Mari Armstrong-Hough
Mari Armstrong-Hough
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Associate Professor of Social & Behavioral Sciences and Epidemiology
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Professional overview
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Dr. Mari Armstrong-Hough is Associate Professor in the Department of Social & Behavioral Sciences and in the Department of Epidemiology. She is a medical sociologist and epidemiologist of respiratory disease.
Dr. Armstrong-Hough’s global health research examines the epidemiologic interfaces among tuberculosis (TB), HIV, and non-communicable diseases. Combining training in epidemiology and sociology, her work develops and evaluates interventions to increase early case-finding, status awareness, and linkage to care in high-burden settings like Uganda and South Africa. She has published on predictors of evaluation for TB among high-risk groups, novel approaches to active case-finding for TB and HIV, the ways that providers and patients imagine and communicate risk for respiratory infection, and the availability of essential medicines in settings with double burdens of infectious and non-communicable disease. Her first book, Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan (University of North Carolina Press, 2018), examined how the practice and experience of global evidence-based medicine is shaped by local cultural repertoires. Her recent work has appeared in the Journal of AIDS, International Journal of Tuberculosis and Lung Disease, and the The Lancet Respiratory Medicine. She also co-directs the NIH-funded Mixed-Methods Fellowship of the Pulmonary Complications of AIDS Research Training Program at Makerere University in Kampala, Uganda. She is PI of a prospective cohort study of patients initiating treatment for pulmonary TB in Uganda and a co-investigator on NIH-funded studies of contact tracing for TB.
Dr. Armstrong-Hough’s US-based research examines racial and ethnic disparities in survival of respiratory failure and seeks to develop interventions to ensure that all patients with respiratory failure receive evidence-based care. Approximately 750,000 Americans die each year from respiratory failure, and its 2.5 million survivors experience poor physical function and quality of life persisting five years after discharge. Minority patients are significantly less likely to survive respiratory failure, with up to twice the odds of death as non-Hispanic White patients. Dr. Armstrong-Hough co-PIs the Promoting Equity via Changes In Practice for Respiratory Failure (PRECIPICE) studies, which use large-scale, multicenter data from US ICUs to identify care processes associated with inequities in survival and long-term outcomes. Early work related to these studies has been accepted to Annals of the American Thoracic Society.
Before coming to NYU, Dr. Armstrong-Hough was an Associate Research Scientist in Epidemiology in the Department of Epidemiology of Microbial Diseases at Yale School of Public Health. She previously taught at Davidson College, Meiji University in Tokyo, and Duke University. She has conducted fieldwork in the United States, Japan, Uganda, Ethiopia, and Nepal and is a recipient of the Robert E. Leet and Clara Guthrie Patterson Trust Mentored Research Award in Clinical, Health Services and Policy Research.
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Education
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BA, Sociology, History, and Political Science, University of Wisconsin–MadisonMA, East Asian Studies, Duke UniversityPhD, Sociology, Duke UniversityPostdoctoral MPH, Applied Biostatistics and Epidemiology, Yale
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Publications
Publications
An educational intervention improves HIV competence of secondary school staff in Uganda: a stepped wedge cluster randomized trial
AbstractArmstrong-Hough, M., Kimera, E., Armstrong-Hough, M., Alanyo, L. G. G., Ouma, S., Kyadondo, D., Nangendo, J., & Kamya, M. R. (n.d.).Publication year
2026Journal title
AIDS careVolume
38Issue
1Page(s)
72-82AbstractHIV competence, encompassing knowledge, skills, attitudes, and practices to prevent, manage, and reduce HIV impact, is critical for meeting young people's HIV prevention and care needs. This study evaluated the effect of the Community of Practice on HIV (CoP-HIV) educational intervention on staff HIV competence and prevention knowledge in Ugandan schools, where HIV prevalence is rising among youth. Using a stepped-wedge cluster randomized trial, the intervention was implemented across six schools in western Uganda (March-September 2023). It included two eight-hour workshops and a handbook on HIV prevention and care, delivered over one month per school. Data were collected from 174 randomly selected staff (mean age 34.9 years, 49.9% female) at four points: baseline, T1, T2, and T3. Linear mixed-effects modeling showed significant improvements in HIV competence (20-point increase; = 19.87, SE = 1.02,Association of Sepsis Survivor Subtypes With Long-Term Mortality and Disability After Discharge: A Retrospective Cohort Study
AbstractArmstrong-Hough, M., Flick, R. J., Kamphuis, L. A., Valley, T. S., Armstrong-Hough, M., & Iwashyna, T. J. (n.d.).Publication year
2026Journal title
Critical care medicineVolume
54Issue
1Page(s)
45-54AbstractDetermine if previously described sepsis survivor subtypes can be applied outside of their derivation cohort using a parsimonious algorithm. Test the association between subtype and the primary outcome of 3-month mortality, and secondary outcomes of readmission, physical function, and health-related quality of life through 1 year of follow-up.Effectiveness of behavioural tobacco cessation interventions with and without pharmacotherapy among people living with HIV in Viet Nam: a three-arm pragmatic randomised controlled trial
AbstractArmstrong-Hough, M., Shelley, D., Armstrong-Hough, M., Nguyen, T., Alvarez, G. G. G., Kapur, R., Shuter, J., Goldsamt, L., Tozan, Y., Van Minh, H., Van Vu, G., Phan, P. T. T., Cleland, C. M., & Nguyen, N. (n.d.).Publication year
2026Journal title
The Lancet. Global healthVolume
14Issue
3Page(s)
e407-e416AbstractPeople living with HIV are two to three times more likely to smoke than the general population, resulting in higher risk for tobacco-related morbidity and mortality. Despite this growing burden of disease, there is little evidence for the long-term effectiveness of tobacco cessation interventions among people living with HIV, particularly in low-income and middle-income countries. We aimed to compare the effectiveness of three tobacco cessation interventions among people living with HIV.Effectiveness of routine tuberculosis education in a high-burden setting: A prospective observational cohort study
AbstractArmstrong-Hough, M., Johnson, T. S. S., Nanziri, L., Gupta, A. J., Ggita, J. M., Armstrong-Hough, M., Ayakaka, I., Shenoi, S. V., Katamba, A., & Davis, J. L. L. (n.d.).Publication year
2026Journal title
PloS oneVolume
21Issue
3Page(s)
e0344250AbstractLow adherence to tuberculosis (TB) treatment remains a major driver of adverse health outcomes in high-burden countries. While guidelines recommend routine client education, its effectiveness and the knowledge constructs that influence adherence remain poorly defined.Multilevel barriers and facilitators to smoking cessation among men living with HIV in Vietnam: a qualitative study of male patients and healthcare providers
AbstractArmstrong-Hough, M., Hoang, T. H.-L. H., Nguyen, C. V. T., Alvarez, G. G. G., Nguyen, T., Nguyen, N., Adermark, L., Ng, N., Shelley, D., & Armstrong-Hough, M. (n.d.).Publication year
2026Journal title
BMC health services researchVolume
26Issue
1AbstractIn Vietnam, tobacco smoking is highly prevalent among people living with HIV. However, research on engaging this population in tobacco use treatment is limited. To fill this gap, we aimed to identify barriers and facilitators to smoking cessation and examine implications for the design and implementation of tobacco use treatment for people living with HIV in Vietnam.Scheduling early primary care follow-up after pneumonia: A retrospective target trial emulation in five hospitals
AbstractArmstrong-Hough, M., Davis, A. J., Taylor, S. P., Hough, C. L., Armstrong-Hough, M., Yan, L., Ettman, C. K., Sadowski, K., Aziz, K. B., Lyons, P. G., Hauschildt, K. E., Kowalkowski, M., Perrin, E. M., & Iwashyna, T. J. (n.d.).Publication year
2026Journal title
Journal of hospital medicineAbstractCurrent guidelines make no recommendations on discharge interventions or scheduling outpatient follow-up after hospitlization for commnity-acquired pneumonia (CAP).Strategies to integrate non-communicable disease interventions in HIV and tuberculosis care contexts in low- and middle-income countries: a scoping review
AbstractArmstrong-Hough, M., Luo, L., Kapur, R., Armstrong-Hough, M., Alvarez, G. G. G., Moucheraud, C., Purtle, J., Namusisi, K. N. N., Yang, L., Raghavan, R., Lappen, H., & Shelley, D. (n.d.).Publication year
2026Journal title
BMJ global healthVolume
11Issue
2AbstractIntegration of management of tuberculosis (TB) and HIV with prevention and treatment of non-communicable diseases (NCDs) is a global priority. However, delivering the full spectrum of HIV/TB and NCD services is hindered by a lack of evidence regarding effective models and strategies for integrating NCDs and HIV/TB care services in varying contexts and across interventions. We conducted a scoping review to describe service delivery models and strategies used to facilitate integration of NCD care in HIV and/or TB care settings in low- and middle-income countries (LMICs).A Delphi Consensus on Recommendations for Improving Research Processes and Infrastructure to Address Health Disparities
AbstractArmstrong-Hough, M., Mohamed, A., Adegunsoye, A., Armstrong-Hough, M., Ferguson-Myrthil, N., Hassan, I., Mayr, F. B., Valley, T. S., Winkfield, D. R., Walsh, C. B., & Chen, J. T. (n.d.).Publication year
2025Journal title
CHEST Critical CareVolume
3Issue
3AbstractBackground: Racial and ethnic disparities in critical care medicine remain poorly understood, making them difficult to address. This initiative developed a thought leader consensus with recommendations for critical care research to document, assess, and understand potential disparities. Research Question: What key areas should future critical care research focus on to better identify and address disparities related to race, ethnicity, and language? Study Design and Methods: A modified Delphi-based method was used to form a consensus about addressing racial disparities through future critical care research. Nine thought leaders discussed aspects related to 4 topics: collection of race, ethnicity, and language variables; establishing recruitment plans for researchers from racial and ethnic minority groups; designating minority serving institutions; and health disparity education and community engagement. Consensus was reached when ≥ 80% of members agreed (answered with yes or with 4 to 5 points on a Likert scale). Results: Thought leaders arrived at a consensus agreement (100%) that improved data quality, achieved by more robust recruitment of research participants from racial and ethnic minority groups and standardization of race and ethnicity data, is crucial as the initial step of uncovering health disparities. They agreed that collection of language preferences should be part of all research studies to expose potential biases and disparities in non-English speakers (100% agreement). Engagement of racial and ethnic minority communities was agreed to be essential to obtain involvement of research participants from such minoritized groups (100%). Interpretation: This consensus revealed the notable data deficiency impacting health disparities within critical care research especially when compared with other settings, highlighting the crucial need for comprehensive focus on this domain. Standardization of race, ethnicity, and language data collection, with the goal of increasing the number of research participants from racial and ethnic minority groups, is vital for understanding health disparities in critical care research and its potential causes.Adaptation and validation of perceived HIV and TB stigma scales among persons with TB
AbstractArmstrong-Hough, M., Ponticiello, M. N., Nanziri, L. M., Hennein, R., Ochom, E., Gupta, A. J., Turimumahoro, P., White, M. A., Armstrong-Hough, M., Katamba, A., Davis, J. L., & Davis, J. L. (n.d.).Publication year
2025Journal title
International Journal of Tuberculosis and Lung DiseaseVolume
29Issue
3Page(s)
127-134AbstractB A C K G R O U N D: Stigma is a barrier to care for people affected by TB and HIV in Uganda, where these conditions remain endemic. While scales have been adapted and validated to measure stigma among TB-affected households in Uganda, there is a need for scales that measure the experiences of persons with TB (PWTB). M E T H O D S: We adapted the Van Rie 12-item individual perspectives TB scale and 10-item individual perspectives HIV scale for use in Uganda through cross-cultural discussions with a multidisciplinary research team and four cognitive interviews with community health workers and PWTB. We then conducted a cross-sectional study administering each scale to 125 PWTB. We performed exploratory factor analysis, evaluated internal validity, and assessed convergent validity with perceived social support. R E S U L T S: Exploratory factor analysis yielded a one-factor solution for both scales, with marginal model fit (standardised root mean square residual ¼ 0.09 for TB, ¼ 0.07 for HIV). There was evidence of convergent validity through a positive correlation of the TB (r ¼ 0.22, p ¼ 0.01) and HIV stigma (r ¼ 0.22, p ¼ 0.01) scales with perceived social support. Both scales had good internal validity (Cronbach’s a ¼ 0.86 for TB, ¼ 0.87 for HIV). C O N C L U S I O N: Adapted scales to measure perceived HIV and TB stigma among PWTB in Uganda demonstrated promising psychometric properties by removing one and two items, respectively.Communication attributes modify the anxiety risk associated with problematic social media use : Evidence from a prospective diary method study
AbstractAllen Weng, C., Bulgin, J., Diaz, S., Zhang, J., Tan, R., Li, L., & Armstrong-Hough, M. (n.d.).Publication year
2025Journal title
Addictive BehaviorsVolume
166AbstractPurpose: Social media use in younger people has shown mixed associations with mental health. We hypothesized that communication types during social media use might alter the relationship between problematic social media use (PSMU) and anxiety over time. We aimed to identify how four dimensions of communication influence the link between PSMU and anxiety. Methods: We recruited a cohort of undergraduate students aged 18–26 to participate in daily surveys over two weeks using a diary method to assess daily social media use, PSMU, anxiety symptoms, and the four dimensions of communication: Consumption, Broadness, Online Exclusivity, and Parasociality. Lagged logistic regression models with generalized estimating equations evaluated the influence of daily PSMU and communication type on subsequent anxiety levels. Results: Out of 79 participants, 1009 daily records were analyzed. PSMU positively correlated with anxiety (Kendall rank correlation τ = 0.30). Interaction analysis indicated that levels of parasociality and consumption moderated the association between PSMU components and anxiety outcomes. In young adults with high levels of consumption or parasociality, a 1-standard-deviation rise in PSMU's social conflict component led to an 11 %-13 % increase in next-day anxiety scores. This association was absent for those with low to moderate levels of parasociality and consumption. Discussion: Elevated levels of passive consumption and one-sided interactions amplify the anxiety risk associated with PSMU. Further longitudinal evidence can elucidate the connections between communication types, social media exposure, and anxiety, guiding the development of a model for healthy social media use.Communication attributes modify the anxiety risk associated with problematic social media use: Evidence from a prospective diary method study
AbstractArmstrong-Hough, M., Allen Weng, C., Bulgin, J., Diaz, S., Zhang, J., Tan, R., Li, L., & Armstrong-Hough, M. (n.d.).Publication year
2025Journal title
Addictive behaviorsVolume
166Page(s)
108324AbstractSocial media use in younger people has shown mixed associations with mental health. We hypothesized that communication types during social media use might alter the relationship between problematic social media use (PSMU) and anxiety over time. We aimed to identify how four dimensions of communication influence the link between PSMU and anxiety.Female sex worker preferences for HIV pre-exposure prophylaxis delivery in Uganda : A discrete choice experiment
AbstractMpirirwe, R., Makabayi-Mugabe, R., Muteebwa, L., Kamacooko, O., Wamono, F., Kajumba, M. M., Nangendo, J., Semitala, F. C., Kyambadde, P., Davis, K. J., Kalyango, J., Karamagi, C., Kiragga, A., Armstrong-Hough, M., Moor, S. E., Katahoire, A. R., Kamya, M. R., & Mujugira, A. (n.d.).Publication year
2025Journal title
PLOS Global Public HealthVolume
5Issue
6AbstractCisgender female sex workers (FSWs) in sub-Saharan Africa have a high risk of HIV acquisition, highlighting the need for innovative approaches to expand coverage of evidence-based HIV prevention methods, including oral pre-exposure prophylaxis (PrEP). Our study aimed to identify FSWs’ preferences for a PrEP delivery model with structured choices for delivery location, services offered, and adherence support. We conducted a discrete choice experiment (DCE) with female sex workers (FSWs) aged 18 and above at the Most At-Risk Population Initiative (MARPI) clinic in Kampala, Uganda, from October to November 2023. Participants were recruited consecutively. To identify the most preferred PrEP delivery model, we designed eight choice sets using a D-efficient design. Each set included three PrEP service options and an opt-out. Options varied by provider, delivery location, channel, and support services. Participants selected their preferred option in each set. Preferences and trade-offs were analyzed using a panel mixed model, and the highest median utility identified the top model. Overall, 203 participants completed the DCE. The median age was 24 years (interquartile range [IQR] 20–32). Most FSWs preferred receiving PrEP from a healthcare worker at the clinic with short message service (SMS) reminders for adherence support (median utility score 0.87; interquartile range [IQR] 0.82, 0.94). This preference remained consistent across all age groups, with a median utility score of 0.88 for ages 15–19, 0.87 for ages 20–24, and 0.85 for ages ≥25. FSWs preferred to receive PrEP care directly from providers at healthcare facilities and highlighted the need for additional support in the form of SMS reminders to improve adherence and prevent HIV acquisition. This preferred model, if implemented, could increase prevention coverage and inform future approaches to delivering PrEP through the Uganda National PrEP Program.Female sex worker preferences for HIV pre-exposure prophylaxis delivery in Uganda: A discrete choice experiment
AbstractArmstrong-Hough, M., Mpirirwe, R., Makabayi-Mugabe, R., Muteebwa, L., Kamacooko, O., Wamono, F., Kajumba, M. M., Nangendo, J., Semitala, F. C., Kyambadde, P., Davis, K. J. J., Kalyango, J., Karamagi, C., Kiragga, A., Armstrong-Hough, M., Moor, S. E. G., Katahoire, A. R., Kamya, M. R., & Mujugira, A. (n.d.).Publication year
2025Journal title
PLOS global public healthVolume
5Issue
6Page(s)
e0003848AbstractCisgender female sex workers (FSWs) in sub-Saharan Africa have a high risk of HIV acquisition, highlighting the need for innovative approaches to expand coverage of evidence-based HIV prevention methods, including oral pre-exposure prophylaxis (PrEP). Our study aimed to identify FSWs' preferences for a PrEP delivery model with structured choices for delivery location, services offered, and adherence support. We conducted a discrete choice experiment (DCE) with female sex workers (FSWs) aged 18 and above at the Most At-Risk Population Initiative (MARPI) clinic in Kampala, Uganda, from October to November 2023. Participants were recruited consecutively. To identify the most preferred PrEP delivery model, we designed eight choice sets using a D-efficient design. Each set included three PrEP service options and an opt-out. Options varied by provider, delivery location, channel, and support services. Participants selected their preferred option in each set. Preferences and trade-offs were analyzed using a panel mixed model, and the highest median utility identified the top model. Overall, 203 participants completed the DCE. The median age was 24 years (interquartile range [IQR] 20-32). Most FSWs preferred receiving PrEP from a healthcare worker at the clinic with short message service (SMS) reminders for adherence support (median utility score 0.87; interquartile range [IQR] 0.82, 0.94). This preference remained consistent across all age groups, with a median utility score of 0.88 for ages 15-19, 0.87 for ages 20-24, and 0.85 for ages ≥25. FSWs preferred to receive PrEP care directly from providers at healthcare facilities and highlighted the need for additional support in the form of SMS reminders to improve adherence and prevent HIV acquisition. This preferred model, if implemented, could increase prevention coverage and inform future approaches to delivering PrEP through the Uganda National PrEP Program.Health Insurance and Interhospital Transfer for Critically Ill Patients With Respiratory Failure
AbstractArmstrong-Hough, M., Harlan, E. A., Ghous, M., Cortinas, N., Nadig, N. R., Vranas, K. C., Armstrong-Hough, M., Krein, S. L., & Valley, T. S. (n.d.).Publication year
2025Journal title
JAMA network openVolume
8Issue
8Page(s)
e2528889AbstractCritically ill patients with acute respiratory failure may benefit from transfer to higher-volume centers with specialized care. However, health insurance is often considered prior to interhospital transfer and may represent a factor other than severity of illness that influences transfer processes and outcomes for patients with respiratory failure.Interventions to improve racial and ethnic equity in critical care: A scoping review
AbstractArmstrong-Hough, M., Ge, S., Lappen, H., Mercado, L., Lamarche, K., Iwashyna, T. J., Hough, C. L., Chang, V. W., Cuevas, A., Valley, T. S., & Armstrong-Hough, M. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
11Page(s)
e0336922AbstractRacial and ethnic disparities in the delivery and outcomes of critical care are well documented. However, interventions to mitigate these disparities are less well understood. We sought to review the current state of evidence for interventions to promote equity in critical care processes and patient outcomes.Patterns and Correlates of Tobacco Use Among PLWH in Viet Nam: A Cross-Sectional Analysis
AbstractArmstrong-Hough, M., Kapur, R., Nguyen, N., Nguyen, T., Alvarez, G. G. G., Cleland, C. M., Armstrong-Hough, M., & Shelley, D. (n.d.).Publication year
2025Journal title
Tobacco use insightsVolume
18Page(s)
1179173X251353030AbstractThe use of multiple tobacco products may increase nicotine dependence and reduce success in quitting. In Viet Nam, the prevalence of dual cigarette and waterpipe use is high, yet the characteristics of dual users, particularly among people living with HIV (PLWH) in low-and-middle income countries (LMICs) are underexplored. This paper describes patterns and correlates of tobacco use among PLWH in Viet Nam.Representation of Hispanic Patients in Clinical Trials for Respiratory Failure : A Systematic Review
AbstractHarlan, E. A., Malley, K., Quiroga, G., Mubarak, E., Lama, P., Schutz, A., Cuevas, A., Hough, C. L., Iwashyna, T. J., Armstrong-Hough, M., & Valley, T. S. (n.d.).Publication year
2025Journal title
Critical Care ExplorationsVolume
7Issue
1Page(s)
e1193AbstractOBJECTIVES: Hispanic individuals comprise one-fifth of the U.S. population and Hispanic patients with acute hypoxemic respiratory failure (AHRF) experience higher odds of death compared with non-Hispanic White patients. Representation of Hispanic patients in clinical trials for respiratory failure is critical to address this inequity. We conducted a systematic review to examine the inclusion of Hispanic patients in randomized controlled trials for AHRF and assessed language as a potential barrier to enrollment. DATA SOURCES: National Library of Medicine PubMed, Elsevier Embase, and Cochrane Central Register of Controlled Trials databases through January 2024. STUDY SELECTION: Randomized controlled trials assessing AHRF interventions enrolling U.S. patients receiving mechanical ventilation, noninvasive mechanical ventilation, or high-flow nasal cannula were included. The systematic review was registered prospectively through PROSPERO (CRD42023437828). DATA EXTRACTION: Two authors independently screened studies and extracted data for each included study. DATA SYNTHESIS: Ninety-four trials published from 1975 to 2023 were included; 33.0% (n = 31) of studies reported ethnicity, and 11.2% of participants in studies reporting race or ethnicity (1,320/11,780) were identified as Hispanic. The proportion of Hispanic-identified participants was significantly lower than the U.S. Hispanic population from 1996 to 2019 (p < 0.01). Starting in 2020, the proportion of Hispanic-identified participants was significantly higher than the U.S. population (27.8% vs. 19.1%; p < 0.01). Two studies (4.9%) reporting race or ethnicity excluded non-English speaking participants; the remainder did not specify language requirements for enrollment. CONCLUSIONS: Hispanic-identified individuals were underrepresented in trials for AHRF until 2020 when Hispanic patient representation increased during COVID-19. Exclusion of participants who do not speak English may represent a barrier to trial enrollment.Tobacco spending and the perceived cost of tobacco among smokers living with HIV and receiving treatment at outpatient clinics in Viet Nam : A mixed methods study
AbstractAlvarez, G. G., Hoang, T., Kapur, R., Nguyen, C., Armstrong-Hough, M., Nguyen, T., Nguyen, N., Van Minh, H., & Shelley, D. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
7 JulyAbstractBackground Tobacco use among people living with HIV (PWH) is 2–3 times higher than among HIV-negative individuals. In Viet Nam, over 50% of men living with HIV use tobacco. Reducing smoking is important to improving disparities among PWH who smoke including their higher exposure to chronic disease. However, data on tobacco spending as well as the potential impact of tobacco policies, such as taxation, is limited among PWH. Viet Nam has one of the lowest taxes on tobacco in the world, thus underutilizing this tool. Our study aims to understand tobacco spending among PWH who smoke as well as examine the financial burden of tobacco use, and their perceptions about the affordability of tobacco products. Methods We conducted qualitative interviews (n=24) that explored smoking behavior and perceptions about the cost of tobacco, alongside cross-sectional quantitative surveys (n=75) that assessed daily tobacco expenditures and the proportion of income spent on tobacco. We applied convergent parallel design to these two independent samples taken from the same study population of PWH enrolled in a tobacco use treatment study at HIV clinics in Ha Noi, Viet Nam. Results Participants spent 7.47% of their annual income on tobacco products. Tobacco dependence was positively associated with higher daily expenditure on tobacco. Qualitatively, participants did not describe tobacco-related spending as a financial burden and did not consider the price of cigarettes as a motivation to quit. However, participants acknowledged that smoking is still a costly expenditure and indicated that quitting would yield financial savings which could be redirected to other household needs. Conclusion Despite spending a considerable percentage of their income spent on tobacco, most participants perceived cigarettes as affordable. This may reflect our sample’s strong socioeconomic resources as well as the low price of cigarettes in Viet Nam, which may be too low to cause financial hardship and thus reduce motivation to quitting.Tobacco spending and the perceived cost of tobacco among smokers living with HIV and receiving treatment at outpatient clinics in Viet Nam: A mixed methods study
AbstractArmstrong-Hough, M., Guevara Alvarez, G., Hoang, T., Kapur, R., Nguyen, C., Armstrong-Hough, M., Nguyen, T., Nguyen, N., Van Minh, H., & Shelley, D. (n.d.).Publication year
2025Journal title
PloS oneVolume
20Issue
7Page(s)
e0327490AbstractTobacco use among people living with HIV (PWH) is 2-3 times higher than among HIV-negative individuals. In Viet Nam, over 50% of men living with HIV use tobacco. Reducing smoking is important to improving disparities among PWH who smoke including their higher exposure to chronic disease. However, data on tobacco spending as well as the potential impact of tobacco policies, such as taxation, is limited among PWH. Viet Nam has one of the lowest taxes on tobacco in the world, thus underutilizing this tool. Our study aims to understand tobacco spending among PWH who smoke as well as examine the financial burden of tobacco use, and their perceptions about the affordability of tobacco products.An adapted scale to measure perceived TB and HIV stigma during household contact investigation
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Shelby, T., Ggita, J., Nangendo, J., Gupta, A. J., Davis, J. L., & Katamba, A. (n.d.).Publication year
2024Journal title
International Journal of Tuberculosis and Lung DiseaseVolume
28Issue
9Page(s)
433-438AbstractBACKGROUND: Measuring stigma for TB and HIV in households undergoing contact investigation for TB is critical for understanding its impacts on health behaviours and identifying opportunities for intervention. However, standardised measurements for TB-HIV stigma in household contact investigations are limited. METHODS: We adapted and validated a household stigma scale in Uganda. This involved field testing measures from another setting with 163 household contacts of newly diagnosed TB patients, conducting cognitive interviews with seven household contacts, adapting scale items using cognitive interview data, and retesting the adapted scales in a random sample of 60 contacts. We assessed inter-item covariance and performed factor analysis to select the final scale items. RESULTS: In whole-scale factor analysis, no cross-loading of items with scores ≥0.32 was found after the elimination of items based on covariance and symmetry. All TB items were loaded onto a single factor with scores ≥0.5, and all but one HIV item was loaded onto a second factor with scores ≥0.5. The final subscale internal consistency (Cronbach’s alpha) was 0.92 for TB and 0.89 for HIV. CONCLUSIONS: The adapted TB-HIV stigma scale demonstrated acceptable psychometric properties and is substantially shorter and easier to administer than previous scales, making it suitable for programmatic research and evaluation.Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam : A cross-sectional analysis
AbstractNguyen, N. T., Nguyen, T., Vu, G. V., Truong, N., Pham, Y., Guevara Alvarez, G., Armstrong-Hough, M., & Shelley, D. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
2AbstractObjectives To assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam. Design A cross-sectional survey of smokers living with HIV. Setting The study was carried out in 13 HIV OPCs located in Ha Noi, Vietnam. Participants The study included 527 PLWH aged 18 and above who were smokers and were receiving treatment at HIV OPCs. Outcome measures The study used the Centre for Epidemiology Scale for Depression to assess depressive symptoms. The associations between depressive symptoms, tobacco dependence and other characteristics were explored using bivariate and Poisson regression analyses. Results The prevalence of depressive symptoms among smokers living with HIV was 38.3%. HIV-positive smokers who were female (prevalence ratio, PR 1.51, 95% CI 1.02 to 2.22), unmarried (PR 2.06, 95% CI 1.54 to 2.76), had a higher level of tobacco dependence (PR 1.06, 95% CI 1.01 to 1.11) and reported their health as fair or poor (PR 1.66, 95% CI 1.22 to 2.26) were more likely to have depression symptoms compared with HIV-positive smokers who were male, married, had a lower level of tobacco dependence and self-reported their health as good, very good or excellent. Conclusion The prevalence of depressive symptoms among smokers receiving HIV care at HIV OPCs was high. Both depression and tobacco use screening and treatment should be included as part of ongoing care treatment plans at HIV OPCs.Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: a cross-sectional analysis
AbstractArmstrong-Hough, M., Nguyen, N. T. T., Nguyen, T., Vu, G. V. V., Truong, N., Pham, Y., Guevara Alvarez, G., Armstrong-Hough, M., & Shelley, D. (n.d.).Publication year
2024Journal title
BMJ openVolume
14Issue
2Page(s)
e077015AbstractTo assess the prevalence of depressive symptoms and associated factors among people living with HIV (PLWH) who were current cigarette smokers and receiving treatment at HIV outpatient clinics (OPCs) in Vietnam.Efficacy and Impact of Peer-Led Education for Persons with Tuberculosis in Kampala, Uganda: A Pre-Post Implementation Study
AbstractArmstrong-Hough, M., Baker, A., Gupta, A. J., Nanziri, L., Ggita, J. M., Hernandez-Ramirez, R. U., Shenoi, S. V., Ayakaka, I., Armstrong-Hough, M., Katamba, A., & Davis, J. L. (n.d.).Publication year
2024Journal title
Research squareAbstractUniversal TB education and counseling (TEC) is routinely recommended for promoting knowledge and medication adherence, but the quality of delivery often varies because of inadequate clinic space, time, and health worker training. Peer-led counseling is a promising but understudied solution to these challenges. We sought to evaluate the efficacy of a peer-led TEC strategy among newly diagnosed adults initiating TB treatment in Kampala, Uganda.Ethnic Disparities in Deep Sedation of Patients with Acute Respiratory Distress Syndrome in the United States : Secondary Analysis of a Multicenter Randomized Trial
AbstractArmstrong-Hough, M., Lin, P., Venkatesh, S., Ghous, M., Hough, C. L., Cook, S. H., Iwashyna, T. J., & Valley, T. S. (n.d.).Publication year
2024Journal title
Annals of the American Thoracic SocietyVolume
21Issue
4Page(s)
620-626AbstractRationale: Patients identified as Hispanic, the largest minority group in the United States, are more likely to die from acute respiratory distress syndrome (ARDS) than non-Hispanic patients. Mechanisms to explain this disparity remain unidentified. However, Hispanic patients may be at risk of overexposure to deep sedation because of language differences between patients and clinicians, and deep sedation is associated with higher ARDS mortality.Objective: We examined associations between Hispanic ethnicity and exposure to deep sedation among patients with ARDS.Methods: A secondary analysis was conducted of patients enrolled in the control arm of a randomized trial of neuromuscular blockade for ARDS across 48 U.S. hospitals. Exposure to deep sedation was measured over the first 5 days that a patient was alive and received mechanical ventilation. Multilevel mixed-effects models were used to evaluate associations between Hispanic ethnicity and exposure to deep sedation, controlling for patient characteristics.Results: Patients identified as Hispanic had approximately five times the odds of deep sedation (odds ratio, 4.98; 95% confidence interval, 2.02-12.28; P < 0.0001) on a given day, compared with non-Hispanic White patients. Hospitals with at least one enrolled Hispanic patient kept all enrolled patients deeply sedated longer than hospitals without any enrolled Hispanic patients (85.8% of ventilator-days vs. 65.5%; P < 0.001).Conclusions: Hispanic patients are at higher risk of exposure to deep sedation than non-Hispanic White patients. There is an urgent need to understand and address disparities in sedation delivery.Ethnic Disparities in Deep Sedation of Patients with Acute Respiratory Distress Syndrome in the United States: Secondary Analysis of a Multicenter Randomized Trial
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Lin, P., Venkatesh, S., Ghous, M., Hough, C. L., Cook, S. H., Iwashyna, T. J., & Valley, T. S. (n.d.).Publication year
2024Journal title
Annals of the American Thoracic SocietyAbstractPatients identified as Hispanic, the largest minority group in the United States (U.S.), are more likely to die from acute respiratory distress syndrome (ARDS) than non-Hispanic patients. Mechanisms to explain this disparity remain unidentified. However, Hispanic patients may be at risk of overexposure to deep sedation due to language differences between patients and clinicians, and deep sedation is associated with higher ARDS mortality.