Disruptions in diet are common during stressful times. Similar to the present study, a study of Belgian university students found students with more stress and less physical activity were at greatest risk for increased snacking during a stressful final exam period . COVID-19 SIP is a more widespread, disruptive, long-term stressful circumstance than a final exam period, yet similar results were found. Sleep disruptions have also been linked to stress during COVID-19 self-isolation . Indeed, in the current study, participants who managed stress by eating more, sleeping more, or watching TV/movies were more likely to report increased stress. Eating, sleeping, and watching TV/movies may have been used to manage stress by participants who were already experiencing a great deal of stress. These activities require less energy to initiate than the more active strategies and may have felt more manageable. Concurrently, these less active strategies may have been less effective than strategies involving physical activity. Participants who coped with stress using PA or reading were less likely to report increased stress. Making PA—especially outdoor PA— more accessible during COVID-19 SIP may help ease stress. Recent changes in SIP policies in the San Francisco Bay Area have opened up local parks and activity areas . Overall level of PA during SIP, rather than change in PA, was associated with stress. Specifically, participants who became active or became less active during SIP did not significantly differ in likelihood of increased stress from those who were active throughout SIP. On the other hand, those who were less active both before and during SIP were more likely to experience increased stress.
Low physical activity may be associated with other risk factors for stress,mobile vertical rack such as long work hours, that persisted during SIP.Other research has found that improvement in stress management over time is associated with increases in PA . As people adjust to COVID-19 and its associated restrictions, stress management and PA may improve. Although PA remained fairly consistent over the one-month study period , the proportion of participants reporting increased stress during SIP decreased substantially . Engaging in PA throughout SIP may further decrease stress. Stress management is crucial during COVID-19, as stress can increase susceptibility to viral infection . This study was observational and precludes causal conclusions about the role of PA in reducing stress. Analyses adjusted for numerous potential confounding factors; however, analyses were correlational. Generalizability of results is limited due to the non-representative sample. Most participants resided in Northern California, where the weather is generally conducive to outdoor PA year-round. The sample was predominantly middle-aged, female, White or Asian, and highly educated, with high household incomes. Although PA has near universal benefits, disparities in the ability to engage in PA during COVID-19 are likely. To our knowledge, such disparities have not yet been studied. Future research is needed to examine the role of PA in COVID-19 stress management among more socio-demographically and geographically diverse populations. Participants were surveyed at the beginning of SIP and one month into SIP. Longer follow-up may show different patterns of results. The measure of stress used in this study was designed to capture changes in stress specific to SIP in a single item, with high face validity. Validated measures of stress, while less specific to SIP, should be used in future longitudinal research to expand upon the present study.
Substance use among women living with HIV is a major public health concern that is both an independent and aggravating risk factor for HIV transmission . Although fewer women than men use drugs, women are more likely to experience detrimental health effects from drug use, and may become addicted to substances more quickly . Compared with men, women may have unique reasons for initiating drug use, including the use of substances to lose weight, to cope with anxiety and exhaustion, and to deal with higher rates of chronic pain that has been treated with prescription drugs . In one study, 37% of WLHIV had substance-use problems, which was significantly higher than men . Substance use increases the risk of HIV infection while diminishing the ability of PLHIV to adhere to their medications and self-manage their illness . However, few investigations have examined substance use among WLHIV. Illicit substance use negatively affects HIV self-management tasks, including HIV medication adherence and initiation and retention in HIV primary care . Recently, data from the Women’s Interagency HIV Study reinforced that women who use illicit substances encounter sub-optimal medication adherence, despite simplification of HIV drug regimens . Social capital is the aggregation of potential resources, linked to a durable network of relationships of mutual acquaintance or recognition. While debated , components of social capital include reciprocity, trust, safety, social agency, social networks, value of life, and employment connections . Research on social capital and HIV has predominantly focused on preventing HIV transmission with increased social capital being associated with decreased HIV transmission . High social capital was the strongest predictor of HIV self-management in WLHIV and specifically on HIV medication adherence . Social capital has also been negatively associated with substance use among youth and African Americans . Discrimination was associated with illicit drug use in African American women, and aspects of social capital protected women against its effects . However, in rural Appalachia, illicit drug use was associated with greater social capital , highlighting the need to carefully assess social capital and its relationship to substance use behaviors. Given that most examinations of social capital among PLHIV are quantitative and cross sectional, there is a need to gather more qualitative and mixed methods data to better understand its relationship to health outcomes .
We conducted a 6-month, mixed methods longitudinal study with 29 WLHIV who were either current or previous illicit substance users. The use of a concurrent mixed methods longitudional design was necessary because while numerous studies document a relationship between social capital and HIV health outcomes , little is known about how the dimensions of social capital are developed and used to improve those outcomes over time. Integrating concurrent qualitative and quantitative data to examine social capital in this population will allow a more in-depth understanding of how social capital influences HIV self-management and substance use patterns among WLHIV. Social capital cannot be fully captured by psychometric scales, but by integrating qualitative data with quantive measures, we can more comprehensively describe its dimensions.To be included in this study, eligible participants had to be biologically female at birth, adult , diagnosed with HIV , and currently prescribed HIV antiretroviral therapy medication. Potential participants were excluded if they were either unable to understand spoken English or if they had plans to move out of the area in the next 12 months. This descriptive study was designed as a pilot study to examine whether and how social capital influences HIV self-management in this population,cannabis grow tray and if a relationship was observed, we planned to conduct future, fully powered studies to examine these relationships across multiple sites. As such, our anticipated sample size was approximately 40 WLHIV at a single site.Potential subjects were from an existing HIV-research registry of approximately 300 adults living with HIV in Northeast Ohio. All registry participants had contacted the study team about previous research opportunities and had given written consent to be included in the registry. All women in the registry were sent an institutional review board -approved letter explaining the study and asking them to contact the study team via telephone if they were interested in participating. Those who responded were screened via telephone for illicit drug use using the Drug Abuse Screening Test-10 . Subjects scoring > 1 were included in the current illicit drug use strata, and those scoring a 0 were included in the not using illicit drugs strata. If we found out during the qualitative interview that the participant has used illicit substances within the past 12 months, she was given a DAST score > 1 regardless of the screening form or the surveys. If a woman met eligibility criteria, she was scheduled for a research visit. At the first research visit, a research assistant explained the study and obtained written informed consent. Next, she completed a battery of surveys in REDCap and an open-ended social capital interview. Interviews were guided by a semi-structured interview guide and audio-recorded. Quantitative surveys were completed prior to interviews to introduce the concepts that were to be discussed and to standardize the data collection. At the conclusion of the visit, participants were compensated with $20 cash for their time and travel. Data were collected between July 2015 and June 2016. All procedures were approved by the Institutional Review Board at the Medical Center.To quantitatively describe how social capital influences HIV self-management and substance use patterns over time among WLHIV, we assessed the following variables, based on the literature described earlier: social capital, HIV self-management, substance use, and potential confounding variables.
Participants completed study assessments at baseline and then approximately 3 and 6 months later. Social capital was measured using the 36-item Social Capital Scale. This widely used and psychometrically validated instrument generates a total social capital score and measures eight sub-scales, including participation in the local community, social agency, feelings of trust and safety, neighborhood connections, friends and family connections, tolerance of diversity, value of life, and workplace connections . Participants rated each item on a 1-to-4 Likert-type scale. Higher mean scores indicate more social capital. Cronbach’s alpha reliability for the social capital scale in adults living with HIV is 0.88 . We examined two aspects of HIV self-management, HIV medication adherence and a global measure of HIV self*management. HIV antiretroviral medication adherence was assessed with a 30-day adherence visual analog scale . To measure HIV self-management more globally, participants also completed the 20-item HIV Self-Management Scale, which generates a total score from items measured on a 0-to-3 scale and measures three domains of HIV self-management . This scale has been previously examined and was found to be psychometrically valid for use among WLHIV . Substance use was assessed with the valid and reliable 11-item self-report Drug Use Disorders Identification Testdeveloped to screen individuals for drug problems . Total scores range from 0 to 44, with higher scores being suggestive of a more severe drug use problem. Descriptive and potential confounding variables included demographic and medical characteristics, traumatic events, and experiences of discrimination, and were selected based on previous literature reviewed earlier. Demographic characteristics were self-reported and included race, education level, family composition, employment, sexuality, and housing status. Medical characteristics, abstracted from the participant’s electronic medical record, included year diagnosed with HIV, current CD4+ T cell count, HIV viral load, HIV medication history, and retention in HIV primary care. Recent traumatic events were assessed with the 20-item List of Threatening Experiences Scale, which lists the experience of traumatic events in the past month. Each of these 20 items are summed, and higher scores indicate more traumatic experiences . Experiences with discrimination were assessed with the widely used and valid nine-item Everyday Discrimination Scale . Participants noted how often they experienced acts of discrimination. All items are summed , and higher scores indicate more discrimination. To qualitatively describe how social capital influenced HIV self-management and substance use patterns, we developed a semistructured qualitative interview guide based on existing literature to guide in-person interviews. Prior to using it with participants, experts in substance use and women and in WLHIV assessed the interview guide for clarity, relevance, and appropriateness. The baseline interview guide initially focused on early substance use, current health practices, past and current social networks, and social capital dimensions . After several interviews, based on new themes spontaneously emerging from the interviews, it was revised to include more probes related to how trust influences health behaviors and the specific role of faith and its influence on health behaviors. In other words, in the first few interviews, WLHIV discussed the role of trust and faith on their health behaviors, and we deemed it so important that we wanted to give all respondents a chance to discuss these topics. The 3- and 6-month interview guides were shorter and focused on changes in life situations, health practices, social capital, substance use, and resilience that were observed in their quantitative measures.