BACKGROUND:Although substance use continues to increase among people living with HIV (PLWH), it is often overlooked among older PLWH and may explain poor engagement in care and the increase in overdose deaths, particularly among Black PLWH. The purpose of this study was to assess the relationship between stimulant and opioid use and visit and medication non-adherence among African American older adults with HIV. METHODS:An online survey was completed among 52 older PLWH in Ohio, who identified as Black, living with HIV, and 50 years of age and older. Past three-month use of cocaine, amphetamines, and opioids were self-reported. Visit non-adherence was defined as missing at least one clinic visit in the past 12-months and medication non-adherence was defined as missing all medications for ≥4 days in the past 3-months, both self-reported. Inverse probability weighting was used to adjust for confounding and odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS:The study sample was predominately male (94%). Cocaine use was the most prevalent substance reported (56.0%), followed by amphetamine (54.0%) and opioid use (52.0%). Visit non-adherence was associated with amphetamine (OR: 20.42; 95% CI: 2.35, 177.35), cocaine (OR: 21.81; 95% CI: 2.54, 186.99), and opioid use (OR: 11.93; 95% CI: 3.74, 38.05). There were no statistically significant associations between substance use and medication non-adherence. CONCLUSIONS:Stimulant and opioid use impedes optimal engagement in HIV care among older Black PLWH.

Introduction: Psychological safety is the perception that it is safe to express oneself without fear of ridicule. Better patient outcomes are associated with health care teams that experience psychological safety. However, the psychological safety of the patient has largely been ignored, even though it may affect patient forthrightness and adherence. We developed an initial Patient Psychological Safety Scale (PPSS) to assess patients' experience of psychological safety. Methods: Thirteen items modified from team-focused measures of psychological safety comprised the initial version of the PPSS. To explore criterion validity, 8 items pertaining to nondisclosure of important information were used. A convenience sample of 100 patients from 4 primary care settings completed a survey comprised of the PPSS and nondisclosure questions. Results: A confirmatory factor analysis (CFA) indicated that the 13-item PPSS did not measure 1 factor. A subsequent exploratory factor analysis (EFA) identified 2 factors. A second CFA was conducted on a modified 9-item PPSS representing the 2 factors and retaining items with a factor loading of 0.40 or higher, and the results indicated a good fit. Internal reliability and validity for factors 1 (relationship comfort) (a = 0.95) and 2 (belonging) (a = 0.88) were strong. Although few respondents endorsed nondisclosure, there was a significant association between lower relationship comfort and nondisclosure of disagreement with clinician recommendation (median difference = 5.0, P = .001). Conclusions: Patients' experience of psychological safety may affect clinical outcomes. The PPSS provides a starting point for further study of this potentially important variable. ( J Am Board Fam Med 2024;37:809-815.)

OBJECTIVE:The use of endoscopic vein harvest (EVH) vs open vein harvest (OVH) for lower extremity arterial bypass has been an area of continued interest. Previous studies have suggested wound complication rates are improved with EVH, but there has been concern for decreased patency of these grafts long term from possible damage with EVH techniques. This study aims to evaluate the effect of EVH and patency rates. METHODS:This retrospective study evaluated 340 patients who underwent any infrainguinal bypass with continuous segment great saphenous vein from 2013 to 2023 with OVH (n = 111) vs EVH (n = 229). Demographics, harvest technique, incisional breakdown, and need for arterial procedure from 1 to 5 years were evaluated. Primary, primary assisted, and secondary patency rates were evaluated. RESULTS:The average age was 62.6 ± 8.8 years, and the majority of individuals were male (71.5%). The majority of participants were White (88.8%), current smokers (52.2%), had hypertension (78.0%), and the average body mass index was 27.9 ± 6.0 kg/m2. Of these, 254 (75%) had below-knee outflow targets, and 86 (25%) had above-knee outflow targets. Mean operative time was 193 minutes for EVH and was 228 minutes for OVH (P = .03). Hospital length of stay was similar between the groups. Primary patency rates including above- and below-knee targets were 43.8% EVH vs 49.6% OVH (P = .43), primary-assisted patency of 89.0% EVH vs 91.0% OVH (P = .52), and secondary patency of 81% EVH vs 75.0% EVH (P = .35). Patients with EVH were less likely to have incision breakdown compared with OVH (11.9% vs 21.1%; P = .04). A logistic regression model showed that EVH had a lower odds of failure of initial bypass requiring new bypass creation compared with OVH (adjusted odds ratio, 0.66; 95% confidence interval, 0.33-0.99). Additionally, there was also a reduction in the odds of wound complications and need for amputation with EVH vs OVH. CONCLUSIONS:This study found no significant difference in primary, primary-assisted, and secondary patency rates when comparing EVH with OVH. The benefits of decreased operative time, similar patency rates, and decreased wound complications is promising. When EVH is performed by experienced providers, this technique could be considered for vein harvest, but future studies are needed to better evaluate its long-term efficacy.

INTRODUCTION:Deaths related to drug overdose and suicide in the USA have increased 500% and 35%, respectively, over the last two decades. The human and economic costs to society associated with these 'deaths of despair' are immense. Great efforts and substantial investments have been made in treatment and prevention, yet these efforts have not abated these increasing trajectories of deaths over time. The COVID-19 pandemic has exacerbated and highlighted these problems. Notably, some geographical areas (eg, Appalachia, farmland) and some communities (eg, low-income persons, 'essential workers', minoritised populations) have been disproportionately affected. Risk factors have been identified for substance use and suicide deaths: forms of adversity, neglect, opportunity indexes and trauma. Yet, the biological, psychological and social mechanisms driving risk are not uniform. Notably, most people exposed to risk factors do not become symptomatic and could broadly be considered resilient. Achieving a better understanding of biological, psychological and social mechanisms underlying both pathology and resilience will be crucial for improving approaches for prevention and treatment and creating precision medicine approaches for more efficient and effective treatment. METHODS AND ANALYSIS:The State of Ohio Adversity and Resilience (SOAR) study is a prospective, longitudinal, multimodal, integrated familial study designed to identify biological, psychological and social risk and resilience factors and processes leading to mental health disorders, substance use disorders, substance overdose, suicide and associated psychological/medical comorbidities which reduce life expectancy and quality of life. It includes two nested longitudinal samples: (1) WD Survey: an address-based random population epidemiological sample of 15 000 individuals (unique households) representative of the state of Ohio assessed for psychosocial, psychiatric, behavioural health and substance use factors and (2) Brain Health Study: a family-based, multimodal, deep-phenotyping study conducted in 1200 families (up to 3600 persons aged 12-72 years) including MRI, electroencephalography, blood biomarkers and psychiatric diagnostic interviews, as well as neuropsychological, psychosocial functioning and family/community history, dynamics and support assessments. SOAR is designed to discover, develop and deploy advanced predictive analytics and interventions to transform mental health prevention, diagnosis, treatment and recovery. ETHICS AND DISSEMINATION:All participants will provide written informed consent (or parental permission and assent for minors). The study was approved by The Ohio State University Institutional Review Board (study numbers 2023H0316 (Brain Health) and 2023H0350 (Wellness Survey). The Brain Health study was also approved by institutional review boards at each partnering institution involved in conducting participant assessments. Findings will be disseminated to academic peers, clinicians and healthcare consumers, policymakers and the general public, using local and international academic channels (academic journals, evidence briefs and conferences) and outreach (workshops and seminars).

BACKGROUND:Radial forearm free flaps represent a workhorse reconstructive modality in microsurgical rehabilitation. The reliable anatomy, availability of thin, pliable tissue, and a long pedicle afford the surgeon a significant latitude of reconstructive freedom, allowing this flap to be useful for a multitude of body sites. Although the arterial anatomy is straightforward, the venous outflow of the flap is generally through a circuit utilizing a superficial, deep, and united venous system. This has allowed surgeons a variety of venous options to utilize, but has also generated debate in the community regarding the optimal vessel choice. This manuscript seeks to examine published studies in the literature in an effort to determine if a statistically significant difference exists among venous outflow options as they lead to microsurgical success. METHODS:A systematic review and meta-regression were conducted examining 14 studies with a total of 1182 radial forearm flaps. A university-based statistician was recruited to perform a detailed analysis of the results. RESULTS:Results show that there is no statistically significant difference in flap outcomes among the superficial, deep, and united venous drainage systems when outflow is deemed to be favorable intraoperatively. CONCLUSIONS:The choice of venous outflow system does not impact outcomes of the radial forearm flap. Surgeon preference, technical skill, and patient anatomy should be the guiding factors in determining vein choice so long as the venous outflow is favorable.

Background: Substance use is highly prevalent among older people with HIV and continues to have a negative impact on engagement along the HIV care continuum, particularly among African Americans (AA). Social factors like resource insecurity, stigma, and discrimination may play a role in substance use behaviors. However, there is limited research on how these social factors impact substance use among older people with HIV. Objectives: The purpose of this descriptive study was to examine associations between demographic and social factors and substance use among older AAs with HIV. Results: Fifty-two participants who were ≥50 years of age, living in Ohio, and identified as Black or AA completed an online survey. Past three-month substance use was self-reported for alcohol, opioids, cocaine, cannabis, and/or amphetamine type stimulants. Separate unadjusted, logistic regression models were conducted to examine factors between each type of substance and HIV-related stigma, food and housing insecurity, discrimination, history of incarceration, employment status, and demographics. The majority of participants self-reported past three-month use of cocaine (53.8%), cannabis (67.3%), amphetamine type stimulants (51.9%), and risky alcohol use (85.0%), and half reported opioid use. HIV-related stigma, discrimination, and housing insecurity were all associated with increased odds of opioid, cocaine, and amphetamine use. Discrimination, food, and housing insecurity were associated with increased odds of cannabis use and risky alcohol use. Conclusions: More research is needed to further understand how social factors impact substance use among older people with HIV. This understanding can lead to interventions that target these social factors which in turn reduces substance use.

Iodine impregnated adhesive drapes, such as Ioban, have been shown to reduce overall incidence of surgical site infection (SSI) in cardiothoracic surgery. However, their use in other surgical specialties has yielded conflicting results with a Cochrane review evaluating the use of Ioban in the fields of OBGYN, orthopedic surgery, abdominal surgery, and CT surgery with significantly more SSIs in the adhesive group vs control group (13.7% vs 11.2%). There have been no studies to date on the use of adhesive drapes in the field of vascular surgery and infrainguinal SSIs. This study aims to evaluate the effect of adhesive drapes in infrainguinal vascular surgery SSI prevention. This was a retrospective study evaluating patients who underwent any infrainguinal vascular surgical procedure from 2013-2023. Demographics, intraoperative variables such as the use of Ioban, closed-incision negative pressure wound therapy (ciNPWT), topical antibiotics, and use of vein or graft were recorded. We then evaluated the occurrence of SSI up to 90 days postoperatively. Patients were excluded if they were undergoing a procedure in an already infected field. A total of 1292 patients were included in this study. The average age was 62.1 ± 8.8 years, and the majority were male (64.9%). Fifty-two percent were current smokers, 80.0% had Ioban used, and 18.1% had an SSI, with 79.6% being superficial and 20.4% deep. Patients were noted to more likely have SSI if they had a higher BMI, were female, or had diabetes. A significant relationship was found between SSI and ciNPWT use (P = .046). A multivariable logistic regression model was conducted to examine the effect of Ioban on SSI. Although not significant, there was a 14% decrease in the odds of an SSI for those with Ioban compared to those without (OR, 0.86; 95% CI, 0.57-1.30). On secondary analysis, there was a significant interaction between Ioban use and BMI (P = .007) with a higher odd of SSI being seen in patients with higher BMI. The use of Ioban in vascular surgery is variable and originates from previous studies showing benefit in cardiothoracic patients. However, it has not been evaluated specifically in the vascular population. This study showed a decrease in SSI with its use, but that BMI may impact its preventative effect. Future multicenter prospective randomized trials will be needed to better elucidate its true impact on SSI prevention.

Background Finding time in the medical curriculum to focus on motivational interviewing (MI) training is a challenge in many medical schools. We developed a software-based training tool, “Real-time Assessment of Dialogue in Motivational Interviewing” (ReadMI), that aims to advance the skill acquisition of medical students as they learn the MI approach. This human-artificial intelligence teaming may help reduce the cognitive load on a training facilitator. Methods During their Family Medicine clerkship, 125 third-year medical students were scheduled in pairs to participate in a 90-minute MI training session, with each student doing two role-plays as the physician. Intervention group students received both facilitator feedback and ReadMI metrics after their first role-play, while control group students received only facilitator feedback. Results While students in both conditions improved their MI approach from the first to the second role-play, those in the intervention condition used significantly more open-ended questions, fewer closed-ended questions, and had a higher ratio of open to closed questions. Conclusion MI skills practice can be gained with a relatively small investment of student time, and artificial intelligence can be utilized both for the measurement of MI skill acquisition and as an instructional aid.

Existing slow and labor-intensive processes to assess and disseminate performance-feedback in training health pro-fessionals in counseling techniques like Motivational Interviewing(MI) does not scale to meet the demands of mental health workforce. To automate this process we present ReadMI, a fully functional mobile-cloud computing based dialogue-assessment tool that harnesses latest advancements in automatic speech recognition and natural language processing to analyze MI trainee utterances in real-time and generate instantaneous feed-back. In this paper we present the design and development details of ReadMI prototype. We also present the validation results obtained by comparing ReadMI's performance with MI experts. Our results demonstrate that, by automatically generating feed-back and reducing training delay, ReadMI demonstrates strong potential to scale up MI training workflow.

OBJECTIVE:The aim of this study was to examine the effects of internalized HIV stigma on viral nonsuppression via depressive symptoms, alcohol use, illicit drug use, and medication adherence and investigate whether social support moderates these effects. DESIGN:Longitudinal observational clinical cohort of patients in HIV care in the US.Methods: Data from the CFAR Network for Integrated Clinical Systems (2016-2019) were used to conduct structural equation models (SEM) to test the indirect effects of internalized HIV stigma on viral nonsuppression through depressive symptoms, illicit drug use, alcohol use, and medication adherence. Moderated mediation with an interaction between social support and internalized HIV stigma was examined. RESULTS:Among 9574 individuals included in the study sample, 81.1% were men and 41.4% were black, non-Hispanic. The model demonstrated good fit (root mean square error of approximation = 0.028; standardized root means square residual = 0.067). The overall indirect effect was significant [b = 0.058; se  = 0.020; β = 0.048; 95% confidence interval (95% CI) = 0.019-0.098], indicating that internalized HIV stigma's impact on viral nonsuppression was mediated by depressive symptoms, illicit drug use, and medication adherence. An interaction was observed between internalized HIV stigma and social support on alcohol use; however, there was no moderated mediation for any of the mediators. CONCLUSION:Internalized HIV stigma indirectly impacts viral nonsuppression through its effects on depressive symptoms, illicit drug use, and medication adherence. Social support may buffer the impact, but more research is needed. Understanding the pathways through which internalized stigma impacts viral suppression is key to improving health of people with HIV.

Background and Purpose: Because there are conflicting perspectives on the factor structure of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) Questionnaire among college students, we evaluated the psychometric properties of the instrument in a sample of U.S. college students. Methods: We conducted secondary analysis of data collected from 1,138 undergraduate students from a large metropolitan university in the southeastern United States. Results: Confirmatory factor analysis did not support the original 4-factor structure. Based on exploratory factor analysis, three factors were retained and rotated using Varimax rotation, which accounted for 96% of the item variance. Coefficient alphas for the factors were: social/psychological health, 0.84; physical health, 0.81; and environment, 0.77. Sexual minorities had significantly lower scores on all factors than those who identified as heterosexuals. Conclusions: In this sample of college students, the WHOQOL-BREF was three-dimensional, and a significant amount of the item variance was explained. Lower quality of life scores of nonWhites and sexual minority college students point to a critical need that should be addressed.

Background: The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that personcentered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians. Methods: We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions. Results: A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout. Conclusion: Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being. Plain Language Summary: Teaching resident physicians how to take care of their own health, and how to help patients take more responsibility for their health, are typically viewed as two separate challenges. However, studies have shown that patient-centered approaches have benefits both for patient health and clinician health. In our survey of resident physicians, we found that those who say they use motivational interviewing, a patient-centered approach, also report less burnout. This means that teaching resident physicians an effective way to interact with patients is also good for the trainees' health.

Introduction The opioid crisis is a major public health issue, and postoperative opioids play a unique role. Many institutions have implemented standardized protocols to decrease excess opioids available. The objective of this study was to establish a standardized pain protocol for common surgical procedures and assess postoperative pain control. Methods This is a prospective observational study based on the Michigan Opioid Prescribing Engagement Network network guidelines which provides prescription recommendations for surgical procedures. We evaluated all laparoscopic/robotic cholecystectomy, appendectomy, and all herniorrhaphies. Patients were prescribed a predetermined number of narcotics by procedure as part of a multimodal pain regimen. A survey was conducted within 14 d postoperatively to assess pain control and narcotic utilization. Results A total of 442 patients were included from July 1, 2022 to October 28, 2022. Survey response was 40% (178/442) with 56% (249/442) prescribed per protocol. Fewer patients prescribed per protocol required refills, 9.6% (24/249) compared to 18.1% (35/193) (P = 0.007) without protocol. Patients reported taking significantly fewer narcotics with the protocol versus without (median = 5.0 versus 10.0, P < 0.001). The median number of narcotics taken were 5.5 for appendectomy, 7.0 for cholecystectomy, and 9.0 for herniorrhaphy. There was no difference in pain control when comparing patients with and without protocol (91.1% versus 90.5%, P = 1.0). Conclusions This study demonstrated that postoperative opioid prescriptions can be decreased by implementing a standardized protocol incorporating a multimodal regimen while adequately controlling pain following surgery.

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient?s point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

BACKGROUND:Few studies have examined which subgroups of people with HIV (PWH) carry the greatest burden of internalized HIV stigma (IHS), which may be important to care provision and interventions. METHODS:PWH in the CFAR Network of Integrated Clinical Systems (CNICS) longitudinal, US-based, multisite, clinical care cohort completed tablet-based assessments during clinic visits including a four-item, Likert scale (low 1-5 high), IHS instrument. Associations between sociodemographic characteristics and IHS scores were assessed in adjusted linear regression models. RESULTS:Twelve thousand six hundred and fifty-six PWH completed the IHS assessment at least once from February 2016 to November 2022, providing 28 559 IHS assessments. At baseline IHS assessment, the mean age was 49 years, 41% reported White, 38% Black/African American, and 16% Latine race/ethnicity, and 80% were cisgender men. The mean IHS score was 2.04, with all subgroups represented among those endorsing IHS. In regression analyses, younger PWH and those in care fewer years had higher IHS scores. In addition, cisgender women vs. cisgender men, PWH residing in the West vs. the Southeast, and those with sexual identities other than gay/lesbian had higher IHS scores. Compared with White-identifying PWH, those who identified with Black/African American or Latine race/ethnicity had lower IHS scores. Age stratification revealed patterns related to age category, including specific age-related differences by gender, geographic region and race/ethnicity. DISCUSSION:IHS is prevalent among PWH, with differential burden by subgroups of PWH. These findings highlight the benefits of routine screening for IHS and suggest the need for targeting/tailoring interventions to reduce IHS among PWH.

Background: Lifestyle medicine, a patient-centered approach promoting healthy lifestyle behaviors, is an evidence-based tool for preventing and treating chronic diseases. It has been shown to reduce the burden of physical and psychological diseases. Despite this, clinical implementation is lagging, with physicians facing barriers effectively encouraging lifestyle change. Objective: This project studies the Lifestyle Medicine Assessment (LMA) tool regarding ease of implementation and influence on patient motivation, perception of lifestyle changes, and satisfaction. Methods: A two-pronged approach was conducted. First, the implementation time was recorded for multiple encounters (N = 42). Next, a different subset of patients (N = 22) receiving the LMA completed a pre- and post-encounter survey about their motivation to change, perception of lifestyle changes on well-being, and visit satisfaction. A control group (N = 21) also received these surveys. Results: The average time of application was 7.12 min. Intragroup scores for motivation to change were significantly higher in the LMA group post-intervention ( p LMA = .001), but not in the control group. Conclusion: These results show the potential benefits of the LMA tool in a clinical setting, demonstrating realistically achievable implementation times and increased patient motivation regarding better lifestyle choices. Providers should consider using the LMA tool to promote lifestyle change within their practice.

Resource insecurity is a social determinant of health that can impact people with HIV (PWH), in particular older African Americans (AA) or blacks with HIV. The purpose of this study was to identify resource insecurities among older Blacks or AA PWH specifically related to food and housing. Secondary focus was to find associations between resource insecurity and substance use history, stigma, and various forms of discrimination. Eligible participants (N = 52) of this cross-sectional study were 50 years old or older, identified as Black or AA, diagnosed with HIV, and living in Ohio. Food insecurity was assessed using the Household Food Insecurity Access Scale and housing insecurity was defined as not having stable housing. Resource insecurity was categorized into food and housing secure, food or housing insecure, and food and housing insecure. Almost half (48.1

Introduction: Data on how surgeons perceive their habits of prescribing narcotics compared to their actual practice are scarce. This study examines the perception and actual narcotic prescribing habits of surgeons and advanced practitioners.Methods: Surgical residents, attendings, and advanced practice providers (APPs) were sur-veyed to assess their perceived prescribing habits at discharge for laparoscopic appen-dectomy and laparoscopic cholecystectomy. Data on narcotics prescription for patients receiving either of the procedures from January 2017 to August 2020 were extracted from electronic health records. Prescribed narcotics were converted to morphine equivalent doses (MEQs) for comparison.Results: Of the 52 participants, the majority were residents (57.7%). Approximately 90% of residents, 72% of attendings, and 18% of APPs reported regularly prescribing narcotics at discharge. Approximately 67% (889/1332) of patients were discharged with narcotics. Of those, the majority of patients' narcotics were prescribed by surgery residents (71.2%). However, 72% of residents, 80% of attendings, and 72% of APPs were confident on pre-scribing the correct regimen of narcotics. There were no differences in average daily MEQs among the groups. However, the number of narcotics prescribed was higher among APPs compared to that in the other groups (P < 0.0001). Conclusions: Most participants self-reported routinely prescribing narcotics at discharge. Although not the current recommendation, participants felt confident they were pre-scribing the correct regimen, but were observed to prescribe more than the recommended number of total narcotics which indicates a discrepancy between perception and actual habits of prescribing narcotics. Our findings suggest a need for education in the general surgery residency and continuing medical education setting.(c) 2022 Elsevier Inc. All rights reserved.

Background: Previous studies supported that sociodemographic characteristics are significantly associated with dietary adherence and glycemic control in adults with type 2 diabetes. The American Diabetes Association recommends that individually designed nutritional plans consider the sociodemographic characteristics of the patients. Few studies were specifically conducted to address the association of sociodemographic characteristics with adherence to dietary guidelines and glycemic control in adults with type 2 diabetes employing data from a US national dataset. Purpose: The study aimed to examine the relationships of sociodemographic characteristics with adherence to the American Diabetes Association dietary guidelines and glycated hemoglobin in adults with type 2 diabetes. Methods: A secondary analysis study used data for 1,401 adults that were extracted from the National Health and Nutrition Examination Survey conducted between 2007 and 2012. Logistic regression was employed to calculate the unadjusted odds ratios to determine the odds of non-adherence with dietary guidelines for each sociodemographic characteristic. Results: A large percentage of the sample was non-Hispanic White (66.1%) and female (52.7%). Sex, race/ethnicity, marital status, education, and income were significantly related to glycemic control. Race/ethnicity and marital status were significantly related to adherence to dietary guidelines. Single participants were at greater risk of being non-adherent compared to married participants. Furthermore, non-Hispanic Whites had much lower odds of nonadherence to dietary guidelines compared to Hispanics. Conclusion: Individualizing patients’ nutritional plans based on sociodemographic characteristics is crucial for improving glycemic control and health outcomes in patients with type 2 diabetes. Implications for Nursing: Clinicians should pay attention to the dietary behaviors among people of different ethnic/racial backgrounds. Assessment sheets should be revised accordingly and health caregivers should be aware of how to design and modify dietary plans for their clients based on clients’ food preferences and cultures. Keywords: Type 2 diabetes, Sociodemographic characteristics, Glycemic control, Dietary adherence.

The purpose of this pilot study was to explore the effect of HIV-related stigma and everyday major experiences of discrimination on medication and clinic visit adherence among older African Americans living with HIV in Ohio. We collected data from 53 individuals who were living with HIV in Ohio, ≥ 50 years of age, and who identified as Black or African American. We conducted logistic regression models to examine the impact of HIV-related stigma and experiences of discrimination on medication and visit adherence. Each model controlled for age, time since diagnosis, and sexual orientation. The average age was 53.6 ± 2.1 years and 94.3% were men. Almost half (49.1%) of the participants reported poor medication adherence and almost a third (31.4%) reported poor visit adherence. HIV-related stigma (adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI) = 1.02–1.89) and major experiences of discrimination (aOR = 1.70; 95% CI = 1.11–2.60) were associated with a greater odds of poor medication adherence. Additionally, major experiences of discrimination were associated with a threefold increase in the odds of poor visit adherence (aOR = 3.24; 95% CI = 1.38–7.64). HIV-related stigma and major experiences of discrimination impede optimal medication and HIV clinic visit adherence for older African Americans living with HIV. To reduce the impact of stigma and discrimination on HIV care engagement, our first step must be in understanding how intersecting forms of stigma and discrimination impact engagement among older African Americans living with HIV.