Exploratory Procedures Research Articles

EXPLORATORY STRUCTURAL PROCEDURES IN HEALTH SERVICES RESEARCH

Abstract When analysing data where little knowledge of relationships is available, exploratory structuring techniques, e.g., clustering and scaling techniques, are applied, using an inductive approach to construct analogies and thus suggest how to organize the data. These procedures in Health Service Research mainly focus on latent variables and are particularly used in the development of instruments or theories. Our symposium includes three presentations on research studies in which exploratory structural procedures were used for data analysis, that were considered appropriate for Health Service Research. Dr. Johannes Bergmann will present a concept mapping technique of the German Preferences for Everyday Living Inventory (PELI-D), for structuring the questionnaire from the perspective of professional nurses. This is a mixed methods participatory approach that combines interpretation and decisions by the researchers with a sequence of multivariate statistical analyses (multidimensional scaling, cluster analysis).. Jan Dreyer will present a Multiple Correspondence Analysis and Hierarchical Cluster Analysis as exploratory data reduction procedures. His aim was to identify types of home-based care arrangements for people living with dementia. To analyse the relationships between care arrangement variables, he performed Multiple Correspondence Analysis. To cluster the care arrangements, he performed Hierarchical Cluster Analysis. Anna Louisa Hoffmann will present an alternative, modified procedure of Multiple Correspondence analysis. Since Multiple Correspondence Analysis underestimates the true quality of data representation, she used Adjusted Multiple Correspondence Analysis to explore construct validity of the Dementia Policy Questionnaire (DemPol-Q). This procedure was considered appropriate to assign categorical variables to latent variables.

RECYCLING OF CATTLE MANURE ASSOCIATED WITH RICE HUSK AS VERMICOMPOST VIA THE EISENIA FÉTIDA EARTHWORM

Agro-silvopastoral residues such as cattle manure and rice husks are abundant in the southeastern region of Pará. As an alternative aimed at sustainability, recycling through vermicomposting has advantages such as low cost, easy and fast application, besides the production of a material rich in nutrients. The objective of the work was to analyze the use of the vermicomposting technique in the degradation of agroforestry residues for the construction of organic fertilizer. The research method used was hypothetical-deductive, of quanti-qualitative scope under applied nature and descriptive, exploratory and experimental procedures, with standardized techniques of data collection and systematic observation on the processes of the study. Within this, the study followed within a greenhouse environment under open sides, located in the back of the Pará State University, Marabá campus, Pará. The materials used were rice husk from a rice mill in the municipality, along with black soil and bovine manure. For the initial stages, the manure needed to go through a washing process (tanning), and the rice husk by carbonization of the material, transforming it into ash. A pre-composting was performed for a period of 36 days before the increment of Eisenia fétida earthworms. The experimental design was employed with the use of 4 treatments, T1 - Cattle manure + rice husk in natura + Soil (composted), T2 - Cattle manure + rice husk in natura + Soil (Vermicompost), T3 - Cattle manure + rice husk ash + Soil (composted), T4 - Cattle manure + rice husk ash + Soil (Vermicompost). To measure pH and temperature data, the AMT-300® equipment was used, while soil moisture was measured using a soil hygrometer sensor connected to the Arduino UNO R3 board. At the end, samples of the organic compost were analyzed in the soil laboratory of Embrapa Amazonia Occidental, with data submitted to descriptive statistics and comparison of means using the Tukey 5% test. The pre-composting required 36 days, a period considered long due to the problem of assembling the beds during the rainy season in Marabá. They had pH values suitable for worm casting (5.5 - 6.9) and temperatures < 30°C, considered suitable environments for the development of Eisenia fétida. T2 and T4 presented a significant difference in moisture and chemical composition compared to T1 and T3, with moisture levels above 70% and organic matter contents 40% higher. T4 was the one with the highest C/N ratio, with values higher than the other treatments. The nutritional gain observed in the organic composts from vermicomposting in the pilot experiment, supports the need for implementation of vermicomposting on a larger quantitative scale in the evaluation of the of Eisenia fetida earthworms and their potential for degradation of agroforestry residues, resulting in ecological alternatives for the southeastern region of Pará.

Introducing the Home Learning Environment Questionnaire and examining the profiles of home learning environments in Greece

The Home Learning Environment (HLE) plays a prominent role in children’s development. Several measures have been developed to assess its quality; however, most of them seem to mainly focus on specific aspects of the HLE construct. The aim of this study was to develop and validate the Home Learning Environment Questionnaire (HLEQ); and to examine the characteristics of the HLE and the HLE profiles using the new instrument in the Greek educational context. The HLEQ is a parent-reported measure addressing both activities and interactions, comprising of six factors that are considered key elements of the HLE: indoor, outdoor, and digital learning activities, warmth/support, conflict, and inconsistent discipline. The development of HLEQ followed a robust methodological approach, including the collection of an initial pool of items, expert review to examine its content validity, and piloting. The HLEQ was administrated to 814 parents (Mage = 37.86 years, SD = 4.84) of children (Mage = 64.12 months, SD = 7.19) attending 84 state funded kindergartens in Greece. A cross-validation approach was used to examine the factor structure of the HLEQ. Exploratory and confirmatory factor analysis and exploratory structural equation modeling procedures were implemented. Latent profile analysis was employed to identify the HLE profiles. Results provided initial support for the factor structure, reliability, and validity of the HLEQ. The HLEQ displayed good psychometric properties for measuring the quality of home learning activities and home learning interactions in the contemporary early HLE. Four HLE profiles were revealed, representing different parent-child interaction patterns during the learning activities. Limitations and implications for policy and practice are discussed.

Complications infectieuses liées à l’utilisation du propofol : une nouvelle série de cas et revue de la littérature

Propofol is the most commonly used hypnotic agent for the induction and maintenance of general anesthesia. Due to its lipid-based composition, propofol requires a strict handling protocol to avoid an increased risk of extrinsic contamination. On September 09, 2021, 05patients with post-anaesthetic Enterobacter cloacae infections were identified in the pediatric exploration department of the Hassan II University Hospital of Fez in Morocco. We describe the investigation into this outbreak. All patient medical records were reviewed to determine patient characteristics and potential risk factors. For the literature review, we identified relevant articles by searching PubMed, Medline, Embase and Science Direct. Our study included five patients, 80% were boys. The average age was 4.6years (1-7years), with no medical history. All five patients underwent exploratory procedures. Immediately after the procedures, all 5patients presented with chills, tachycardia and fever in the same order of admission. They were all admitted to hospital and blood samples were taken. Blood cultures were positive for E.cloacae. All patients had elevated levels of C-reactive protein (CRP) and an elevated white blood cell count. Bacteriological investigation revealed that the infection was caused by extrinsic contamination of the intravenous anesthetic propofol by E.cloacae. Fatal infections due to contaminated drugs, including propofol, have been reported worldwide. Propofol is a potential source of infections due to its lipophilic nature which promotes microbial growth. This probably remains an underestimated problem that deserves awareness for early recognition.

Consider Hereditary Angioedema in the Differential Diagnosis for Unexplained Recurring Abdominal Pain.

Health care providers are likely to encounter patients with recurrent unexplained abdominal pain. Because hereditary angioedema (HAE) is a rare disease, it may not be part of the differential diagnosis, especially for patients who do not have concurrent skin swelling in addition to abdominal symptoms. Abdominal pain is very common in patients with HAE, occurring in up to 93% of patients, with recurrent abdominal pain reported in up to 80% of patients. In 49% of HAE attacks with abdominal symptoms, isolated abdominal pain was the only symptom. Other abdominal symptoms that commonly present in patients with HAE include distension, cramping, nausea, vomiting, and diarrhea. The average time from onset of symptoms to diagnosis is 6 to 23 years. Under-recognition of HAE in patients presenting with predominant gastrointestinal symptoms is a key factor contributing to the delay in diagnosis, increasing the likelihood of unnecessary or exploratory surgeries or procedures and the potential risk of related complications. HAE should be considered in the differential diagnosis for patients with unexplained abdominal pain, nausea, vomiting, and/or diarrhea who have complete resolution of symptoms between episodes. As highly effective targeted therapies for HAE exist, recognition and diagnosis of HAE in patients presenting with isolated abdominal pain may significantly improve morbidity and mortality for these individuals.

Cross-Validated Loss-Based Covariance Matrix Estimator Selection in High Dimensions

The covariance matrix plays a fundamental role in many modern exploratory and inferential statistical procedures, including dimensionality reduction, hypothesis testing, and regression. In low-dimensional regimes, where the number of observations far exceeds the number of variables, the optimality of the sample covariance matrix as an estimator of this parameter is well-established. High-dimensional regimes do not admit such a convenience. Thus, a variety of estimators have been derived to overcome the shortcomings of the canonical estimator in such settings. Yet, selecting an optimal estimator from among the plethora available remains an open challenge. Using the framework of cross-validated loss-based estimation, we develop the theoretical underpinnings of just such an estimator selection procedure. We propose a general class of loss functions for covariance matrix estimation and establish accompanying finite-sample risk bounds and conditions for the asymptotic optimality of the cross-validation selector. In numerical experiments, we demonstrate the optimality of our proposed selector in moderate sample sizes and across diverse data-generating processes. The practical benefits of our procedure are highlighted in a dimension reduction application to single-cell transcriptome sequencing data.

The RIPASA scoring system: A new Era in appendicitis diagnosis

IntroductionEven though acute appendicitis is a common acute abdominal disease, it is nonetheless difficult to detect. In order to minimize the risk of complications and negative exploratory procedures, early and accurate diagnosis is critical.We aimed to compare the predictive accuracy of the RIPASA score in diagnosing acute appendicitis with the gold standard of histopathological proven appendicitis as the gold standard. MethodologyA Prospective Cohort Study was conducted from December 2021 to May 2022 at KRL Hospital. A total of 171 patients who sought treatment for acute RIF pain or suspected appendicitis were included in the study. Patients' surgical proclivities were judged in part based on images and surgeon's expertise. SPSS version 26 was used to enter and analyze the data. This was done using a chi-square test and a Kendall's Tau (Kendall Rank Correlation Coefficient) to evaluate both groups of patients. ResultsAt diagnosis, the mean age was 37.93 10.36 years. Kendall's Tau and Chi Square were shown to be significant in contrast to Alvarado scoring. RIPASA Scoring exhibited a 98.02% positive predictive value, a 96.75% sensitivity, an 82.35% specificity, and 95.3% diagnostic accuracy. ConclusionThe RIPASA score is superior to the Alvarado score when it comes to detecting acute appendicitis in Asian populations. With a brief medical history, a clinical examination, and two simple procedures, parameters can be simply and swiftly obtained in any demographic circumstance.

Human-Exploratory-Procedure-Based Hybrid Measurement Fusion for Material Recognition

While various biomimetic robotic haptic sensors are often utilized to measure multifarious physical interactions to identify material properties under human exploratory procedures (EPs), traditional methods are unable to fuse well multimodal measurements under EPs. In order to solve this problem, an innovative hybrid joint group kernel sparse coding model for material recognition under EPs is proposed. First, a series of feature representations according to the characteristics of different measures are introduced. Second, we propose an innovative hybrid fusion framework based on statistical learning with kernel sparsity to effectively fuse the measurements from robotic EPs. Third, a matched optimization algorithm is constructed to deal with the innate optimization problem in the proposed framework. Finally, we develop an evaluation based on three different classification levels (coarse, medium, and fine) with the public dataset containing 184 material classes to verify the proposed method and compare with some other similar kernel methods. The evaluation results show that the accuracy of coarse, medium, and fine classification of the proposed hybrid fusion framework is 98.4%, 96.2%, and 98.4%, respectively. The framework can be extended easily to other fusion tasks with multiple measurements.

Design of a Soft Gripper With Improved Microfluidic Tactile Sensors for Classification of Deformable Objects

Tactile object recognition is vital for robotic handling systems; however, existing technologies that concentrate on tactile sensors with high modulus are not suitable for soft grippers to classify deformable objects. In this letter, we integrated an indenter layer into the traditional microfluidic tactile sensor to increase its sensitivity based on the lensing effect of human skin. For the application of the developed sensor, we built HustGripper, a tendon-driven soft gripper, where the sensor was bonded on the fingertip. Experiments on the tactile classification of the deformable objects were conducted to validate the performance of the sensor, where different indenters, exploratory procedures, and data processing approaches were considered to explore the key factor to determine the classification accuracy.

Lower secondary school experiences as predictors of career aspirations toward engineering, and production and processing occupations

ABSTRACT The global demand for technically educated persons is greater than the supply. It is believed that interest and school experience can influence career choice. 624 Slovenian high school students participated in the survey. Exploratory and Confirmatory Factorial Analysis procedures were used to investigate the influence of school and out-of-school-related factors on career aspirations. Predictors of career aspirations in (a) engineering and (b) production and processing occupations in the models were: (1) students’ opinions on technical topics, (2) the content of school subject Technics and Technology; and (3) related classroom experiences. The results of the models showed that career aspirations were explained by out-of-school generated opinions on technical topics and not by school-related factors. Boys are more enthusiastic than girls in their career aspirations for technically oriented occupations. This calls for a fundamental revision of the school subject and the corresponding teaching.

What must supervisees do to promote supervision? An exploratory sequential mixed methods approach

ABSTRACT To date, researchers have not outlined supervisees’ perspectives on their behaviors, responsibilities, and/or practices to promote clinical supervision. In this study, we used Concept Mapping (CM) to explore what counselor trainees (supervisees; n = 16) perceived as their responsibilities to contribute to their clinical supervision experiences. Exploratory sequential mixed methods procedures of CM revealed five areas of supervisees’ responsibilities (e.g., Essential Tasks of Supervision, Inclusion of Multicultural Considerations) represented by 21 clusters. We discussed the results with limitations and implications for supervision practice and research.

Getting Insights From Twitter: What People Want to Touch in Daily Life.

Understanding what people want to touch in daily life has been one of the central topics in the fields of haptic science, engineering, and marketing. Several studies have addressed the topic, however, their findings were highly dependent on the experimental stimuli in the laboratory environment. In this study, we tried to gain insights into targets that people want to touch in daily life by conducting a Twitter survey. We collected a considerable amount of Japanese Twitter posts containing references to the desire for touch. To capture the motivation underlying these desires in relation to haptic properties, we used several queries that comprehensively covered exploratory procedures. The results showed that targets that people wanted to touch depended on the exploratory procedures in the queries used (e.g., "want to stroke" tended to target people and animals). We also found that these targets were desirable to touch not only for their haptic properties but also as a means of communicating with other people or living animals. Our findings would be important for understanding human haptic function in the real world and for developing consumer haptic displays and applications.

Longitudinal measurement invariance of the Behavioral Health Measure in a clinical sample.

The practice of routine outcome monitoring (ROM) has grown in popularity and become a fixture in feedback-supported clinical practice and research. However, if the interpretation of an ROM measure changes over time, treatment outcome scores may be inaccurate and produce erroneous or misguided interpretations of client progress and therapist efficacy. The current study examined whether factorial invariance held when using the Behavioral Health Measure (BHM-20) longitudinally in a clinical sample (n = 12,467). Using multidimensional item response theory-based models for the investigation of the BHM-20 factor structure, at a single time point and then longitudinally. Based on the original factor structure of the BHM-20 a unidimensional model, a three-factor orthogonal model, and a three-factor correlated model were fit to the data, indicating poor model fit with the proposed three-factor or unidimensional models. Next, using exploratory factor analysis and subsequent multidimensional item response theory procedures, a new 4-factor (General Distress, Life Functioning, Anxiety, and Alcohol/Drug Use) model was proposed with improved model-fit statistics. Finally, when testing the longitudinal invariance of the BHM-17 over 10 sessions of treatment, it was found to be fully consistent. The current study proposes the use of a 17-item, 4-factor model for a new understanding of the BHM-17. Implications for use in ROM and limitations are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

ON THE STRUCTURE OF PERSONAL MATURITY OF UNIVERSITY STUDENTS

The article sets out a problem aimed at determining the structure of personal maturity in the period of early adulthood. The theoretical study revealed a lack of unanimity in terms of interpreting and conceptualizing the concept of personal maturity and defining its structural and content elements. The empirical study involved humanitarian students from the first to the third courses (females (103) and males (22) aged 17-20 years). As a result of the exploratory factor analysis procedures, an integrative variable of personal maturity has been calculated which is considered as a set of cognitive (self-understanding, positive thinking), emotional (self-sympathy) and behavioral characteristics (autonomy, sociability). The personality of a mature subject in the period of early adulthood can be described as distinguished by an optimistic view of the world and a deep understanding of his or her identity combined with positive emotions and self-attitude and the ability to maintain personal boundaries even creating close relationships with others. The considered algorithm for calculating the integral variable can be applied in studies aimed at studying latent psychological phenomena.

182 Surgical Simulator Design, What are Educators and Trainees Requirements?

Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to enable trainees to learn technical skills, practice skills and to be assessed in competency exams, need to be of the highest standard and to be of consistent design. Input into the design and makeup of task trainers used to teach surgical skills come from a multitude of sources. Enquiry into the perspectives of simulation has been described in the past but there is little description, in the literature, of the expectations of the desired features of the simulator itself.This study investigates the perceived requirements of simulation and simulators used to acquire skills in the surgical field, particularly in limb exploratory procedures in trauma.This study concentrated on the implementation and desired features of simulators for the acquisition of surgical technical skills.Semi-structured interviews were conducted until data saturation was achieved. An international group of 11 surgical educators and 11 surgical trainees, who had experience with surgical simulation, were interviewed via one-to-one video calls. The interviews focussed on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. This study concentrated on synthetic and virtual reality simulators for open surgical skills, as these types of simulators are open to design and redesign or adaptation. Interviews were recorded, transcribed and underwent thematic analysis. Ethical approval was obtained for this study.Analysis of the perspectives of surgical educators and surgical trainees on simulated training in open surgery yielded three main themes: (1) attitudes to simulation, (2) implementing simulation, (3) features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt that simulation could be improved with increased accessibility and a variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost-effectiveness, easy setup and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.There is a clear positive appetite for the incorporation of simulation into general surgical and limb trauma training. The findings of this will inform the optimal requirements for high-quality implementation of simulation into a surgical trauma curriculum. The findings will inform the optimal features desired in a simulator or task trainer design. The aim is to inspire a more considered design approach to optimize surgical skills training and ultimately lead to increased patient safety.

Motives for Studying and Student Wellbeing: Validation of the Motivational Mindset Model.

Research on the joint effect of multiple motives for studying was recently given a push in a new direction with the introduction of the motivational mindset model (MMM). This model contributes to a better understanding of study success and student wellbeing in higher education. The aim of the present study is to validate the newly developed model and the associated mindset classification tool (MCT). To this end, 662 first-year university students were classified in one of the four types of motivational mindset using the classification tool and three exploratory validation procedures were conducted through sense of purpose, study engagement, and students’ background characteristics in terms of gender and ethnicity. Both purpose and study engagement are central dimensions of student wellbeing and predictors of study success. The results show that (1) sense of purpose and study engagement differ across the four types of mindset, (2) students in the low-impact mindset show the least optimal pattern of study engagement and sense of purpose, (3) sense of purpose and study engagement are positively related and this relationship is consistent across mindsets, and (4) overall differences in purpose and study engagement between gender and ethnic subgroups stem from one specific type of motivational mindset. The results provide support for the validity of the MMM and the usefulness of the MCT. The implications of the findings are discussed as well as promising avenues for future research.

Designing a synthetic simulator to teach open surgical skills for limb exploration in trauma: a qualitative study exploring the experiences and perspectives of educators and surgical trainees

BackgroundSimulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to adequately enable trainees to learn, practice and be assessed in surgical skills need to be of the highest standards. This study investigates the perceived requirements of simulation and simulators used to acquire skills in limb exploratory procedures in trauma.MethodsSemi-structured interviews were conducted with an international group of 11 surgical educators and 11 surgical trainees who had experience with surgical simulation. The interviews focused on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. Interviews were recorded, transcribed and underwent thematic analysis.ResultsAnalysis of the perspectives of surgical educators and surgical trainees on simulated training in limb trauma surgery yielded three main themes: (1) Attitudes to simulation. (2) Implementing simulation. (3) Features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt simulation could be improved with increased accessibility and variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost effectiveness, easy set up and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.ConclusionThere is a clear positive appetite for the incorporation of simulation into limb trauma training. The findings of this will inform the optimal requirements for high quality implementation of simulation into a surgical trauma curriculum and a reference to optimal features desired in simulator or task trainer design.

Sex-Positivity, Medical Mistrust, and PrEP Conspiracy Beliefs Among HIV-Negative Cisgender Black Sexual Minority Men in Atlanta, Georgia.

Because the public health response to the disproportionate HIV burden faced by Black sexual minority men (BSMMM) has focused on sexual risk reduction and disease prevention, other vital components of sexual health (e.g., intimacy, pleasure, benefits of sex) have been often overlooked. Sex-positive describes a more open, holistic approach toward sex and sexuality that prioritizes these other components, though such an approach is rarely applied to BSMM's sexual health. For sex-positive BSMM, risk/preventive discourse may foster or exacerbate medical mistrust as a reaction to the dissonance between how these men view sexual health and how the medical establishment views it, which may discourage sexual healthcare-seeking. We assessed sex-positivity and its association with medical mistrust and PrEP conspiracy beliefs among 206 HIV-negative cisgender BSMM in Atlanta, Georgia. We performed exploratory factor analytic procedures on responses to a sex-positivity scale, followed by multivariable linear regressions to determine sex-positivity's associations with medical mistrust and PrEP conspiracy beliefs. We extracted two sex-positivity factors: sexual freedom (α = 0.90), reflecting openness toward casual sex and rejection of sexual mores, and essence of sex (α = 0.77), reflecting the intimate, relational, and pleasurable qualities of sex. Sexual freedom was independently associated with perceived provider deception (β = 0.19, CI = 0.04, 0.34). Essence of sex was independently associated with PrEP conspiracy beliefs (β = 0.16, CI = 0.02, 0.31) and marginally associated with perceived provider deception (β = 0.14, CI = - 0.00, 0.29). Healthcare providers and public health practitioners may cultivate greater trust with BSMM by incorporating a sex-positive approach into patient/participant interactions, clinical decision-making, and interventions. Improving access to sexual pleasure acknowledges BSMM's right to optimal, holistic sexual health.

Actions and attitudes on the immunized patients against SARS-CoV-2.

The access to COVID vaccines by millions of human beings and their high level of protection against the disease, both in its mild and severe forms, together with a plausible decrease in the transmission of the infection from vaccinated patients, has prompted a series of questions from the members of the College of Physicians of Madrid (ICOMEM) and the society. The ICOMEM Scientific Committee on this subject has tried to answer these questions after discussion and consensus among its members. The main answers can be summarized as follows:The occurrence of new SARS-CoV-2 infections in both vaccinated and previously infected patients is very low, in the observation time we already have. When breakthrough infections do occur, they are usually asymptomatic or mild and, purportedly, should have a lower capacity for transmission to other persons.Vaccinated subjects who have contact with a SARSCoV-2 infected patient can avoid quarantine as long as they are asymptomatic, although this decision depends on variables such as age, occupation, circulating variants, degree of contact and time since vaccination. In countries with a high proportion of the population vaccinated, it is already suggested that fully vaccinated persons could avoid the use of masks and social distancing in most circumstances.Systematic use of diagnostic tests to assess the immune response or the degree of protection against reinfection after natural infection or vaccination is discouraged, since their practical consequences are not known at this time. The existing information precludes any precision regarding a possible need for future revaccination.This Committee considers that when mass vaccination of health care workers and the general population is achieved, SARS-CoV-2 screening tests could be avoided at least in out-patient care and in the case of exploratory procedures that do not require hospitalization.

Metrics of Sexual Behavior Stigma Among Cisgender Men Who Have Sex With Men in 9 Cities Across the United States.

Men who have sex with men (MSM) in the United States are stigmatized for their same-sex practices, which can lead to risky sexual behavior, potentiating risk for human immunodeficiency virus (HIV) infection. Improved measurement is necessary for accurately reporting and mitigating sexual behavior stigma. We added 13 sexual behavior stigma items to local surveys administered in 2017 at 9 sites in the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance system, which uses venue-based, time-sampling procedures to survey cisgender MSM in US Census Metropolitan Statistical Areas. We performed exploratory factor analytical procedures on site-specific (Baltimore, Maryland; Denver, Colorado; Detroit, Michigan; Houston, Texas; Nassau-Suffolk, New York; Portland, Oregon; Los Angeles, California; San Diego, California; and Virginia Beach-Norfolk, Virginia) and pooled responses to the survey items. A 3-factor solution-"stigma from family" (α=0.70), "anticipated health-care stigma" (α=0.75), and "general social stigma" (α=0.66)-best fitted the pooled data and was the best-fitting solution across sites. Findings demonstrate that MSM across the United States experience sexual behavior stigma similarly. The results reflect the programmatic utility of enhanced stigma measurement, including tracking trends in stigma over time, making regional comparisons of stigma burden, and supporting evaluation of stigma-mitigation interventions among MSM across the United States.