The Cognitive Escape Scale: Measuring HIV-related Thought Avoidance

Abstract

Cognitive escape provides a model for examining the cognitive processes involved in escaping from thoughts of HIV/AIDS in a population of men who have sex with men (MSM). This investigation presents psychometric information and validation data on the Cognitive Escape Scale (CES), a measure of HIV-related cognitive avoidance. This study also examined the associations between the CES and self-report measures of theoretically related constructs, including HIV-related worry, sensation-seeking, depressive symptoms, perceived stress, and risky sexual behaviors. Participants were 709 MSM (71% White, 13% Latino, 8% African-American, 6% Native American; M age = 35). The CES measured HIV-related thought avoidance. Exploratory and confirmatory factor analyses supported a 3-factor structure to the CES, suggesting three strategies of cognitive escape: fatalism/short-term thinking, thought suppression/distraction, and alcohol/drug use. These factors are differentially related to several variables of interest including risky sexual behaviors. Although the CES is designed for use with both HIV negative and positive men, correlates differed between groups.

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Fig. 1

Notes

  1. 1.

    McKirnan et al. (2001) developed a 12-item measure of escape-related alcohol and drug use, which assesses sexual disinhibition expectancies from consuming alcohol and drugs. While this measure predicts risky sexual behaviors, it does not measure escape from HIV-related thoughts, per se.

  2. 2.

    Two-spirited is a Native American term that indicates that someone possesses both a male and a female spirit. It has been likened to being “gay” in the non-Native American context (Tafoya 2003).

  3. 3.

    Our logic, in grouping those who were unaware of their HIV status together with HIV negative men for statistical analyses, was that it is self-perceptions of HIV status that drive the psychological and behavioral processes of interest. Further, Huebner and Davis (2007) found that HIV unaware men did not differ from HIV negative men on self-reported health outcomes, whereas both differed from HIV positive men. Given the low prevalence of HIV in the sampled community, the probability is that the majority of unaware men were in fact negative.

  4. 4.

    These items had been included in the ‘Thought Suppression/Distraction’ scale in a previous study (see Hoyt et al. 2006).

  5. 5.

    An EFA including only HIV-negative men yielded the same factor structure as reported for the entire exploratory sample, as reported.

  6. 6.

    Covariance matrices for the exploratory and confirmatory samples are available from the authors.

  7. 7.

    To determine that the specified models were identified (if there is a unique solution), the t-rule for CFA was utilized. This states that the number of free parameters (t) must be less than or equal to ½ q(q + 1), where q is the number of measured items. This is a necessary, but not sufficient condition for establishing identification. t was estimated for models a, b, and c above, and all three models met the criterion. These models also satisfied the sufficient three-indicator rule as a unit is defined for all factors in each model, there are at least three measured items per latent factor, each item loads on only one factor, and the matrices of unique covariance are diagonal (see Bollen 1989 for identification rules).

  8. 8.

    Although HIV-related cues did not differ significantly by HIV status, it should be noted that the same cues were administered to all participants and were likely better suited for HIV negative men. It may be that an alternate list of cues would be more salient to HIV positive men. We further note that the statistical power to detect effects differed by HIV status due to the smaller sample size for the HIV positive group, thus weaker effects may not have been detected among HIV positive men.

  9. 9.

    We thank the anonymous reviewer who brought this to our attention.

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Acknowledgments

This research was supported in part by a grant from the Centers for Disease Control and Prevention to the Arizona Department of Health Services through cooperative agreement #99004. The authors would like to thank Leona Aiken, Brendt Parrish, and Roger Millsap for their important contributions, and the anonymous reviewers for their insightful and constructive comments. We also thank the many AIDS service organizations and participants of the Heads Up Study for their time, effort, and dedication.

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Correspondence to Carol J. Nemeroff.

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Nemeroff, C.J., Hoyt, M.A., Huebner, D.M. et al. The Cognitive Escape Scale: Measuring HIV-related Thought Avoidance. AIDS Behav 12, 305–320 (2008). https://doi.org/10.1007/s10461-007-9345-1

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Keywords

  • Cognitive escape
  • HIV
  • AIDS
  • Thought suppression
  • Fatalism