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Background: Community-level health data are needed to identify and prioritize the most pressing health issues at the local level., Objectives: To conduct a community-driven probability health survey of disadvantaged Chicago communities in 2015-2016., Methods: A safety-net hospital completed questionnaire development and dissemination in close partnership with a Community Advisory Committee (CAC), so the data captured accurately reflected community priorities., Lessons Learned: The final survey sample included 1,543 adult interviews and proxy reports for 394 children, well below our original recruitment goal. Although ideal for area probability sampling, face-to-face surveys are challenging given declining response rates. Nevertheless, these data provide representative community-level data that is otherwise unavailable., Conclusions: Hyper-local data are especially critical for diverse and segregated cities such as Chicago. Lessons learned can be applied to future community surveys done by hospital systems, health departments, and community advocates to maximize the usefulness of findings.

Background: Among women in the general population, childhood physical abuse (CPA) is associated with poor adult health status and engagement in health risk behaviors. Sexual minority women (SMW) are at elevated risk of CPA, have higher rates of smoking, and may be at higher risk for poorer general health. In this study, we examined the influences of CPA on health status in a diverse sample of SMW. We hypothesized that SMW with a history of CPA would report poorer health than those without such histories and that early onset of smoking-an important health risk behavior-would mediate the relationship between CPA and current health status., Methods: Structural equation modeling was used to evaluate the influence of CPA on early health risk behavior (i.e., age of smoking onset) and current perceived health status in a community based sample of 368 SMW., Results: More than one fifth of the sample (21.5%) reported a history of CPA. One fourth of the sample was current smokers; the average age of smoking onset was 19 to 20 years old. The mean level of self-rated health status was between "fair" and "good." When relationships were simultaneously estimated, the effect of CPA on health status was mediated by two sequential smoking factors: CPA was associated with earlier age of smoking onset, and age of smoking onset was associated with current smoker status. Being a current smoker had a negative effect on perceived health status., Implications for Practice And/or Policy: These results suggest that tobacco use is an important pathway by which CPA influences current health status. Prevention and early intervention initiatives should focus on the reduction of CPA among SMW to eliminate the long-term health consequences of adverse childhood events among SMW., (Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Aims: Although research shows that sexual minority women report high rates of lifetime sexual victimization and high rates of hazardous drinking, investigators have yet to explore the relationships between sexual victimization and hazardous drinking in this population. In addition, because the rates of these problems may vary within the sexual minority population, we examined and compared relationships between sexual victimization and hazardous drinking in exclusively heterosexual and sexual minority (mostly heterosexual, bisexual, mostly lesbian and exclusively lesbian) women., Method: Data from 548 participants in the National Study of Health and Life Experiences of Women and 405 participants in the Chicago Health and Life Experiences of Women study were pooled to address these relationships. We compared hazardous drinking, childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization (both CSA and ASA) across the five sexual identity subgroups. We then fit a multilevel general linear model to examine group differences in the relationships between hazardous drinking and sexual victimization and to test for potential interactions between victimization and identity on hazardous drinking., Results: Sexual minority women reported higher levels of hazardous drinking and higher rates of CSA and sexual revictimization than did exclusively heterosexual women. Revictimization was the strongest predictor of hazardous drinking among women who identified as mostly heterosexual and mostly lesbian., Conclusions: This study extends previous research by examining associations between sexual victimization and hazardous drinking in heterosexual and sexual minority women and by exploring within-group variations in these associations among sexual minority women. Higher rates of lifetime sexual victimization and revictimization may help to explain sexual minority women's heightened risk for hazardous drinking. The findings highlight the need for additional research that examines the meanings of sexual identity labels to more fully understand differences in risk within groups of sexual minority women as well as how sexual identity may affect responses to and interpretations of sexual victimization., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: This study examines the relationship between self-reported symptoms of substance dependence and risky sexual behavior among 187 HIV-negative men who have sex with men., Method: In a supplement to a Chicago household survey, using random probability sampling, men who reported consensual sex with other men or who identified as gay or bisexual were selected for interviews. Participants reported on sexual behavior, substance use, and symptoms of substance dependence related to past year use of alcohol, marijuana, cocaine, and sedatives, tranquilizers or pain relievers. Risky sexual behavior was defined as unprotected insertive or receptive anal intercourse plus having multiple partners, casual partners, or a partner who was HIV positive or of unknown serostatus., Results: Risky sexual behavior in the past six months was significantly and positively associated with alcohol dependence symptoms, cocaine dependence symptoms (receptive only), and prescription drug dependence symptoms (insertive only). Confirmatory factor analyses revealed that dependence symptoms loaded on separate factors by substance, which in turn loaded on an overarching dependence symptoms factor. In structural equation models, individual substance factors were not significantly associated with sexual risk behavior, however the higher order dependence symptoms factor was significantly and positively associated with both receptive and insertive risk behavior., Conclusions: MSM with symptoms of multiple substance use dependencies are more likely to be engaged in sexual behavior that places them at risk for acquiring HIV and other sexually transmitted infections. Alcohol and drug abuse treatment providers should be aware of the need for HIV testing and counseling in this population., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Employing data from two Chicago-based household probability samples of men who have sex with men (MSM) implemented 5 years apart (the "UMHS 1997" and the "2002 MSM supplement" studies), we evaluated changes in risk behavior as well as the potential viability of two alternative perspectives for explaining these changes--risk management and safe-sex norm abandonment. We found significantly increased rates of unprotected insertive and receptive anal intercourse in the 2002 study. Sixty-eight percent of UMHS men reported having sex with partners having HIV positive or unknown status, compared with 38% of the MSM supplement men (p < .0001). Serosorting mediated and moderated the most extreme forms of risk behavior. Positive statistical associations between drug use and unprotected sex were stronger in the UMHS sample than in the MSM supplement. Findings suggesting that "risk management" strategies have shaped MSM behavior as it emerged in the early part of this decade have considerable implications for HIV prevention strategies.

Objective: To examine whether patterns in socioeconomic characteristics in Chicago over a 30-year period are associated with neighborhood distribution of youth diabetes risk., Research Design and Methods: Incident cases of diabetes in youth aged 0-17 years were identified from the Chicago Childhood Diabetes Registry between 1994 and 2003. Those with a type 2 diabetes-like clinical course or related indicators were classified as non-type 1 diabetic; the remaining cases were considered to have type 1 diabetes., Results: Compared with stable diversity neighborhoods, significant associations for type 1 diabetes were found for younger children residing in emerging low-income neighborhoods (relative risk 0.56 [95% CI 0.36-0.90]) and older children residing in emerging high-income neighborhoods (1.52 [1.17-1.98]). For non-type 1 diabetes, older youth residing in desertification neighborhoods were at increased risk (1.47 [1.09-1.99])., Conclusions: Neighborhood socioeconomic characteristics in Chicago may be associated with the risk of diabetes in youth.

This study compares a sample of urban men who have sex with men (MSM) with a general population sample of men in the same city on self-reported problems with substance use indicative of dependence and history of substance use treatment. Both samples were randomly selected using multistage probability methods. All participants completed audio computer-assisted self-interviews, including questions on substance use, problems related to substance use experienced in the past 12 months, and substance treatment. Problem use of alcohol, marijuana, and cocaine did not differ between samples. Compared to men in the general population sample, MSM were significantly more likely to experience problems related to the use of sedatives, tranquilizers, or prescription pain relievers. Among MSM, history of substance treatment was associated with a positive HIV test, and treatment usually preceded HIV diagnosis. Research is needed on effective methods for integrating HIV prevention for MSM into substance treatment settings, including physician-administered buprenorphine treatment for opiate addiction.

Purpose: To understand the validity of self-reported recent drug use in men who have sex with men (MSM)., Methods: We obtained a probability sample of Chicago men who have sex with men (MSM; n=216) and administered urine and saliva drug testing after a self-administered interview. Analyses examined participation in drug testing, the agreement between self-reported past month drug use and drug test results, correlates of underreporting, and the relative utility of drug testing versus self-reports in identifying recent marijuana and cocaine use. For marijuana and cocaine, findings were compared with those obtained from a general population sample of men (n=241)., Results: More than three quarters of the participants in both samples provided at least one specimen for drug testing. Self reports in both samples showed a high degree of correspondence with drug tests for marijuana but not for cocaine. Sensitivity for cocaine use reporting was 60% for the MSM sample and 40% for the general-population men. Conditional kappa and sensitivity statistics for marijuana, cocaine, 3,4 methylenedioxymethamphetamine (i.e., MDMA, "ecstacy"), and methamphetamine suggested that self reports among MSM are provided with a high degree of validity. Underreporting was a correlate of social class (education, income, and employment) in the general population but not in the MSM sample. The utility of drug testing was dependent on social class in the general population sample., Conclusions: Drug testing is feasible in epidemiological surveys of drug use. Self reports among MSM are at least as valid as those provided by a general population sample of men. In some instances (e.g., cocaine use), they may actually be of higher quality. Although the findings support the merit of epidemiological studies of MSM drug use that have relied completely on self-reporting, drug tests may be useful for clarifying club drug ingestion patterns.

This paper explores whether elevated rates of self-reported substance use among MSM compared to other males may be an artifact of reporting bias. Past month prevalence rates of marijuana, cocaine, heroin, methamphetamine, Ecstasy, and Ketamine use were compared between a sample of men who have sex with men (MSM), and a general household sample of men, all residing in Chicago. We compared rates of self-reported use, and corrected rates based on the results of drug testing (urine and oral fluid tests). While MSM over 30 years old were significantly more likely than other men in this age group to report past month use of cocaine, test-corrected rates of use were equivalent. On the other hand, test-corrected estimates confirmed elevated rates of Ketamine and Ecstasy use in the MSM sample. Differential disclosure of substance use between MSM and other males may in some cases lead to distorted conclusions about differences in substance use between these groups. The use of biological testing in epidemiological studies of substance use can reduce the uncertainty of such comparisons.

This study investigated the impact of the 9/11 attacks on substance use in Chicago, Illinois. The study design was a cross-sectional, audio-computer-assisted self-interview survey conducted in 2001 and 2002. Biological samples were also collected for toxicological analyses. Using a multistage area probability design, residents between the ages of 18 and 40 years were randomly selected. Compared to pre-9/11 interviewees, post-9/11 interviewees showed significantly less self-reported marijuana use, marijuana use per test results, and cocaine use per test results. Law enforcement and social-structural explanations for the findings are discussed.

Background: Questions regarding the nature of the association between drug use and risk of homelessness remain unresolved and have important policy implications., Methods: To address this issue, data are presented from a 2001 community survey in Chicago, Illinois that collected information regarding histories of drug use behaviors and homeless experiences from 627 adults aged 18 to 40. Using covariance structure analyses, two alternative models of the association between drug use and homelessness were evaluated: social selection versus social adaptation processes., Results: These findings provide evidence consistent with the social adaptation perspective, as early homeless experiences were predictive of subsequent drug use behavior in this community sample. Social selection processes were observed in bivariate, but not in multivariate, analyses., Conclusions: The role of homelessness as a risk factor for drug use initiation should be further explored. Efforts to prevent homelessness may also contribute to the prevention of drug abuse.

Data were analyzed from a multistage probability household survey of over 600 adults, ages 18-40 from the city of Chicago conducted during 2001-2002. The survey employed audio computer-assisted self-interviews to obtain information about drug use. To investigate race/ethnicity differences in reporting validity, drug test results were compared with self-reports of past month drug use for cocaine, marijuana, and a combined indicator of both substances. The main indicators of validity were self-report sensitivity and concordance. Possible theoretical models accounting for potential cultural differences in reporting validity were discussed. Survey variables reflecting these potential explanations were examined as potential mediators of race/ethnicity differences in validity and as direct correlates of validity. Socioeconomic status was identified as one potential mediator. With this exception, race/ethnicity differences suggesting lower levels of marijuana and cocaine concordance for African Americans as compared with Whites were sustained after controlling for potential mediators. Methodological implications for epidemiological and health disparities research are discussed.

We compared responses to questions about tobacco use and passive exposure to smoking with biological tests for cotinine in order to estimate tobacco-reporting validity in an epidemiological survey on drug use. Respondents identified via multistage sampling (n=627) completed household surveys that were administered using an Audio Computer-Assisted Self-Interview (ACASI) procedure. Following the survey, respondents were asked to participate in drug testing. Saliva (oral fluid) was used to screen for the presence of cotinine, a major metabolite of tobacco. Hair, urine, and oral fluid testing were used to detect the presence of illicit drugs such as amphetamines, cocaine, heroin, and marijuana. While underreporting of tobacco was relatively rare, estimates from this recent study suggest that it may be increasing over time. Even after adjusting for passive exposure, self-report sensitivity estimates were still well below the 90% level suggested in prior reviews. Underreporting of marijuana and race/ethnicity showed a strong association with underreporting of tobacco use, suggesting that factors associated with the underreporting of illicit substance use parallel those associated with the underreporting of tobacco use.

Drug testing was used as an adjunct to a general population household drug use survey administered via audio computer assisted self-interview. Participants, ages 18-40 years residing in Chicago, were recruited to participate in three different biological tests (hair, oral fluid, and urine) presented in random order subsequent to completing an interview. Subjects had the option of participating in zero to three different tests. We examined participation/refusal in tests, reaction to testing requests, as well as variables associated with participation and reaction. Subjects were randomly assigned to a low (US$ 10 per test) or high (US$ 20 per test) incentive condition. Over 90% of the sample participated in at least one test, usually the oral fluid test. Associations between refusal status and two variables, socioeconomic status (SES) and presence of children in the household, provided partial support for the notion that drug test participation parallels the survey response process in general. Incentive level did not directly increase drug test participation. Reporting of recent illicit drug use was associated with participation in only one procedure, hair testing. Type of test offered and individual differences in willingness to be drug tested were important predictors of drug test refusal and subject reaction to testing requests. Compared with urine and hair testing, oral fluid testing had lower refusal rates and was generally more acceptable to respondents in a general population survey. The findings support the feasibility of incorporating multiple drug tests with modest incentives into general population household surveys on drug abuse.

Aims: To assess the utility of biological testing in a general population survey for estimating prevalence and evaluating self-report data quality., Design: An audio computer-assisted interview was administered to subjects from June 2001 to January 2002. Immediately following the interview, subjects were requested to participate in hair, oral fluid and urine testing., Setting: Subjects were from randomly selected households in the City of Chicago using multi-stage sampling methods. Interviews were conducted in subjects' homes., Participants: The data represent 627 randomly selected adult participants, ages 18-40 years., Measurements: Prevalance, kappa, conditioned kappa, sensitivity, specificity, under-reporting, 'mixed model' and logistic regression., Findings: Higher rates of marijuana use were generated from survey reports than from drug testing. Drug testing generated higher prevalence rates than survey reports for recent use of cocaine and heroin. Under-reporting of recent drug use was apparent for all three substances. Sensitivity was particularly low for cocaine and heroin. Race was related to under-reporting, with African Americans less likely to report marijuana use despite a positive test result., Conclusions: The utility of drug testing for surveys depends on the type of substance examined as well as on the type of test employed. Multiple tests have more utility than a single test. Drug testing is useful for identifying the levels and sources of under-reporting in a survey and provides a basis for adjusting prevalence estimates based on self-reports.

Aims: To examine whether neighborhood racial characteristics are associated with the under reporting of life time cocaine/crack use., Design: A household survey of high-risk communities with above-average admissions to state-supported drug and alcohol treatment programs., Setting: Chicago, Illinois, USA., Participants: A total of 303 adults., Measures: Self-reported use of cocaine/crack during a respondent's life time, hair test assays for cocaine use and level of neighborhood diversity measured using the Simpson Index., Findings: Respondents from more segregated neighborhoods were more likely than those from diverse neighborhoods to under report life time cocaine/crack use., Conclusions: Neighborhood racial characteristics should be considered as an important factor in household surveys on illicit substance use.

Aims: To better understand the prevalence, correlates, risk factors and context of club drug use among US adults in the City of Chicago., Design: An Audio Computer-Assisted Self Interview was administered to a household probability sample of adults, aged 18-40 years, from June 2001 to January 2002., Setting: Subjects were drawn from randomly selected households using a multi-stage area probability design., Participants: The data represent 627 randomly selected adult participants., Measurement: Weighted prevalence estimates with design-effect adjusted confidence intervals of life-time, past 12 month and past 30 day use of any club drug and of specific club drugs; prevalence of rave attendance, other drug use, motivation for use among club drug users; chi2 tests of significance, logistic regression and adjusted odds ratios., Findings: Overall club drug prevalence rates were nearly twice those obtained for MDMA alone. Club drug users were more likely to use multiple illicit substances and to report having been in treatment for substance use. A majority of life-time club drug users never attended a rave although rave attendees were more likely to report frequent use of MDMA. Use was associated with gender, race and sexual orientation., Conclusions: Prevention research should be informed by further population-based research on club drug use. Research should not focus exclusively on rave attendees, as they are only a subset of club drug users. Research is needed on neurological and behavioral sequelae across different types of club drugs, gender differences in the impact of sexual orientation on club drug risk and on the effects of personality characteristics such as sensation seeking on club drug use behavior.