Assistant Professor of Biostatistics
Assistant Professor of Social and Behavioral Sciences
Dr. Stephanie Cook aims to understand the pathways and mechanisms linking attachment, minority stress, and health among disadvantaged individuals. She examines how the inter- and intra- personal features of close relationships influence the health of racial/ethnic and sexual minorities.
Through her development of an integrated theory of adult attachment (i.e., the development, or lack, of strong socio-emotional bonds) and minority stress (i.e., social stress experienced by individuals in minority social groups), she seeks to better understand the poor health and HIV prevention needs of disadvantaged youth transitioning into adulthood. She then utilize this theoretical framework of attachment and minority stress to inform effective prevention programs for vulnerable racial/ethnic and sexual minority youth transitioning to adulthood.
As the Principal Investigator and Director of the Attachment and Health Disparities Research Lab, her team assesses the association of attachment-related functioning on health disparities among racial/ethnic and sexual minority youth. Dr. Cook is first exploring how adult attachment orientation is associated with HIV risk in a community sample of Black gay and bisexual men transitioning into adulthood. Second, she illustrates how transitions in attachment during adolescence are associated with trajectories of depression among a community based cohort sample of African-American youth. Third, she seeks to understand how adult attachment, in the context of minority stress, is associated with biomarkers of physical health.
Dr. Cook teaches Global Issues in Social and Behavioral Health and Regression and Multivariate Analysis. At the Center for Health, Identity, Behavior, and Prevention Studies, she conducts research and has published numerous peer-reviewed articles.
BA, Psychology and Women’s Studies, University of Michigan, Ann Arbor, MIMPH, Sociomedical Sciences, Columbia University, New York, NYDrPH, Sociomedical Sciences, Columbia University, New York, NY
Matilda White Riley Distinguished Early Stage Investigator Award, National Institutes of Health (Office of Behavioral and Social Sciences) (2016)Outstanding Postdoctoral Fellow Award, The University of Michigan (2015)American Psychological Association Smoking Dissemination Award (2015)Poster Award, Excellence in Innovation and Advanced Research in the Field of Sexual Health, American Public Health Association (2014)Excellence in Abstract Submission, American Public Health Association (2011)
BiostatisticsCenter for Health, Identity, Behavior and Prevention StudiesHIV/AIDSMinority HealthSocial BehaviorsStress
Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort StudyKapadia, F., D’Avanzo, P. A., Cook, S., Barton, S., Halkitis, S. N., & Halkitis, P. N.
Journal titleBehavioral MedicineWe seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18–22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development–the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.
Are trajectories of a syndemic index in adolescence linked to HIV vulnerability in emerging and young adulthood?Córdova, D., Heinze, J. E., Hsieh, H. F., Mistry, R., Salas-Wright, C. P., Cook, S., & Zimmerman, M. A.
Page(s)495-503Objectives: To examine trajectories of adolescent psychosocial risk-drug use, depressive and anxiety symptoms, and violence victimization and observation-and the longitudinal relationship between psychosocial risk trajectories during adolescence and HIV risk behaviors in adulthood. Methods: The 18-year longitudinal study was conducted from September 1994 through May 2013, in Michigan. Eight hundred and fifty predominantly (80%) African-American adolescents completed demographics and measures of drug use, depressive and anxiety symptoms, violence victimization and observation at Times 1-4, sexual risk behaviors at Times 5 and 6, and social conditions (i.e. family, peer, and community-level factors) between 14.9 and 32.0 years of age. Results: Growth mixture modeling revealed two trajectories of psychosocial risk factors which can be characterized as a syndemic index: high-frequency and low-frequency. The high-frequency class was more likely to report HIV risk behaviors, including condomless sex at last sexual intercourse with their primary and secondary partner, sexual intercourse with someone they just met, at least four sexual partners, and licit and illicit drug use prior to sexual intercourse at Time 5 (mean age 23.1). At Time 6 (mean age 32.0), the high-frequency class was more likely to report sexual intercourse with someone they just met and at least four sexual partners, relative to the low-frequency class. In addition, the high-frequency class was linked to peer and family-level indicators of social conditions. Conclusion: A syndemic index comprised of co-occurring psychosocial risk factors in adolescence seem to have lasting effects on the vulnerability to engage in HIV risk behaviors in emerging adulthood, some of which extend into young adulthood.
Family conflict, chaos, and negative life events predict cortisol activity in low-income childrenDoom, J. R., Cook, S., Sturza, J., Kaciroti, N., Gearhardt, A. N., Vazquez, D. M., Lumeng, J. C., & Miller, A. L.
Journal titleDevelopmental Psychobiology
Page(s)364-379Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic-pituitary-adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low-income 7–10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow-up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.
Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort studyCook, S., Halkitis, P. N., & Kapadia, F.
Journal titleJournal of Health Psychology
Page(s)1884-1894This study examines how romantic relationship cognitions are associated with changes of condomless anal sex among emerging adult gay and bisexual men. The sample was drawn from four waves of a prospective cohort study (N = 598; Mage = 18.2). Results suggest that condomless anal sex increased over the emerging adulthood period. Romantic relationship fear was associated with increased receptive condomless anal sex. Perceptions of greater romantic relationship control increased the likelihood of having insertive and receptive condomless anal sex. Findings suggest that romantic relationship cognitions are important to consider when understanding longitudinal changes in condomless anal sex in this population.
Sexual orientation moderates the association between parental overprotection and stress biomarker profilesCook, S., Pruessner, J. C., Lupien, S. J., & Juster, R. P.
Journal titlePsychology and Sexuality
Page(s)1-17Early experiences with parents may be particularly difficult for lesbian, gay and bisexual (LGB) individuals who face stigma that is linked to potentially distinct stress-related biobehavioural profiles. This study examined the association between parental bonding in relation to acute stress (cortisol reactivity) and chronic stress (allostatic load) in LGB and heterosexual individuals. The sample consisted of 87 healthy adults (mean [SD] age = 24.6 [0.6] years; LGB: n = 46, 43% women; and heterosexual n = 41, 49% women). Regressions tested the main effects of retrospectively assessed parental overprotection and care before the age of 16 on stress reactive cortisol (area under the curve) and allostatic load (indexed using 21 neuroendocrine, immune, metabolic and cardiovascular biomarkers), and whether sexual orientation status moderated this association. Results revealed that parental overprotection was associated with increased cortisol reactivity only for LGB participants, but not for heterosexual participants. By contrast, parental overprotection was associated with higher allostatic load only for heterosexual participants, but not for LGB participants. While the functional significance of this requires further study, these preliminary findings suggest that adaptive processes among LGB individuals may mitigate the negative effects of parental overprotection on markers of chronic stress.
Stress levels are associated with poor sleep health among sexual minority men in Paris, FranceMountcastle, H. D., Park, S. H., Al-Ajlouni, Y. A., Goedel, W. C., Cook, S., Lupien, S., Obasi, E. M., Hale, L., Jean-Louis, G., Redline, S., & Duncan, D.
Journal titleSleep HealthObjective: The objective of this study was to examine the association between perceived stress and sleep health among a sample of sexual minority men (SMM). Design: Cross-sectional survey. Setting: Paris, France. Participants: Gay, bisexual and other SMM users ≥18 years on a geosocial networking application in Paris, France (N = 580). Measurements: Participants were directed to a web-based survey measuring stress, sleep health, and socio-demographics. Multivariate log-binomial regression models were used to estimate the adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to examine how stress may affect different dimensions of sleep health: 1) poor sleep quality, 2) short sleep duration, 3) problems falling asleep, and 4) problems staying awake in the daytime. Results: Most participants (69.9%) reported at least sometimes feeling stressed (compared to never or rarely). Additionally, results demonstrate that higher perceived stress was associated with poorer sleep health; compared with those who reported feeling stress never or rarely, those who felt stress sometimes, often, or always were more likely to experience poor sleep quality (aRR = 6.67; 95% CI = 3.61–12.3), short sleep duration (aRR = 1.67; 95% CI = 1.17–2.38), problems falling asleep (aRR = 3.20; 95% CI = 2.26–4.52), and problems staying awake during the daytime (aRR = 3.52; 95% CI = 1.64–7.53). Conclusion: Elevated perceived stress can negatively influence sleep health among SMM in Paris, France.
Teacher-Based Racial Discrimination: The Role of Racial Pride and Religiosity Among African American and Caribbean Black AdolescentsButler-Barnes, S. T., Cook, S., Leath, S., & Caldwell, C.
Journal titleRace and Social Problems
Page(s)30-41This study explored the extent to which private regard and religiosity beliefs serve as protective factors for school bonding among African American and Caribbean black adolescents who experience racial discrimination in school. Findings are drawn from a nationally representative sample of (n = 810) African American and (n = 360) Caribbean black adolescents (52% girls) aged 13–17 (Mage = 15, SD = 1.42) years. Results suggest that perceiving racial discrimination from teachers was associated with lower levels of school bonding for African American and Caribbean black adolescents. For African American adolescents, perceiving more racial discrimination from teachers and reporting lower private regard beliefs was associated with less school bonding. The findings for Caribbean black adolescents revealed that endorsing moderate levels of religiosity and perceiving higher rates of teacher discrimination was associated with less school bonding. The developmental significance and implications for future research are discussed.
Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual MenCook, S., Valera, P., Wood, E. P., Calebs, B. J., & Wilson, P. A.
Journal titleJournal of Sex Research
Page(s)1-16We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.
Cortisol profiles differ by race/ethnicity among young sexual minority menCook, S., Juster, R. P., Calebs, B. J., Heinze, J., & Miller, A. L.
Page(s)1-4Much of the extant scientific research examining hypothalamic-pituitary-adrenal (HPA)-axis functioning is conducted among White heterosexuals. Very little research examines HPA-axis functioning between different minority groups. Individuals who identify as both sexual and racial minorities may experience increased stigma and discrimination that can affect HPA-axis functioning. In the current study, we examined diurnal cortisol rhythm in young White gay men (WGM) compared to young Black gay men (BGM). The sample consisted of 70 healthy gay men (mean [SD] age = 22.9 [3.2]: 68% White and 38% Black) who collected four saliva samples daily for five days. Repeated measures analysis of covariance and post-hoc tests revealed that BGM had higher cortisol levels than WGM in the evening. Secondary analyses revealed no significant group differences for the cortisol awakening response or systemic output throughout the day. However, BGM compared to WGM had a lower drop from peak (morning) to lowest (evening) cortisol concentrations. Taken together, these findings reveal a flatter diurnal cortisol rhythm among BGM compared to WGB. The functional significance of these preliminary findings must be explored further with assessment of psychosocial factors among sexual minorities at the intersection of multiple identities. In summary, we expand health disparities research aimed at delineating sexual minority and race/ethnic variation in stress physiology.
Friendship Attachment Style Moderates the Effect of Adolescent Exposure to Violence on Emerging Adult Depression and Anxiety TrajectoriesHeinze, J. E., Cook, S., Wood, E. P., Dumadag, A. C., & Zimmerman, M. A.
Journal titleJournal of Youth and Adolescence
Page(s)1-17Exposure to violence during adolescence is associated with increased risk behaviors and mental health problems in adulthood. Friendship attachment during adolescence may, however, mitigate the negative effects of exposure to violence on trajectories of depression and anxiety in young adulthood. In this study, we used growth curve modeling to examine associations between exposure to violence and mental health outcomes, followed by multi-group analyses with friendship attachment as the moderator. The sample was drawn from a longitudinal study (12 waves; 1994–2012) of 676 (54% female) urban high school students. We found strong positive associations between exposure to violence during adolescence and later self-reported depressive and anxiety symptoms. Notably, securely attached adolescents reported faster decreases in mental health symptoms as a function of violence relative to their insecurely attached peers as they transitioned into adulthood.
Minority males: Cultural stressors and their impact on health and well-beingCook, S., Calebs, B., Perry, M., & Hopkins, R.
Psychometric Analysis of the Life Worries Scale for a New Generation of Sexual Minority Men: The P18 Cohort StudyHalkitis, P. N., Cook, S. H., Ristuccia, A., Despotoulis, J., Levy, M. D., Bates, F. C., & Kapadia, F.
Journal titleHealth PsychologyObjective: Sexual minority men (SMM) in the United States continue to experience adverse health problems and psychosocial burdens. However, there is limited psychometric research seeking to quantify the life worries of this population. Informed by syndemic theory, the Life Worries Scale (LWS) was developed to measure the concerns of young SMM. Method: Analyses of the scale were undertaken using baseline data (n = 665) from an ongoing cohort study of emerging adult, SMM. Results: Exploratory factor analyses (EFA) of an initial set of 24 Likert-type items, followed by confirmatory factor analysis (CFA) and an exploratory structural equation model (ESEM), indicated a structure consisting of 6 domains of worries: financial stability, social stability, self esteem, loneliness, physical appearance, and physical health. These 6 subscales were highly correlated and also demonstrated high levels of internal consistency. Differences in life worries were noted across demographic states, specifically HIV serostatus, sexual attraction, housing status, and self-rated health. High levels of association were also detected between all 6 subscales with both depression and PTSD, while significant correlations were detected between suicidality and both self esteem and loneliness related worries. Conclusions: The results of our analyses provide evidence for the strong psychometric characteristics of the LWS. This newly developed instrument should be utilized in research to examine the extent to which life worries explain health outcomes and risk behaviors in sexual minority males, and may be potentially extended for use in other populations. (PsycINFO Database Record
Adult Attachment as a Moderator of the Association Between Childhood Traumatic Experiences and Depression Symptoms Among Young Black Gay and Bisexual MenCook, S., Valera, P., Calebs, B. J., & Wilson, P. A.
Journal titleCultural Diversity and Ethnic Minority PsychologyObjective: The present study examined the moderating effect of adult attachment on the association between childhood traumatic experiences, (i.e., physical abuse, emotional abuse, emotional neglect, and being bullied), age of childhood traumatic experience, and young adult depression symptoms among young Black gay and bisexual men (YBGBM). Method: Self-report measures of attachment, childhood traumatic experiences, and depression symptoms were collected from a community-based sample of YBGBM living in New York City (n = 228). Regression analyses were conducted to address the study goals. Results: Findings indicated that YBGBM who were more anxious in their adult attachment style and experienced being bullied or physically abused by a non-family member during childhood experienced greater depression in young adulthood than YBGBM who were less anxious in their adult attachment style. In addition, we found that being bullied later in childhood was associated with greater depression symptoms than being bullied earlier. Lastly, we found that YBGBM who were more avoidant and bullied later in adolescence reported more depression symptoms in young adulthood than YBGBM who were less avoidant in their attachment style. Discussion: The findings suggest that it may be important to utilize an attachment perspective that is sensitive to age of traumatic experience when creating mental health and trauma interventions for YBGBM. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
Attachment orientation and sexual risk behaviour among young Black gay and bisexual menCook, S., Watkins, D. C., Calebs, B. J., & Wilson, P. A.
Journal titlePsychology and Sexuality
Page(s)177-196This mixed methods study used an explanatory sequential design to examine the relationship between attachment and sexual behaviour among young Black gay and bisexual men (YBGBM). Cross sectional online surveys and sex diaries were completed by a sample of YBGBM in New York City (n = 153) to assess the association between adult attachment insecurity and sexual risk behaviour. The Experiences in Close Relationships Scale-Revised (ECR-R) was used to assess three types of adult attachment (i.e., secure, anxious and avoidant). Participants reported condomless sex encounters, as well as serodiscordant condomless anal sex encounters, as measures of sexual risk. Quantitative findings suggested that there were few associations between attachment type and sexual risk behaviour; only men with attachment avoidance were likely to engage in condomless sex. However, qualitative findings illuminated some of the social complexities of the association between attachment in childhood, attachment in young adulthood and intimate partnerships, which could be linked to young adult sexual risk behaviour. The study findings highlight the need for researchers to further examine the process by which individual differences in attachment orientation are related to YBGBM’s sexual behaviour.
Profiles of Resilience and Psychosocial Outcomes among Young Black Gay and Bisexual MenWilson, P. A., Meyer, I. H., Antebi-Gruszka, N., Boone, M. R., Cook, S., & Cherenack, E. M.
Journal titleAmerican Journal of Community Psychology
Page(s)144-157Young Black gay/bisexual men (YBGBM) are affected by contextual stressors - namely syndemic conditions and minority stress - that threaten their health and well-being. Resilience is a process through which YBGBM achieve positive psychosocial outcomes in the face of adverse conditions. Self-efficacy, hardiness and adaptive coping, and social support may be important resilience factors for YBGBM. This study explores different profiles of these resilience factors in 228 YBGBM in New York City and compares profiles on psychological distress, mental health, and other psychosocial factors. Four profiles of resilience were identified: (a) Low self-efficacy and hardiness/adaptive coping (23.5%); (b) Low peer and parental support (21.2%); (c) High peer support, low father support (34.5%); and (d) High father and mother support, self-efficacy, and hardiness/adaptive coping (20.8%). YBGBM in profile 1 scored markedly higher on distress (d =.74) and lower on mental health functioning (d =.93) compared to men in the other profiles. Results suggest that self-efficacy and hardiness/adaptive coping may play a more important role in protecting YBGBM from risks compared to social support and should be targeted in interventions. The findings show that resilience is a multidimensional construct and support the notion that there are different patterns of resilience among YBGBM.
Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort studyCook, S., Halkitis, P. N., & Kapadia, F.
Journal titleJournal of Health Psychology
Sex Differences in Virtual Network Characteristics and Sexual Risk Behavior Among Emerging AdultsCook, S., Bauermeister, J. A., & Zimmerman, M. A.
Journal titleEmerging Adulthood
Page(s)284-297Emerging adults (EAs) aged 18–24 account for a large proportion of all sexually transmitted infections (STIs), HIV infections, and unintended pregnancies in the United States. Given the increased influence of online media on decision making, we examined how EA online networks were associated with sexual risk behaviors. We used egocentric network data collected from EAs aged 18–24 years old across the United States (N = 1,687) to examine how online social norms (e.g., acceptance of HIV infections, other STIs, and pregnancy) and network characteristics (i.e., network size and density; ties’ closeness, race, age, and sex similarities) were associated with participants’ unprotected vaginal intercourse in the last 30 days. Findings suggested that in male EAs, there was a strong association between online social norms, structural characteristics, and sexual risk behavior compared to females. Researchers and practitioners may wish to address online peer norms and EAs’ online network composition when developing online sexual risk prevention tools.
Sexual identity and HIV status influence the relationship between internalized stigma and psychological distress in black gay and bisexual menBoone, M. R., Cook, S., & Wilson, P. A.
Journal titleAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Page(s)764-770Experiences of internalized homophobia and HIV stigma in young Black gay and bisexual men (GBM) may lead to psychological distress, but levels of distress may be dependent upon their sexual identity or HIV status. In this study, we set out to explore the associations between psychological distress, sexual identity, and HIV status in young Black GBM. Participants were 228 young Black GBM who reported on their psychological distress, their HIV status, and their sexual identity. Results indicated that internalized homophobia was significantly related to psychological distress for gay men, but not for bisexual men. HIV stigma was related to psychological stress for HIV-positive men, but not for HIV-negative men. Results indicate a need for more nuanced examinations of the role of identity in the health and well-being of men who have sex with men.
The Integrated Attachment and Sexual Minority Stress Model: Understanding the Role of Adult Attachment in the Health and Well-Being of Sexual Minority MenCook, S., & Calebs, B. J.
Journal titleBehavioral Medicine
Page(s)164-173Gay and bisexual boys and men experience social stigma associated with their sexual minority status that can negatively influence health. In addition, experiencing sexual orientation stigma may be linked to a decreased capacity to effectively form and maintain secure attachment relationships with parents, peers, and romantic partners across the life-course. We proposed that utilizing a framework that integrates the process by which sexual minority men develop attachment relationships in the context of sexual minority stress can lead to a better understanding of health and well-being among sexual minority boys and men. In addition, we highlight where future research can expand upon the presented model in order to better understand the developmental processes through which attachment and sexual minority stress influences health and health behaviors among sexual minority boys and men.
Transitions in Friendship Attachment during Adolescence are Associated with Developmental Trajectories of Depression Through AdulthoodCook, S., Heinze, J. E., Miller, A. L., & Zimmerman, M. A.
Journal titleJournal of Adolescent Health
Page(s)260-266Purpose Forming secure friendship attachments during adolescence are important for mental health; few, however, have specifically examined the ways in which the transitions in attachment during adolescence may influence future mental health outcomes among African Americans. Methods The present study examines how transitions in attachment in adolescence predicted changes in depression symptoms from late adolescents through adulthood in an African-American sample. We used growth curve modeling to examine the association between transitions in friendship attachment and changes in depression symptoms in adulthood. Results At age 16 years, 346 (64.0%) adolescents reported secure attachment with 195 (36.0%) reporting either avoidant or resistant attachment. At age 17 years, 340 (62.9%) reported secure attachment and 201 (37.2%) reported avoidant or resistant attachment. The largest percentage of participants (46.2%) reported stable-secure attachment across the two time points. Results of the growth model indicated that adolescents who reported a stable-secure attachment style had lower levels of depression symptoms during adulthood than those individuals who transitioned from secure-to-insecure, from insecure-to-secure, or were in the stable-insecure group. Interestingly enough, individuals in both the attachment transition groups had a faster declining rate of depression symptoms over time compared to the two stability groups. Conclusions Data support existing research showing an association between transitions in attachment during adolescence and depression through adulthood. Furthermore, these study findings suggest there may be protective features associated with transitioning between attachment styles during adolescence on later depression, compared to African Americans who remain stable in their attachment style.
HIV status disclosure, depressive symptoms, and sexual risk behavior among HIV-positive young men who have sex with menCook, S., Valera, P., & Wilson, P. A.
Journal titleJournal of Behavioral Medicine
Page(s)507-517The rate of HIV infection among young men who have sex with men (YMSM) is increasing in the United States, and targeted research is needed to inform interventions aimed at reducing HIV transmission in this population. This study aims to understand the association between HIV status disclosure and sexual risk behavior among HIV-positive YMSM. A particular focus is given to depressive symptoms and their potential role in explaining the association between HIV disclosure and sexual risk behavior. In a sample of 991 YMSM receiving care at 20 clinics across the United States, Univariate and multivariate analyses were conducted to explore these associations. Approximately one-half (52.4 %) of participants reported disclosing to their current sexual/romantic partner. Disclosure to family members was negatively associated with sexual risk behavior. Also, depressive symptoms were positively associated with sexual risk behavior. We discuss the implications of our findings for future research and intervention.
The Smoking Behaviors and Cancer-Related Disparities Among Urban Middle Aged and Older Men Involved in the Criminal Justice SystemValera, P., Anderson, M., Cook, S., Wylie-Rosett, J., Rucker, J., & Reid, A. E.
Journal titleJournal of Cancer Education
Page(s)86-93This study examined cancer knowledge, mental health, and tobacco use in formerly incarcerated men. The Cancer-Health Research Study with Formerly Incarcerated Men in New York City used a cross-sectional research design to examine cancer knowledge and prevention (CKP) outcomes among 259 justice-involved males, ages 35–67. CKP was assessed using items from the National Cancer Institute’s Health Information National Trends Survey. Psychological symptoms were examined using the Brief Symptom Inventory. Of the 259 men who completed the survey, 76 % of the respondents self-reported as current smokers. Current smokers smoked between 1 and 40 cigarettes per day. The mean number of cigarettes smoked per day was 10.37 (SD = 6.76). Sixty-five percent (n = 165) of the respondents underwent cancer-screening tests. CKP scores ranged from 2 to 28; the mean was 15.05 (SD = 5.49), indicating that the men scored very low in terms of CKP. CKP scores were negatively associated with the number of cigarettes smoked per day, τ = −.13, p =.01. These results have important implications for enhancing access to cancer-health education programs in justice-involved settings.
What does attachment have to do with HIV transmission among young gay black and bisexual men?Cook, S.
Journal titleThe American Men's Studies Association Quarterly Newsletter
"They are not taking cigarettes from me... I'm going to smoke my cigarettes until the day I die. I don't care if I get cancer": Smoking behaviors of men under community supervision in New York CityValera, P., Cook, S., Darout, R., & Dumont, D. M.
Journal titleNicotine and Tobacco Research
Page(s)800-806Introduction: Cigarette smoking declined from 42.4% in 1965 to 19.3% in 2010 among the general population, but it remains the leading cause of preventable death and illness in the United States, especially among high-risk populations, including those with criminal justice involvement. Methods: A mixed-methods approach was used to investigate the smoking behaviors of men under parole or probation. Phase I focused on qualitative data of 30 semi-structured interviews of men who were recently released from a state prison and/or jail. Phase II analyzed quantitative data resulting from a study that examined smoking characteristics and treatment approaches of 259 participants, 197 of whom were cigarette smokers. Results: The survey participants' age of tobacco initiation ranged from 7 to 45 years of age. Participants smoked between 1 and 40 cigarettes per day; the mean number of cigarettes smoked per day was 10.37. Men released from prison used cigarettes for more years on average than men released from jail (t = -2.22, p < .05). A linear regression procedure revealed that the influence of friends and family significantly predicted smoking behavior (β = .25, p < .0001). The qualitative data revealed the following themes: unintended consequences of the prison smoking ban, smoking as anxiety management, smoking cigarettes as part of a daily routine, and barriers to quitting. Conclusions: Given the rapid growth of individuals under community supervision, public health and policy makers are missing an opportunity to develop strategies that promote smoking cessation treatments, especially among men who are serving parole or probation and during the incarceration period itself.
Conducting Health Disparities Research with Criminal Justice Populations: Examining Research, Ethics, and ParticipationValera, P., Cook, S., Macklin, R., & Chang, Y.
Journal titleEthics and Behavior
Page(s)164-174This study explored the challenges of informed consent and understanding of the research process among Black and Latino men under community supervision (e.g., parole and/or probation). Between February and October 2012, we conducted cognitive face-to-face interviews using open-ended questions on the significant areas of research participation (i.e., the informed consent process, confidentiality, compensation, what is meant by human subject and clinical trials) among 259 men aged 35 to 67 under community supervision in Bronx, New York. Content analysis of the open-ended questions revealed limited knowledge concerning the understanding of research participation. The study participants appeared to generally understand concepts such as compensation after research participation and confidentiality. Participants demonstrated a lack of understanding of certain aspects of the research process-informed consent, human subject, Institutional Review Board, and clinical trials. These findings are informative to researchers conducting studies with criminal justice populations and Institutional Review Boards reviewing research studies.