Research Spotlights: August 2018

research spotlight

mHealth intervention increases HIV medication adherence and reduces HIV transmission risk

Behavioral interventions increase adherence to combination antiretroviral therapies (cART) and reduce HIV viral load, but require resource-intensive in-person sessions. In a recently published study funded by NIDA and NIAID, researchers adapted this intervention to an mHealth platform to provide more flexibility and reach.

Men (n = 383) and women (n = 117) living with HIV in Atlanta, Georgia, were randomized either to the mHealth behavioral intervention to enhance HIV treatment as prevention (B-TasP) or a general health control intervention. B-TasP was modeled after an existing CDC program based on cognitive-behavioral skill building and improving access to care. Over one year, data on HIV RNA viral load, cART adherence, indicators of genital tract inflammation (GTI), and sexual behavior were collected. Except for one in-person session, interventions were delivered by cell phone.

Subjects in the B-TasP intervention group had significantly lower HIV RNA with a reduction of 2917 copies/mL in B-TasP group compared to 60 copies/mL in the comparison group. B-TasP interventions also resulted in greater cART adherence and fewer instances of GTI. Lower rates of substance use in sexual contexts were reported but unprotected sex increased, possibly due to belief that cART reduces HIV transmission risk. Intervention effects were most pronounced for individuals who were not viral suppressed at baseline. This study demonstrates the effectiveness of mHealth interventions in reducing HIV transmission with greater reach and scalability than in-person interventions.

Kalichman SC, Cherry C, Kalichman MO, Eaton LA, Kohler JJ, Montero C, Schinazi RF. 2018. Mobile health intervention to reduce HIV transmission: A randomized trial of behaviorally enhanced HIV treatment as prevention (B-TasP). J Acquir Immune Defic Syndr 78(1):34-42.

Quality sleep during childhood predicts resilience in young adults

Children of alcoholics (COAs) are more likely to develop alcohol use disorder and have behavioral problems, but in those who do not, what contributes to resilience? This was the focus of a recently funded NIAAA study that considered how quality sleep in COAs is related to behavioral control in adolescents and resilience in emerging adulthood.

In a prospective, longitudinal design, 715 Caucasian COAs and matched controls were assessed at eight timepoints from early childhood to adolescence to young adulthood. Sleep rhythmicity at ages 3–5 and behavioral control at ages 9–17 were measured through maternal report and interviewer ratings. Resilience at ages 21–26 was defined by absence of alcohol disorder diagnoses, absence of alcohol and drug related problems, and measures of depressive symptoms, work satisfaction, and relationship satisfaction.

Greater rhythmicity of sleep, including less trouble sleeping and less tiredness, predicted behavioral control in adolescents which subsequently predicted resilience in young adulthood. This was true for both COAs and controls. The findings provide preliminary evidence for the relationship between good sleep, self-regulation, and resilience and suggest that sleep quality in childhood may serve as biomarker for resilience in later life.

Wong MM, Puttler LI, Nigg JT, Zucker RA. 2018. Sleep and behavioral control in earlier life predicted resilience in young adulthood: A prospective study of children of alcoholics and controls. Addict Behav 82:65-71.

Aversive reactions to photo warnings on cigarette packs increase quit attempts

Pictorial warnings on cigarette packs lead to more quit attempts by smokers than text-only warnings, but the reasons for this difference are unclear. In a recent study funded by NCI and NIEHS, researchers sought to identify psychological mechanisms that explain the increased quit attempts seen with pictorial warnings.

The study included 2,149 adult smokers from California and North Carolina randomly assigned to receive picture warnings or text-only warnings on cigarette packs for 4 weeks. Baseline and weekly surveys throughout the study collected information on smoker’s attention and reaction to warnings, social interactions, attitudes and beliefs, intentions to quit, and perceived effectiveness of warnings. Outcomes included number of quit attempts.

Results indicate that compared to text-based warning, pictorial warnings increase attention and reaction to warnings, and increase social interactions about warnings. The pictorial warning led to greater avoidance of the warnings, but this also led to more quit attempts. Contrary to previous hypotheses, pictorial warnings had minimal effect on changing beliefs or attitudes and no effect on changing risk perception compared to text-based warnings.

Pictorial warnings appear to increase quit attempts by provoking negative emotional reactions which makes the message more salient in smokers’ minds. Based on these findings, the researchers propose a model for pictorial warnings that target attention, negative affect, social interactions, motivation, and recurring thoughts about warnings.

Brewer NT, Parada H Jr, Hall MG, Boynton MH, Noar SM, Ribisl KM. 2018. Understanding why pictorial cigarette pack warnings increase quit attempts. Ann Behav Med.