Socio-behavioral Factors Research Articles

PrEP Stigma as a Minority Stressor among Black Sexual Minority Men: A Mixed-Methods Study.

Black sexual minority men (BSMM) remain disproportionately affected by HIV, yet Pre-exposure prophylaxis (PrEP) uptake in this population remains relatively low. Informed by minority stress theory, PrEP stigma may manifest in and exacerbate societal marginalization based on sexuality and race. We used an exploratory sequential mixed-methods approach to determine if PrEP-specific stigma was associated with reduced PrEP uptake among BSMM, and qualitatively explored how PrEP use is stigmatized among BSMM. We analyzed cross-sectional data from a pilot sample of BSMM (n = 151) collected in late 2020 in the United States, testing for associations between PrEP stigma and PrEP use using modified Poisson regression. Subsequently, we selected participants (n = 23) from this sample for qualitative interviews starting in 2022. Responses to questions related to PrEP stigma were analyzed using thematic analysis. PrEP stigma was associated less than half the PrEP use (aPR = 0.43, 95% CI = 0.24, 0.75) among BSMM after adjustment. Qualitatively, we identified three major themes in how PrEP use is stigmatized among BSMM: PrEP-specific sexual stigma, intersections between PrEP and HIV stigma, and PrEP misinformation and disinformation. Aligned with minority stress theory, each theme was based in part in stigma related to sexuality or race. We found strong relationships between PrEP stigma and PrEP use independent of several sociobehavioral factors. Each of our themes were based in part in minority stressors, and underscore the importance of culturally competent PrEP promotion efforts towards BSMM. Addressing stigma is a core component of health equity efforts towards ending the HIV epidemic.

Common pitfalls when mitigating cyber risk : Addressing socio-behavioural factors

Although humans constitute a pivotal dimension of the cyber security attack surface, prevailing approaches are often ineffective at addressing human risk. From the vantage point of three key socio-behavioural perspectives, a critical analysis of contemporary cyberattacks and cyber security practices offers insights and a range of opportunities to manage the human factor in cyber security. First, the role of metaphors in shaping cyber security discourse, particularly militaristic analogies, is analysed, supported by research advocating for careful metaphor selection to enhance comprehension, foster shared responsibility and reduce counterproductive assumptions. Secondly, the paper explores the significance of psychological safety within organisational cultures. It discusses the concept of a ‘just culture’ and the impact of cultivating an environment that encourages risk reporting. The discussion expands to highlight the interconnectedness of security culture with broader organisational values, emphasising the critical role of leadership in shaping resilient cyber security postures. Finally, an examination of blame-centric practices and associated consequences provides an insight into less visible forms of victim blaming, such as phishing tests and traditional training-centric strategies. It offers a psychological perspective on the distinction between blame and accountability and highlights the need for a shift away from a compliance-based focus towards a positivist approach. In presenting insights from these three key perspectives, this paper offers opportunities to innovatively manage socio-behavioural risk in cyber security, critiquing prevailing approaches that fail to do so. By linking metaphors, psychological safety and blame-centric practices, it contributes to a comprehensive understanding of the human dimension in cyber security and provides a foundation for advancing effective risk management strategies.

Inequalities in accelerated cognitive decline: Resolving observational window bias using nested non-linear regression.

Limited observational windows lead to conflicting results in studies examining educational differences in Alzheimer's disease and related dementias (ADRD) risk, due to observational window bias relative to onset of accelerated cognitive decline. This study tested a novel model to address observational window bias and tested for the presence and sources of disparities in accelerated cognitive declines due to ADRD. The sample examined 167,314 cognitive assessments from 32,441 Health and Retirement Study participants. We implemented a parametric non-linear nested longitudinal regression and reported multivariable-adjusted nodal incidence ratios (aNIR). University degrees were associated with lower incidence (aNIR=0.253, 95% confidence interval [CI]=[0.221 to 0.289], p<0.001), while black participants had a higher incidence (aNIR=1.995, [1.858 to 2.141], p<0.001) of accelerated cognitive decline, adjusting for demographic, sociobehavioral, and medical risk factors. Sex-stratified analyses identified diminished educational returns for women and increased incidence among minoritized women. Addressing observational window bias reveals large social inequalities in the onset of accelerated cognitive declines indicative of ADRD. This study identifies observational window bias as a source of conflicting results among previous studies of educational achievement in Alzheimer's disease and related dementias (ADRD) disparities. The study locates preclinical accelerated cognitive decline, which is indicative of ADRD while occurring 10+ years prior to symptom onset, as a site to study ADRD disparities that mitigates observational window bias. A novel method, nested non-linear regression, is developed to test for differences in the onset of accelerated cognitive decline. Educational and racial/ethnic disparities are demonstrated in the onset of accelerated cognitive decline, as are their intersecting differences with sex/gender.

Socio-behavioral factors contributing to recent mortality trends in the United States

Socio-behavioral factors contributing to recent mortality trends in the United States

Socioeconomic Status, Lifestyle, and DNA Methylation Age Among Racially and Ethnically Diverse Adults

Variation in DNA methylation at specific loci estimates biological age, which is associated with morbidity, mortality, and social experiences. Aging estimates known as epigenetic clocks, including the Dunedin Pace of Aging Calculated From the Epigenome (DunedinPACE), were trained on data predominately from individuals of European ancestry; however, limited research has explored DunedinPACE in underrepresented populations experiencing health disparities. To investigate associations of neighborhood and individual sociobehavioral factors with biological aging in a racially and ethnically diverse population. This cohort study, part of the Multiethnic Cohort study conducted from May 1993 to September 1996 to examine racial and ethnic disparities in chronic diseases, integrated biospecimen and self-reported data collected between April 2004 and November 2005 from healthy Hawaii residents aged 45 to 76 years. These participants self-identified as of Japanese American, Native Hawaiian, or White racial and ethnic background. Data were analyzed from January 2022 to May 2024. DNA methylation data were generated from monocytes enriched from cryopreserved lymphocytes and used to derive DunedinPACE scores from November 2017 to June 2021. Neighborhood social economic status (NSES) was estimated from 1990 US Census Bureau data to include factors such as educational level, occupation, and income. Individual-level factors analyzed included educational level, body mass index (BMI), physical activity (PA), and diet quality measured by the Healthy Eating Index (HEI). Linear regression analysis of DunedinPACE scores was used to examine their associations with NSES and sociobehavioral variables. A total of 376 participants were included (113 [30.1%] Japanese American, 144 [38.3%] Native Hawaiian, and 119 [31.6%] White; 189 [50.3%] were female). Mean (SE) age was 57.81 (0.38) years. Overall, mean (SE) DunedinPACE scores were significantly higher among females than among males (1.28 [0.01] vs 1.25 [0.01]; P = .005); correlated negatively with NSES (R = -0.09; P = .08), HEI (R = -0.11; P = .03), and educational attainment (R = -0.15; P = .003) and positively with BMI (R = 0.31; P < .001); and varied by race and ethnicity. Native Hawaiian participants exhibited a higher mean (SE) DunedinPACE score (1.31 [0.01]) compared with Japanese American (1.25 [0.01]; P < .001) or White (1.22 [0.01]; P < .001) participants. Controlling for age, sex, HEI, BMI, and NSES, linear regression analyses revealed a negative association between educational level and DunedinPACE score among Japanese American (β, -0.005 [95% CI, -0.013 to 0.002]; P = .03) and Native Hawaiian (β, -0.003 [95% CI, -0.011 to 0.005]; P = .08) participants, yet this association was positive among White participants (β, 0.007; 95% CI, -0.001 to 0.015; P = .09). Moderate to vigorous PA was associated with lower DunedinPACE scores only among Native Hawaiian participants (β, -0.006; 95% CI, -0.011 to -0.001; P = .005), independent of NSES. In this study of a racially and ethnically diverse sample of 376 adults, low NSES was associated with a higher rate of biological aging measured by DunedinPACE score, yet individual-level factors such as educational level and physical activity affected this association, which varied by race and ethnicity. These findings support sociobehavioral interventions in addressing health inequities.

Multi-modality risk prediction of cardiovascular diseases for breast cancer cohort in the All of Us Research Program.

This study leverages the rich diversity of the All of Us Research Program (All of Us)'s dataset to devise a predictive model for cardiovascular disease (CVD) in breast cancer (BC) survivors. Central to this endeavor is the creation of a robust data integration pipeline that synthesizes electronic health records (EHRs), patient surveys, and genomic data, while upholding fairness across demographic variables. We have developed a universal data wrangling pipeline to process and merge heterogeneous data sources of the All of Us dataset, address missingness and variance in data, and align disparate data modalities into a coherent framework for analysis. Utilizing a composite feature set including EHR, lifestyle, and social determinants of health (SDoH) data, we then employed Adaptive Lasso and Random Forest regression models to predict 6 CVD outcomes. The models were evaluated using the c-index and time-dependent Area Under the Receiver Operating Characteristic Curve over a 10-year period. The Adaptive Lasso model showed consistent performance across most CVD outcomes, while the Random Forest model excelled particularly in predicting outcomes like transient ischemic attack when incorporating the full multi-model feature set. Feature importance analysis revealed age and previous coronary events as dominant predictors across CVD outcomes, with SDoH clustering labels highlighting the nuanced impact of social factors. The development of both Cox-based predictive model and Random Forest Regression model represents the extensive application of the All of Us, in integrating EHR and patient surveys to enhance precision medicine. And the inclusion of SDoH clustering labels revealed the significant impact of sociobehavioral factors on patient outcomes, emphasizing the importance of comprehensive health determinants in predictive models. Despite these advancements, limitations include the exclusion of genetic data, broad categorization of CVD conditions, and the need for fairness analyses to ensure equitable model performance across diverse populations. Future work should refine clinical and social variable measurements, incorporate advanced imputation techniques, and explore additional predictive algorithms to enhance model precision and fairness. This study demonstrates the liability of the All of Us's diverse dataset in developing a multi-modality predictive model for CVD in BC survivors risk stratification in oncological survivorship. The data integration pipeline and subsequent predictive models establish a methodological foundation for future research into personalized healthcare.

Negative mood is associated with sociobehavioral factors contributing to cardiovascular risk in an immigrant population

BackgroundAfter settling in the United States (US), immigrants often accumulate obesity and cardiovascular risk factors. As mood is often associated with health behaviors in the US population, mood may be an important mediating factor in immigrant populations.MethodsThe Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention designed to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered “negative”, while ratings of good, very good, or excellent were considered “positive”.ResultsHispanic/Latino (n = 268) and Somali (n = 181) adults enrolled in HIC completed baseline measures and were included in this analysis. Participants endorsing negative mood compared to positive mood had lower healthy eating scores (p = 0.02), lower physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood reported receiving less social support to eat healthy (p = < 0.001) and be physically active (p = 0.01). They also accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) less frequently than participants endorsing positive mood.ConclusionsOn self-report, negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions to reduce obesity and cardiovascular risk among immigrants who report negative mood.Trial registrationClinicalTrials.gov registration: NCT05136339; April 23, 2022.

Sociobehavioral Risk Factors and Clinical Implications of Late Presentation Among People Living with HIV in the Brazilian Amazon Region

This study aimed to analyze the prevalence, sociobehavioral factors and clinical-laboratory consequences of late presentation among people living with HIV (PLHIV) in the Brazilian Amazon region. In total, 402 HIV + individuals treated at reference units in Belém city (Pará, Brazil) between 2018 and 2019 were evaluated. Late presentation was defined as a first-collection LTCD4+ count below 350 cells/µL. Sociodemographic, behavioral and clinical data were obtained from questionnaires or medical records. Th1, Th2 and Th17 cytokine profiles were evaluated by flow cytometry. Longitudinal data on viral load, T lymphocytes, and antiretroviral therapy administration were obtained from control and logistic databases. Approximately 52.73% of the participants were late presenters and sought medical care 7–12 + months after their primary HIV diagnosis. Sociobehavioral factors associated with late presentation included illicit drug use for more than 5 years, polyamory, no alcohol consumption, homosexuality, and sexual inactiveness after HIV diagnosis. Clinically, late presentation was associated with coinfection rate; polysymptomatology; high IFN-ɣ, IL-6 and IL-10 levels; nonresponse to antiretroviral therapy; and virological failure- and tuberculosis coinfection-motivated changes to therapy. In summary, the prevalence of late presentation in Pará in the Brazilian Amazon region is high. Delays in seeking specialized care after a primary HIV diagnosis cause medium/long-term changes in the life expectancy and health of PLHIV.

Investigating Microbial Dynamics and Bacterial Vaginosis Susceptibility in Women who have Sex with Women

Bacterial Vaginosis (BV) remains a prevalent gynecologic health concern, with emerging research indicating a potential association between women who have sex with women (WSW) and an increased susceptibility to BV infections. Recent studies have explored the microbial dynamics within the vaginal microbiota of WSW, revealing distinct patterns that may contribute to a higher incidence of BV in this population. The etiological factors underlying this susceptibility include disruptions in the balance of Lactobacillus species, crucial for maintaining vaginal health. However, the existing literature presents a complex interplay of socio-behavioral and biological factors influencing BV risk among WSW, necessitating further investigation. Future research should strive to gain a more comprehensive understanding of the specific mechanisms influencing microbial communities in the context of same-sex sexual activity among women, exploring potential preventive strategies and tailored interventions to mitigate BV risks in this population. Our review highlights the need for a refined and multidisciplinary approach to address the intricacies of BV susceptibility in women engaging in same-sex relationships.

Factors affecting Bangladeshi high school students' practices of sanitation and hygiene

Background: Better sanitation and hygiene standards are beneficial for preventing infections, limiting the spread of pathogens, and fostering overall health in educational environments. On the other hand, not much is known about school-student's hygiene and sanitation habits. The purpose of this study is to identify and comprehend the variables that affect students' behavior related to sanitation and hygiene in classrooms. Method: This study was carried out at the Katiadi Government High School, a high school in a Bangladeshi upazilla town. An exploratory qualitative study design, based on the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH) was used. Before utilizing them, the effectiveness and clarity of the semi-structured interview guides were tested, which included questions about behavior, access, and practices related to sanitation and hygiene. Result: The students had quite low sanitation and hygiene practices despite having a reasonable level of awareness and knowledge. Sanitation and hygiene practices were influenced by a wide range of interrelated factors, which also affected one another. Contextual factors (lack of upkeep and cleanliness, availability of sanitary products), socio-behavioral factors (norms, peer influence), and individual factors (gender awareness, perception, and sense of health benefits). Conclusion: To advance improved sanitation and hygiene practices among school students, multi-level interventions such as regular delivery of WASH-related materials and agents, promotion of low-cost WASH interventions, quality cleaning services improvement, close observation of cleaning activities, individual hygiene behavior promotion, and introduction of gender-sensitive WASH infrastructure and construction may be helpful.

Unintentional weight loss, body composition, and all-cause mortality among United States adults with cancer.

e22527 Background: While unintentional weight loss (UWL) is a common presenting symptom of malignancy, weight changes also occur regularly in patients with diagnosed cancer.UWL is often characterized by considerable muscle and fat loss and can lead to cachexia, which may increase risk of mortality. This nationally representative study aims to assess the association between UWL and mortality among adults with history of cancer and characterize differences in body composition. Methods: This was a retrospective cohort study of the National Health and Nutrition Examination Survey 1999-2018 linked to the 2019 National Death Index. We identified adults with self-reported history of cancer, excluding non-melanoma skin cancer. Weight change was determined as the difference between current weight and self-reported weight 1 year prior to interview. We categorized weight change into: UWL (unintentionally losing &gt; 5% of weight), intention weight loss (IWL) (intentional loss &gt; 5% weight), no weight change (NWC) (≤5% weight change), weight gain (WG) ( &gt; 5% weight gain). We estimated risk of all-cause mortality using gender-stratified multivariable Cox regression, adjusting for demographics (age, race, income, education, insurance status), sociobehavioral factors (smoking, alcohol, nutrition, physical activity, self-reported health), comorbidities, and albumin. We additionally identified participants with cancer who had whole-body dual x-ray absorptiometry scans (2011-2018) and assessed body composition measurements including total lean mass, lean-to-fat ratio, subcutaneous fat mass, and visceral fat mass by weight change category using multivariable linear regression. Results: Among 3,153 participants (mean age 62 years, 55% women, 82% non-Hispanic White), the top four primary cancers were breast (21%), prostate (14%), melanoma (11%), and cervical (11%). Approximately 9% of men and 11% of women experienced UWL. Adults with UWL were more likely to have lower socioeconomic status, more functional limitations, and higher comorbidity burden. Across a median 7 years (IQR, 3-11y) follow-up, 22% of females and 34% of men died. Both men and women experiencing UWL had more than 2 times the risk of all-cause mortality compared to NWC (adjusted HR [95% CI]; men: 2.02 [1.47, 2.78]), women: 2.43 [1.78, 3.34]). Participants with UWL had less subcutaneous fat mass (-113g, 95% CI [-242, 16]) and visceral fat mass (-65g, 95% CI [-146, 16]) compared to NWC, though not statistically significance. Conclusions: UWL in patients with history of cancer is independently associated with more than 2 times the risk of all-cause mortality in both men and women. UWL was associated with proportional loss of both subcutaneous and visceral fat mass. Further longitudinal studies examining UWL’s impact on body composition changes and downstream outcomes by cancer type and stage are needed.

In Utero Mother-to-Child Transmission of HIV-1 and the Associated Factors in Rwanda, Africa.

Mother-to-child transmission (MTCT) of HIV-1 and associated mortality continue to occur at unacceptably high rates, despite the extensive rollout and implementation of Prevention of Mother-to-Child Transmission (PMTCT) Programs, including the modified versions of Option B and B+ in 2010 and 2012, respectively. Maternal HIV viral load (VL) and socio-behavioral factors sustaining MTCT in Rwanda remain largely unexplored. The study examined the effects of socio-behavioral factors on maternal VL and their contribution to in utero transmission of HIV-1 in the context of Rwanda's HIV epidemic. A prospective cohort study was conducted in 862 mother-baby pairs enrolled in 10 PMTCT clinics in Rwanda. VL was determined on plasma and Dried Blood Spots samples, whereas HIV DNA PCR was performed to determine in utero MTCT of HIV of the babies immediately at birth and then at 3 weeks, 4 weeks, 6 months, and 18 months, together with HIV antibody testing to determine other forms of MTCT of HIV. Quantitative data on socio-behavioral factors were collected through a structured questionnaire. Linear regression and univariate analysis of variances using SPSS 25.0 were used to test the hypotheses. We found 22/862 (2.55%) cases of in utero transmission and a total of 32/862 (3.7%) cases of MTCT of HIV-1 over 18 study months. Maternal VL at delivery was significantly associated with the risk of in utero transmission of HIV-1. Socio-behavioral factors associated with elevated maternal VL at delivery included alcohol, smoking, multiple sexual partners, mothers' income, being a casual laborer, and distance to health care services. We report an MTCT rate of 3.7% in our study population over the 18 months, higher than the national average of 1.5%, the majority of which occurred in utero. MTCT cases were attributable to failure to suppress maternal VL.

Socio-behavioral determinants of health-related quality of life among patients with type 2 diabetes: comparison between 2015 and 2018

IntroductionType 2 diabetes (T2D) is a common chronic disease that significantly affects an individual’s overall health and well-being. The aim of this study is to investigate the factors that influence the health-related quality of life (HRQoL) of patients with T2D.MethodsThis study conducted using data from 6th phase (2015–2017) and 7th phase (2018–2022) of the Tehran Lipid and Glucose Study (TLGS). Data were collected through a combination of interviews, physical examinations, and laboratory tests. Quality of life questionnaire (SF-12) that consists of 12 questions was used to assess physical and mental health functioning. The generalized estimating equation model was used to assess the association between socio-behavioral factors and changes in HRQoL.ResultsThe study included 498 patients with T2D. The changes in HRQoL in patients with T2D followed a sex-specific pattern. Analysis of the physical component score (PCS) and the mental component score (MCS) showed a non-significant change in the total score during the three-year longitudinal study. However, the role physical (RP) of the PCS and the social functioning (SF) of the MCS showed a statistically significant change during this period. In addition, sex, body mass index (BMI), and having cardiovascular disease (CVD) and chronic kidney disease (CKD) showed a significant association with RP changes, and only job status showed a significant association with SF changes.ConclusionsBy recognizing the sex-specific patterns in HRQoL changes and understanding the multifaceted nature of factors such as BMI, CVD and CKD, healthcare professionals can develop targeted interventions that go beyond traditional diabetes management.

"I'll take them another day": A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements.

Despite improvement over recent decades, childhood vaccination uptake remains a concern across countries. The World Health Organization observed that over 25 million children missed out on one or more vaccines in 2021, with urban poor and other marginalized groups being the most affected. Given the higher risk of disease transmission and vaccine-preventable diseases (VPD) outbreaks across densely populated urban slums, identifying effective interventions to improve childhood vaccination in this vulnerable population is crucial. This study explored the behavioral and social factors influencing childhood vaccination uptake in urban informal settlements in Nairobi, Kenya. A grounded theory approach was employed to develop a theoretical account of the socio-behavioral determinants of childhood vaccination. Five focus group discussions (FGDs) were conducted with purposively sampled caregivers of children under five years of age residing in informal settlements. The Theory of Planned Behavior guided the structuring of the FGD questions. An iterative process was used to analyze and identify emerging themes. Thirty-nine caregivers (median age 29 years) participated in the FGDs. From the analysis, four main thematic categories were derived. These included attitude factors such as perceived vaccine benefits, cultural beliefs, and emotional factors including parental love. Additionally, subjective norms, like fear of social judgment, and perceived behavioral control factors, such as self-control and gender-based influences, were identified. Furthermore, a number of practical factors, including the cost of vaccines and healthcare providers attitude, also affected the uptake of vaccination. Various social, behavioral, cultural, and contextual factors influence caregiver vaccination decisions in urban poor settings. Community-derived and context-specific approaches that address the complex interaction between socio-behavioral and other contextual factors need to be tested and applied to improve the timely uptake of childhood vaccinations among marginalized populations.

Socio-behavioural factors influencing meat intake and meat reduction intention in Vietnam and Switzerland

Meat consumption is declining in developed countries but increasing in emerging countries. This study, for the first time, compares the socio-behavioural factors influencing individuals' meat consumption level and meat reduction intention between Vietnam, an emerging economy and Switzerland, a developed country. Online consumer surveys were conducted in late 2022, yielding 552 usable replies from Switzerland and 592 from Vietnam for this study. Drawing upon an extended Protection Motivation Theory and using structural equation modelling, we found similarities as well as differences in the determinants of meat consumption behaviour. Perceived health risks of meat overconsumption, self-efficacy of meat reduction, attitude toward ethical and environmental issues, and pressure from family members' reluctance to change diet drove the intention to reduce meat in both countries. Meat attachment emerges as the most important determinant of meat consumption level in not only Switzerland but also Vietnam and thus presents the largest barrier to meat reduction. The association between response cost of eating less meat and intention to reduce meat was negative in Switzerland but positive in Vietnam. Self-efficacy of meat consumption reduction influenced meat consumption level solely in Switzerland. Ethical and environmental attitudes significantly facilitated meat reduction intention of Swiss respondents only, reflecting cultural differences. Policy implications were discussed.

Relationships Between Socio-behavioral Factors and the Symptoms Among Asian American Breast Cancer Survivors: A Structural Equation Modeling.

Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS). This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy. This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28. The overall fitness of the hypothetical model to the data is acceptable (χ2 = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (β = -0.054, P = .019, and β = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (β = 0.121, P = .024) and significant direct effects (β = 0.605, P = .003) on symptom distress. Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience. Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS.

Socio-behavioral factors associated with overweight and obesity among school children in Menoufia Governorate, Egypt

Socio-behavioral factors associated with overweight and obesity among school children in Menoufia Governorate, Egypt

Socio-Behavioural Barriers to Viral Suppression in the Older Adult Population in Rural South Africa

South Africa has the largest share of people living with HIV in the world and this population is ageing. The social context in which people seek HIV care is often ignored. Apart from clinical interventions, socio-behavioural factors impact successful HIV care outcomes for older adults living with HIV. We use cross-sectional data linked with demographic household surveillance data, consisting of HIV positive adults aged above 40, to identify socio-behavioural predictors of a detectable viral load. Older adults were more likely to have a detectable viral load if they did not disclose their HIV positive status to close family members (aOR 2.56, 95% CI 1.89-3.46), resided in the poorest households (aOR 1.98, 95% CI 1.23-3.18), or were not taking medications other than ART (aOR 1.83, 95% CI 1.02-1.99) likely to have a detectable. Clinical interventions in HIV care must be supported by understanding the socio-behavioural barriers that occur outside the health facility. The importance of community health care workers in bridging this gap may offer more optimum outcomes for older adults ageing with HIV.

Abstract 1013: Strengths, weaknesses, opportunities, and threats of conducting clinical trials in Nigeria: The IRONMAN study

Abstract Background: The need to increase understanding of prostate cancer (CaP) is ever increasing. Unfortunately, there is limited understanding of how CaP affects men of African ancestry (MAA) despite significant disparities in CaP prevention, diagnosis, and treatment due to genetic and sociobehavioral factors. Conducting CaP clinical trials (CTs) in Africa presents multiple opportunities to improve upon collective knowledge of CaP in MAA experiences, expand patient access to CTs, and provide opportunities for African scientists and urologists to contribute to research on the global stage. The International Registry of Men with Advanced Prostate Cancer (IRONMAN) seeks to reduce CaP disparities by sponsoring sites throughout Africa. Four Prostate Cancer Transatlantic Consortium (CaPTC) institutions in Nigeria currently participate in IRONMAN: University of Ilorin Teaching Hospital, Federal Medical Center, University of Maiduguri, and Lagos State University Teaching Hospital. Because CTs of this scale are infrequently conducted in Africa, there are special considerations when conducting CTs in low-middle-income countries (LMICs) like Nigeria. Methods: Hourlong interviews dedicated to site staff were conducted via Zoom in Spring 2023 (four total). Interviews utilized a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis approach. Each interview was recorded, transcribed, and validated by study staff for accuracy. Themes from each were inductively coded and then collated across all four sites. Results: The urologists, oncologists, phlebotomists, pathologists, nurses, research coordinators that make up the study teams identified the holistics of conducting the IRONMAN study at their sites. Strengths included a large patient population to recruit from and appropriate resources to conduct the study (ex., lab space, clinical knowledge, staffing levels). Weaknesses included the social determinants of health that negatively impact patient participation, limited biorepository space to store samples, and the need for patient-physician trust. The greatest opportunity presented was Nigerian institutions joining more CTs in the future, particularly multi-site global trials. Described threats included staff turnover, national stability, and increased economic disparities. Discussion: While increasing the overall number of CTs in Africa is a noble cause, sponsors and institutions should note the unique circumstances in implementing CTs in Africa when designing CTs and recruiting sites. Listening to the experiences of study teams is pivotal in ensuring CTs are Africa-minded - they will be complimentary to established research infrastructure, appropriately funded, and culturally responsive all in the name of equitable research. By doing so, ethical compliance and quality data collection will ensue and reduce disparities at the micro, mezzo, and macro levels. Citation Format: Opeyemi Oreoluwa Bolajoko, Parisa Fathi, Oluwaseyi Toye, Dottington D. Fulwood, Ademola Popoola, Chidiebere Ogo, Hassan Dogo, Omolara Fatiregun, Anthonia Sowumi, Paul Jibrin, Mutiu A. Jimoh, Faruk Mohammed, Folakemi Odedina, Prostate Cancer Transatlantic Consortium. Strengths, weaknesses, opportunities, and threats of conducting clinical trials in Nigeria: The IRONMAN study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1013.

Abstract P458: Negative Mood is Associated With Sociobehavioral Factors Contributing to Cardiovascular Risk in an Immigrant Population

Introduction: Immigrants to the United States often experience structural barriers to healthy nutrition and physical activity, which increases their risk of developing obesity, cardiovascular disease (CVD), and other chronic conditions. In our prior work with immigrant communities to co-develop interventions to improve nutrition and physical activity, mood was identified as a possible mediating factor. Hypothesis: We hypothesized that self-reported negative mood would be associated with unhealthy lifestyle behaviors such as poor nutrition and less physical activity. We also evaluated the relationship between mood and sociobehavioral factors such as social support and community belongingness. Methods: The Healthy Immigrant Community (HIC) study, set in Rochester, Minnesota and embedded with the Rochester Healthy Community Partnership, is a randomized, waitlist-controlled obesity and CVD risk reduction intervention. Community-based mentoring and education for health behaviors are delivered by trained health promoters, who are members of the immigrant populations, to their social networks. Baseline self-reported and biometric measures assessed nutrition, physical activity, self-efficacy, and sociobehavioral effects on healthy lifestyle behaviors. On a single-item rating of mood over the past 7 days, responses of poor or fair were considered “negative”, while good, very good, or excellent were considered “positive”. Results: The HIC study enrolled 475 adult participants; 268 Hispanic/Latino and 181 Somali participants completed baseline measures and were included in this analysis. Of the 449 participants, 107 (24%) reported “negative” mood. This group was more likely to be Hispanic/Latino (74%), female (68%), uninsured in the past 12 months (46%), or younger age (mean = 41 years; range = 18-79). Participants who endorsed negative mood at baseline had lower healthy nutrition scores ( p =0.02), lower physical activity scores ( p =0.03), and less confidence in eating healthily ( p =0.001). Those reporting negative mood also reported less support from family and friends to eat healthy ( p =&lt;0.001) and be physically active ( p =0.01), accessed community resources for healthy eating ( p =0.001) and physical activity ( p =&lt;0.01) less often, and reported less sense of belonging to their community ( p =0.01) than those with positive mood. Conclusion: Negative mood was significantly associated with eating a less healthy diet and being sedentary, lower confidence in maintaining a healthy diet, less perceived social support for healthy behaviors, and less sense of belonging to the community among Hispanic/Latino and Somali immigrants. Behavioral interventions designed to support a healthy lifestyle may benefit from incorporating culturally-aligned mood management and sociobehavioral strategies to reduce CVD risk and promote health equity in immigrant populations.