Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use

PURPOSE: To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. DESIGN: Repeated cross-sectional sampling with matched intervention and comparison communities. SETTING: Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. SUBJECTS: 3081 injecting drug users who were sexually active and/or shared injection equipment. INTERVENTION: Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. MEASURES: Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. RESULTS: Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p < .001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p < .01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p < .05) and other partners (p < .01) and for cleaning injection equipment with bleach (p < .05). CONCLUSIONS: The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.     

Substance abuse risk reduction: Verbal mediational training for children by parental and nonparental models

Little is known regarding the etiology and maintenance of substance abuse, especially factors which place children at higher risk for later drug use. The present study evaluated the impact of a 12‐week verbal mediational program (Think Aloud), which teaches children and parents cognitive and social problem‐solving skills and addresses early childhood risk factors related to the onset of drug use in adolescence. Fifty children and parents were included in the present study and were randomly divided into four groups: two groups received either a verbal mediation condition comprising the Think Aloud training or time to complete homework assignments. Each of the topic groups was subdivided into two groups, one in which the parents served as models and one in which the experimenter served as the model. Measures of family cohesion, expressiveness, and conflict, family organization and control, social skills, level of disruptiveness of the child's peer choice, academic competence, and the child's problem behaviors were administered to the parents and the teachers pre‐ and postinterventivefy. Children in the verbal mediation condition with parental models were expected to show the greatest reduction in risk factor scores, and children in the verbal mediation condition with the experimenter model were predicted to show the second greatest reduction in risk factor scores at posttest. Results of the study demonstrated partial support for experimental hypotheses in that the children involved in the Think Aloud program showed improvement on four of the six factors on posttest measures. The superiority of the parental model was not found.     

Microanalysis of eating behavior of three leptin deficient adults treated with leptin therapy

Leptin deficiency has been associated with extreme obesity and hyperphagia in rodents and humans. A rare genetic disorder in humans yields the absence of the hormone leptin, extreme obesity, and a ravenous appetite. Reports on these rare cases have indicated that therapy using leptin injections can yield significant weight loss and changes in appetite. The aim of this report on acute leptin therapy in three leptin deficient adults was to provide a microanalysis of changes in eating behavior and ratings of hunger and satiety. In addition to substantial weight loss, 15 weeks of leptin therapy was associated with approximately 50% reduction in food intake and substantial changes in ratings of hunger and satiety before most meals. After short-term leptin therapy, the three participants ate until ratings indicated they were satiated, which was comparable to the ratings before leptin therapy. These findings suggest that one of the primary effects of acute leptin therapy may be to reduce the ravenous hunger associated with leptin deficiency, resulting in reduced food intake and significant weight loss. These results are discussed in the context of the scientific literature pertaining to leptin and its effects on appetite and obesity.     

Implementing local pay systems in nursing and midwifery

BACKGROUND: The paper is based on a case study, which was part of a Department of Health commissioned research study covering 10 National Health Service (NHS) trusts in England that had adopted a range of approaches to the employment terms and conditions of nurses, midwives, and other non-medical staff, as the precursor to evaluating Agenda for Change, the modernized pay system for the NHS. AIM: The aim of this paper is to discuss a case study of the effects of changing nurses' pay progression. METHODS: Fieldwork took place in 2000, and included interviews with managers, union representatives and other staff, and analysis of internal documents. FINDINGS: Findings discussed include the constraints on managers when devising a new pay system, the time and detailed work needed and the challenges of assessing their effects (particularly in relation to patient care). Although the latter are difficult to assess, staff involved in the scheme reported benefits from the closer focus on competences which resulted from the scheme. CONCLUSIONS: The effects of changes to pay schemes are difficult to assess, and the evaluation of the proposed national scheme (Agenda for Change) will be challenging.     

Contingency management interventions for treating the substance abuse of adolescents: a feasibility study

This article reports on the feasibility of using a contingency management intervention with adolescent smokers that has proven efficacious in adult substance abuse treatment. The study used 8 adolescent participants in an A (1 week)-B (1 week)-A (1 week) reversal design. During the 2 baseline phases, no contingencies were placed on cigarette smoking, and adolescents received money noncontingently. During the experimental intervention week, adolescents received payment contingent on not smoking. The magnitude of reimbursement available during the baseline and intervention phases was equated. Results indicated that the contingency management intervention was effective in reducing smoking, both in terms of increasing the total number of abstinences and consecutive abstinences. In addition, changes in adolescents' affective states during smoking cessation were found. Anxiety, depression, anger, and fatigue were reported, and these negative states ceased once smoking resumed.