Search

Despite the increase in media attention on "meth cooking" in rural areas of the United States, little is known about rural stimulant use--particularly, the criminality associated with stimulant use. Data were collected from community stimulant users in rural Ohio, Arkansas, and Kentucky (N = 709). Findings from three logistic regression models indicate that younger stimulant users (M = 32.55, SD = 10.35), those with more convictions, and those who used crack frequently were significantly more likely to have been arrested for committing a substance-related crime, a property crime, or another crime in the 6 months before entering the study. Implications include the need for longitudinal studies to further understand rural stimulant use, as well as increased community and corrections-based drug abuse prevention and treatment interventions for stimulant users who live in rural areas. (Contains 4 tables.)

Abstract: Background: Although the Brief Symptom Inventory-18 (BSI-18) has been widely used for mental health screenings in both clinical and non-clinical populations, the validation of its application to Chinese populations has been very limited. The objective of this research is to assess the factorial structure of the BSI-18 within a Chinese drug using population. Methods and results: A total sample of 303 drug users recruited via Respondent Driven Sampling (RDS) from Changsha, China was used for the study. Our results show: (1) The BSI-18 item scores are highly skewed; (2) With dichotomous items measures (1 – problem at least moderately caused respondent discomfort during the past week; 0 – otherwise), our findings support the designed 3 – factor solution of the BSI-18 (somatization, depression, and anxiety); (3) The BSI-18 has a hierarchical factorial structure with 3 first-order factors and an underlying second-order factor (general psychological distress); (4) Tentative support should also be given to a single dimension of general psychological distress in Chinese drug using populations. Our study recommends a useful alternative approach for evaluating the factorial structure of the BSI-18 – i.e. CFA with dichotomous item measures. Both the total BSI-18 score and the three subscales (SOM, DEP, and ANX) can be used in applications of the BSI-18. Conclusion: Overall, our findings suggest the BSI-18 is useful with Chinese drug users, and shows potential for use with non-Western and substance using populations more generally. [Copyright &y& Elsevier]

Abstract: The purpose of this study is to examine the factorial structure of the Brief Symptom Inventory 18 (BSI-18) and test its measurement invariance among different drug using populations. A total sample of 710 drug users was recruited using respondent-drive sampling (RDS) from three states: Ohio (n =248), Arkansas (n =237), and Kentucky (n =225). The results of confirmatory factor analysis (CFA) show: 1) the BSI-18 has a three-factor structure (somatization, depression, and anxiety) with an underlying second-order factor (global severity index of distress); and 2) its factorial structure and metric (factor loadings) are invariant across populations under study. However, the scalars (intercepts) of the BSI-18 items are not invariant, and the means of the latent factors also varied across populations. Our findings provide evidence of a valid factorial structure of the BSI-18 that can be readily applied to studying drug using populations. [Copyright &y& Elsevier]

Abstract: Crack cocaine is a highly addictive drug. To learn more about crack addiction, long-term crack smokers who had never met the DSM-IV criteria for lifetime cocaine dependence were compared with those who had. The study sample consisted of crack users (n =172) from the Dayton, Ohio, area who were interviewed periodically over 8 years. Data were collected on a range of variables including age of crack initiation, frequency of recent use, and lifetime cocaine dependence. Cocaine dependence was common with 62.8% of the sample having experienced it. There were no statistically significant differences between dependent and non-dependent users for age of crack initiation or frequency of crack use. In terms of sociodemographics, only race/ethnicity was significant, with proportionally fewer African-Americans than whites meeting the criteria for cocaine dependence. Controlling for sociodemographics, partial correlation analysis showed positive, statistically significant relationships between lifetime cocaine dependence and anti-social personality disorder, attention deficit/hyperactivity disorder, and lifetime dependence on alcohol, cannabis, amphetamine, sedative-hypnotics, and opioids. These results highlight the importance addressing race/ethnicity and comorbid disorders when developing, implementing, and evaluating interventions targeting people who use crack cocaine. Additional research is needed to better understand the role of race/ethnicity in the development of cocaine dependence resulting from crack use. [Copyright &y& Elsevier]

Abstract: Non-medical drug use in rural communities in the United States is a significant and growing public health threat. Understanding what motivates drug users in rural areas to seek substance abuse treatment may help in addressing the problem. Perceived need for treatment, a construct indicative of problem recognition and belief in problem solution, has been identified as an important predictor of help-seeking behavior. This cross-sectional study used data collected through face-to-face interviews to examine factors associated with perceived need for drug abuse treatment among not-in-treatment, adult, illicit stimulant drug users (n =710) in rural areas of Ohio, Kentucky, and Arkansas. More than one-quarter of the sample perceived a need for treatment. Results from a stepwise multiple regression analysis showed that white users, users with better physical and mental health status, and occasional users of methamphetamine were significantly less likely to see a need for treatment. Users with higher Addiction Severity Index composite scores for family/social problems or legal problems, and users with prior drug abuse treatment experience were significantly more likely to perceive a need for treatment. These findings have practical implications for efforts addressing substance abuse in rural areas. [Copyright &y& Elsevier]

Aims Although crack cocaine first appeared in cities in the United States in the mid-1980s, little is known about its use over long periods of time. This study identified crack cocaine user groups on the basis of long-term trajectories. Design Following a natural history approach, data were collected periodically from 1996 to 2005. Group-based modeling assessed the probability of a crack smoker becoming abstinent during the observation period. Setting A targeted sampling plan guided the recruitment of a community sample of crack cocaine users in Dayton, Ohio. Participants Crack smokers ( n = 430) 18 years or older whose urine tested positive for cocaine metabolites at the baseline interview. Measurements Interviewer-administered and audio computer self-administered, structured questionnaires were used to collect data on a range of variables, including frequency of crack use. Abstinence was defined as not having used crack for at least 6 consecutive months during the study. Findings Three trajectory-based groups were identified: (1) No Change, characterized by a very low probability of abstinence; (2) Some Change, characterized by a low to moderate probability of abstinence; and (3) Dramatic Change, characterized by a high probability of abstinence. African Americans and men were significantly less likely to become abstinent. For the majority of the people (63.6%), crack use was uninterrupted by extended periods of abstinence during the study. Conclusion Crack cocaine use that persists for a decade or longer may well be the norm for a large proportion of people who have experience with the drug. [ABSTRACT FROM AUTHOR]

Abstract: Increasingly, respondent-driven sampling (RDS) is being applied to study not-in-treatment users of illicit drugs. Although RDS has been successfully applied in recruiting active users in densely-populated, metropolitan areas, its utility with hidden populations in rural areas has yet to be determined. This study critically evaluates the sample of not-in-treatment, illicit stimulant drug users (n =249) recruited from the application of RDS in three rural counties in west-central Ohio. The findings of this study largely support the results of earlier studies in urban areas and suggest that RDS is a useful method of sampling hidden drug using populations in less densely populated rural areas. Some limitations of RDS are also discussed. [Copyright &y& Elsevier]

Context: There is growing concern about illicit rural stimulant use, especially regarding methamphetamine use and its health consequences. Purpose: The present study describes associations between aspects of stimulant use and illness experience in rural areas, with additional focus on the role of demographic characteristics in these associations. Methods: The research participants were 710 stimulant drug users who were recruited from rural areas of Arkansas, Kentucky, and Ohio using Heckathorn’s respondent-driven sampling method. Health was measured by self-reports of perceived health and extent of current, recent, and lifelong health problems. Drug use was measured with self-reports of type and frequency of use. Findings: Several associations were found between drug use and illness, controlling for demographics. Stimulant use pattern related significantly with the sum of health problems in the previous 6 months and the sum of lifetime illness diagnoses, after adjustment for demographic factors. Extent of illicit drug use in the past month and self-perceived drug and alcohol problems were associated with several measures of health. Conclusions: In this sample of stimulant users, methamphetamine use was associated with fewer recent medical problems than crack cocaine, combined crack and powder cocaine use, and use of all 3 of these stimulants. These results, across the 3 sites, suggest that prevalent assumptions about the methamphetamine “plague” and its negative health consequences must be viewed cautiously and examined with additional research. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR=0.79, 95%CI=0.62-0.99), as did participants with higher levels of education (OR=0.83, 95%CI=0.73-0.94). Number of times in drug abuse treatment (OR=1.04, 95%CI=1.01-1.09), having a chronic disease (OR=1.46, 95%CI=1.06-1.99), and higher Addiction Severity Index composite medical scores (OR=1.62, 95%CI=1.15-2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers. [ABSTRACT FROM AUTHOR]

Abstract: Recruiting samples that are more representative of illicit drug users is an on-going challenge in substance abuse research. Respondent-driven sampling (RDS), a new form of chain-referral sampling, is designed to eliminate the bias caused by the non-random selection of the initial recruits and reduce other sources of bias (e.g. bias due to volunteerism and masking) that are usually associated with regular chain-referral sampling. This study provides a methodological assessment of the application of RDS among young adult MDMA/ecstasy users in Ohio. The results show that the sample compositions converged to equilibrium within a limited number of recruitment waves, independent of the characteristics of the initial recruits (i.e. seeds). The sample compositions approximated the theoretical equilibrium compositions, and were not significantly different from the estimated population compositions—with the exception that White respondents were over-sampled and Black respondents were under-sampled. The effect of volunteerism and masking on the sampling process was found not to be significant. Though identifying productive seeds and improving the referral rate are significant challenges when implementing RDS, the findings demonstrate that RDS is a flexible and robust sampling method. RDS has the potential to be widely employed in studies of illicit drug-using populations. [Copyright &y& Elsevier]

This article describes the process of recruiting research subjects for a natural history study of illicit stimulant use in rural Ohio using respondent-driven sampling and ethnographic methods. Participant observation, qualitative interviews, and focus groups were used to establish the project and to evaluate and modify the sampling process as it unfolded. We outline the steps taken in several different rural counties, using ethnographic data to illustrate local differences and obstacles that were faced. The article concludes that respondent-driven sampling is a promising method for identifying and recruiting members of hidden populations in rural areas. However, adequate time must be allotted to establish ethnographic footholds and to reach various networks in separate communities. [ABSTRACT FROM AUTHOR]

Abstract: This study describes the drug-use practices and treatment histories of 249 not-in-treatment, drug-using individuals living in small towns in rural Ohio. Respondent-driven sampling was used to recruit participants who answered questionnaires administered by interviewers. Descriptive statistics and latent class analysis (LCA) were used to examine the data. The illicit drugs most commonly used in the 6 months before entering the study were marijuana (89.6%), cocaine hydrochloride (80.3%), and crack cocaine (76.3%). Injection drug use was not uncommon. About a third of the sample experienced drunkenness frequently. Less than 14% had been in substance abuse treatment recently. LCA revealed two groups: (1) heavy users of virtually all drug classes and (2) moderate-to-light users of fewer drug classes. White and younger people were more likely to be classified in the heavy user group. The results suggest that comprehensive substance abuse prevention and treatment programs are needed in rural communities. [Copyright &y& Elsevier]

The goal of this cross-sectional study was to assess the perceived accuracy and the importance of various sources of information about MDMA/ecstasy among young adult users. A respondent driven sampling plan was used to recruit a community sample of recent ecstasy users (n=304), aged 18–30, in Ohio, who responded to structured interviews. Friends, drug abuse treatment programs, and physicians were perceived to be the most accurate sources of information about ecstasy by 45.7, 37.2, and 30.3% of the sample, respectively. Friends were considered the most important source of information about ecstasy (40.2%), followed by web sites like DanceSafe (16.2%), and MTV/VH1 televison specials (6.9%). About half the sample used the Internet to obtain information about ecstasy, with younger and more educated participants significantly more likely to do so. Educated users were also significantly more likely to consider the Internet to be an important source of information. Web sites like DanceSafe were visited by four times as many users as government-sponsored web sites. Findings support the development of peer-oriented, network strategies to reach ecstasy users with prevention messages. Efforts to make prevention web sites more attractive should be considered. [Copyright &y& Elsevier]

Abstract: Drug treatment services of varying types have been scaled up in China over the past decade. Yet, barriers to treatment remain among the population of drug users in China. In this paper, we use a person-centered approach to examine external barriers to drug treatment among a sample of Chinese drug users. Specifically, we used a latent class analysis to determine a typology of external barriers to treatment among a sample of 262 drug users. The results of the analyses suggest three-classes of drug users with respect to their perceptions of external barriers to treatment – Major Barriers, Low Barriers, and Systems-level Barriers – indicating that drug users are a heterogeneous population on this matter. Age and types of drugs used were predictors of class membership. In this regard, different tactics must be utilized in order to successfully reach this wide ranging group of individuals. [Copyright &y& Elsevier]

Abstract: The primary objective of this study was to investigate whether drug use severity is associated with physical health-related quality of life (HRQL) over time. Data are from a longitudinal, multi-state, natural history community study of users of cocaine and/or methamphetamine who were interviewed at 6-month intervals over 2years with a 79% follow-up participation rate. Physical HRQL was assessed with the physical component summary (PCS) of the SF-8™ Health Survey and drug, alcohol, and psychiatric severity were all assessed with the Addiction Severity Index (ASI). Random coefficient regression analyses were conducted to test for longitudinal associations between the independent variables and SF-8 PCS scores. Reductions in drug use severity over time were accompanied by only minor improvements in SF-8 PCS scores, underscoring the potential long-term harm of illicit drug use on physical health. Greater psychiatric severity was strongly associated with lower SF-8 PCS scores, suggesting that clinical attention to mental health issues could potentially lead to improvements in perceived physical health as well as among stimulant users. [Copyright &y& Elsevier]