Search

SafePort is a residential substance abuse treatment program within public housing to provide drug treatment to parenting women in Key West, Florida. All family members--women, children, and significant others--receive comprehensive assessments to determine appropriate therapeutic interventions. Preliminary evaluation findings suggest that women who participate with their children are more likely to remain drug free. (Author/JPB)

Substance abuse is marginalized both as an activity and as an area of study. Substance abuse research is a relatively new field, and in the early days faculty members engaging in such research found it difficult to obtain tenure track positions at universities. Funding for substance abuse study was limited, depending mainly on the National Institute on Drug Abuse for grants. This article describes one professoris role in the institutionalization of substance abuse research in academia and the benefits of a career in this field.

Few studies have examined the relationships between drug use, health services utilization and the cost of medical care for a community-based sample of drug users. The purpose of this study was to analyze recently collected data on chronic drug users (CDUs), CDUs who were also injecting drug users (IDUs) and non-drug users (NDUs) to determine whether these groups exhibited differences in health services utilization and cost. In addition to descriptive analyses, these relationships were estimated with multivariate regression models. Data were collected in 1996 and 1997 through a standardized self-reported questionnaire administered to individuals who were recruited through community outreach activities in the USA. Annual differences in health services utilization between CDUs, IDUs and NDUs were estimated for three measures: number of times admitted to a hospital, number of outpatient visits and number of emergency room episodes. Results of this study indicate that CDUs and IDUs consumed significantly more inpatient and emergency care, but less outpatient services relative to NDUs. Analyses of total health care costs showed that CDUs and IDUs each generated about $1000 in excess services utilization per individual relative to NDUs. This research is the first study to compare differences in health services utilization and cost among out-oftreatment drug users relative to a matched group of non-users in a community-based setting. The findings suggest that health care providers and managed care organizations should consider policies that promote more ambulatory care and discourage emergency room and inpatient care among drug users. Innovative and culturally acceptable approaches may be necessary to provide incentives without posing unusual financial hardship.

As illustrated powerfully by the 2013–2016 Ebola outbreak in western Africa, infectious diseases create fear and psychological reactions. Frequently, fear transforms into action – or inaction – and manifests as “fear-related behaviors” capable of amplifying the spread of disease, impeding life-saving medical care for Ebola-infected persons and patients with other serious medical conditions, increasing psychological distress and disorder, and exacerbating social problems. And as the case of the US micro-outbreak shows, fear of an infectious-disease threat can spread explosively even when an epidemic has little chance of materializing. Authorities must take these realities into account if they hope to reduce the deadly effects of fear during future outbreaks. [ABSTRACT FROM AUTHOR]

The organization and delivery of medical care are undergoing a major transformation in the United States. Today, only a minority of the people in this nation still receive their health [...], This article compares the health care need and health care use of injection drug users, other chronic drug users, and nondrug users. Data from 1,330 non-Hispanic White, African American, and Hispanic/Latino men and women were analyzed to determine independent risk factors for two outcome variables: (a) need for health care treatment and (b) use of health care treatment. Ten independent demographic, health, and drug use variables were assessed in logistic regression models. Drug use (injection drug use or other chronic drug use), being female, having insurance, and perceived health status of very good/good or fair/poor were independently associated with increased need.for health care. Injection drug use and other chronic drug use decreased the likelihood of receiving health care treatment, whereas being female, having, insurance, and a perceived health status of fair/poor increased the likelihood of receiving health care.

The purpose of this study was to explore the associations among living arrangements, HIV seroprevalence, and HIV risk and protective factors among 1,322 drug users participating in the University of Miami CARES (Community AIDS Research and Evaluation Studies) HIV intervention program. Living arrangements may be associated with HIV prevention behaviors; however, these influences can be either protective or destructive and therefore merit further examination. Statistical analyses indicated differences in the living arrangements of women compared with men, and significant associations were noted among women's living arrangements, HIV seroprevalence, risk behaviors and protective behaviors. The data from this study suggest that future HIV prevention research should investigate not only high-risk individuals, but persons with whom they interact often, especially those with whom they live or with whom they have sex. The next phase of HIV and drug interventions should be attentive to the incorporation of social context and social influences, paying particular attention to understudied populations such as high-risk women. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

In the US, the number of women diagnosed with AIDS continues to increase. In this study, women in New York City (East Harlem) and Miami, two sites with high rates of drug use and HIV infection, were first compared on sociodemographic variables and risk behaviors. Logistic regression analyses were used to identify significant, independent predictors of HIV infection in each city. In comparing women from the two cities, several differences in sociodemographic characteristics and drug use were observed. In both cities, ever exchanging sex for drugs and/or money was predictive of HIV infection; and in East Harlem only, other lifetime risk variables independently predicted HIV infection: drug injection, having a sexually transmitted disease, and not having graduated from high school. Results suggest that intervention efforts with women who exchange sex should be intensified in both cities. Also, further comparisons of women drug users in AIDS epicenter cities are necessary to provide information on similarities and differences in sociodemographic characteristics and individual risk behaviors. More research attention should be focused on examining the social context of HIV risk in order to develop innovative intervention strategies which focus on the link between contextual factors and HIV infection. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

A prospective cohort study was conducted among chronic injecting and crack cocaine drug using women. The hypothesis tested was that participation in a standard-plus-innovative intervention was more likely to produce behavior change than participation in a standard intervention. Standardized intervention protocols and corresponding instruments were designed. Data were collected on drug and sex risk behaviors at baseline and six-month follow-up intervals. The level of behavioral change in two intervention arms--standard and a standard-plus-innovative intervention--was measured by composite sex risk and drug risk scores using the generalized estimating equation approach. The results show that on four risk measures the enhanced intervention was significantly associated with positive change in both drug use and sexual behavior: less frequent drug use, less drug use during sex, and more frequent condom use during particular frequencies for specific types of sexual activities. Public health interventions are effective when targeting specific risk behaviors through interventions tailored to prevent HIV and reduce risk behaviors among specific cultural and gender groups. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: getinfo@haworthpressinc.com]

We studied HIV seropositivity among a targeted sample of migrant workers who used drugs, primarily crack cocaine, and their sexual partners in rural southern Florida from 1993 to 1995. We enrolled men and women who were born in the United States (n=369) or in other countries (n=174). Overall, 11.2% of the sample were HIV positive, including 18% of Blacks from the United States, and about 8% of non-Hispanic whites from the United States, Blacks from the Caribbean, and persons from Central or South America. No Hispanics from the United States or the Caribbean, but 3.4% of Hispanics from Mexico, were HIV positive. In logistic regression analyses, race/ethnicity, gender, and age were most highly associated with HIV seropositivity. Immigration status, current drug use, and current sexual activity were not related to HIV seropositivity. HIV prevention programs must help reduce heterosexual transmission of HIV associated with drug use both locally and where migrants travel and work.

The Yunnan Province in China may be experiencing the highest incidence of heroin use in China, in part because of its proximity to the Golden Triangle. This high incidence, as elsewhere, threatens to increase associated problems in China, including the spread of HIV. Furthermore, the high purity of heroin used in this Province leads to rapid addiction and increased difficulties in treating the symptoms of withdrawal. One response to this epidemic is the development and implementation of the Kunming Drug Rehabilitation Center. The Center, with a capacity for 620 addicts, is grounded in a recovery-oriented perspective that is based on the Therapeutic Community model and modified for the Yunnan Province and China. It is referred to as the Kunming Model and is known for the development of its own medicine for detoxification and its individualized psychological, psychiatric, medical, and biosocial program. Similarities and differences between the Kunming Center and treatment programs in the United States are discussed and implications for universal approaches to drug treatment are addressed.

Sharing needles among injection drug users appears to be associated with becoming infected with HIV. Researchers compared 21 injection drug users who became infected with HIV while they were tracked over a two-year period with 76 similar persons who remained HIV negative. Injection drug users who became infected were four times more likely to have shared needles and syringes during the previous year than the noninfected group. Contracting a sexually transmitted disease during the previous year was marginally significant. African American descent was significant even after adjusting for behavioral and demographic factors. Programs to reduce HIV transmission among injection drug users should focus on reducing sharing of syringes and needles in addition to promoting safer sexual practices.

Smoking crack cocaine may promote the heterosexual transmission of HIV by increasing high-risk sexual practices such as having sex without using a condom for protection and exchanging sex for drugs or money. A study of 1967 persons recruited from the streets of San Francisco, Miami, and New York who had never injected drugs found that 15.7% of 1137 crack smokers were HIV positive. Only 5.2% of nonsmokers of crack were HIV positive. Rates of HIV positivity were highest among crack smoking women: 30% in New York and 23% in Miami. Heterosexual transmission of HIV may be quite high in low-income minority communities, because high rates of crack smoking and HIV exist in these places. The high rate of sexually transmitted diseases among crack smokers in these communities may facilitate transmission of HIV. Aggressive interventions may be needed to prevent further transmission of HIV by preventing addiction to crack, treating those who are addicted, and lowering the rate of high-risk sexual practices among crack smokers.

In 1985, residents of a suburban community in South Florida became concerned when several young women were diagnosed with breast cancer. First as individuals, then through a community-based effort, they attempted to gain attention and action on what they believed to be a cluster of breast cancer. Through their efforts to find out whether some agent or toxic exposure existed in the community that might have caused breast cancer, the women formed a community-based organization. This paper describes the activism of the women to resolve the issue through an epidemiologic study of the breast cancer occurrence in their community. Furthermore, it substantiates the need and role of rational community response in resolving community threats and concerns.