Howard J Cabral
Biographic Data
| ID | 2087009 |
|---|---|
| NAME | Howard J Cabral |
| GIVEN NAMES | Howard J |
| FAMILY NAME | Cabral |
| SIGNATURE | CABRAL H J |
| AFFILIATIONS | Boston University |
| ORCID | 0000-0002-1185-8331 |
| VERIFIED | Yes |
| TOTAL WORKS | 42 |
| TOTAL CITATIONS | 72 |
| AUTHOR COUNT | 42 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1990 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 3 |
HIV Stigma Reduction Interventions in People Living with HIV in the United States: A Systematic Review
Hospital Breastfeeding Support during the Early Coronavirus Disease 2019 (Covid-19) Pandemic: Worsening Care for Black, Hispanic, and Asian Mothers
This study examines changes in Baby Friendly Hospital Initiative (BFHI) key clinical practices in US hospitals during the early coronavirus disease 2019 (COVID-19) pandemic (April– December 2020) compared to before the pandemic. Using data from PRAMS (Pregnancy Risk Assessment Monitoring System) between 2016 and 2020, we conducted linear regression analyses to calculate the percentage-point change in BFHI key clinical practices overall and by rac…
Racial and Ethnic Disparities in Hospital Breastfeeding Care in the US
Despite a steady increase in the number of BFHI hospitals in the US, there are racial and ethnic disparities in the receipt of BFHI key clinical practices. More US hospitals must adopt BFHI key clinical practices and consistently implement those practices for every racial and ethnic group
Differences in HIV Outcomes and Quality of Life Between Older and Younger Black Women With HIV in the United States, 2021–2023
Objectives. To characterize differences in outcomes of 733 Black women aged 50 years and older compared with younger women with HIV engaged in bundled interventions across 12 US sites from 2021 to 2023. Methods. We examined age differences in physical component score (PCS) and mental component score (MCS) for health-related quality of life, stigma, and viral suppression over 12 months. We examined outcome effects by age and intervention. We colle…
Using Bundled Interventions to Improve Health Outcomes for Black Cisgender and Transgender Women: Findings From the Black Women First Initiative
Objectives. To examine the effects of replicating a bundled package of evidence-informed interventions on social determinants, HIV health outcomes, and health-related quality of life (HRQoL) for 697 Black cisgender and transgender women with HIV across 12 US sites from 2021 to 2023. Methods. Women participated in a minimum of 2 interventions. We collected self-reported HRQoL and social determinants via interview at baseline, 6 months, and 12 mont…
Longitudinal experience of primary care in a cohort of multiply diagnosed persons with HIV experiencing homelessness
Increasing evidence shows benefit of patient-tailored medical care on patients’ experiences of care and, consequently, retention in care and clinical outcomes. Many studies of patient experience use cross-sectional data sampled from broad patient populations. In this study, we assessed longitudinal patient experience of tailored care in a cohort of homeless persons diagnosed with HIV and substance use/mental health disorders. This population face…
Advancing Patient Navigation for HIV: Evaluating Models of Care for Housing and Employment
Leveraging a Longitudinally Linked Dataset to Assess Recurrence of Severe Maternal Morbidity
Hospital utilization after a birth with SMM might indicate an elevated risk of a second SMM event. Providers should counsel their patients about prevention and warning signs
Pre-Paid Phone Distribution: A Tool for Improving Healthcare Engagement for People with Substance Use Disorder
Background The COVID-19 pandemic drove significant disruptions in access to substance use disorder (SUD) treatment and harm reduction services. Healthcare delivery via telemedicine has increasingly become the norm, rendering access to a phone essential for engagement in care.Methods Adult patients with SUD who lacked phones (n = 181) received a free, pre-paid phone during encounters with inpatient and outpatient SUD programs. We evaluated changes…
Effectiveness of an Enhanced Community Doula Intervention in a Safety Net Setting: A Randomized Controlled Trial
Background: Racial inequities in maternal health outcomes, the result of systemic racism and social determinants of health, require maternity care systems to implement interventions that reduce disparities. One such approach may be support from a community doula, a health worker who provides emotional support, peer education, navigation, and advocacy for pregnant, birthing, and postpartum people who share similar racial identities, cultural backg…
Depression and PTSD among Houston Residents who Experienced Hurricane Harvey and Covid-19: Implications for Urban Areas Affected by Multiple Disasters
A smoking cessation induction intervention via virtual reality headset during a dental cleaning: Protocol for a randomized controlled trial
NCT04524533 Registered August 24, 2020
Does HIV Stigma Predict Social Networks Over Time: A Latent Growth Curve Analysis
Medicaid Expansion and Change in Federally Qualified Health Center Accessibility From 2008 to 2016
BACKGROUND: The Affordable Care Act expanded health coverage for low-income residents through Medicaid expansion and increased funding for Health Center Program New Access Points from 2009 to 2015, improving federally qualified health center (FQHC) accessibility. The extent to which these provisions progressed synergistically as intended when states could opt out of Medicaid expansion is unknown. OBJECTIVE: To compare change in FQHC accessibility…
Outcomes from the Adaptation of an Evidence-Based Peer Linkage & Re-Engagement Intervention for Women of Color with HIV in Three Urban Clinics
Phone-based monitoring to evaluate health policy and program implementation in Kenya
Monitoring and evaluating policies and programs in low- and middle-income countries are often difficult because of the lack of routine data. High mobile phone ownership in these countries presents an opportunity for efficient data collection through telephone interviews. This study examined the feasibility of collecting data on medicines through telephone interviews in Kenya. Data on the availability and prices of medicines at 137 health faciliti…
Reliability and Validity of a Brief Self-Report Adherence Measure among People with HIV Experiencing Homelessness and Mental Health or Substance Use Disorders
Changes to dietary and health outcomes following implementation of the 2012 updated US Department of Agriculture school nutrition standards: Analysis using National Health and Nutrition Examination Su…
Objective: In 2012, the US government overhauled school nutrition standards, but few studies have evaluated the effects of these standards at the national level. The current study examines the impact of the updated school nutrition standards on dietary and health outcomes of schoolchildren in a nationally representative data set. Design: Difference-in-differences. We compared weekday fruit and vegetable intake between students with daily school l…
Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers
Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated i…
First-Generation Immigrant Mothers Report Less Spanking of 1-Year-Old Children Compared with Mothers of Other Immigrant Generations
Early Autism Spectrum Disorders in Children Born to Fertile, Subfertile, and ART-Treated Women
Risk factors associated with multi-dimensional stigma among people living with HIV/Aids who are homeless/unstably housed
BACKGROUND: Stigma may serve as a barrier to HIV care among homeless living with HIV/AIDS (PLWHA). The role of layered stigma related to the syndemic of homelessness, mental health, and substance use among PLWHA has not been examined. We explored the syndemic of HIV, homelessness, mental health, and substance use, as well as perceived and experienced provider stigma. We also examined factors contributing to high levels of stigma. METHODS: We iden…
Peer Support and the HIV Continuum of Care: Results from a Multi-Site Randomized Clinical Trial in Three Urban Clinics in the United States
The Impact of Housing and HIV Treatment on Health-Related Quality of Life Among People With HIV Experiencing Homelessness or Unstable Housing
Objectives. To determine the impact of improvements in housing and HIV clinical parameters on health-related quality of life (HRQOL) in persons with HIV infection experiencing homelessness. Methods. This prospective cohort study took place in 9 US sites. Local efforts sought to improve HIV and housing status. Longitudinal data analyses determined the impact of changes in housing status, HIV suppression, and CD4 cell counts on HRQOL at 12 months, …
Longitudinal Stigma Reduction in People Living with HIV Experiencing Homelessness or Unstable Housing Diagnosed With Mental Health or Substance Use Disorders: An Intervention Study
Objectives. To assess changes in perceived external stigma among people living with HIV (PLWH) experiencing homelessness or unstable housing diagnosed with mental health or substance use disorders following an intervention including care coordination and navigation assistance, building trusting relationships, addressing unmet needs, and reducing barriers to seeking and engaging in care. Methods. This study was part of a national multisite interve…
Foreign-born and US-born black women: Differences in health behaviors and birth outcomes
We studied health behaviors and birth outcome among 201 foreign-born and 616 US-born Black women receiving prenatal care at Boston City Hospital. Foreign-born women had better pre-pregnancy nutritional status and prenatal health behaviors, and their infants had greater intrauterine growth. Black women are not a homogeneous group; culture and ethnicity, in addition to other variables, must be considered in the study of their birth outcomes
Violence during pregnancy and substance use
Violent incidents were assessed as part of a prospective study of 1,243 pregnant women. Participants were predominantly poor, urban, minority group women. Seven percent (n = 92) of women reported physical or sexual violence during pregnancy. Most of the women (94 percent) knew their assailant. Victims of violence were at greater risk of having a history of depression and attempted suicide, having more current depressive symptoms, reporting less h…
The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness
Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017. Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervent…
Using Bundled Interventions to Improve Health Outcomes for Black Cisgender and Transgender Women: Findings From the Black Women First Initiative
Objectives. To examine the effects of replicating a bundled package of evidence-informed interventions on social determinants, HIV health outcomes, and health-related quality of life (HRQoL) for 697 Black cisgender and transgender women with HIV across 12 US sites from 2021 to 2023. Methods. Women participated in a minimum of 2 interventions. We collected self-reported HRQoL and social determinants via interview at baseline, 6 months, and 12 mont…
The role of motivation in predicting antiretroviral therapy adherence in China
Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on impro…
Patient navigation for depressed mothers in Head Start: A pilot study of intervention mechanism
We sought to assess potential mechanisms of action of a patient navigation intervention in Head Start, designed to help depressed mothers engage with mental health care. We employed mixed methods, linking qualitative interviews (n = 21) to a randomized intervention pilot (n = 47). Early in follow-up, navigated mothers had lower mean depressive symptom scores than non-navigated mothers (9.61 vs. 12.95, p = 0.03). These differences attenuated but p…
The Impact of Housing and HIV Treatment on Health-Related Quality of Life Among People With HIV Experiencing Homelessness or Unstable Housing
Objectives. To determine the impact of improvements in housing and HIV clinical parameters on health-related quality of life (HRQOL) in persons with HIV infection experiencing homelessness. Methods. This prospective cohort study took place in 9 US sites. Local efforts sought to improve HIV and housing status. Longitudinal data analyses determined the impact of changes in housing status, HIV suppression, and CD4 cell counts on HRQOL at 12 months, …
Longitudinal Determinants of Housing Stability Among People Living With HIV/Aids Experiencing Homelessness
Objectives. To examine patterns of and factors associated with housing stability over time among people living with HIV (PLWH) experiencing homelessness with co-occurring substance use and mental health disorders enrolled in a patient-centered medical home (PCMH) intervention. Methods. Between September 2013 and February 2017, we ascertained housing trajectories among PLWH in 9 sites in the United States by conducting interviews at baseline, 6, a…
Effects of intrauterine substance and postnatal violence exposure on aggression in children
During the cocaine epidemic of the 1980s and early 1990s, many expressed fears that children with intrauterine cocaine exposure (IUCE) would grow up to be unusually violent. The present study examines the relationship of caregiver reports of school-age children's aggressive behavior with IUCE and postnatal exposure to violence. Respondents were 140 low-income, primarily African American children, ages 8-11, and each child's current primary caregi…
Foreign-born and US-born black women: Differences in health behaviors and birth outcomes
We studied health behaviors and birth outcome among 201 foreign-born and 616 US-born Black women receiving prenatal care at Boston City Hospital. Foreign-born women had better pre-pregnancy nutritional status and prenatal health behaviors, and their infants had greater intrauterine growth. Black women are not a homogeneous group; culture and ethnicity, in addition to other variables, must be considered in the study of their birth outcomes
Violence during pregnancy and substance use
Violent incidents were assessed as part of a prospective study of 1,243 pregnant women. Participants were predominantly poor, urban, minority group women. Seven percent (n = 92) of women reported physical or sexual violence during pregnancy. Most of the women (94 percent) knew their assailant. Victims of violence were at greater risk of having a history of depression and attempted suicide, having more current depressive symptoms, reporting less h…
Company characteristics and workplace medical testing
OBJECTIVES. This study measures the relative impact of company economic characteristics and workplace hazards on the prevalence of several types of medical testing. It uses the results to assess likely public health impacts of testing. METHODS. We used data on potential exposure to workplace hazards, medical testing, unionization, firm size, and turnover from the National Occupational Hazards Survey and the National Occupational Exposure Survey. …
Neighborhood Safety and Overweight Status in Children
OBJECTIVE: To determine if there is a relationship between parental perception of neighborhood safety and overweight at the age of 7 years. DESIGN: Cross-sectional analysis of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. SETTING: Ten urban and rural US sites. PARTICIPANTS: A total of 768 children selected via conditional random sampling with complete data at follow-up. MAIN OUTCOME …
A Comparison of Maternal Interview and Medical Record Ascertainment of Violence among Women who had Poor Pregnancy Outcomes
Health Services Utilization for People with HIV Infection: Comparison of a Population Targeted for Outreach with the U.S. Population in Care
BACKGROUND: Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services. OBJECTIVE: This study compared the sociodemographic, clinical, and health care utilization characteristics of a multisite sample of HIV-positive persons who were hard to reach with a natio…
Mental health of Somali adolescent refugees: The role of trauma, stress, and perceived discrimination.
The primary purpose of this study was to examine relations between trauma exposure, post-resettlement stressors, perceived discrimination, and mental health symptoms in Somali adolescent refugees resettled in the U.S. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135) who had resettled in the U.S. Participants were administered an interview battery comprising self-report instruments that included…
Discrimination and mental health among Somali refugee adolescents: The role of acculturation and gender
This study examines the role of social identity (acculturation and gender) in moderating the association between discrimination and Somali adolescent refugees' mental health. Participants were English-speaking Somali adolescent refugees between the ages of 11 and 20 (N = 135). Perceived discrimination, trauma history, posttraumatic stress disorder (PTSD), depressive symptoms, and behavioral acculturation were assessed in structured interviews. Fo…
Intrauterine substance exposures and Wechsler Individual Achievement Test-II scores at 11 years of age
The goal of this study was to evaluate whether intrauterine exposure to cocaine, alcohol, tobacco, or marijuana was associated with unique variance in children's academic achievement test scores after controlling for other substance exposures and contextual variables. Academic achievement scores (Wechsler Individual Achievement Test-Second Edition (WIAT-II)) were collected from 119, low-income, urban 11-year-olds enrolled in a prospective longitu…
Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (Emsant-W) …
Differences by gender at twelve months in a brief intervention trial among Mexican-origin young adults in the emergency department
In this study, we investigate the role of gender in prevalence and consequences of binge drinking and brief intervention outcomes among Mexican-origin young adults aged 18-30 years at the U.S.-Mexico border. We conducted a secondary analysis, stratified by gender, from a randomized controlled trial of a brief motivational intervention in a hospital emergency department. Intervention effects for males included reductions in drinking frequency, bin…
The Prevalence and Impact of Substance Use Disorder and Treatment on Maternal Obstetric Experiences and Birth Outcomes Among Singleton Deliveries in Massachusetts
Effects of intrauterine substance and postnatal violence exposure on aggression in children
During the cocaine epidemic of the 1980s and early 1990s, many expressed fears that children with intrauterine cocaine exposure (IUCE) would grow up to be unusually violent. The present study examines the relationship of caregiver reports of school-age children's aggressive behavior with IUCE and postnatal exposure to violence. Respondents were 140 low-income, primarily African American children, ages 8-11, and each child's current primary caregi…
Patient navigation for depressed mothers in Head Start: A pilot study of intervention mechanism
We sought to assess potential mechanisms of action of a patient navigation intervention in Head Start, designed to help depressed mothers engage with mental health care. We employed mixed methods, linking qualitative interviews (n = 21) to a randomized intervention pilot (n = 47). Early in follow-up, navigated mothers had lower mean depressive symptom scores than non-navigated mothers (9.61 vs. 12.95, p = 0.03). These differences attenuated but p…
Risk factors associated with multi-dimensional stigma among people living with HIV/Aids who are homeless/unstably housed
BACKGROUND: Stigma may serve as a barrier to HIV care among homeless living with HIV/AIDS (PLWHA). The role of layered stigma related to the syndemic of homelessness, mental health, and substance use among PLWHA has not been examined. We explored the syndemic of HIV, homelessness, mental health, and substance use, as well as perceived and experienced provider stigma. We also examined factors contributing to high levels of stigma. METHODS: We iden…
Peer Support and the HIV Continuum of Care: Results from a Multi-Site Randomized Clinical Trial in Three Urban Clinics in the United States
The Impact of Housing and HIV Treatment on Health-Related Quality of Life Among People With HIV Experiencing Homelessness or Unstable Housing
Objectives. To determine the impact of improvements in housing and HIV clinical parameters on health-related quality of life (HRQOL) in persons with HIV infection experiencing homelessness. Methods. This prospective cohort study took place in 9 US sites. Local efforts sought to improve HIV and housing status. Longitudinal data analyses determined the impact of changes in housing status, HIV suppression, and CD4 cell counts on HRQOL at 12 months, …
Longitudinal Stigma Reduction in People Living with HIV Experiencing Homelessness or Unstable Housing Diagnosed With Mental Health or Substance Use Disorders: An Intervention Study
Objectives. To assess changes in perceived external stigma among people living with HIV (PLWH) experiencing homelessness or unstable housing diagnosed with mental health or substance use disorders following an intervention including care coordination and navigation assistance, building trusting relationships, addressing unmet needs, and reducing barriers to seeking and engaging in care. Methods. This study was part of a national multisite interve…
Longitudinal Determinants of Housing Stability Among People Living With HIV/Aids Experiencing Homelessness
Objectives. To examine patterns of and factors associated with housing stability over time among people living with HIV (PLWH) experiencing homelessness with co-occurring substance use and mental health disorders enrolled in a patient-centered medical home (PCMH) intervention. Methods. Between September 2013 and February 2017, we ascertained housing trajectories among PLWH in 9 sites in the United States by conducting interviews at baseline, 6, a…
The Influence of Housing Status on the HIV Continuum of Care: Results From a Multisite Study of Patient Navigation Models to Build a Medical Home for People Living With HIV Experiencing Homelessness
Objectives. To examine the effect of patient navigation models on changes in housing status and its subsequent effects on HIV outcomes for 700 people living with HIV (PLWH) who were unstably housed with co-occurring substance use and psychiatric disorders across 9 demonstration sites in the United States between the years of 2013 and 2017. Methods. Self-reported housing status was collected at baseline, and at 6 and 12 months during the intervent…
The role of motivation in predicting antiretroviral therapy adherence in China
Patient motivation is important in managing medication regimens such as antiretroviral treatment for HIV/AIDS. We tested whether self-determination theory could predict adherence behavior among 115 HIV-positive patients in the China Adherence through Technology Study, a randomized controlled trial of an intervention using text reminders and supportive counseling to increase adherence. Being in the treatment group had a significant effect on impro…
Designing and Evaluating a Digital Family Health History Tool for Spanish Speakers
Digital family health history tools have been developed but few have been tested with non-English speakers and evaluated for acceptability and usability. This study describes the cultural and linguistic adaptation and evaluation of a family health history tool (VICKY: VIrtual Counselor for Knowing Your Family History) for Spanish speakers. In-depth interviews were conducted with 56 Spanish-speaking participants; a subset of 30 also participated i…
First-Generation Immigrant Mothers Report Less Spanking of 1-Year-Old Children Compared with Mothers of Other Immigrant Generations
Early Autism Spectrum Disorders in Children Born to Fertile, Subfertile, and ART-Treated Women
Reliability and Validity of a Brief Self-Report Adherence Measure among People with HIV Experiencing Homelessness and Mental Health or Substance Use Disorders
Medicine (38 works) · Psychiatry (23 works) · Environmental health (22 works) · Psychology (19 works) · Family medicine (16 works) · Public health (15 works) · HIV/AIDS Research and Interventions (14 works) · Nursing (14 works) · Population (14 works) · Demography (13 works)