Autoregressive Cross-lagged Models Research Articles

Coping with COVID-19: Longitudinal Impact of the Pandemic on Adjustment and Links with Coping for Adolescents with and without ADHD.

Understanding factors that foster resilience and buffer against the negative psychological impact of COVID-19 is critical to inform efforts to promote adjustment, reduce risk, and improve care, particularly for adolescents with neurodevelopmental disorders. This prospective longitudinal study addresses this gap by investigating the impact of the COVID-19 pandemic on adolescents’ mental health and substance use, and by assessing specific positive coping strategies among adolescents with and without attention-deficit/hyperactivity disorder (ADHD). Using multi-group autoregressive cross-lagged path models, the present study explored the reciprocal influence of positive coping behaviors on multiple adjustment outcomes including mental health symptoms, substance use, stress, and worry. Participants included 238 adolescents (132 male participants; ages 15–17; 118 with ADHD). Parents provided ratings of adolescent routines, and adolescents provided ratings of coping behaviors and psychological adjustment in spring (May/June), summer (July/August), and fall (October/November) 2020. All models included the effects of adjustment at the prior timepoint as well as relevant covariates including adolescent race, ethnicity, sex, medication status, and family income. Adolescents with ADHD were at greater risk for experiencing increases in mental health symptoms and substance use throughout the pandemic, relative to adolescents without ADHD. The use of positive coping strategies and adolescent routines buffered against increases in substance use and mental health problems for adolescents with ADHD. These findings have important clinical and public policy relevance for parents, schools, and employers who may aim to prioritize keeping schedules as consistent as possible to promote healthy adjustment.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10802-021-00857-2.

Modeling longitudinal dyadic processes in family research.

In this article, several dyadic analyses are applied to illustrate how they can be used to answer distinct research questions regarding associations between dyad members over time (longitudinal interdependence). This article focuses on how to conceptualize and empirically assess distinct dyadic processes, including time-sequential processes involving change in rank-order, parallel change processes involving intra-individual changes, dynamic dyadic processes involving both intra-individual changes and time-specific deviations (from intra-individual change), and accelerated dyadic processes involving acceleration of intra-individual change. These dyadic processes are depicted by four different dyadic models; a cross-lagged autoregressive model, a dyadic latent growth model (with and without structured residuals), and a dyadic latent change score model, respectively. These four longitudinal dyadic models are illustrated using a sample of 251 husbands and wives in enduring marriages. Each model focuses on a different dyadic process demonstrating distinct ways to empirically assess longitudinal interdependence; thus, when analyzing data, dyadic researchers must weigh the advantages and disadvantages of each and select the modeling approach that is most appropriate for the research question. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using Crime Data to Assess Longitudinal Relationships Between Community Violent Crime and Aggressive Behavior Among At-Risk Youth

The goal of this study was to assess longitudinal, predictive relationships between community violent crime and reactive and proactive aggression. Community violent crime data were gathered from local law enforcement agencies and combined with an existing dataset of at-risk youth. Aggression was assessed by parents using the Reactive and Proactive Aggression Questionnaire (RPQ). Data were examined over four time points. Autoregressive cross-lagged modeling was used to test two models: one for proactive aggression and one for reactive aggression. Results revealed a positive relationship between community violent crime and proactive aggression, whereas the model including reactive aggression had poor model fit. Therefore, results support reactive and proactive aggression as distinct constructs. Findings also demonstrate that publicly accessible violent crime data can be used to predict children’s behavior over time. Finally, results have important implications for preventive interventions for at-risk youth.

Reciprocal associations between affectual, associational, and normative solidarity with parents during children's early to established adulthood.

Intergenerational solidarity has become increasingly important to understand, as close family members mobilize the provision of social support across generations and contribute to family wellbeing. However, less is known about continuity and change in normative (eldercare norms), affectual, and associational solidarity with mothers and fathers as children emerge into full or established adulthood. Therefore, we focused on reciprocal associations between three dimensions of intergenerational solidarity (normative, affectual, and associational) as reported by young-adult children from their early twenties to late thirties. Data were derived from respondents in the Longitudinal Study of Generations: daughters reported about relationships with 291 mother-father pairs and sons reported about relationships with 309 mother-father pairs in 2000, 2005, and 2016. Autoregressive cross-lagged models prospectively predicted mutual influences among the three dimensions of solidarity across daughter-parent and son-parent relationships. In addition, multiple group analysis was conducted to examine the children's gender difference. We found that normative solidarity and emotional closeness with mothers were mutually reinforcing in daughters' and sons' parental relationships. However, normative solidarity predicted emotional closeness with fathers in both daughter-parent and son-parent relationships. The study concludes that sons and daughters establish eldercare norms based on emotional components of solidarity with mothers, and suggest that filial duty is a key reason why mother-child relations become close over the family life course.

The Effect of Abdominal Breathing on Empathy for Pain: The Role of Interoceptive Awareness

Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.

Growth Mindset of Individuals Can Influence Their Self-Report of Mental Health and Life Events

Individual differences in grit and growth mindset predict effort and achievement in the face of challenges, but little is known about how the two traits influence each other during adolescence. In the current investigation, we analyzed data on grit and growth mindset collected from 1667 adolescents and their teachers on four occasions over 2 academic years. In autoregressive cross-lagged models, grit predicted rank-order increases in growth mindset and growth mindset predicted rank-order increases in grit. These findings suggest that during adolescence, grit and growth mindset are distinct but mutually reinforcing.

A Longitudinal Study on the Relationship between Physical Education and Social Health.

This study aimed to examine whether school physical education (PE) promotes students’ social health using a longitudinal design. To this end, data from 1979 students from a 4th grade cohort, established by the Korean Children and Youth Panel Survey with data collected from 2010 to 2016, who participated in all of the 7th grade (2013), 8th grade (2014), and 9th grade (2015) surveys were analyzed. We used autoregressive cross-lagged structural equation modeling conducted with AMOS 23.0 to examine the longitudinal causality among the factors. The following results were obtained. First, there was reciprocal causation between PE and social health (PE→SR, β = 0.099, β = 0.100; SR→PE; β = 0.207, β = 0.226). Second, PE did not influence sense of community, whereas the latter had a negative effect on PE (β = −0.078, β = −0.077). Third, social relationships influenced the sense of community (β = 0.248, β = 0.266). Based on these findings, we suggest the need for a system that enables students to frequently monitor their performance. This includes implementing a program to improve social relationships to enhance the quality of PE participation, designing programs that foster a sense of community in PE in Korean middle schools, and structuring PE programs that consider the hierarchy between social relationships and a sense of community.

자기회귀교차지연 모형을 적용한 청소년 체육수업 운동시간과 자아건강평가 및 우울감의 종단적 관계 분석

This study analyzed of longitudinal relationship between exercise activity time of physical education(PEA), self-health assessment(SHA), and depression(DP) in adolescent using auto-regressive cross-lagged(ARCL) model. The longitudinal time data(middle school 2nd year, high school 1st year, high school 3rd year) was collected through the Korea national youth policy insitute(NYPI), that was 1905-adoelscent(967-boy, 938-girl). SPSS 26, AMOS 26 programs were used to analyze the ARCL model. Alpha level was set at 0.05. The results were as follows. First, there was no change of the auto-regressive effect in PEA, SHA, and DP. Students who didn’t actively participate in physical education classes, students with poor health, and students with depression needed early detection and prescription. Second, there was significant difference of the cross-lagged effect in PEA, SHA, and DP with the passage of time. The effect that students who value SHA highly participated in PEA at the later point were relatively greater than the effect that students who actively participated in PEA evaluated SHA at the later point in time. In addition, the effect of lowering SHA at the later point by students with high DP was greater than the effect of lowering DP at the later point in the students with high rating of SHA. Third, SHA was significant as the longitudinal mediating variable in the effect of PEA on DP. It was found that PEA in the 2nd year of middle school significantly influenced DP in the 3rd year of high school, and the longitudinal mediating effect of SHA in the 1st year of high school was significantly affected.

Analysis of reading activities, description and essay type assessment, discussion & debate activities on middle schoolers' attitude towards Korean literature class: Application of autoregressive cross-lagged modeling

목적 본 연구는 국어태도(국어수업 태도, 국어 효능감, 국어 흥미)에 영향을 줄 수 있는 국어활동(독서 활동, 서술형⋅논술형 평가 활동, 토의⋅토론 활동) 요인의 종단적 관계를 살펴보았다. 방법 연구를 위해 부산교육종단연구 중학생 패널의 2~4차년도 자료를 이용하여 자기회귀교차지연모형을 적용해 검증하였다. 결과 본 연구에서 채택된 최종 연구 모형의 분석 결과는 다음과 같다. 첫째, 국어활동에 대한 학생의 참여 정도는 각각 이전 시점의 값이 이후 시점의 값에 지속적으로 정적 영향을 미치는 것으로 나타났으며 모두 통계적으로 유의하였다. 둘째, 국어 태도는 이전 시점의 이후 시점의 값에 지속적으로 부적 영향을 미치는 것으로 나타났으며, 중3에서 고1로 가는 시기에서만 통계적으로 유의하였다. 셋째, 국어활동이 이후 시점의 국어 태도에 미치는 교차지연효과는 각각 이전 시점의 값이 이후 시점의 값에 지속적으로 정적 영향을 미치는 것으로 나타났으며, 중3에서 고1로 가는 시기에서만 통계적으로 유의하게 나타났다. 결론 연구 결과를 바탕으로 국어 태도 및 국어 활동 교육에 대한 시사점과 후속 연구에 대한 제언을 제시하였다.

The association of child neglect with lifestyles, depression, and self-esteem: Cross-lagged analyses in Chinese primary schoolchildren

Child neglect robustly predicts many behavioral problems and adulthood mental disorders, but little is known about its association with daily lifestyles and psychological development during childhood, particularly in the longitudinal study. We aimed to examine the association of child neglect with physical activity (PA), screen time (ST), eating habits (EHs), and depression/self-esteem using a two-wave follow-up study of primary schoolchildren in Wuhan, China. Data of 1085 schoolchildren aged 8–10 years (boys: 53.5%) were analyzed. Child neglect, lifestyles, and depression/self-esteem were collected in 2018 (T1) and 2019 (T2). Autoregressive cross-lagged models (ARCLMs) were fitted to explore the interrelationships among these variables. In ARCLM including child neglect and lifestyles, higher child neglect at T1 was significantly associated with higher ST and more risky EHs at T2, while insignificantly associated with PA. In ARCLM including child neglect and depression/self-esteem, lower T1 child neglect significantly predicted a higher T2 depression, but insignificantly for T2 self-esteem. In ARCLM including all variables, child neglect still significantly predicted later ST and depression, but insignificantly predicted EHs. Our study underscores that child neglect is strongly intertwined with ST, EHs, and depression during childhood. The prevention of child neglect may promote some healthy lifestyles and depression in children.

Time spent in outdoor light is associated with mood, sleep, and circadian rhythm-related outcomes: A cross-sectional and longitudinal study in over 400,000 UK Biobank participants

BackgroundLight has powerful effects on mood, sleep, and the circadian system. Humans evolved in an environment with a clear distinction between day and night, but our modern environments have blurred this distinction. Negative effects of light exposure at night have been well characterized. The importance of daytime light exposure has been less well characterized. Here we examine the cross-sectional and longitudinal associations of time spent in daytime outdoor light with mood, sleep, and circadian-related outcomes. MethodsParticipants were drawn from the UK Biobank cohort, a large study of UK adults (n = 502,000; 37–73 years old; 54% women). ResultsUK Biobank participants reported spending a median of 2.5 daylight hours (IQR = 1.5–3.5 h) outdoors per day. Each additional hour spent outdoors during the day was associated with lower odds of lifetime major depressive disorder (95% CI OR:0.92–0.98), antidepressant usage (OR:0.92–0.98), less frequent anhedonia (OR:0.93–0.96) and low mood (OR:0.87–0.90), greater happiness (OR:1.41–1.48) and lower neuroticism (incident rate ratio, IRR:0.95–0.96), independent of demographic, lifestyle, and employment covariates. In addition, each hour of daytime light was associated with greater ease of getting up (OR:1.46–1.49), less frequent tiredness (OR:0.80–0.82), fewer insomnia symptoms (OR:0.94–0.97), and earlier chronotype (adjusted odds ratio; OR:0.75–0.77). Auto-Regressive Cross-Lagged (ARCL) models were used to examine the longitudinal association of time spent in outdoor light at baseline with later mood-, sleep- and circadian-related outcomes reported at time point 2. Overall, longitudinal associations support cross-sectional findings, though generally with smaller effect sizes. LimitationsFuture studies that examine the intensity of daytime light exposure at the ocular level are needed. ConclusionsOur findings suggest that low daytime light exposure is an important environmental risk factor for mood, sleep, and circadian-related outcomes.

Discrepancy in Dyadic Sexual Desire Predicts Sexual Distress over Time in a Community Sample of Committed Couples: A Daily Diary and Longitudinal Study.

In long-term relationships, sexual desire discrepancy (SDD) occurs frequently between partners. For many, this discrepancy is persistent and significant, and a source of distress. However, the dynamics of SDD in couples and, specifically, its implications for sexual distress have received scant empirical attention. This study examined the associations between SDD and sexual distress from one day to the next and over a 12-month span, in a community sample of 229 same-sex/gender and mixed-sex/gender couples. Two datasets were collected: A 35-day daily diary and a 12-month longitudinal survey. In both, dyadic sexual desire and sexual distress were measured, and SDD was calculated as the absolute value of the difference in sexual desire between partners. Directional associations between SDD at one time point and sexual distress at the next time point were assessed using multilevel, 2-pane autoregressive cross-lagged models, controlling for within-variable changes, dependencies between partners, and partner age. Results were consistent with the study's hypotheses: Couples' SDD on one day predicted sexual distress on the next day. Similarly, SDD at baseline predicted sexual distress 12months later. Participant gender, partner gender, and couple type did not significantly moderate these associations, nor did differentiating partners based on higher and lower average sexual desire. The reverse associations (i.e., sexual distress predicting SDD) were non-significant. The associations' directionality and the fact that they remained significant over days and months were consistent with the proposal that SDD is a precursor of sexual distress. The present study provides support for dyadic conceptualizations of sexual desire. Clinically, findings suggest that therapeutic approaches should address issues with sexual desire and sexual distress by focusing not on the individual, but on the couple.

Longitudinal Associations of PROMIS-29 Anxiety and Depression Symptoms With Low Back Pain Impact in a Sample of U.S. Military Service Members.

The Impact Stratification Score (ISS) is a measure of the impact of chronic low back pain (LBP) consisting of nine Patient-Reported Outcomes Measurement Information System (PROMIS-29) items, but no studies have examined the ISS or its association with psychological symptoms in military samples. This study examines longitudinal associations between psychological symptoms and the ISS among military service members. The study involved secondary data analysis of a sample of active duty U.S. military service members aged 18-50 years with LBP (n = 733). Participants completed the PROMIS-29 at three time points during treatment: baseline (time 1, T1), week 6 of treatment (time 2, T2), and week 12 of treatment (time 3, T3). The impact of LBP was quantified using the ISS (ranging from 8 = least impact to 50 = greatest impact). Psychological symptoms were assessed as PROMIS-29 anxiety and depression scores. Separate autoregressive cross-lagged models examined reciprocal associations of ISSs with anxiety, depression, and emotional distress scores from T1 to T3. Within each time point, the ISS was significantly and positively correlated with anxiety and depression. In autoregressive cross-lagged models, anxiety and depression predicted the ISS at the next time point and associations were similar in magnitude (e.g., anxiety T2 to ISS T3: β = 0.12, P < .001; depression T2 to ISS T3: β = 0.12, P <.001). The ISS did not predict future depression or emotional distress scores at any time point, but the ISS at T2 was significantly, positively associated with anxiety scores at T3 (β = 0.07, P = .04). Psychological symptoms consistently and prospectively predict the impact of LBP as measured by the ISS among service members undergoing pain treatment. The ISS may also be associated with future anxiety but not depression. PROMIS-29 anxiety and depression items may be useful adjunctive measures to consider when using the ISS to support LBP treatment planning and monitoring with service members.

Cortisol Reactivity and Socially Anxious Behavior in Previously Institutionalized Youth.

The current study investigated the association between cortisol stress reactivity to a social stressor and observed socially anxious behaviors both concurrently and over time among previously institutionalized (PI) (N = 132; ages 7-17) youth and a comparison non-adopted (NA) sample (N = 176). Cortisol reactivity was captured during the Trier Social Stress Test for Children (TSST-C; Yim et al., 2015) and youths' social anxiety behaviors were coded during the speech portion of the TSST-C. Autoregressive cross-lagged panel models with structured residuals showed that for PI youth, greater cortisol reactivity predicted increases in socially anxious behavior during the TSST-C across three sessions. However, greater cortisol reactivity was negatively associated with concurrent social anxiety behavior. Thus, increases in cortisol reactivity across adolescence may aid in behavioral control in social situations in the short-term but may exacerbate PI youths' socially anxious behavior over time. No significant associations emerged for NA youth.

Parenting stress mediates the longitudinal effect of maternal depression on child anxiety/depressive symptoms

BackgroundEvidence is lacking for the longitudinal bidirectional relationship between maternal depression and child anxiety/depressive symptoms through pre-school to adolescence and regarding parenting stress as having a mediating effect on this association. MethodsWe performed a secondary analysis of data from the Fragile Families and Child Well-being Study (n = 1,446 child-mother dyads in 20 main U.S. cities) collected at baseline, Year-5 (T1), Year-9 (T2) and Year-15 (T3) (from 1998 to 2017). Maternal depression, child anxiety/depressive symptoms and parenting stress were assessed at three time points (T1-T3). The associations were evaluated using autoregressive cross-lagged panel models. ResultsCross-lagged models indicated that 1) maternal depression significantly predicted subsequent higher child anxiety/depressive symptoms across all time points, and 2) greater child anxiety/depressive symptoms significantly predicted subsequent maternal depression across all time points. Furthermore, T1 maternal depression was indirectly associated with T3 child anxiety/depressive symptoms via T2 parenting stress [b = 0.010 (SE=0.004), p = 0.017]. However, T2 parenting stress did not significantly mediate the association between T1 child anxiety/depressive symptoms and T3 maternal depression [b = 0.004 (SE=0.004), p = 0.256]. LimitationsThe FFCWS oversampled unmarried parents and had a higher proportion of socio-economically disadvantaged racial and ethnic minority families, limiting the generalizability of findings. ConclusionsMaternal depression is indirectly linked to child anxiety/depressive symptoms via parenting stress.

The verification of causal relationship between acculturative stress and bicultural acceptance attitude using autoregressive cross-lagged modeling

The verification of causal relationship between acculturative stress and bicultural acceptance attitude using autoregressive cross-lagged modeling

Examining the simple view of reading in Kiswahili: Longitudinal evidence from Kenya

The present study examines the applicability of the simple view of reading (SVR) (Gough & Tunmer, 1986) model of reading comprehension in Kiswahili, a language that has a transparent orthography. We examined the developmental relationships among nonword decoding, listening comprehension, oral reading fluency, and reading comprehension using longitudinal data from a sample of 628 Kenyan children, enrolled in first and second grade. Children completed eight different tasks. We fit autoregressive cross-lagged path models with maximum likelihood estimation to examine the developmental relationships. Our findings showed support for the SVR model, given that both nonword decoding and listening comprehension were significant predictors of reading comprehension in Kiswahili. Nonword decoding was the stronger predictor. The results further revealed that both accuracy and speed of nonword decoding played significant roles in reading comprehension in Kiswahili for beginning readers. Our findings suggest that oral reading fluency and accuracy were significant predictors of reading comprehension.

Victimized in many ways: Online and offline bullying/harassment and perceived racial discrimination in diverse racial-ethnic minority adolescents.

Objectives: Racial-ethnic minority youth face multiple types of victimization associated with negative developmental outcomes. The present study examined the interplay of youth experiences of online and offline bullying/harassment and racial-ethnic discrimination across three waves. Methods: Racial-ethnic minority adolescents aged 10-19 (N = 735) at Midwest schools were surveyed yearly on Internet usage and experiences, mental well-being, and related risk and protective factors. We analyzed offline and online bullying/harassment, offline and online racial-ethnic discrimination, and time online in an autoregressive cross-lagged panel model. Results: Youth who reported more of one type of victimization also reported more of other victimization types and more time online concurrently. Our results show some (but not consistent) influences over time. Youth who experienced more offline bullying/harassment at wave 1 were more likely to report more wave 2 victimization in another context (online bullying/harassment) and in other content (offline racial-ethnic discrimination), although these associations did not appear in the second wave. Youth who reported more online bullying/harassment at wave 2 also experienced increased risk for offline bullying/harassment at wave 3. Youth who reported more time online were not more likely to experience later victimization, though youth who experienced more wave 1 offline bullying/harassment were more likely to report more next-wave time online. Conclusions: Racial-ethnic minority youth simultaneously and persistently face multiple types of victimization. Offline bullying/harassment interventions may have the added benefit of reducing other forms of victimization down the road, while reducing time online alone is unlikely to protect youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations between hedonic hunger and BMI during a two-year behavioural weight loss trial.

ObjectiveProspective studies on relationships between hedonic hunger and BMI (Body Mass Index) during weight management are lacking. This study examined if hedonic hunger reduced during a behavioural weight management programme, and if hedonic hunger predicted future BMI.MethodsParticipants were 594 community-dwelling, UK-based adults(396 female; age 56.43 years, s.d. = 12.50, range 20–83 years); 490 participants (82.5%) had obesity. Participants were randomised to a 12- or 52-week behavioural weight management intervention (WW12 or WW52, respectively) or a brief self-help intervention (BI). Relationships between hedonic hunger and BMI over 24 months (baseline, 3, 12, 24 months) were analysed using an autoregressive cross-lagged model.ResultsHedonic hunger scores decreased from 2.71 (s.d. = .91) at baseline to 2.41 (s.d. = .88) at 3 months (p < .001, CI .22 to .38), remained reduced to 24 months, and were not affected by intervention arm at any time point (p’s>.05). Baseline hedonic hunger scores predicted 3-month scores (B = .76, SE = .03, p < .001, CI .71 to .82), 3-month scores predicted 12-month scores (B = .76, SE = .03, p < .001 CI .72 to .80), and 12-month scores predicted 24-month scores (B = .72, SE = .03, p < .001, CI .64 to .77). Higher hedonic hunger at 3 months predicted higher BMI at 12 months (B = .04, SE = .02, p = .03, CI .01 to .07) but not at 24 months (p>.05). BMI at 12 months was lower in WW52 30.87kg/m2, s.d. = 5.02) than WW12 (32.12 kg/m2, s.d. = 5.58, p = .02, CI .16 to 2.34) and BI (32.74 kg/m2, s.d. = 4.15, p = .01, CI .30 to 3.45). BMI was not affected by intervention at any other time point (p’s>.05).ConclusionHedonic hunger reduced during weight management irrespective of intervention. Early reductions in hedonic hunger appear to be associated with lower BMI in the medium-term. Identifying ways to reduce hedonic hunger during weight loss could aid weight management for some people.

An autoregressive cross-lagged model unraveling co-occurring stimulant use and HIV: Results from a randomized controlled trial

BackgroundEvidence-based interventions are needed to address the use of stimulants such as methamphetamine as a driver of onward HIV transmission and faster clinical HIV progression among sexual minority men. Prior randomized controlled trials with people living with HIV who use substances indicate that financial incentives provided during contingency management (CM) are effective for achieving short-term reductions in stimulant use and HIV viral load. However, the benefits of CM are often not maintained after financial incentives for behavior change end. PurposeData from a recently completed randomized controlled trial with 110 sexual minority men living with HIV who use methamphetamine was leveraged to examine mediators of the efficacy of a positive affect intervention for extending the benefits of CM. MethodsAn autoregressive cross-lagged model was fit to determine if reductions in HIV viral load were mediated by intervention-related increases in positive affect and decreases in stimulant use measured in four waves over 15 months. ResultsHigher baseline positive affect predicted significantly lower self-reported stimulant use immediately following the 3-month CM intervention period, even after controlling for self-reported stimulant use at baseline. Moreover, decreased stimulant use emerged as an independent predictor of long-term reductions HIV viral load at 15 months, even after adjusting for HIV viral load at baseline and the residual effect of the positive affect intervention. ConclusionsFindings underscore the importance of durable reductions in stimulant use as a primary intervention target that is essential for optimizing the clinical and public health benefits of HIV treatment as prevention.