Although the health of young Black men who have sex with men (YBMSM) is typically discussed in terms of HIV, they are significantly affected by depression. The present study explored protective and risk pathways to depressive symptoms among YBMSM within a social-ecological framework. A cross-sectional sample of 1,817 YBMSM in two large, southern cities in the United States completed a survey of sociodemographic characteristics as well as individual (e.g., resilience, internalized heterosexism) and contextual (e.g., peer social support, experiences of racism) factors. In cross-sectional analyses, structural equation modeling was used to examine whether there were indirect associations between contextual factors and depressive symptomology that were mediated by individual factors. Higher peer social support was associated with lower depressive symptoms via greater resilience; there was no direct association between peer social support and depressive symptoms when controlling for this indirect association. Additionally, there were indirect associations between several contextual risk factors and higher depressive symptoms via perceived HIV-related stigma and internalized heterosexism; some direct associations between contextual risk factors and higher depressive symptoms were significant when controlling for these indirect associations. Despite a number of risk factors for depression for YBMSM, resilience is a key protective factor that may play a critical role in the beneficial effects of peer social support. Broadly, findings suggest that public health efforts must continue to build upon and leverage YBMSM's community-based strengths in the service of improving their mental health and, indirectly, their physical health.
Objective To provide the first data which evaluates an HIV risk reduction intervention designed to reduce HIV high-risk sexual behavior in African-American homosexual and bisexual men. Subjects Participants (n = 318) were recruited from bars, bathhouses, and erotic bookstores, and through homosexual African-American organizations, street outreach, media advertisements, and personal referrals of individuals aware of the study. Methods Participants were randomized into a single or triple session experimental group or a wait-list control group. Both experimental interventions included AIDS risk education, cognitive-behavioral self-management training, assertion training, and attempts to develop self-identity and social support. Data collection involved assessments of self-reported changes in sexual behavior at 12− and 18-month follow-up. Results Participants in the triple session intervention greatly reduced their frequency of unprotected anal intercourse (from 46 to 20%) at the 12-month follow-up evaluation and (from 45% to 20%) at the 18-month follow-up evaluation. However, levels of risky behavior for the control group remained constant (from 26 to 23% and from 24 to 18%) at 12− and 18-month follow-up evaluations, respectively. In addition, levels of risky behavior for the single session intervention decreased only slightly (from 47 to 38% and from 50 to 38%) at the 12− and 18-month follow-up evaluations, respectively. Conclusions Results were interpreted to demonstrate the superiority of a triple session over a single session intervention in reducing risky sexual behavior in this cohort.
PrEP willingness may be different among black and white men who have sex with men (MSM) given known disparities in HIV incidence, sociodemographic factors, and healthcare access between these groups. We surveyed 482 black and white HIV-negative MSM in Atlanta, GA about their willingness to use pre-exposure prophylaxis (PrEP) and facilitators and barriers to PrEP willingness. Overall, 45% (215/482) of men indicated interest in using PrEP. Engaging in recent unprotected anal intercourse (UAI) was the only factor significantly associated with PrEP willingness in multivariate analyses (OR 1.73, 95% CI 1.13, 2.65). Willing men identified “extra protection” against HIV as the most common reason for interest in using PrEP, whereas unwilling men most commonly cited not wanting to take medication daily, and this reason was more common among white MSM (42.3% of white MSM vs. 28.9% of black MSM, p = 0.04). Most men indicated willingness to use PrEP if cost was <50 dollars/month; however, more black MSM indicated wil...
Depression in adolescence and adulthood is common, afflicting up to 20 percent of these populations. It represents a significant public health concern and is associated with considerable suffering and functional impairment. Adolescent-onset depression tends to be a particularly malignant and recalcitrant condition, increasing the likelihood of recurrence and chronicity in adulthood. Clinical presentations for various medical and psychiatric conditions, as well as reactions to psychosocial stressors, can mimic or confound the picture of depression in adolescents. Therefore, careful assessment and differential diagnosis is essential. Effective treatments, both pharmacological and psychosocial in nature, exist, and so early detection and intervention is paramount. This article presents an overview of optimal prevention, assessment, and clinical decision-making strategies for managing depression in adolescents.
The stapedial muscle reflex was investigated in a group of normal and sensorineural ears. Pure tones of 250, 500, 1 000, 2 000, and 4 000 Hz, 600 Hz bandwidth narrow-band noise centered at 500, 1 000, 2 000, and 4 000 Hz and modified wide-band noise were utilized as reflex producing stimuli. All stimuli were presented through either of 2 prototype reflex-indicator systems generating probe tones of 625 and 800 Hz developed in the Audiology Department of Sahlgren's Hospital, or a Madsen ZO-70 electro-acoustic impedance meter generating a probe tone of 220 Hz. Reflex thresholds for pure tones and noise stimuli were determined with the prototype system delivering a probe tone of 800 Hz for normal and sensorineural ears. the average reflex threshold for pure tone stimuli approximated 85 dB hearing level for normal ears and 86 dB for the ears showing a sensorineural hearing loss. No differences were found for an ascending or descending approah to threshold or by measuring reflex response for changes in amplitude or amplitude phase. The hearing level limits for normal reflex response found in this study for pure tones between 250 and 4 000 Hz ranged from a lower limit of 75 dB to an upper limit of 95 dB. Comparison of reflex thresholds for 500 and 4 000 Hz for the 3 reflex-indicator systems resulted in most sensitive thresholds for the 220 Hz probe tone system (82.5 dB) and least sensitive thresholds for the 625 Hz probe tone system (88.0 dB). Narrowband and white noise stimuli produced reflex thresholds approximately 15 dB more sensitive than for pure tones. As was true for pure tones, aspproaching threshold from above or below, or measuring reflex response as change in amplitude or amplitude phase showed no difference. Altered middle ear pressure by Valsalva and Toynbee maneuvers in normal ears elevated reflex thresholds as much as 20 dB for pressure changes exceeding ±50 mm water pressure. Studies of reflex growth for pure tone stimuli increasing or decreasing in intensity shows a steeper response pattern for normal ears than those with sensorineural hearing loss and more shallow response for both grops at 4 000 Hz than for lower frequencies. An abnormally flat reflex growth rate may be of diagnostic significance.
