Ecstasy use and its Association with Sexual Behaviors Among Drug Users in New York City

In the past two decades, recreational use of ecstasy has become a growing concern in the United States, although most studies assessing ecstasy use have focused on white, middle-class adolescents who use ecstasy during raves and in clubs. We assessed the prevalence of recent ecstasy use among predominantly minority heroin, cocaine, and crack users in New York City and the association between ecstasy and sexual risk above and beyond that of the other drugs. Between 2002 and 2004, injection and non-injection heroin, crack and cocaine users (N = 534) completed a risk behavior questionnaire that included items on ecstasy use. Logistic regression was used to investigate the relation between current ecstasy use and sexual behaviors. Of 534 illicit drug users, 69.7% were aged 25 years or older, 65.2% were Hispanic, 27.9% Black and 77.4% male; 36.7% were injectors. 17.2% of respondents reported recent (last six months) ecstasy use. In a multivariable logistic regression model, current ecstasy use was associated both with initiating sex before age 14 (adjusted odds ratio (AOR) = 1.51) and having two or more partners in the past two months (AOR = 1.86) after adjusting for age at study entry, current cocaine and marijuana use and being an injection drug user. This study suggests that ecstasy use may be more prevalent among urban drug users. Ecstasy use in urban settings, beyond clubs and raves, should continue to be monitored.     

School Climate and Adolescent Drug Use: Mediating Effects of Violence Victimization in the Urban High School Context

This study tested the mediating effects of violence victimization in the relationship between school climate and adolescent drug use. The hypothesized path model fit data collected from a probability sample of urban high school students (N=586) participating in an evaluation of a violence prevention program funded by the Substance Abuse and Mental Health Services Administration. Findings indicated that the lack of enforcement of school rules and the presence of unsafe places in and around the school influenced adolescent drug use directly and indirectly through their effects on violence victimization. Editors’ Strategic Implications: This research confirms the importance of the environment as a contributor to violence victimization. Violence victimization is obviously of concern in its own right, but in addition, these data indicate that it also contributes to adolescent drug use. School administrators should be aware that unsafe places in schools and the failure to enforce school rules may affect such victimization and drug use. Portions of this paper were presented at the Eighth Annual Conference of the Society for Social Work and Research, New Orleans, LA, January 17, 2004 and the Society for Community Research and Action – 10th Biennial Conference, University of Illinois at Urbana-Champaign, June 9–12, 2005.     

Crime Prevention Through Environmental Design (CPTED) Characteristics Associated With Violence and Safety in Middle Schools

BACKGROUND

This study used a new Crime Prevention Through Environmental Design (CPTED) assessment tool to test the associations between physical attributes of schools and violence‐related behaviors and perceptions of students.

METHODS

Data were collected from 4717 students from 50 middle schools. Student perceptions of risk and safety, and violence were assessed. Evaluators used the CPTED School Assessment (CSA) to quantify how well the physical elements of each school correspond to ideal CPTED principles. Generalized linear mixed models were used to adjust for school‐ and student‐level characteristics.

RESULTS

Higher CSA scores were generally associated with higher perceptions of safety and lower levels of violence perpetration and perceived risk in unadjusted models. Higher CSA scores were also associated with lower odds of missing school because of safety concerns in most adjusted models, with significant adjusted odds ratios (AORs) ranging from 0.32 to 0.63. CSA scores for parking and bus loading areas also remained associated with higher perceived safety (AORs = 1.28 and 1.32, respectively) and lower perceived risk (AORs = 0.73 and 0.66, respectively) in adjusted models.

CONCLUSIONS

The CSA is useful for assessing school environments that are associated with violence‐related behaviors and perceptions. The CSA might help guide school environmental modifications to reduce violence.

     

Update and Overview of Practical Epidemiologic Aspects of HIV/AIDS among Injection Drug Users in the United States

In a changing public health landscape in which local, state, and federal agencies must confront threats of bioterrorism, emerging infections, and numerous chronic diseases, transmission of HIV among injection drug users (IDUs) continues to be an important public health issue and one of the driving forces behind the HIV epidemic. Using a computerized MEDLINE search of published articles from January 1981 through October 2005, we conducted a literature review of practical epidemiologic aspects of HIV/AIDS among IDUs in the United States. Although recent trends indicate a decline in the proportion of newly diagnosed HIV infections associated with injection drug use, drug-use behaviors overall still account for 32% of new HIV diagnoses. Factors in addition to syringe sharing contribute to HIV transmission among IDUs: risky sexual behaviors, sharing of drug preparation equipment and drug solutions, and contextual and social factors. Promising approaches for HIV prevention include rapid HIV testing, office-based substance abuse treatment, behavioral interventions, improved communication about syringe exchange programs, and case management. HIV among IDUs continues to be an important public health problem in the 21st century. It is imperative that public health agencies continue to monitor and combat the HIV epidemic among IDUs to ensure that hard-won gains will not be eroded. Santibanez, Garfein, Swartzendruber, Purcell, Paxton, and Greenberg are with the Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop K-39, Atlanta, GA 30333, USA.     

Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States

Objectives. We present the prevalence of exposure to political violence (PV) among Latino immigrants in the US, and perceived need for and correlates of mental health services use among this population.

Methods. We use the National Latino and Asian American Study (NLAAS), a nationally representative epidemiological survey of US Latinos, including a probability sample of 1630 immigrant Latinos. Our conceptual framework assumes a strong role of social and cultural factors in understanding the risk for psychopathology and mental health service use.

Results. Eleven percent of all immigrant Latinos reported PV exposure and 76% described additional lifetime traumas. Among those with a history of PV, an increased likelihood of using mental health services was associated with female gender, English language proficiency, experiencing personal assaults, higher perceived discrimination, and having an anxiety or substance disorder. Latino men and specific subgroups of Latinos were less likely to access mental health services after experiencing PV. Perceived need for mental health services use is the strongest correlate of any lifetime and last-12-months service use.

Conclusions. Individuals who come from countries with a history of political violence often have multiple traumatic experiences. This suggests a need for systematic screening for trauma and related psychiatric disorders. Specific outreach interventions focused on perceptions of need could be helpful for subgroups of Latinos including men who are particularly underrepresented in mental health services but who exhibit significant trauma histories.     

福建省近年来吸毒人群吸毒行为特征的调查分析

［目的］了解福建省吸毒人群的吸毒行为特征，为艾滋病防制措施的制定提供依据。［方法］1998-2000年，对福州市某强制戒毒所中的1637名戒毒人员进行问卷调查。［结果］吸毒者中注射吸毒的比例已从1998年的29.2%上升到2000年的61.0%，注射吸毒者中有21.1%曾与他人共用过注射针具。［结论］福建省注射吸毒者中存在HIV流行传播的危险性，迫切需要进行预防艾滋病的健康教育和行为干预活动。     

The shrinking world of girls at puberty: Violence and gender-divergent access to the public sphere among adolescents in South Africa

Participatory mapping was undertaken with single-sex groups of grade 5 and grade 8–9 children in KwaZulu-Natal. Relative to grade 5 students, wide gender divergence in access to the public sphere was found at grade 8–9. With puberty, girls' worlds shrink, while boys' expand. At grade 5, female-defined community areas were equal or larger in size than those of males. Community area mapped by urban grade 8–9 girls, however, was only one-third that of male classmates and two-fifths that of grade 5 girls. Conversely, community area mapped by grade 8–9 boys was twice that of grade 5 boys. Similar differences emerged in the rural site. No female group rated a single community space as more than ‘somewhat safe’. Although curtailed spatial access is intended to protect girls, grade 8–9 girls reported most places in their small navigable areas as very unsafe. Expanded geographies of grade 8–9 boys contained a mix of safe and unsafe places. Reducing girls' access to the public sphere does not increase their perceived safety, but may instead limit their access to opportunities for human development. The findings emphasise the need for better violence prevention programming for very young adolescents.     

Substance use,gender inequity,violence and sexual risk among couples in Cape Town

Alcohol and other drug use, gender power inequities and violence are key contributors to sexual risks for HIV among South African men and women. Little is known about the intersection between these sex-risk behaviours among couples in established heterosexual relationships. We conducted 10 focus-group discussions with men and women in relationships of 1 year or longer recruited from shebeens (informal taverns) in Cape Town, South Africa. Participants described: high levels of alcohol consumption at shebeens; low levels of condom use with main and casual sex partners; gender roles disfavouring women's condom negotiating power that also promoted economic dependency on male partners; men often spending a portion of the household income on alcohol and other drugs and sex with others in shebeens; loss of household income driving women to trade sex to provide for their families; and sexual violence and the exploitation of women occurring in shebeens. Findings highlight how the social contexts of alcohol and other drug use, gender inequitable norms and gender violence promote HIV risk within established heterosexual relationships in South African communities. Evidence of this kind should inform the design of HIV-risk-reduction interventions tailored to heterosexual couples who drink alcohol in shebeens.     

The role of Ecstasy (MDMA) in managing intimacy and conflict in stable relationships

Abstract

This paper discusses motivations for the use of MDMA among young adults in intimate relationships living in resource poor environments, where structural constraints limit potential for economic mobility and impact upon interpersonal relations. Drawing from in-depth interviews with men and women in intimate relationships with one or more partners, we report the range of motivations for MDMA use and their association with indicators of relationship quality, specifically trust and romantic exclusivity. Findings demonstrate that both men and women use MDMA primarily for the purpose of sexual enjoyment. However, men report the use of MDMA for sexual enjoyment more often, while women more frequently report the use of MDMA to compensate for psychological or physical displeasure, particularly in relationships characterised by distrust. We discuss how these motivations to use MDMA are shaped by gender norms and larger contextual and socio-economic factors and conclude with a call for more relational and sexual counselling opportunities for urban young adults to avoid MDMA use for self-medication.     

Mortality, the Social Environment, Crime and Violence

Starting out from the relationship between income equality and indicators of social cohesion and social trust, this paper explores the social processes which might account for the relationship between greater income equality and lower population mortality rates. We note that: homicide shows an even closer relationship to income inequality than does mortality from all other causes combined; there are several reports that homicide rates are particularly closely related to all cause mortality; and that there is a growing body of research on crime in relation to social disorganisation.
We use US state level data to examine the relationships between various categories of income inequality, median state income, social trust and mortality. The data suggest that violent crime, but not property crime, is closely related to income inequality, social trust and mortality rates, excluding homicide. The second half of the paper is devoted to literature on the antecedents of violence. Feeling shamed, humiliated and disrespected seem to be central to the picture and are plausibly related to the way in which wider income differences are likely to mean more people are denied access to traditional sources of status and respect. We suggest that these aspects of low social status may be central to the psychosocial processes linking inequality, violence, social cohesion and mortality.     

Attitudes about Violence and Involvement in Peer Violence among Youth: Findings from a High-Risk Community

Peer violence perpetration and victimization are the most common types of violence among youth. This study determined the associations among violent attitudes toward peers, involvement in peer violence perpetration, and experience with peer violence victimization among boys and girls in a high-risk, urban community. Analyses were based on data from the 2004 Youth Violence Survey, which was administered to over 80% of public school students in grades 7, 9, 11, and 12 (N = 4,131) in a disadvantaged, urban, school district in the USA. Logistic regression analyses were conducted to test the associations between attitudes in support of violence and involvement in violent behaviors. Results show that among youth, attitudes supporting boys hitting boys significantly increased the odds of peer violence perpetration after controlling for potential confounders (adjusted odds ratio [AOR], 1.35; 95% confidence interval [CI] = 1.07, 1.72). However, stratified analyses for boys and girls show that attitudes supporting boys hitting boys increased the odds of peer violence perpetration for girls only after controlling for potential confounders (AOR, 1.49; 95% CI = 1.05, 2.13). The findings demonstrate that there are important differences between boys and girls in terms of their associations with violent attitudes and involvement in actual violent behaviors. However, additional research is needed to determine how attitude modifications can be incorporated into youth violence prevention programs.     

Incarceration and High-Risk Sex Partnerships among Men in the United States

Incarceration is associated with multiple and concurrent partnerships, which are determinants of sexually transmitted infections (STI), including HIV. The associations between incarceration and high-risk sex partnerships may exist, in part, because incarceration disrupts stable sex partnerships, some of which are protective against high-risk sex partnerships. When investigating STI/HIV risk among those with incarceration histories, it is important to consider the potential role of drug use as a factor contributing to sexual risk behavior. First, incarceration’s influence on sexual risk taking may be further heightened by drug-related effects on sexual behavior. Second, drug users may have fewer economic and social resources to manage the disruption of incarceration than nonusers of drugs, leaving this group particularly vulnerable to the disruptive effects of incarceration on sexual risk behavior. Using the 2002 National Survey of Family Growth, we conducted multivariable analyses to estimate associations between incarceration in the past 12 months and engagement in multiple partnerships, concurrent partnerships, and unprotected sex in the past 12 months, stratified by status of illicit drug use (defined as use of cocaine, crack, or injection drugs in the past 12 months), among adult men in the US. Illicit drug users were much more likely than nonusers of illicit drugs to have had concurrent partnerships (16% and 6%), multiple partnerships (45% and 18%), and unprotected sex (32% and 19%). Analyses adjusting for age, race, educational attainment, poverty status, marital status, cohabitation status, and age at first sex indicated that incarceration was associated with concurrent partnerships among nonusers of illicit drugs (adjusted prevalence ratio (aPR) 1.55, 95% confidence interval (CI) 1.06–2.22) and illicit drug users (aPR 2.14, 95% CI 1.07–4.29). While incarceration was also associated with multiple partnerships and unprotected sex among nonusers of illicit drugs (multiple partnerships: aPR 1.66, 95% CI 1.43–1.93; unprotected sex: aPR 1.99, 95% CI 1.45–2.72), incarceration was not associated with these behaviors among illicit drug users (multiple partnerships: aPR 1.03, 95% CI 0.79–1.35; unprotected sex: aPR 0.73, 95% CI 0.41–1.31); among illicit drug users, multiple partnerships and unprotected sex were common irrespective of incarceration history. These findings support the need for correctional facility- and community-based STI/HIV prevention efforts including STI/HIV education, testing, and care for current and former prisoners with and without drug use histories. Men with both illicit drug use and incarceration histories may experience particular vulnerability to STI/HIV, as a result of having disproportionate levels of concurrent partnerships and high levels of unprotected sex. We hypothesize that incarceration works in tandem with drug use and other adverse social and economic factors to increase sexual risk behavior. To establish whether incarceration is causally associated with high-risk sex partnerships and acquisition of STI/HIV, a longitudinal study that accurately measures incarceration, STI/HIV, and illicit drug use should be conducted to disentangle the specific effects of each variable of interest on risk behavior and STI/HIV acquisition.     

Violence and newborn health: Estimates for Colombia

This paper examines the relationship between maternal exposure to violence during pregnancy and newborn birthweight. The identification strategy exploits variation in the timing of exposure and in the geographic location of expectant mothers across Colombian municipalities. Exposure to violence in early pregnancy had a large negative impact on birthweight, primarily for boys, and the effect was mitigated by their mothers' education. Girls' birthweight was affected mainly by shocks in later stages of gestation. Furthermore, their mothers were more likely to engage in potentially harmful behaviors during the pregnancy. This evidence exposes the importance of parental responses in shaping the effect of exposure to violence on newborn health.     

Power, Control, and Intimate Partner Sexual Violence in Haiti

This study sought to determine how power and control in intimate relationships influenced women's exposure to sexual violence. Multilevel modeling was used to determine the risk of partner sexual violence in the past 12 months among 2240 women aged 15–49 years who were currently married or cohabiting. The data were drawn from the 2000 Haiti Demographic and Health Survey. Strong positive effects on intimate partner sexual violence were found for husband's jealousy and perpetration of controlling behavior and women's endorsement of traditional norms concerning a husband's rights to beat his wife. Female dominance in decision making about purchases for daily household needs was positively associated with intimate partner sexual violence but its effects were mediated by relationship quality. The effect of wife's education on intimate partner violence was nonlinear. The analysis also showed that high community female headship rates were independently associated with higher risks of partner sexual violence. The findings highlight the importance of adopting a multidimensional approach to the measurement of power in sexual relationships and the need for programs to work at multiple levels to address gender-based norms and the structural factors that put women at increased risk of sexual violence.     

Prevalence and Characteristics of Femoral Injection among Seattle-Area Injection Drug Users

Injection drug use (IDU) into central veins, most common among long-term IDUs with no other options, can lead to severe infectious, vascular, and traumatic medical consequences. To follow-up on anecdotal reports of femoral vein injection and related medical problems in Seattle, we analyzed data from the annual survey of a community-based syringe exchange program. A total of 276 (81%) of 343 program attendees completed the survey in August 2010. Among 248 IDUs, 66% were male, 78% white, and 86% primarily injected opiates. One hundred respondents (40%) had injected into the femoral vein, 55% of whom were actively doing so, and 58% of whom reported medical complications that they attributed to the practice. Most (66%) used the femoral vein due to difficulty accessing other veins, although 61% reported other veins they could access and 67% reporting using other sites since initiating femoral injection. While injecting into muscle was more frequent among older IDUs with longer injection careers, the prevalence of femoral injection was highest among respondents in their late twenties with 2.5–6 years of injecting drugs. Multivariate analysis demonstrated an increased risk of initiating femoral injection each calendar year after 2007. Injecting into the femoral vein was also associated with white versus other race (odds ratio [OR] 2.7, 95% CI 1.3–5.4) and injection of primarily opiates versus other drugs (OR 6.3, 95% CI 1.2–32.9) and not associated with age, length of IDU career, or a history of injecting into muscle. These findings suggest a secular trend of increasing femoral injection among Seattle-area IDUs with a high rate of related medical problems. Interventions, such as education regarding the hazards of central venous injection and guidance on safe injection into peripheral veins, are needed to minimize the health consequences of femoral injection.