = 207) and European American ( n = 208) students attending a primary White institution. Cultural congruity was negatively associated with reports of interpersonal and behavioral suicide risk for both African and European American students. However, ethnic differences in the magnitude of these relationships emerged. Specifically, as predicted, for African Americans, lower levels of cultural congruity were more strongly related to greater interpersonal factors associated with a desire to die. Finally, the relationships between cultural congruity and multiple indices of suicide risk were partially mediated by defectiveness schemas for both African and European American students, suggesting a useful intervention target for students. These results also have implications for suicide screening, prevention, and intervention strategies directed toward African American students.

The study's goal was to determine if differences in weight misperception by race and/or gender occur within a sample of economically disadvantaged rural patients with diabetes and/or hypertension. Diabetic and hypertensive patients were enrolled in the study from a network of federally qualified health centers (FQHCs) in the rural South. Multivari-ate logistic regression analysis suggests that, even when controlling for age, education level, employment status, and poverty, rural African American patients with chronic disease are more likely than their White counterparts to misperceive their weight status (OR = 1.709, p = .037). This difference in perceived weight occurred despite the absence of an underlying difference in actual weight status between African American and White patients (p = .171). In addition, rural men were much more likely than rural women to misperceive their weight status (OR = 2.688, plt; .001). Implications for intervention development and implementation are discussed.

Optimal management of HIV disease requires high levels of lifelong adherence once a patient initiates highly active antiretroviral therapy (HAART). Because suboptimal adherence to HAART is associated with adverse consequences, many providers are hesitant to prescribe HAART for patients whom they perceive as not being ready to initiate treatment. Accurately predicting HIV treatment readiness is challenging. Despite the importance of this construct, few reliable and valid instruments to assess HIV treatment readiness have been developed; none of these have been validated with adolescents and young adults, who comprise an increasing proportion of new HIV cases diagnosed. As a first step to achieve this goal, we developed the HIV Treatment-Readiness Measure (HTRM) for administration by way of audio computer-assisted self-interview (ACASI) and conducted a study to examine its internal consistency, test-retest reliability, acceptability, and preliminary factor structure. We recruited 201 adolescents and young adults living with HIV from 15 adolescent medicine clinics that were part of the Adolescent Trials Network for HIV Interventions. Youth completed the initial assessment and two weeks later the retest assessment. The refined HTRM had high internal consistency (α = 0.84). Test-retest reliability using both sum scores and mean scores were high. The HTRM was also highly acceptable and feasible to use in routine clinical practice. In exploratory factor analysis we found that a five-factor solution was the best fit; each of the subscales (Disclosure, Psychosocial Issues, Connection with Care, HIV Medication Beliefs, and Alcohol and Drugs) had good to acceptable alphas and eigenvalues greater than 2.0. Our findings support conducting a future study to examine the tool's predictive validity.

Despite continued high HIV risk among Hispanic men who have sex with men (HMSM), culturally tailored, theoretically based interventions have yet to be developed and tested. As a first step toward intervention development, we collected quantitative and qualitative data on sociocultural and psychological factors associated with drug use and risky sex among 566 HMSM recruited from community and Internet venues. Participants reported high rates of drug use (43%), unprotected anal sex (45%), and multiple sex partners (median 4) in the past 6 months. In multivariate analyses, use of drugs was associated with HIV seropositivity, less orientation to the Hispanic community, stronger attachment to the gay community, lower levels of homophobia, higher numbers of sex partners and more unprotected anal sex. The need for acceptance and desire to please partners emerged as core drivers of HIV risk in the qualitative data. Findings were used to guide development of Proyecto SOL, a theoretically grounded intervention that targets core determinants of HIV risk, builds on protective cultural influences, and strengthens positive social connections.

OBJECTIVE: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS: Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS: In the previous 6 months, 44% of the sample engaged in UAI, and 41% used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSIONS: Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.

OBJECTIVE: The goal of this study is to describe the sexual practices, drug use behaviors, psychosocial factors, and predictors of unprotected anal intercourse (UAI) in a sample of Hispanic men who have sex with men (MSM) born in Latin American and Caribbean (LAC) countries who currently reside in Miami-Dade County, Florida. METHODS: Hispanic MSM (N = 566) recruited from community and Internet venues completed a computer-assisted self-interview assessing sociodemographic factors, drug use, sexual behaviors, and psychosocial factors. We focused on the 470 men who were born in LAC countries, including Puerto Rico. We first examined separately, by country of origin, the sexual practices, drug use behaviors, and psychosocial factors of the sample. We then collapsed the groups and examined the factors associated with UAI in the previous 6 months for the entire sample of Hispanic MSM from LAC countries. RESULTS: In the previous 6 months, 44% of the sample engaged in UAI, and 41% used club drugs. At the multivariate level, psychological distress, higher number of sexual partners, club drug use, HIV-positive status at the time of immigration, and greater orientation to American culture were significantly associated with UAI in the previous 6 months. CONCLUSIONS: Many MSM born in LAC countries engage in HIV-related risk behaviors in the AIDS epicenter of Miami-Dade County, Florida. Culturally appropriate interventions should address these risk behaviors in this underserved population.OBJETIVO: Describir las prácticas sexuales, el consumo de drogas y los factores psicosociales y de predicción del coito anal sin protección (CASP), en una muestra de hombres nacidos en América Latina y el Caribe (ALC) residentes actualmente en el Condado de Miami-Dade, Florida, que tienen sexo con hombres. MÉTODOS: En total, 566 hispanos que tienen sexo con hombres (HSH), captados en la comunidad y sitios de Internet, completaron una encuesta autoaplicada por computadora que abordaba los factores socioeconómicos, el consumo de drogas, el comportamiento sexual y los factores psicológicos. El estudio se centró en 470 hombres nacidos en ALC, incluido Puerto Rico. La muestra se analizó por país de origen, prácticas sexuales, consumo de drogas y factores psicológicos. Luego se unieron los grupos y se analizaron los factores asociados con el CASP en los 6 meses previos en toda la muestra. RESULTADOS: En los 6 meses previos, 44% de la muestra tuvo CASP y 41% consumió drogas de las llamadas recreativas. Según el análisis multifactorial, los factores asociados significativamente con el CASP en los 6 meses previos fueron: los problemas psicológicos, el mayor número de parejas sexuales, el consumo de drogas recreacionales, la positividad al VIH en el momento en que inmigró y el mayor grado de orientación hacia la cultura estadounidense. CONCLUSIONES: Muchos HSH nacidos en ALC incurren en comportamientos de riesgo de infección por el VIH en el epicentro de sida del Condado de Miami-Dade, Florida. Se deben aplicar intervenciones culturalmente apropiadas para combatir estos comportamientos de riesgo en la población marginada estudiada.

Objectives: To examine the relationship between race/ethnicity and motivation for weight loss and motivation for exercise among patients with chronic disease.Design: Cross-sectionalSetting: The current study took place within a network of federally qualified health centers (FQHCs) in the rural southern United StatesPatients or Participants: 463 active FQHC patients with diabetes and/or hypertension identifying as African American, White Hispanic, or non-Hispanic White participated in the current study.Main Outcome Measures: Primary outcomes were assessed using standardized measures of motivation for a) weight loss; and b) hypertension per the Transtheoretical ModelResults: Multivariate logistic regression revealed that, when controlling for age, sex, education status, employment status, poverty, comorbidity, and weight status, there were no significant differences in motivation for exercise among the different racial/ethnic groups (P=.361). However, when controlling for the same factors, there was a significant difference in motivation for weight loss, with African American participants more than twice as likely as non-Hispanic White participants to be motivated to lose weight (ORAD)=2.430, P=.002).Conclusions: Our study suggests that, among rural patients with obesity-related chronic disease, there is a significant variation in motivation to lose weight between racial/ethnic groups. This underscores the importance of culturally tailoring interventions and in considering motivation for change when promoting weight loss behaviors. Additional implications for intervention development and delivery are discussed. Ethn Dis. 2016;26(1):77-84; doi: 10.18865/ed.26.1.77

Rural and minority women are disproportionately impacted by the obesity epidemic; however, little research has studied the intersection of these disparity groups. The purpose of this study was to examine the influence of racial identity on motivation for weight loss and exercise among rural, African-American women with an obesity-linked chronic disease. A total of 154 African-American women were recruited from the patient population of a Federally Qualified Health Center in the rural South to complete a questionnaire battery including the Multigroup Ethnic Identity Measure and separate assessments of motivation for weight loss and exercise. Multivariate analyses, controlling for age, education status, insurance status, and body mass index revealed that attachment to ethnic identity was predictive of motivation for exercise but not for weight loss. Our findings suggest that attachment to ethnic identity may be an important factor in motivation for change among African-American women, particularly with respect to exercise, with direct implications for the development of culturally and geographically tailored weight loss interventions.

Despite the recognized need for culturally tailored HIV prevention interventions for gay, bisexual, and questioning youth, few studies have examined if predictors of unprotected sex vary for youth from different ethnic groups. This study reports on a sample of 189 gay, bisexual, and questioning youth (age 15–22) from three racial/ethnic backgrounds (African American, Hispanic, and White) recruited in Chicago, IL and Miami-Dade and Broward Counties, Florida. For African American youth, being in a long-term relationship, having been kicked out of the home for having sex with men, and younger age at initiation of sexual behavior were associated with unprotected sex. For Hispanic youth, higher ethnic identification and older age at initiation of sexual behavior were associated with unprotected sex. For White youth, no predictors were associated with unprotected sex. Our findings point to the importance of understanding the varying predictors of unprotected sex and integrating them into tailored prevention interventions.

Objectives To determine whether use of crystal methamphetamine increases HIV risk behaviors beyond the risk associated with use of other recreational drugs among Hispanic men who have sex with men (HMSM). Design We compared the sexual behaviors and psychosocial characteristics of non-recreational drug users (non-users), recreational drug users who did not use crystal (non-crystal drug users), and recreational drug users who used crystal (crystal users). Methods We recruited 294 HMSM from Internet and 272 from community venues. Eligible men completed an ACASI to assess socio-demographic factors, drug use, sexual behaviors and psychosocial factors and received $50. Results In the multivariate model, crystal users were more likely than non-crystal drug users to have lower Hispanicism, higher attachment to the gay community, and history of suicide attempts. Crystal users were not significantly different from non-crystal drug users in number of sex partners; however, differences in unprotected receptive anal sex approached significance. Conclusions The additional risk of crystal above that of other recreational drugs needs to be disentangled from those associated with poly-drug use. Our data suggest that it may depend on how one defines risky sexual behavior and is influenced by psychological, physiologic and social factors.