Gender and risk behaviors for HIV and sexually transmitted infections among recently released inmates: A prospective cohort study

Women in prison have a higher prevalence of HIV than men. After release from prison, former inmates have the opportunity to engage in risk behaviors for HIV and other sexually transmitted infections (STIs). We sought to assess change in risk behaviors over time and the association of gender with risk behavior in the postrelease period. In this prospective cohort study, we interviewed 200 former inmates (51 women) approximately two weeks (baseline) and three months (follow-up) after release and tested them for HIV infection at follow-up. We examined the association of gender with unprotected vaginal or anal sex in the last seven days using chi-square and Fisher's exact tests and multivariable logistic regression. At baseline, 22% of men and 41% of women reported unprotected vaginal sex (p < 0.01) and 5% of men and 8% of women reported unprotected anal sex (p = 0.51). Being younger (OR for each decade increase 0.48, 95% CI = 0.29–0.80), being gay/lesbian or being bisexual (compared with being heterosexual, OR = 4.74, 95% CI = 1.01–22.17 and OR = 3.98, 95% CI = 1.41–11.26, respectively), or reporting a drug of choice of heroin/speedballs or cocaine/crack (compared with marijuana/no drug of choice, OR = 24.00, 95% CI = 5.15–111.81 and OR = 3.49, 95% CI = 1.20–10.18, respectively) was associated with unprotected vaginal or anal sex after adjusting for race, homelessness, and hazardous drinking. At follow-up, 21% of men and 44% of women reported unprotected sex (p = 0.005), and female gender (OR = 4.42, 95% CI = 1.79–10.94) and hazardous drinking (compared with not meeting criteria for hazardous drinking, OR = 3.64, 95% CI = 1.34–9.86) were associated with unprotected sex, adjusting for race and homelessness. In this population with a high prevalence of HIV, we demonstrated persistent engagement in sexual risk behavior during the postrelease period. Enhanced efforts to promote sexual health and reduced risk behavior among both male and female current and former prison inmates are needed, including improved access to preventive care and HIV and STI screening, testing, and treatment.     

Predictors of Drug Use in Prison among Incarcerated Black Men

Background: Black men currently comprise a substantial percentage of prisoners in the United States. Drug dependence is common among prison populations, and US prisons are high-risk environments for drug use. Prison drug use exacerbates health problems disproportionately prevalent among Black men and prisoners. Objectives: The goal of this research was to examine predictors of prison drug use among incarcerated Black men. Methods: This study examined drug use within the prison environment in a random sample of 134 Black men incarcerated in maximum-security correctional institution. The Addiction Severity Index (ASI) was used to measure illicit drug use history and the extent to which drug use occurred within the prison environment. Results: Seventy-five percent of the participants reported a history of illicit drug use. Overall, 20% (n 25) of the participants, or 25% of those with a history of drug use, reported using drugs during a time frame consistent with incarceration. Participants with lengthier histories of drug use (OR: 1.1, 95% CI 1.0–1.2) and those who were incarcerated longer (OR: 1.1, 95% CI 1.0–1.2) were more likely to use drugs in prison. Drug use in prison was associated with history of injection drug use and with probation/parole status when arrested. Conclusions: Prisoners are engaging in illicit drug use while incarcerated, suggesting that they could benefit from harm reduction and drug treatment services offered during incarceration. Scientific significance: Drug treatment programs that address long-standing addictions and coping mechanisms for lengthy prison stays, specifically, would be especially useful for this population.     

HIV risk behaviour correlates among injecting drug users in Greek prisons

Aims. To identify the correlates of injecting drug use within prison. Design. A national cross-sectional study, participation being voluntary and anonymous. Setting. Ten Greek prisons. Participants. A representative sample of 1000 male inmates; 861 questionnaires were completed and analysed. Measurement. A self-report questionnaire for demographics, penal history, drug use and sharing injecting equipment. Findings. Two hundred and ninety inmates (33.7%) reported injecting drugs at some time in their lives, of whom 174 (60%) had injected while imprisoned. Among those who had injected while imprisoned, 145 (83%) had shared equipment while incarcerated. Logistic regression analysis suggested that total time in prison, previous drug conviction, being a convict (as opposed to on remand) and having multiple female sexual partners 1 year before incarceration were significant HIV risk behaviour correlates. For every year of imprisonment, the risk of injection in prison increased by about 17% \[OR = 1.17 (95% CI: 1.07-1.27)]. Inmates with a previous drug-related conviction were about twice as likely to inject within prison \[OR = 1.97 (95% CI: 1.16-3.33)]. Finally, convicted inmates were marginally significantly more prone to inject in prison \[OR = 1.58 (95% CI: 0.92-2.74)]. Conclusions. Variables related to the inmates' prison career influence HIV risk behaviours within prison. There is a need to assist IDUs in reducing the likelihood of high-risk behaviour by considering factors such as frequency of incarceration, length of time incarcerated and availability of detoxification programmes within prison.     

Independent Predictors for Lifetime and Recent Substance Use Disorders in Patients with Rapid‐Cycling Bipolar Disorder: Focus on Anxiety Disorders

We set out to study independent predictor(s) for lifetime and recent substance use disorders (SUDs) in patients with rapid‐cycling bipolar disorder (RCBD). Extensive Clinical Interview and Mini‐International Neuropsychiatric Interview were used to ascertain DSM‐IV Axis I diagnoses of RCBD, anxiety disorders, and SUDs . Data from patients enrolling into four similar clinical trials were used. Where appropriate, univariate analyses with t‐test or chi‐square were applied. Stepwise logistic regression was used to examine the relationship among predictor variables and lifetime and recent SUDs. Univariate analysis showed that patients with co‐occurring anxiety disorders (n = 261) had significantly increased rates of lifetime (odds ratio [OR]= 2.1) and recent (OR = 1.9) alcohol dependence as well as lifetime (OR = 3.4) and recent (OR = 2.5) marijuana dependence compared to those without co‐occurring anxiety disorder (n = 303). In logistic regression analyses, generalized anxiety disorder (GAD) was associated with increased risk for lifetime SUDs (OR = 2.34), alcohol dependence (OR = 1.73), and marijuana dependence (OR = 3.36) and recent marijuana dependence (OR = 3.28). A history of physical abuse was associated with increased risk for lifetime SUDs (OR = 1.71) and recent marijuana dependence (OR = 3.47). Earlier onset of first mania/hypomania was associated with increased risk for lifetime SUDs (5% per year), and recent marijuana dependence (12% per year) and later treatment with a mood stabilizer were also associated with increased risk for recent SUDs (8% per year). Positive associations between GAD, later treatment with a mood stabilizer, and early childhood trauma and history of SUDs suggest that adequate treatment of comorbid anxiety, early treatment with a mood stabilizer, and prevention of childhood trauma may reduce the risk for the development of SUDs in patients with bipolar disorder. (Am J Addict 2010;00:1–10)     

Age-Based Correlates of Substance Misuse Among Convicted Felons in Georgia

Objective: This study sought to identify variables that independently correlate with age and substance use among a sample of 187 convicted felons in Georgia. Results: Results of regression analysis indicated that younger inmates were 2 times more likely than older inmates to report the occurrence of alcohol use (RR 2.07; 95% CI. 37, 11.6) and three times more likely than older inmates to report some history of marijuana use (RR 3.07; 95% CI 1.52, 6.11). In addition, younger inmates were half as likely or less to report using sedatives (RR. 53, 95% CI. 22, 1.29), tranquilizers (RR. 49, 95% CI. 22, 1.29), crack or cocaine (RR. 33, 95% CI. 18,. 62), heroin (RR. 48, 95% CI. 16, 1.25), and to having ever received treatment for a drug problem (RR. 46, 95% CI. 23,. 90). Conclusion: In conclusion, age-based factors correlate with participant's history of substance use. Ascertainment of these variables among inmate populations has the potential to improve treatment decisions both during and after incarceration.     

Psychological stress in a Japanese population with systemic lupus erythematosus: Finding from KYSS study

Abstract

Objectives. Daily psychological stress has been proposed as a risk factor for systemic lupus erythematosus (SLE) in Western countries. However, there is little information about the relationship between daily psychological stress and the risk of SLE in a Japanese population. We examined the association between SLE and daily psychological stress.

Methods. A case–control study was conducted to examine the relationship between daily psychological stress and SLE in Japanese females. The participants were 160 female SLE patients and 660 female volunteers. Unconditional logistic regression was used to compute OR and 95% confidence interval (CI), with adjustment for several covariates.

Results. Smoking (OR = 2.59; 95% CI, 1.74–3.86), walking (OR = 1.75; 95% CI, 1.81–2.56) and daily psychological stress (OR = 1.88; 95% CI, 1.14–3.10) were increased in patients with SLE after adjusting for age, region and all factors. Smokers with daily psychological stress (OR = 4.70; 95% CI = 2.53–8.77) were more prevalent than nonsmokers without daily psychological stress in SLE. The multiplicative interaction measures between smoking status and daily psychological stress did not reach statistical significance.

Conclusions. The present study suggests the possibility that daily psychological stress as well as smoking might be associated with an increased risk of SLE.     

Smoking among patients in substance use disorders treatment: associations with tobacco advertising,anti-tobacco messages,and perceived health risks

Background: Although tobacco control efforts have contributed to an overall decline in smoking, individuals with substance use disorders (SUDs) continue to smoke at high rates and remain targets of advertising to vulnerable groups, including those with mental health disorders and SUDs. Objectives: We examined associations of tobacco advertising exposure and receptivity, anti-tobacco message awareness, and health-risk perception with smoking status and cigarettes-per-day (CPD) in a national sample of SUD treatment patients. Methods: The patients (N = 1,113) in 24 programs chosen randomly, stratified by program type, from among publicly funded adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network completed surveys of smoking, advertising exposure and receptivity, anti-tobacco message awareness, and perceived health risks. Results: Current smokers (77.9% of the sample) smoked a daily median of 10 cigarettes (IQR = 13). The participants reporting daily advertising exposure were 1.41 times more likely to be smokers (p = 0.019) than others. Those highly receptive to advertising were 2.34 times more likely to be smokers (p < 0.001) than those with low/moderate receptivity. Higher perceived health risk was associated with lower odds of smoking (OR = 0.99, 95% CI: 0.98–0.99, p < 0.001). CPD for smokers highly receptive to advertising was 11.1% (95% CI: 2.8%–20.0%) higher than for smokers with low/moderate advertising receptivity. Anti-tobacco message awareness was not associated with smoking status or CPD. Conclusion: The high rate of smoking among SUD treatment patients is associated with daily exposure and high receptivity to tobacco advertisements and lower perception of health-related smoking risks. Tobacco control efforts should target this vulnerable population.     

High levels of bisexual behavior and factors associated with bisexual behavior among men having sex with men (MSM) in Nigeria

Nigerian men who have sex with men (MSM) have a high burden of HIV infection and are known to engage in bisexual behavior. This study presents the first data on characteristics and correlates of Nigerian men having sex with men and women (MSMW) in three Nigerian cities. Five hundred and fifty-seven MSM who engaged in anal sex with men completed a behavioral survey; 48.1% of these MSM also engaged in sex with women in the previous 2 months. MSMW displayed high levels of risky sexual behavior with female sex partners; casual (56.0%) and multiple female partners were common (69.0%) and 66.0% had unprotected vaginal sex. As much as 45.1% MSMW had anal sex with female partners of which 74.0% did not use protection in the 2 months prior. In bivariate analyses, bisexual behavior was associated (p<0.05) with being married or living with a women (OR 5.0, 95% CI = 2.6–9.4), less education (OR 2.0, 95% CI = 1.4–3.0), bisexual/straight identity (OR 2.3, 95% CI = 1.6–3.2), being an insertive partner (OR 3.0, 95% CI = 1.9–4.5), being HIV-negative (OR 1.6, 95% CI = 1.1–2.5), living in Lagos (OR 2.3, 95% CI = 1.7–2.2), being Muslim (OR 1.7, 95% CI = 1.1–2.5), and being away from home (OR 1.5, 95% CI = 1.0–2.1). In the multivariate model, being married to or living with a woman (AOR = 5.1; 95% CI = 2.5–10.3), bisexual/straight identity (AOR = 2.2; 95% CIs = 1.5–3.3), being an insertive partner (AOR = 3.0; 95% CI = 1.9–4.9), being away from home (AOR = 1.6; 95% CI = 1.1–2.3) and living in Lagos (AOR = 1.7; 95% CI = 1.0–2.8) remained significant (p< 0.05). High levels of bisexual behavior exist among Nigerian MSM, and these men engage in risky sexual behaviors with both male and female sex partners. While decriminalization of same-sex behavior in Nigeria will promote access to HIV prevention programs, current MSM interventions must incorporate information on safe sex with both male and female sex partners.     

Seroprevalence and Risk Factors for HIV Infection Among Incarcerated Men in Sorocaba, Brazil

We describe prevalence and risk factors for HIV infection among 1,059 inmates in two prisons in Sorocaba, Brazil. Sociodemographics, prison history, and sexual and drug exposures were assessed by interviewer–administered questionnaire. HIV infection was detected in 115 (12.6%) inmates. Seroprevalence was 35% among those with a history of IDU (OR = 11.4, 95% CI 5.58–23.5). Sex with female visitors was reported by 66%, and homosexual practices with other inmates by 10%. Independent predictors of HIV infection were age <35 years (OR = 1.9, 95% CI 1.1–3.4), birthplace (natives of Sorocaba; OR = 2.1, 95% CI 1.2–3.8), and number of previous incarcerations (1 compared to 0) (OR = 1.7, 95% CI 1.07–2.7). Prevalence of HIV infection among these inmates is comparable to rates in metropolitan Sao Paulo and other prison populations internationally. The use of injecting drugs is the most important risk exposure in this population. These findings indicate an urgent need to institute prevention programs for this population both inside and outside prisons.     

Predictors of activity limitation and dependence on walking aids after primary total hip arthroplasty

OBJECTIVES: To study function outcomes and their predictors after primary total hip arthroplasty (THA). DESIGN: Prospective cohort study. SETTING: Mayo Clinic. PARTICIPANTS: All patients who underwent primary THA at the Mayo Clinic between 1993 and 2005 and were alive at the time of follow‐up. MEASUREMENTS: Whether sex, age, body mass index (BMI), comorbidity, anxiety, and depression predict moderate to severe activity limitation (limitation in ≥3 activities) and complete dependence on waling aids 2 and 5 years after primary THA was examined. Multivariable logistic regression adjusted for operative diagnosis, American Society of Anesthesiologists score, implant type, and distance from medical center. RESULTS: At 2 years, 30.3% of participants reported moderate to severe activity limitation; at 5 years, 35% of participants reported moderate to severe activity limitation. Significant predictors of moderate to severe activity limitations at 2‐year follow‐up were female sex (odds ratio (OR)=1.2, 95% confidence interval (CI)=1.1–1.4), aged 71 to 80 (OR=2.0, 95% CI=1.6–2.5), aged 80 and older (OR=4.5, 95% CI=3.4–6.0), depression (OR=2.1, 95% CI=1.6–2.7), and BMI greater than 30.0. At 5‐year follow‐up, significant predictors were aged 71 to 80 (OR=1.7, 95% CI=1.3–2.2), older than 80 (OR=4.3, 95% CI=2.8–6.6), depression (OR=2.3, 95% CI=1.6–3.4), and BMI greater than 30.0.Significant predictors of complete dependence on walking aids at 2 years were female sex (OR=2.0, 95% CI=1.4–2.7), aged 71 to 80 (OR=2.4, 95% CI=1.4–4.2), older than 80 (OR=11.4, 95% CI=6.0–21.9), higher Deyo‐Charlson score (OR=1.5, 95% CI=(1.1–1.2) for 5‐point increase, depression (OR=2.0, 95% CI=1.2–3.4), and BMI greater than 35.0. Each of these factors also significantly predicted complete dependence on walking at 5‐year follow‐up, with similar odds ratios, except that BMI of 30.0 to 34.9 was not significantly associated. CONCLUSION: Higher BMI, depression, older age, and female sex predict activity limitation and complete dependence on walking aids 2 and 5 years after primary THA.     

Cardiovascular risk modification in participants with coronary disease screened by the Kidney Early Evaluation Program

Background: Coronary artery disease (CAD) identifies the need for intensive treatment of risk factors among individuals with chronic kidney disease (CKD), a high‐risk, complex cardiovascular risk state. Methods: An estimated glomerular filtration rate <60 mL/min/1.73 m² or a urine albumin : creatinine ratio (ACR) ≥ 30 mg/g (3.4 mg/mmol) defined CKD. Results: Of 70 454 volunteers screened the mean age was 53.5 ± 15.7 years and 68.3% were female. A total of 5410 (7.7%) had a self‐reported history of CAD; 1295 (1.8%) had a history of prior percutaneous coronary intervention (PCI); and 1124 (1.6%) had a prior history of coronary artery bypass surgery (CABG). Multivariate analysis for the outcome of suboptimal CAD risk management (composite of systolic blood pressure ≥130 mmHg, glucose ≥125 mg/dL (6.9 mmol/L) for diabetics, total cholesterol ≥200 mg/dL (5.2 mmol/L), or current smoking; n= 38 746/53 403, 72.5%) revealed older age (per year) (odds ratio (OR) = 1.04, 95% confidence interval (CI) 1.03–1.04, P < 0.0001), male gender (OR = 1.40, 95% CI 1.34–1.47, P < 0.0001), ACR ≥ 30 mg/g (3.4 mg/mmol) (OR = 1.66, 95% CI 1.55–1.79, P < 0.0001), body mass index (per kg/m²) (OR = 1.06, 95% CI 1.06–1.06, P < 0.0001), CAD without a history of revascularization (OR = 1.14, 95% CI 1.02–1.28, P= 0.02) and care received by a nephrologist (OR = 1.49, 95% CI 1.22–1.83, P < 0.0001) were associated with worse risk factor control. Prior coronary revascularization and being under the care of a cardiologist were not associated with either improved or suboptimal risk factor control. Conclusions: Chronic kidney disease is associated with overall poor rates of CAD risk factor control.     

Gender disparity in utilization rates of substance abuse services among female ex-offenders: a population-based analysis

Abstract

Background: The use and abuse of substances is common among offender populations. Although the female former offender population has risen substantially in recent decades, relatively little is known about their substance abuse treatment experiences. Objective: This study examines disparities in substance abuse treatment utilization among the US population with special focus upon formerly incarcerated female offenders. Methods: Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, n?=?43,093) collected in 2001–2002 and 2004–2005 the authors compared lifetime rates of substance abuse treatment utilization between female and male ex-offenders with the U.S. general population. The sample population covered inpatient and community based substance use treatment, detoxification and rehabilitation programs. It is a nationally representative sample of noninstitutionalized persons over the age of 18. Multinomial logistic regression was performed and likelihood of using substance use treatment and services was calculated using adjusted odds ratios (AOR). Results: Compared to male ex-offenders, female ex-offenders were 52% less likely to use substance-abuse treatment services (AOR?=?0.48, 95% CI?=?0.26–0.89) and 51% less likely to use rehabilitation programs (AOR?=?0.49, 95% CI?=?0.26–0.93). Compared to females in the general population, female ex-offenders were 10 times more likely to use substance-abuse treatment services (AOR?=?10.14, 95% CI?=?5.71–18.00), 10.5 times more likely to use substance detoxification programs (AOR?=?10. 45, 95% CI?=?5.64–19.39); 8 times more likely to use inpatient wards (AOR?=?8.05, 95% CI?=?4.16–15.59); 9 times more likely to use outpatient wards (AOR?=?9.06, 95% CI?=?4.89–16.81), and 12 times more likely to use substance-abuse rehabilitation programs (AOR?=?12.06, 95% CI?=?6.55–22.22). Conclusions: While female ex-offenders were more likely to have used a range of substance abuse services when compared to the general population, they were less likely to use substance-abuse treatment services and rehabilitation programs than male ex-offenders.     

Nonfatal Overdose Among Heroin Users in Southwestern China

Objective: To evaluate the prevalence of and risk factors for nonfatal overdose among heroin users in southwestern China. Methods: In 2005, 731 heroin users in Sichuan Province, China were interviewed for overdose experiences in the past 12 months. Factors hypothesized to be associated with overdose were evaluated with logistic regression models. Results: Eighty-eight (12%) drug users experienced at least one overdose, with a range from 1 to 20; 45 (51%) experienced 2 or more overdoses. Over half of participants with experience of overdose were recently released from prison (52%), and 56% used benzodiazepines before overdose. Longer methadone treatment in the past year (≥180 vs. 0 days; OR,. 3; 95% CI,. 1–.8; P = .02), longer duration of using drugs (≥7 vs. <7 years; OR, 2.2; 95% CI, 1.3–3.6; P = .002), and more frequency of injecting drugs in the past 3 months (≥7 vs. <7 times/week; OR, 5.4; 95% CI, 3.2–9.0; P < .001) were independently associated with increased risk of nonfatal heroin overdose. Conclusions: Nonfatal heroin overdoses are common among Chinese heroin users. Drug users should be encouraged to participate and remain in methadone treatment to prevent overdose and be educated about proper response to overdose to reduce risk of overdose death.     

HIV-Infected Prison Inmates: Depression and Implications for Release Back to Communities

High rates of both HIV and depression are seen in prison populations; depression has been linked to disease progression in HIV, risky behaviors, and medication non-adherence. Despite this, few studies have examined HIV-infected inmates with depression. We therefore conducted an exploratory study of a sample of HIV-infected inmates in North Carolina prisons (N = 101) to determine what proportion of this sample screened positive for depression and whether depression was associated with different pre-incarceration characteristics or post-release needs. A high proportion of HIV infected inmates (44.5%) screened positive for depression. Depressed inmates were significantly more likely have low coping self-efficacy scores (180 vs. 214), to report having had resource needs (OR = 2.91) prior to incarceration and to anticipate needing income (OR = 2.81), housing (OR = 4.07), transportation (OR = 9.15), and assistance with adherence (OR = 8.67) post-release. We conclude by discussion the implications of our findings for prison based care and effective prison release planning for HIV infected inmates.     

Self-reported hypersensitivity and allergy to foods amongst Mexican adolescents: Prevalence and associated factors

Background

The prevalence of food allergy is on the rise on a global scale.

Acceptability and factors associated with willingness to receive short messages for improving antiretroviral therapy adherence in China

This study aimed to understand the acceptability of short message service (SMS) as a reminder for improving antiretroviral therapy (ART) adherence and determine the factors associated with willingness to accept SMS among people living HIV (PLH) in China. A total of 801 adult patients were recruited in a cross-sectional survey. Factors associated with willingness in unadjusted analyses (α = 0.10) were included in a logistic regression model; 88.4% of the participants owned mobile phones, 49.6% read every short message and 16.2% read only if the phone number was familiar, 79.5% reported daily SMS to remind taking medicine would be helpful, and 68.9% were willing to receive them. In the final model, willingness to accept was positively associated with being young (odds ratio [OR] = 0.32; 95% confidence interval [CI]: 0.11–0.99; p = 0.048), living in the middle or north region (OR = 2.36; 95% CI: 1.24–4.50; p = 0.009, OR = 71.79; 95% CI: 21.53–239.37; p < 0.001, respectively), having primary or “junior or higher” education (OR = 5.80; 95% CI: 2.13–15.86; p = 0.001, OR = 3.20; 95% CI: 1.20–8.58; p = 0.021, respectively), having serious disease condition of stage (OR = 10.01; 95% CI: 2.12–47.30; p = 0.004), being a rural resident (OR = 2.96; 95% CI: 1.72–5.10; p < 0.001), having side effect (OR = 4.74; 95% CI: 1.24–18.03; p = 0.023), and taking a dose two or more hours late in the last 30 days (OR = 2.45; 95% CI: 1.26–4.78; p = 0.009). SMS as a reminder for improving ART adherence is acceptable. The survey results indicate that to be effective, messages need to be more acceptable to elderly patients, urban residents, individuals with earlier stage of HIV disease, and individuals not experiencing side effects. Nonetheless, these results suggest that for a high proportion of PLH in China, reminder messages through mobile phones would be useful for increasing compliance with HIV regimens.     

Poor adherence to HIV monitoring and treatment guidelines for HIV-infected injection drug users

Objectives

There is growing concern about access to HIV/AIDS care among injection drug users (IDUs). We examined rates of CD4 cell count monitoring and correlates among HIV‐infected IDUs.

Methods

This prospective observational cohort study of 460 community‐recruited HIV‐infected IDUs was situated in a Canadian city where all medical care is provided free of charge. Over a median follow‐up period of 76 months, we evaluated factors associated with CD4 cell count monitoring through a linkage with a centralized CD4 registry.

Results

Overall, <5% of IDUs had CD4 monitoring consistent with local therapeutic guidelines. In multivariate analyses, after adjustment for being on antiretroviral therapy [odds ratio (OR) 2.21, 95% confidence interval (CI) 1.84–2.70, P<0.001] female gender (OR 0.71, 95% CI 0.57–0.89, P=0.003), non‐White ethnicity (OR 0.75, 95% CI 0.60–0.94, P=0.014), use of methadone maintenance therapy (OR 1.66, 95% CI 1.42–1.94, P<0.001) and daily heroin use (OR 0.72, 95% CI 0.61–0.85, P<0.001) were independently associated with CD4 monitoring.

Conclusions

Strategies to improve CD4 surveillance among IDUs are critically important, particularly for female and non‐White IDUs. Expanded treatment for heroin dependence appears to have the greatest potential for improved care.     

Aggression,Impulsivity, Personality Traits,and Childhood Trauma of Prisoners with Substance Abuse and Addiction

Introduction: The aim of our study is then to analyze psychological and judicial features of a subgroup of inmates with substance abuse. Methods: Prisoners with substance abuse (n = 312) were compared to prisoners without substance abuse (n = 591). Recruited inmates completed a semistructured interview for collection of sociodemographic and judicial data and a battery of psychometric tests for assessement of aggression, impulsivity, depression, personality traits, hostility, resilience, and childhood trauma. Results: Substance abusers had on average multiple incarcerations (78.8%), more juvenile convictions (60.2%), more violent behaviors during detention (29.8%), and a history of one or more suicide attempts (20.8%). They also had higher scores on subscales for childhood trauma, higher scores for psychoticism and neuroticism, higher impulsivity levels, worse resilience, increased hostility, and prevalent suicidal ideation. Conclusion: Prisoners with substance abuse constitute a subgroup with increased judiciary and psychiatric issues, possibly due to early life history and psychological characteristics, such as high impulsivity and aggressiveness, poor resilience, and higher suicidal risk.     

Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems

ABSTRACT

Background: Comorbid depression and substance use disorders (SUDs) are associated with poor health and social outcomes disproportionately affecting under-resourced communities.

Objectives: To test the hypothesis that a coalition approach to collaborative care (CC) for depression would improve outcomes of hazardous drinking and behavioral health hospitalizations, relative to technical assistance, for individuals with comorbid substance use problems. Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.

Methods: Two depression CC implementation approaches were compared: Resources for Services (RS) provided expert technical support for CC toolkits to individual programs. Community engagement and planning (CEP) supported multi-sector coalitions in collaborating in planning, adapting, implementing and monitoring CC toolkits. One thousand eighteen individuals with depression (PHQ-8 ≥10) enrolled. Regression analyses estimated intervention effects in participants with comorbid substance use problems (n = 588, 281 females, 307 males). Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.

Results: There were no significant baseline differences by intervention status among participants with depression and substance use problems. Intervention effects on primary outcomes including depression were not significant at 6 months. Compared to RS, CEP significantly reduced alcohol consumption (CEP = 1.6, RS = 2.1, p = .038), probability of behavioral health hospitalizations (OR = 0.50, p = .036), and use of specialty mental health visits (IRR = 0.52, p = .027), while increasing use of faith-based depression services (IRR = 3.4, p = .001).

Conclusions: Given feasibility and possible benefits, CEP should be considered a promising approach to implementing depression CC with potential benefits to adults with comorbid substance use problems.     

Self‐Reported Psychotic Disorders among Individuals with Substance Use Disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background and Objectives : Comorbidity of substance use disorders (SUDs) and psychotic disorders (PDs) presents many challenges in diagnosis and treatment. Most reports to‐date focus on the prevalence of SUDs among clinical populations of patients with PDs, and there is a lack of data pertaining to rates of PDs among individuals with substance use and SUDs. Methods : We analyzed data on 43,093 respondents age 18 and above from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative US survey (Wave 1, 2001–2002). Cross‐tabulations were used to derive prevalence estimates of PDs among individuals with 12‐month substance use or SUDs across 10 categories of substances. Odds ratios (ORs) were derived from bivariate logistic regression analyses to examine the relationships between lifetime PDs and 12‐month substance use or SUDs for the specific categories of substances. Results : Among individuals with 12‐month substance use, prevalence of PDs was found to be elevated in 8 of 10 categories of substances, particularly among amphetamine (OR = 8.8) and cocaine (OR = 10.3) users compared to nonusers. Among individuals with SUDs, prevalence of PDs was elevated in 9 of 10 categories of substances compared to individuals without SUDs. Conclusions and Scientific Significance : Our findings on the increased rates of PDs among substance users and individuals with SUDs across a wide range of substances emphasize the importance of screening for PDs while treating patients with substance use and SUDs. This may allow for early intervention and adequate referral to appropriate settings. (Am J Addict 2012;21;531–535)