Papers by Kristi E Gamarel
Ageing International, 2013
This study examined the role of psychological well-being in promoting consistent condom use among... more This study examined the role of psychological well-being in promoting consistent condom use among a sample of HIV-positive adults ages 50 and older living in New York City. Data were drawn from the Research on Older Adults with HIV (ROAH) project, and 328 sexually active participants (ages 50 to 78) were included in this cross-sectional analysis. Participants completed the Ryff Scales of Psychological Well-being (Ryff Journal of Personality and Social Psychology 57 (6): [1069][1070][1071][1072][1073][1074][1075][1076][1077][1078][1079][1080][1081] 1989) and a detailed measure of sexual behavior in the past 90 days. Separate regression models were constructed by gender and sexual orientation (i.e., gay/bisexual men, straight men, and women). Psychological well-being was positively associated with sustained prevention practice, i.e. consistent condom use during every act of anal or vaginal sex. The effects of psychological well-being were observed over and above those associated with alcohol and drug use or disease severity (i.e. presence of an AIDS diagnosis). Unique dimensions of psychological well-being were associated with protected sex practice for each of the three gender/ sexual orientation cohorts. This study is among the first to identify associations Ageing Int
Journal of sex research, Jan 19, 2015
Men who have sex with men (MSM) frequently consume sexually explicit online media (SEOM), yet lit... more Men who have sex with men (MSM) frequently consume sexually explicit online media (SEOM), yet little is known about its influence on their sexual behaviors. We describe a sequence of four studies to develop and psychometrically validate a measure of the perceived influence of sexually explicit online media (PI-SEOM) on the sexual behaviors of MSM. Study 1 involved qualitative interviews (N = 28) and a quantitative survey (N = 100) to develop a preliminary measure. Using an Internet sample of MSM (N = 1,170), we assessed its factor structure and reliability in Studies 2 and 3 as well as convergent validity and associations with HIV-related sexual risk in Study 4. Based on findings the measure was divided into two subscales: influences on (1) self and (2) other MSM. Factor analyses confirmed a two-factor model for each subscale, measuring perceived influences on (a) general sexual scripts and (b) condomless sex scripts. Survey results indicated that the more men perceived SEOM influen...
Addictive Behaviors, 2015
Sexual minority women (SMW) are at greater risk for alcohol use disorders (AUDs) compared to hete... more Sexual minority women (SMW) are at greater risk for alcohol use disorders (AUDs) compared to heterosexual women. However, there is a dearth of research on sexual orientation disparities in co-occurring disorders among women with AUDs. We examined disparities in lifetime co-occurring psychiatric and drug use disorders among a nationally representative sample of women with lifetime AUDs. Data were analyzed from the 2004-2005 (Wave 2) of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which was collected in structured diagnostic face-to-face interviews. Adult women with AUDs (N=4342) were included in the analyses and approximately 191 of those women self-identified as SMW. Lifetime alcohol and drug use disorders and psychiatric disorders were assessed using DSM-IV criteria. We conducted multivariate logistic regression analyses to compare SMW and heterosexual women with lifetime AUDs on lifetime psychiatric disorders and drug use disorders, while adjusting for sociodemographic variables. While accounting for several covariates, SMW with lifetime AUDs were more likely than heterosexual women with lifetime AUDs to have lifetime psychiatric disorders (e.g., mood, anxiety, panic disorders) and drug use disorders (e.g., prescription drugs, cannabis use disorders). Sexual minority women with lifetime alcohol use disorders are at heightened risk for co-occurring psychiatric and drug use disorders than heterosexual women with lifetime alcohol use disorders. The findings warrant the need for more research and empirically based interventions for the comprehensive treatment and prevention of alcohol use disorders among sexual minority women.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 16, 2015
Research has demonstrated associations between reports of minority stressors and smoking behavior... more Research has demonstrated associations between reports of minority stressors and smoking behaviors among lesbian, gay, and bisexual (LGB) populations; however, little is known about how minority stressors are related to smoking behaviors and cessation attempts among transgender women. The purpose of this study was two-fold: 1) to examine the associations between transgender-based discrimination and smoking patterns among a sample of transgender women; and 2) to identify barriers to smoking cessation in a sample of transgender women with a history of smoking. A community sample of 241 transgender women completed a one-time survey. Binary and multinomial logistic regression models examined associations between minority stressors and (1) smoking behaviors; (2) cessation attempts. Both models adjusted for income, education, race/ethnicity, recent sex work, HIV status, depression, alcohol use, and current hormone use. Overall, 83% of participants indicating that they had smoked a cigaret...
Health Psychology, 2014
Objective: In the U.S., young men who have sex with men (YMSM) are disproportionately affected by... more Objective: In the U.S., young men who have sex with men (YMSM) are disproportionately affected by HIV, with YMSM of color being the most impacted by the epidemic. Method: To advance prevention research, we examined race-based differences in gay-related stress in conjunction with the moderating role of mental health on substance use and sexual risk among 206 high-risk YMSM, recruited September, 2007-2010. Results: Negative binomial regressions and 3-way interaction graphs indicated that psychological distress and acute gay-related stigma placed all participants at most risk for HIV acquisition. Low psychological distress appeared to "buffer" all YMSM against HIV risk, whereas the reverse was evidenced for those reporting low gay-related stigma and psychological distress. YMSM of color reported more risk behavior, and less decreases in risk with attenuated psychological distress, compared with White YMSM. We hypothesize these trends to be associated with experiencing multiple stigmatized identities, indicating points of intervention for YMSM of color to achieve positive identity integration. There were sharper increases in HIV risk behavior for White YMSM with increasing gay-related stigma than for YMSM of color, which could be attributed to the latter's prolonged exposure to discrimination necessitating building coping skills to manage the influx of adversity. Conclusions: Emphases on: (a) identity-based interventions for YMSM of color; and (b) skills-based interventions for White YMSM should supplement existing successful HIV risk-reduction programs. Lastly, mental health needs to be a target of intervention, as it constitutes a protective factor against HIV risk for all YMSM. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
American Journal of Orthopsychiatry, 2014
This study investigated and applied a compensatory model of risk and resilience to differences in... more This study investigated and applied a compensatory model of risk and resilience to differences in past-year nonsuicidal self-injury (NSSI) and suicide attempts by sexual orientation using representative data from the 2007 Massachusetts Youth Risk Behavior Survey (n = 3,131). Self-identified lesbian, gay, bisexual, and questioning (LGBQ) adolescents comprised 7% of the sample, but accounted for 67% of NSSI and 80% of suicide attempts. Compared with heterosexuals, LGBQ adolescents had an increased odds of NSSI (adjusted Odds Ratio (aOR) = 2.76; 95% Confidence Interval (CI) [2.00, 3.81] and suicide attempts (aOR = 2.73; 95% CI [1.47, 5.08]. NSSI was highly associated with suicidality (aOR = 10.87; 95% CI [6.17, 19.18]. Family support was independently associated with a decreased odds of both NSSI (aOR = 0.56; 95% CI [0.35, 0.89] and suicidality (aOR = 0.48; 95% CI [0.29, 0.79] supporting a compensatory model of resilience. Screening and preventive interventions for LGBQ adolescents are warranted, including at the family level. Sexual orientation should be included as a standard demographic to monitor health disparities.
Journal of Family Psychology, 2014
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2014
Couples' adopting a relational orientation -when partners regard themselves as a collective uniti... more Couples' adopting a relational orientation -when partners regard themselves as a collective unitis associated with optimal health. HIV-positive men and their HIV-negative partners (N = 116 serodiscordant male couples) were surveyed. Logistic regression showed greater relational orientations of HIV-positive (aOR=7.87; 95% CI = 1.63, 38.05) and HIV-negative partners (aOR=6.16; 95% CI: 1.43, 26.59) and HIV-positive partners' higher income (aOR=2.95; 95% CI = 1.13, 7.70) and lower depression (aOR=0.39; 95% CI = 0.15, 0.97) were associated with viral suppression with no evidence of mediation by adherence. Incorporating relationship dynamics into biomedical strategies is a promising avenue for research and intervention.
AIDS and Behavior, 2013
This study describes the results of an online social support intervention, called &am... more This study describes the results of an online social support intervention, called "Thrive with Me" (TWM), to improve antiretroviral therapy (ART) adherence. HIV-positive gay or bisexually-identified men self-reporting imperfect ART adherence in the past month were randomized to receive usual care (n = 57) or the eight-week TWM intervention (n = 67). Self-reported ART outcome measures (0-100 % in the past month) were collected at baseline, post-intervention, and 1-month follow-up. Follow-up assessment completion rate was 90%. Participants rated (1-7 scale) the intervention high in information and system quality and overall satisfaction (Means ≥ 5.0). The intervention showed modest effects for the overall sample. However, among current drug-using participants, the TWM (vs. Control) group reported significantly higher overall ART adherence (90.1 vs. 57.5% at follow-up; difference = 31.1, p = 0.02) and ART taken correctly with food (81.6 vs. 55.7% at follow-up; difference = 47.9, p = 0.01). The TWM intervention appeared feasible to implement, acceptable to users, and demonstrated greatest benefits for current drug users.
ABSTRACT Abstract Purpose: Transgender and gender non-conforming (TGNC) individuals face high lev... more ABSTRACT Abstract Purpose: Transgender and gender non-conforming (TGNC) individuals face high levels of discrimination and mistreatment, including within social and medical service settings, which may lead to negative health and psychosocial sequelae. Given the many barriers to competent care, we sought to determine points of intervention by assessing the current needs, satisfaction, and health care utilization of TGNC individuals in New York City as reported by TGNC individuals. Methods: In January 2013, fifty TGNC individuals were recruited via flyers and direct referrals from healthcare professionals within community spaces and pertinent venues. We administered a brief survey and conducted four focus groups exploring participants' health care utilization and perceived barriers to care, routine care, hormone and silicone use, and recommendations for improving transgender services. Results: Participants were 18- to 64-years-old, racially/ethnically diverse, and the majority were medically insured, underwent routine health care in the last year, and received an HIV test in their lifetime. A significant proportion reported taking hormones prescribed by a medical provider and were in the care of knowledgeable providers. Participants perceived four areas where barriers persisted: utilization of preventive services, access to transition-related procedures, access to legal assistance, and inclusion of TGNC individuals in public health education and campaigns. Conclusions: Structural interventions are needed, such as comprehensive provider training programs for all level staff to better serve the needs of TGNC individuals, increase service utilization and improve wellbeing, while effecting lasting institutional change. Service provision establishments should hire more TGNC staff and integrate transgender care into existing practices.
Annals of Behavioral Medicine, 2014
Journal of Acquired Immune Deficiency Syndromes, 2015
Journal of Health Psychology, 2015
Nicotine and Tobacco Research, 2015
Drug and Alcohol Dependence, 2015
Emerging evidence indicates multiple health risks associated with harmful alcohol use among sexua... more Emerging evidence indicates multiple health risks associated with harmful alcohol use among sexual minority men in the United States. In particular, sexual minority men with alcohol use disorders (AUD) might have greater co-occurring health problems compared with heterosexual men. We used nationally representative data to compare the prevalence of diagnostic co-occurring psychiatric disorders and drug use disorders (DUD) among sexual minority men with AUD compared with heterosexual males with a lifetime AUD diagnosis. We analyzed data from 6899 adult males with AUD participating in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Using weighted multivariable logistic regression models, we compared the odds of lifetime diagnosis of mood disorders, anxiety disorders, and drug use disorders in sexual minority and heterosexual adult males with AUD. Of participants included in this analysis, 176 (2.6%) self-identified as a sexual minority. In adjusted analyses, sexual minority men with AUD were more likely than heterosexual men with AUD to have any mood disorder (including major depressive episode), any anxiety disorder (including panic disorder without agoraphobia, specific phobia, posttraumatic stress disorder, and generalized anxiety disorder), and lifetime DUD. The elevated co-occurrence of psychiatric disorders and DUD among sexual minority men with AUD suggests that future research is warranted. A better understanding of the etiology of diagnostic co-occurring mental health and substance use disorders among sexual minority men is needed in order to develop effective integrated prevention and treatment programs.
Dyadic effects of gender minority stressors in substance use behaviors among transgender women and their non-transgender male partners., 2014
Despite evidence that interpersonal processes shape health behaviors, research concerning the dya... more Despite evidence that interpersonal processes shape health behaviors, research concerning the dyadic effects of gender minority stressors on substance use behaviors of transgender people has been scarce. The objective of this study was to use dyadic analysis to examine whether transgender discrimination is associated with substance use among transgender women and their male partners. Transgender women and their male partners (N ϭ 191 couples, N ϭ 382 individuals) completed questionnaires. Participants' mean age was 37.1 years; 79.1% were racial or ethnic minorities; 61.3% earned less than $500 per month. The mean relationship duration was 37.9 months. Actor-partner interdependence models were used to examine the associations between transgender-related discrimination and past 30-day nonmarijuana illicit drug use, adjusting for age, relationship length, financial hardship, and depressive distress among partners in these dyads. Illicit drug use was reported by 31.4% of transgender women and 25.1% of their male partners. Perceived transgender discrimination was independently associated with increased odds of illicit drug use for transgender women (actor effect), but not for their male partners. Financial hardship statistically predicted drug use for both partners (actor effects). There were no partner effects for financial hardship on drug use. Overall, 34.5% of dyads had discrepant substance use. Discrimination scores of male partners differentiated dyads who reported discrepant substance use. Gender minority stressors are critical to understanding substance use among transgender women and their male partners. Integrating socioeconomic status into gender minority stress frameworks is essential. Results have implications for substance use prevention and treatment, including the need to incorporate gender minority stressors into interventions.
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Papers by Kristi E Gamarel