The results provide evidence for the predictive validity of minority stress, even in the context of a major life stressor, and suggest the importance of targeting minority stress experiences in HIV and mental health interventions with gay men. Future studies are needed to assess the mechanisms through which minority stress is associated with adverse health outcomes.

There is increasing demand for physicians in pediatric settings to address not only the physical but also the psychosocial health of their child and adolescent patients. Brief interventions (BIs), and in particular Motivational interviewing (MI), offer an efficient means of targeting behavioral, developmental, and social problems within the context of pediatric practice. This review addresses the patient-centered care foundation of and empirical support for brief pediatric interventions, including educational and media-based interventions, MI-based prevention and intervention with health risk behaviors, procedural pain control, and adherence to treatment recommendations. In addition, developmental considerations and future directions for BI research in pediatric practice are summarized.Physicians in pediatric health care settings address complex challenges in providing comprehensive care to children, adolescents, and their parents. Toward this end, BIs have been used in pediatric settings to aid in the prevention, early detection, and brief treatment of behavioral, developmental, and social problems associated with health care concerns to serve children and their families more effectively. Brief interventions encompass a diverse range of theoretically based approaches, intervention targets, and delivery methods to address such issues as educational and media-based interventions, MIbased prevention and intervention with health risk behaviors, procedural pain control, and adherence to health care recommendations. One particularly efficacious form of BI used extensively with health risk behaviors is MI.

Pregnant substance users can benefit significantly from substance abuse treatment but treatment retention can be challenging. Two hundred pregnant substance users entering outpatient substance abuse treatment at 1 of 4 treatment programs were randomized to receive either 3 individual sessions of Motivational Enhancement Therapy for pregnant substance users (MET-PS) or the first 3 individual sessions normally provided by the program. All participants were encouraged to participate in all other treatment offered by the program. Outcome measures included treatment utilization according to clinic records, qualitative urine toxicology measures, and self-report of substance use. One hundred and sixty two participants (i.e., 81%) completed the 1 month active phase. Participants attended 62% of scheduled treatment on average and reported decreased substance use during the first month of treatment, with no differences between MET-PS and treatment as usual participants. There was some evidence that the efficacy of MET-PS varied between sites and that MET-PS might be more beneficial than TAU in decreasing substance use in minority participants. These results suggest that MET-PS is not more effective than treatment as usual for pregnant substance users in general but that there might be particular subgroups or treatment programs for which MET-PS might be more or less effective than treatment as usual.

Objectives We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment. Methods Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing. Results We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P < .001; Mantel-Haenszel risk ratio = 4.52; 97.5% confidence interval [CI] = 3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P = .39; incidence rate ratio [IRR] = 1.04; 97.5% CI = 0.95, 1.14) or the 2 on-site testing arms (P = .81; IRR = 1.03; 97.5% CI = 0.84, 1.26). Conclusions This study demonstrated on-site rapid HIV testing’s value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling.