Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men’s mental and sexual health

BMC Public Health. 2019;19(1):1-12 DOI 10.1186/s12889-019-7346-4

 

Journal Homepage

Journal Title: BMC Public Health

ISSN: 1471-2458 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Public aspects of medicine

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


John E. Pachankis (Department of Social and Behavioral Sciences, Yale School of Public Health)

Erin M. McConocha (Department of Social and Behavioral Sciences, Yale School of Public Health)

Jesse S. Reynolds (Department of Biostatistics, Yale School of Public Health)

Roxanne Winston (Department of Social and Behavioral Sciences, Yale School of Public Health)

Oluwaseyi Adeyinka (Department of Social and Behavioral Sciences, Yale School of Public Health)

Audrey Harkness (Department of Public Health Sciences, University of Miami)

Charles L. Burton (Department of Social and Behavioral Sciences, Yale School of Public Health)

Kriti Behari (Department of Social and Behavioral Sciences, Yale School of Public Health)

Timothy J. Sullivan (Department of Social and Behavioral Sciences, Yale School of Public Health)

Adam I. Eldahan (Department of Social and Behavioral Sciences, Yale School of Public Health)

Denise A. Esserman (Department of Biostatistics, Yale School of Public Health)

Mark L. Hatzenbuehler (Department of Sociomedical Sciences, Columbia University Mailman School of Public Health)

Steven A. Safren (Department of Psychology, University of Miami)

EDITORIAL INFORMATION

Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 18 weeks

 

Abstract | Full Text

Abstract Background Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men’s exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men’s health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men’s co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. Methods This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline. Discussion Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men’s depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men. Trial registration Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069.