Research Interests: Research Methodology, Rape, Health, Adolescent, Medicine, and 15 morePopulation, Humans, New York City, Measurement, Female, Florida, Obstetrics Gynecology, Crack Cocaine, Prevalence, Developed Countries, Human immunodeficiency virus, Adult, Odds ratio, Case Control Studies, and Paediatrics and reproductive medicine
It is probable that humans were first infected with HIV in the Kinshasa region of the Democratic Republic of the Congo in the 1950s and yet many decades later we are still studying and discovering how best to control what has become a... more
It is probable that humans were first infected with HIV in the Kinshasa region of the Democratic Republic of the Congo in the 1950s and yet many decades later we are still studying and discovering how best to control what has become a global epidemic. One of the epicenters of the disease was in Miami when people with symptoms that were inexplicable in their particular populations became of interest to clinicians and scientists. This was occurring in other major cities, which also became the epicenters for this strange and destructive disease. This chapter highlights the history of one local region of the United States, Miami-Dade County, Florida and exemplifies the global problem. This chapter will indicate how local teams of scientists were called into action to address the impending epidemic. This is an example of how modern science can mobilize scientific teams that discover the origins and consequences of a highly complex disease. Eventually from that, scientific and medical foundations began to develop interventions for the control of HIV/AIDS and its related consequences.
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Prevalence rates of HIV infection acquired through heterosexual contacts have risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction interventions seeking... more
Prevalence rates of HIV infection acquired through heterosexual contacts have risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction interventions seeking to increase condom use among drug users have met with minimal success, and there is a need for interventions to be strongly grounded in psychosocial models of behaviour change. This study presents the results of an investigation of predictors of intention to use condoms and related therapy processes among heterosexual drug users. Data were analyzed from 586 crack smokers recruited in Washington, DC, Miami, Florida, and Collier County, Florida who reported having both primary and casual sex partners. Participants responded to items derived from the theory of reasoned action, the theory of planned behaviour and the transtheoretical model of change. Condom use beliefs and therapy processes used to initiate and maintain condom use were assessed. Outcome expectancies and normative beliefs were the strongest predictors of intention to use condoms with a primary sexual partner. In turn, beliefs that condoms inhibit sexual romance and decrease sexual pleasure strongly predicted outcome expectancies. Therapy processes found to be associated with these constructs included: self-liberation, counter conditioning and stimulus control/reinforcement. Results suggest that HIV risk reduction interventions using a group format and targeting condom beliefs related to sexual romance and pleasure will decrease negative outcome expectancies about condom use. Also, reinforcing attempts to use condoms with intimate partners should increase positive outcome expectancies and intention to initiate or maintain condoms with a primary sexual partner.
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DESCRIPTION
Research Interests: Latin American Studies, Epidemiology, HIV and AIDS education, Health Education, Public Health, and 12 moreCosta Rica, Infectious Diseases, Drug Use, Drug abuse and addiction, Substance Abuse, Central America, Drug Addiction, Universidad de Costa Rica, HIV/AIDS AND Risky behaviors, Hiv Aids, Mental Health and Addictions, and Sexual Practices
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Abstract 1. Describes a demonstration project in Miami that uses an experimental research design to evaluate an acquired immune deficiency syndrome (AIDS) intervention program among iv drug users and the sexual partners of iv drug users.... more
Abstract 1. Describes a demonstration project in Miami that uses an experimental research design to evaluate an acquired immune deficiency syndrome (AIDS) intervention program among iv drug users and the sexual partners of iv drug users. At the time of the initial ...
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DESCRIPTION
Research Interests: Latin American Studies, Epidemiology, HIV and AIDS education, Health Education, Public Health, and 12 moreCosta Rica, Infectious Diseases, Drug Use, Drug abuse and addiction, Substance Abuse, Central America, Drug Addiction, Universidad de Costa Rica, HIV/AIDS AND Risky behaviors, Hiv Aids, Mental Health and Addictions, and Sexual Practices
The authors provide a review of the economic evaluation literature of breast cancer screening and identify important trends and gaps in the literature. Healthcare resources are limited and economic evaluation plays a critical role in... more
The authors provide a review of the economic evaluation literature of breast cancer screening and identify important trends and gaps in the literature. Healthcare resources are limited and economic evaluation plays a critical role in resource allocation, healthcare policy, and clinical decisions. Many economic evaluations of medical practice, however, are unreliable and do not use appropriate analytic techniques. Three important trends were observed. First, two economic evaluation methods are dominant. Second, a wide range of cost estimates exists across studies. Third, a lack of standardization exists across studies with regard to basic economic evaluation principles. These findings should be considered when conducting future research, analyzing economic evaluations of breast cancer screening, and developing clinical guidelines. Concerns about cost containment in healthcare make it necessary for physicians and clinical administrators to take an active role in resource allocation de...
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In the United States, a major federally-funded approach to HIV-1 prevention for injecting drug users (IDUs) includes teaching them to always rinse their needles/syringes with household bleach and water before use. This report describes... more
In the United States, a major federally-funded approach to HIV-1 prevention for injecting drug users (IDUs) includes teaching them to always rinse their needles/syringes with household bleach and water before use. This report describes interdisciplinary studies of the extent to which HIV-1 can be found in injection equipment and the efficacy of bleach as a disinfectant, under simulated field conditions. Bloody needle/syringe units collected from Miami, Florida, shooting galleries or from community outreach prevention participants were selected for these studies. Groups of needle/syringe units were cleansed with bleach using a standard technique taught to IDUs in community outreach programs. Cleansed and uncleansed groups of needles/syringe units were then tested for the presence of HIV-1. The data demonstrate the efficacy of bleach rinses in reducing the risks of HIV-1 infection from needle/syringe units and indicate that the teaching of a bleach cleansing method to IDUs should be p...
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In Florida, prostate cancer continues to be an increasing public health problem, especially among the elderly and medically underserved. Bilingual, random-digit-dialed telephone interviews were conducted with 897 men who were 65 years and... more
In Florida, prostate cancer continues to be an increasing public health problem, especially among the elderly and medically underserved. Bilingual, random-digit-dialed telephone interviews were conducted with 897 men who were 65 years and older in Dade and Hillsborough counties, with the sample stratified along racial and ethnic lines. The purpose of the survey was to obtain information regarding knowledge, attitudes, practices, and beliefs about prostate cancer, its prevention, and early detection. More than 60% of the 897 respondents believed that a person with prostate cancer had an 80% or greater chance for cure, yet only 67% reported ever having a digital rectal examination. Black (35.7%) and Hispanic respondents (42.5%) were twice as likely to have never had a digital rectal examination than were their white counterparts (19.8%). When asked why they had never had this examination or had not had one in the past 2 years, 38.5% replied that it was "not needed/not necessary&q...
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... The advertisement for the Hamlin product claimed that "there is no sore it will not heal, no pain it will not subdue." The oil was ... For about a 4-month period during 1905 and 1906, a Collier's reporter,... more
... The advertisement for the Hamlin product claimed that "there is no sore it will not heal, no pain it will not subdue." The oil was ... For about a 4-month period during 1905 and 1906, a Collier's reporter, Samuel Adams, chronicled the fraudulent claims of the patent medicine sellers ...
Research Interests: Criminology and Prison
This paper examines barriers to health care utilization and the correlates associated with these barriers. As part of a larger study of health services utilization, the study sample of 1085 including injection drug users, other chronic... more
This paper examines barriers to health care utilization and the correlates associated with these barriers. As part of a larger study of health services utilization, the study sample of 1085 including injection drug users, other chronic users of heroin or cocaine, and a demographically similar group who had used neither heroin nor cocaine, was selected based on the criterion of not having received health care for at least one health problem within the previous 12 months. Both categories of chronic drug users were more likely than non-users not to want health care treatment and to put off seeking needed health care.
Research Interests: Psychology, Epidemiology, Accessibility, Statistical Analysis, Treatment, and 15 morePublic Health, Multivariate Analysis, Drug Use, Humans, Substance Use, Female, Health Care Services, Florida, Male, Drug Addiction, Cost Analysis, Adult, Substance use and misuse, Treatment Refusal, and Health Services Accessibility
In a follow-up study of 184 emergency room patients experiencing acute drug reactions, several respondents were inaccessible. In this paper the 83 accessible and 101 nonaccessible patients are compared in order to determine why... more
In a follow-up study of 184 emergency room patients experiencing acute drug reactions, several respondents were inaccessible. In this paper the 83 accessible and 101 nonaccessible patients are compared in order to determine why respondents are often difficult to locate in a follow-up study. Those patients who were the most accessible proved to be primarily young, White males who had been referred to a traditional drug treatment program from the hospital emergency room. Those patients who were the least accessible proved to be primarily White females between 24 and 29 years of age who had not been referred for further treatment.
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Page 1. 324 RELIGIOUS INSTITUTIONS AS SOURCES OF AIDS INFOR-MATION FOR STREET INJECTION DRUG USERS Duane C. McBride Andrews University Clyde B. McCoy Dale D. Chitwood University of Miami School of Medicine James A. Inciardi ...
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To determine the prevalence of recent rape, the characteristics or recent rape survivors, and the seroprevalence of human immunodeficiency virus (HIV), syphilis, and genital herpes (HSV-2) among recent rape survivors. We surveyed women... more
To determine the prevalence of recent rape, the characteristics or recent rape survivors, and the seroprevalence of human immunodeficiency virus (HIV), syphilis, and genital herpes (HSV-2) among recent rape survivors. We surveyed women 18-29 years old who were recruited from places unassociated with medical or drug treatment or the criminal justice system in three urban communities where illicit drug use is common. We compared characteristics and HIV, syphilis, and HSV-2 seroprevalence of women who reported recent rape with those of women who denied recent rape. One hundred fifty-one of 1104 (13.7%) women reported having been raped in the year before our interview. Rape survivors were more likely than women who denied recent rape to smoke crack cocaine (86.8 versus 56.7%; odds ratio [OR] 5.0, 95% confidence interval [CI] 3.2-7.8), to be homeless (17.2 versus 6.1%; OR 3.2, CI 2.0-5.2), to report a recent sexually transmitted disease (38.7 versus 18.7%; OR 2.7, CI 1.9-3.9), and to be infected with syphilis (42.4 versus 28.4%; OR 1.9, CI 1.3-2.6) and HSV-2 (71.9 versus 57.5%; OR 1.9, CI 1.3-2.8). Survivors were more likely to acknowledge any HIV risk behavior (including sex work) (85.4 versus 49.5%; OR 5.9, CI 3.9-9.0) and to be HIV-infected (23.3 versus 13.4%; OR 1.9, CI 1.3-2.9). Rape was not independently associated with HIV (OR 0.8, 95% CI 0.4-1.3), syphilis (OR 0.9, 95% CI 0.6-1.3), or HSV-2 (OR 1.3, 95% CI 0.9-2.0) infections after adjustment for confounding factors. One in seven women reported being raped recently. Rape was most common among sex workers, crack smokers, and the homeless. Most survivors reported HIV risk behaviors, and many were HIV-infected. Programs to prevent repeated rape, voluntary HIV counseling and testing, and other medical and social services may benefit survivors in these and similar communities.
Research Interests: Research Methodology, Rape, Health, Adolescent, Population, and 15 moreHumans, New York City, Measurement, Female, Florida, Obstetrics Gynecology, Risk factors, Crack Cocaine, Prevalence, Developed Countries, Human immunodeficiency virus, Adult, Risk Factors, Case Control Studies, and Paediatrics and reproductive medicine
Research Interests: Risk Taking, Adolescent, Urban Health, Disease Outbreaks, Humans, and 15 moreFemale, Male, Sexual Behavior, San Francisco, Confidence intervals, Young Adult, Hiv Infection, Crack Cocaine, New York, Prevalence, Adult, New England, New England Journalof Medicine, Medical and Health Sciences, and HIV infections
Research Interests: Cognitive Science, Behavior, Drug Use, Child Behavior, Prospective studies, and 15 morePregnancy, Humans, Child, Female, Cocaine, Young Adult, Questionnaires, Adult, Intelligence tests, Neurosciences, Prenatal Cocaine Exposure, Case Control Studies, Severity of Illness Index, Neuropsychological Tests, and Child preschool
... The authors thank LaDora Bankston, David Brown, Ronald Correa, Diamela Delcastillo, Margaret Pereya, Selina Smith, Bunny Templeton, Joseph Zavertnik, and two anonymous reviewers for helpful comments and research assistance. ... 1992;... more
... The authors thank LaDora Bankston, David Brown, Ronald Correa, Diamela Delcastillo, Margaret Pereya, Selina Smith, Bunny Templeton, Joseph Zavertnik, and two anonymous reviewers for helpful comments and research assistance. ... 1992; Hurley et al. ...
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ABSTRACT Background: HIV disease remains a chronic yet manageable disease that disproportionally impacts marginalized populations such as injection drug users. This research sought to identify correlates of perceived self-efficacy to... more
ABSTRACT Background: HIV disease remains a chronic yet manageable disease that disproportionally impacts marginalized populations such as injection drug users. This research sought to identify correlates of perceived self-efficacy to disclose drug use to one's HIV primary care provider (DISDR) among a sample of HIV-positive injection drug users (IDUs). Methods: This study uses cross-sectional and longitudinal data collected as part of the multi-site, CDC-funded study entitled "Intervention Research for HIV-positive Injection Drug Users" (INSPIRE). The relationship between identified correlates and DISDR was evaluated among a longitudinal cohort (N=814) to determine whether it persists longitudinally. Potential correlates consisted of individual characteristics (socio-demographic, health care service utilization, sex/drug- use behaviors, and psychosocial characteristics). It was postulated that selected variables from these domains would be associated with DISDR. Results: Baseline and longitudinal data suggest a positive association between self-efficacy to disclose injection drug use to one's HIV primary care provider and the following variables: patient-provider relationship, attendance of a drug treatment program during the previous six months, taking control of one's healthcare, and social support. However, current receipt of HIV medications and being recruited from the city of Miami were negatively associated with reporting a high DISDR. Conclusions: These findings will potentially inform interventions that can improve HIV treatment among drug users and inform policymakers and stakeholders regarding the importance of providing comprehensive HIV care in conjunction with substance abuse treatment options to achieve optimal health outcomes.
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Substance abuse and welfare reform are among the nation's highest priorities, and research that examines linkages between the two is of extreme importance to both government policy and the community. Welfare reform will have... more
Substance abuse and welfare reform are among the nation's highest priorities, and research that examines linkages between the two is of extreme importance to both government policy and the community. Welfare reform will have serious implications for substance abusers as well as for the various professionals who treat them and work to move their clients into functional recovery and self-sufficiency. Within the context of welfare reform and the special needs of substance-abusing populations, the present study examines current welfare status, work status, and barriers and facilitators to gaining and maintaining employment among 100 low income women who participated in a long-term residential substance-abuse treatment program in Miami, Florida. Participants completed a face-to-face interview to assess a detailed employment history and current sources of income as well as the Addiction Severity Index. Results indicate that completers of the treatment program were more likely to be working post-discharge than non-completers. Similarly, the longer the length of stay in the program, the more likely the client was to be working post-discharge. Multivariate analysis indicates a high-school education, participation in the treatment center's aftercare program, and treatment duration of more than one year were independently related to work status. These data suggest that as welfare reform becomes a reality, continuing support of various types, particularly drug treatment, is needed to assist substance-abusing women in gaining and maintaining employment.
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Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the... more
Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the historical national concern about heroin use has been concern about the increase in crack cocaine use. There has been speculation that crack use may have become a substitute for the higher risk of heroin injection. This article examines the impact of crack use in a national population of heroin users. It was consistently found that there was a correlation between the frequency of crack use and the frequency of speedballing as well as the use of other forms of cocaine, amphetamines, and marijuana. There was also a positive relationship between frequency of crack use and such HIV risk behaviors as renting needles and having a large number of sex partners. The data suggest that in this population of heroin users, crack is not a substitute for heroin but rather is a part of a drug-use pattern that includes an increased use of other drugs and increased high-risk behaviors for contracting HIV.
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This preliminary study collected data from 326 heroin users in Guangxi Province, China, in 1997. Logistic regression analysis was performed to identify the risk factors for injection. Survival analysis identified factors independently... more
This preliminary study collected data from 326 heroin users in Guangxi Province, China, in 1997. Logistic regression analysis was performed to identify the risk factors for injection. Survival analysis identified factors independently associated with time from initiation of heroin use to adoption of injection. Four factors were independently associated with injection: number of friends who used heroin in the last year, duration of heroin use, dose of heroin consumed, and total number of times detoxified in drug treatment and rehabilitation centers. Only gender and duration of heroin use were independently associated with time to first injection. Median time to first injection was 11 months for males and 22 months for females. Median time to first injection varied by age. Median time to injection for those who used heroin for more than one year was 8.1 months; it was 19.1 months for on to five years of use, and 40.5 months for more than five years of use. This study's preliminary findings suggest that younger, more recent heroin users, and males are at increased risk of becoming injectors, a major risk behavior for HIV acquisition.
Research Interests: Psychology, Demography, Epidemiology, China, Adolescent, and 15 moreComplication, Humans, Psychoactive Drugs, Female, Male, Drug Addiction, Heroin Dependence, Logistic Regression Analysis, Chine, Risk Factor, Adult, Public health systems and services research, Risk Behavior, Logistic Models, and Drug treatment
Research Interests: Africa, HIV, Spain, Clinical Microbiology, Biological Sciences, and 15 moreHumans, Child, HIV protease, Female, Clinical, Male, Prevalence, Middle Aged, Human immunodeficiency virus, Adult, Viral Load, Molecular Sequence Data, reverse transcriptase polymerase chain reaction, Medical and Health Sciences, and HIV infections
This study considers both met and unmet need for dental services among chronic drug users in Miami, Florida, and compares them with non-drug users recruited from the same neighborhoods (N = 1,479). Three primary findings emerged: (1)... more
This study considers both met and unmet need for dental services among chronic drug users in Miami, Florida, and compares them with non-drug users recruited from the same neighborhoods (N = 1,479). Three primary findings emerged: (1) dental problems are among the most frequently reported health problems, (2) drug use is independently associated with need for dental services, and (3) injection drug use is independently associated with increased odds of unmet need for dental services. These findings suggest that policies that increase access to dental services for drug users and other disadvantaged groups are needed. These services could be integrated into existing behavioral health programs already targeting active drug users.
Research Interests: Demography, Social Work, Drug Use, Humans, Needs Assessment, and 15 moreFemale, Florida, Male, Injecting Drug Use, The, Adult, Health Problems, Public health systems and services research, Odds ratio, Tooth Diseases, Behavioral Health Services, Logistic Models, Substance-Related Disorders, Socioeconomic Factors, and Health Services Accessibility
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Recent studies continue to document lack of consistent condom use by active drug users. However, personal HIV risk reduction strategies other than, or in addition to, condom use may be practiced. In this study, data from qualitative... more
Recent studies continue to document lack of consistent condom use by active drug users. However, personal HIV risk reduction strategies other than, or in addition to, condom use may be practiced. In this study, data from qualitative interviews with 92 active users of crack and injection drugs illustrate risk reduction strategies employed either instead of or in addition to condom
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Research Interests: Western blotting, HIV, Humans, Virus, Florida, and 14 moreDrug Addiction, Risk factors, Sharing, Risk Factor, Paraphernalia, Western blot, Risk Factors, Needles, Needle Sharing, Viral Load, syringes, Psychology and Cognitive Sciences, reverse transcriptase polymerase chain reaction, and Medical and Health Sciences
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To assess cancer incidence among Hispanic males in Dade County, Florida, data were analyzed from the statewide tumor registry. For all cancer sites (combined), the age standardized rate among Hispanic males was 308.75 cases per 100,000... more
To assess cancer incidence among Hispanic males in Dade County, Florida, data were analyzed from the statewide tumor registry. For all cancer sites (combined), the age standardized rate among Hispanic males was 308.75 cases per 100,000 person-years, compared with 349.55 among non-Hispanics (standardized rate ratio [SRR] = 0.88; 95% confidence interval [CI] = 0.84-0.93). Hispanics experienced significantly greater rates of cancers of the larynx (SRR = 1.58; 1.19-2.09), thyroid (SRR = 3.12; 1.18-8.26), and gallbladder (SRR = 5.45; 1.55-19.15), compared with non-Hispanics, but significantly lower rates of testicular cancer (SRR = 0.17; 0.09-0.37), melanoma (SRR = 0.20; 0.12-0.34), esophagus (SRR = 0.52; 0.49-0.55), stomach (SRR = 0.61; 0.43-0.87), pancreas (SRR = 0.65; 0.45-0.94), kidney and renal pelvis (SRR = 0.68; 0.48-0.97), colon (SRR = 0.79; 0.67-0.94), lung (SRR = 0.82; 0.73-0.94), and Kaposi's sarcoma (SRR = 0.03; 0.00-0.25). These data suggest that Dade Hispanic males have not experienced the cancers traditionally elevated among US Latinos, or those common among non-Hispanics.
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Drug injectors and crack users (526) in South Florida responded to a survey questionnaire that was designed to examine belief in the effectiveness of various strategies, other than condom use, employed to reduce personal risk of... more
Drug injectors and crack users (526) in South Florida responded to a survey questionnaire that was designed to examine belief in the effectiveness of various strategies, other than condom use, employed to reduce personal risk of contracting HIV during sexual acts. Each strategy was believed to be effective by at least one quarter of the study participants. Factor analysis was used to group these strategies. Subsequent multivariate analysis indicated that the participants who believed in the effectiveness of HIV prevention strategies other than condom use were also less likely to report using condoms. These findings highlight the need for prevention interventions to elicit prevention myths and the full range of risk reduction strategies practiced.
Research Interests: HIV and AIDS education, Risk Taking, Multivariate Analysis, Factor analysis, Humans, and 14 moreFemale, Florida, Male, Sexual Behavior, HIV Prevention, Condom use, Middle Aged, Questionnaires, Adult, Risk Reduction, Public health systems and services research, Condoms, Substance-Related Disorders, and HIV infections
Prevalence rates of HIV infection acquired through heterosexual contacts have risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction interventions seeking... more
Prevalence rates of HIV infection acquired through heterosexual contacts have risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction interventions seeking to increase condom use among drug users have met with minimal success, and there is a need for interventions to be strongly grounded in psychosocial models of behaviour change. This study presents the results of an investigation of predictors of intention to use condoms and related therapy processes among heterosexual drug users. Data were analyzed from 586 crack smokers recruited in Washington, DC, Miami, Florida, and Collier County, Florida who reported having both primary and casual sex partners. Participants responded to items derived from the theory of reasoned action, the theory of planned behaviour and the transtheoretical model of change. Condom use beliefs and therapy processes used to initiate and maintain condom use were assessed. Outcome expectancies and normative beliefs were the strongest predictors of intention to use condoms with a primary sexual partner. In turn, beliefs that condoms inhibit sexual romance and decrease sexual pleasure strongly predicted outcome expectancies. Therapy processes found to be associated with these constructs included: self-liberation, counter conditioning and stimulus control/reinforcement. Results suggest that HIV risk reduction interventions using a group format and targeting condom beliefs related to sexual romance and pleasure will decrease negative outcome expectancies about condom use. Also, reinforcing attempts to use condoms with intimate partners should increase positive outcome expectancies and intention to initiate or maintain condoms with a primary sexual partner.
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The purpose of this paper is to assess sexual behaviours which place heroin sniffers (HSs) at high risk for HIV infection. A stratified network-based sample was used to recruit HSs who had no history of injection drug use was recruited... more
The purpose of this paper is to assess sexual behaviours which place heroin sniffers (HSs) at high risk for HIV infection. A stratified network-based sample was used to recruit HSs who had no history of injection drug use was recruited from the streets of South Florida, USA. HSs displayed a high HIV seroprevalence rate of 12.1%; women (18.1%) were more likely than men (8.7%) to test positive for HIV. Both men and women HSs engaged in considerable high risk sex behaviour, including high risk sex-exchange behaviour. The use of crack cocaine was associated with increased sex exchange behaviour among women. The need for intervention programs targeted toward HSs is discussed.
Research Interests: Psychology, Risk Taking, Humans, Female, Florida, and 15 moreMale, Injecting Drug Use, Heroin Dependence, Hiv Infection, Risk factors, Crack Cocaine, Prevalence, Middle Aged, Risk Reduction, Public health systems and services research, Risk Factors, Safe Sex, AIDS care, High risk, and HIV infections
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It is the purpose of this paper to examine the major research issues in the study of the relationship between crime and drugs and to examine the relevant research literature as it applies to those issues. Typologies are constructed for... more
It is the purpose of this paper to examine the major research issues in the study of the relationship between crime and drugs and to examine the relevant research literature as it applies to those issues. Typologies are constructed for both criminal and drug using behavior and it is argued that the relationship between crime and drugs should be examined for each type of crime and each type of drug. A variety of issues regarding the nature of the relationship are discussed. These issues include the statistical association, causal priority, heroin use and increased, sustained and type of criminal activity, the direction of the causal effect and the ecology of crime and drugs. Finally, it is argued that a longitudinal design is necessary before the complexities of the nature of the crime-drug relationship can begin to be unraveled.
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Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of... more
Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit.
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Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the... more
Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the historical national concern about heroin use has been concern about the increase in crack cocaine use. There has been speculation that crack use may have become a substitute for the higher risk of heroin injection. This article examines the impact of crack use in a national population of heroin users. It was consistently found that there was a correlation between the frequency of crack use and the frequency of speedballing as well as the use of other forms of cocaine, amphetamines, and marijuana. There was also a positive relationship between frequency of crack use and such HIV risk behaviors as renting needles and having a large number of sex partners. The data suggest that in this population of heroin users, crack is not a substitute for heroin but rather is a part of a drug-use pattern that includes an increased use of other drugs and increased high-risk behaviors for contracting HIV.
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ABSTRACT
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Research Interests: Demography, China, Hepatitis C, Drug Use, Hepatitis B, and 15 moreHumans, Female, Male, Disease Prevention, Detoxification, Risk factors, Questionnaires, Methadone, Adult, Cross Section, Risk Factors, Cross Sectional Studies, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
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Cigarette smoking has been identified as an independent risk factor for many human diseases. However, the association between cigarette smoking and illegal drug use has not been thoroughly investigated. We have analyzed the 1994 National... more
Cigarette smoking has been identified as an independent risk factor for many human diseases. However, the association between cigarette smoking and illegal drug use has not been thoroughly investigated. We have analyzed the 1994 National Household Survey on Drug Abuse to clarify whether cigarette smoking has any effect on the initiation of illegal drug use. Data from 17,809 respondents completing the 1994 "new" (1994-B) questionnaire were analyzed. Logistic regression analyses were performed with the use of statistical package SUDAAN, taking into consideration the multistage sampling design. The results show that those who had smoked cigarettes were far more likely to use cocaine (OR = 7.5; 95% CI: 5.7-9.9), heroin (OR = 16.0; 95% CI: 6.8-37.9), crack (OR = 13.9; 95% CI: 7.9-24.5) and marijuana (OR = 7.3; 95% CI: 6.2-8.7). The associations are consistent across age-strata and remain after adjusting for race and gender. This study suggests that cigarette smoking may be a gateway drug to illegal drug use.
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In the United States, a major federally-funded approach to HIV-1 prevention for injecting drug users (IDUs) includes teaching them to always rinse their needles/syringes with household bleach and water before use. This report describes... more
In the United States, a major federally-funded approach to HIV-1 prevention for injecting drug users (IDUs) includes teaching them to always rinse their needles/syringes with household bleach and water before use. This report describes interdisciplinary studies of the extent to which HIV-1 can be found in injection equipment and the efficacy of bleach as a disinfectant, under simulated field conditions. Bloody needle/syringe units collected from Miami, Florida, shooting galleries or from community outreach prevention participants were selected for these studies. Groups of needle/syringe units were cleansed with bleach using a standard technique taught to IDUs in community outreach programs. Cleansed and uncleansed groups of needles/syringe units were then tested for the presence of HIV-1. The data demonstrate the efficacy of bleach rinses in reducing the risks of HIV-1 infection from needle/syringe units and indicate that the teaching of a bleach cleansing method to IDUs should be part of a total AIDS prevention protocol.
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The purpose of this study was to examine the relationships between problem drinking, health services utilization, and the cost of medical care in a community-based setting. In addition to descriptive analyses, these relationships were... more
The purpose of this study was to examine the relationships between problem drinking, health services utilization, and the cost of medical care in a community-based setting. In addition to descriptive analyses, these relationships were estimated with multivariate regression models. Data were collected in 1996 and 1997 through a standardized self-administered questionnaire designed to obtain important information on demographics, health status, morbidity, health care utilization, drug and alcohol use, and related lifestyle behaviors. The survey instrument also included the 10-item Michigan Alcoholism Screening Test (MAST-10), which was used to identify problematic alcohol users (PAUs). The empirical findings indicated that PAUs had a significantly higher number of outpatient visits, more emergency room episodes, and more admissions to a hospital than a combined group of nondrinkers and nonproblematic alcohol users (NPAUs). Analyses of total health care cost showed that the estimated d...
Research Interests: Health Care, Questionnaire design, Drug Use, Humans, Health Service utilization, and 15 moreEmergency Room, Health Services, Alcoholism, Female, Florida, Male, Patient Admission, Medical Care, Health Status, Adult, Multivariate Regression, Health Care Utilization, Interaction effect, Alcohol Use, and Costs and Cost Analysis
This article discusses the impact of insurance status on drug abuse treatment completion in a not-for-profit organization, presents demographic findings, mentions financial obstacles to paying for treatment, and describes the relationship... more
This article discusses the impact of insurance status on drug abuse treatment completion in a not-for-profit organization, presents demographic findings, mentions financial obstacles to paying for treatment, and describes the relationship between different variables: treatment modalities versus type of drug, treatment modality versus length of stay, reason for discharge versus type of drug, and reason of discharge versus treatment status (completed/not completed). Baseline data (n = 6,539) for the period 1990-1997 was analyzed. For the insurance status analysis we randomly selected and analyzed 1,153 client entries. A statistical software package (STATA) was used for a combination of bivariate and multivariate analysis. Our results indicated, consistent with expectations, that lack of health insurance is associated significantly with not completing treatment. Therefore, new strategies and mechanisms of payment should be created to overcome these obstacles and facilitate treatment co...
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The purpose of this paper is to examine the extent of Dilaudid use and characteristics of users in a population of individuals admitted to drug treatment programs over a four-year period. It was found that the number and rate of Dilaudid... more
The purpose of this paper is to examine the extent of Dilaudid use and characteristics of users in a population of individuals admitted to drug treatment programs over a four-year period. It was found that the number and rate of Dilaudid use had increased from 1% of those admitted in 1974 to 10% in late 1977. In comparison to other drug users, Dilaudid users were more likely to be white and middle-class. Dilaudid users were also likely to use the drug intravenously and to obtain it by street buys and to also use heroin. Data suggest that Dilaudid use is easily integrated into a heroin-using life style and may serve as a heroin substitute, and that Dilaudid users are a population that has characteristics similar to the type described as the Southern addict.
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The Key West Housing Authority created SafePort, a residential substance abuse treatment program within public housing to provide drug treatment to parenting women. All family members-women, children, and significant others-receive... more
The Key West Housing Authority created SafePort, a residential substance abuse treatment program within public housing to provide drug treatment to parenting women. All family members-women, children, and significant others-receive comprehensive assessments to determine appropriate therapeutic interventions to resolve their problems. Preliminary evaluation findings suggest that women who participate with their children are more likely to remain drug free than are those who participated without their children.
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To describe and estimate the frequency of different types of drug preparation and injection practices that could result in the transfer of blood and blood-borne infections among injection drug users (IDUs). We analyzed data from... more
To describe and estimate the frequency of different types of drug preparation and injection practices that could result in the transfer of blood and blood-borne infections among injection drug users (IDUs). We analyzed data from interviews administered to 12,323 active IDUs recruited from 19 sites in the United States. The interviews ascertained drug-related behaviors during the previous 30 days. 31.9% of IDUs reported that they engaged in the use of both needle/syringes and cookers/cotton/water previously used by another IDU; 8.6% engaged only in the use of needle/syringes previously used by another IDU; 17.5% engaged only in the use of cookers/cotton/water previously used by another IDU; and 42.0% reported using neither needle/syringes nor cookers/cotton/water previously used by another IDU. Only 12.6% reported use of new (never-used) needle/syringes. The 3935 IDUs who used both needle/syringes and cookers/cotton/water that had been previously used by another IDU had more than 311...
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Bleach cleansing of injection equipment has been recommended to reduce the risk of human immunodeficiency virus (HIV) transmission associated with the reuse of injection equipment by injecting drug users (IDUs). We evaluated the recall... more
Bleach cleansing of injection equipment has been recommended to reduce the risk of human immunodeficiency virus (HIV) transmission associated with the reuse of injection equipment by injecting drug users (IDUs). We evaluated the recall and performance of the most commonly recommended bleach cleansing procedure of two complete fillings of the syringe with bleach, followed by two complete fillings with rinse water, and not putting used bleach and water back into source containers. IDUs were taught this procedure on enrollment in an HIV prevention demonstration project in Dade County, Florida. During follow-up session 6-12 months after initial training, the knowledge and ability of IDUs to perform bleach cleansing were assessed by trained observers using a standardized method. In 1988-90, we assessed the knowledge and ability of 450 IDUs to perform the bleach cleansing procedure taught at enrollment. More than 90% of IDUs assessed performed the basic steps. However, only 43.1% complete...
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To evaluate the effectiveness of bleach disinfection of injection equipment, we tested HIV-1 inactivation by household bleach in needles and syringes. We obtained blood from HIV-1 infected injecting drug users (IDUs), placed small... more
To evaluate the effectiveness of bleach disinfection of injection equipment, we tested HIV-1 inactivation by household bleach in needles and syringes. We obtained blood from HIV-1 infected injecting drug users (IDUs), placed small aliquots in needles and syringes. Blood with and without anticoagulant was incubated at room temperature for 3, 6, 18, and 24 h, and some needles and syringes from each condition were exposed to undiluted bleach for 15 and 30 s. The needles and syringes were then rinsed and the rinses were used to inoculate peripheral blood mononuclear cells (PBMNCs). HIV-1 replication was monitored using p24 enzyme linked immunosorbent assay (ELISA). We describe results that HIV-1 is inactivated in clotted and unclotted blood allowed to stand at room temperature for 3, 6, 18, and 24 h in needles and syringes using undiluted household bleach at 30 s of exposure time. These results are consistent with earlier findings that micropellets of HIV-1 were inactivated by bleach un...
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Socioeconomic status is the most significant factor influencing the decreased survival associated with breast cancer in minority groups in the United States. Barriers to the use of early detection programs by low-income women often result... more
Socioeconomic status is the most significant factor influencing the decreased survival associated with breast cancer in minority groups in the United States. Barriers to the use of early detection programs by low-income women often result in the detection of breast cancer at stages too advanced to assure optimum outcomes. In an effort to increase accessibility of breast cancer screening among such individuals, the Early Detection Program (EDP) was initiated in 1987. The program provided breast cancer screening to women 40 years of age and older who attended eight primary healthcare centers located in low-income neighborhoods throughout Dade County, Florida. From its inception in October 1987 through December 1993, 23,866 medically underserved women had mammography examinations, with more than 17,000 of these women undergoing baseline mammograms. Since the program's inception, 126 cancers were diagnosed in 123 women. A dramatic shift from later to earlier stage breast cancers was...
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The main focus of this study is to present some historical information on inhalant use as well as to review certain findings from the last three decades concerning the "sniffing" of volatile hydrocarbons. Additionally, in order... more
The main focus of this study is to present some historical information on inhalant use as well as to review certain findings from the last three decades concerning the "sniffing" of volatile hydrocarbons. Additionally, in order to examine some suggested hypotheses which have emerged from prior inhalant studies, an analysis of 248 inhalant users who were treated in the emergency room of Jackson Memorial Hospital for reactions to the use of volatile hydrocarbons during a five-year period is presented. These "sniffers" appear to include individuals older than those previously studied and members of a large minority group, to be predominantly Caucasian, and to use primarily a locally manufactured transmission fluid "sealer" known as Transmission-Go.
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Migration adds a complex dimension to the task of those who plan and allocate resources for health care. The authors offer a methodology for estimating the contribution of migration to the incidence of cancer, allow for age- and... more
Migration adds a complex dimension to the task of those who plan and allocate resources for health care. The authors offer a methodology for estimating the contribution of migration to the incidence of cancer, allow for age- and sex-specific cancer risks, and estimate, by country, the impact of recent migration on the annual incidence of cancer in Florida. Cancer and migration data were used to develop estimates of the number of cancer cases for Florida counties that were attributable to recent migrants. A net gain and loss ratio was calculated for new cancer cases in 1980 resulting from the 1975-80 migration pattern. Florida data was used because that State has one of the highest crude cancer incidence rates in the nation, is one of the most populous States, and has a population growth from migration rather than from natural increase. Preliminary findings on the relationship between cancer health services resources and net cancer rates from migration are discussed. County cancer he...
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Diagnosis and treatment of cancers at advanced stages have contributed to a significantly lower survival rate among individuals of low socioeconomic status compared with those in higher brackets. In an effort to increase the accessibility... more
Diagnosis and treatment of cancers at advanced stages have contributed to a significantly lower survival rate among individuals of low socioeconomic status compared with those in higher brackets. In an effort to increase the accessibility and acceptability of cancer screening among such individuals in Dade County, Florida, the Cancer Control Division of the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine initiated a pilot early detection program in 1987. The program initially provided breast cancer screening for women, aged 40 and older, who attended ten community health care centers located in low-income neighborhoods. With the selection of Miami by the American Cancer Society as one of three sites for conducting a screening demonstration project for the socioeconomically disadvantaged, this program has recently been expanded to include pelvic screening for women, aged 40 and older, and prostate screening for men, aged 65 and older.
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The value of mammography for asymptomatic women younger than 50 years of age has been under debate, and it had been suggested that each woman should decide for herself whether to start having mammograms in her 40s. This decision-making... more
The value of mammography for asymptomatic women younger than 50 years of age has been under debate, and it had been suggested that each woman should decide for herself whether to start having mammograms in her 40s. This decision-making process requires women to have knowledge of screening guidelines. This study reported key determining informational factors that led women age 40 and older to obtain a mammogram. To examine the relationship between sources of information and utilization of mammography, the authors conducted a communitywide telephone survey, in English and Spanish, of a stratified random sample of 999 white, black, and Hispanic women in Dade County, Florida. The survey was designed to measure knowledge, attitudes, practices, and beliefs about breast cancer, its prevention, and its early detection. Data for 784 women 40 years and older are analyzed and reported here. The most commonly cited source of information was the media (90.2%). In a logistic regression, having had a checkup in the past year was the strongest predictor of having had a recent mammogram as opposed to a distant one (OR 4.17; 95% CI 2.92-5.95). Women who named their physician as an important source of information about health and prevention were also more likely to have had a recent examination (OR 1.85; 95% CI 1.27-2.69). This analysis of the relationship between the source of information and utilization of mammography suggests that physicians, as sources of information, serve to motivate women to obtain a mammogram. This is true even after taking into account the patient's age and utilization of the healthcare system for preventive care in general. For this reason, it is imperative that clinicians be aware of national guidelines for breast cancer screening; of the risks and benefits of screening measures; and of the implications of a positive and negative test result. In addition, clinicians must realize the importance of follow-up to remind the patient to obtain a mammogram or other screening test and should develop strategies to provide this service.
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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... more
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-of-treatment 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.
Research Interests: Demography, Anthropology, Health Services Research, Drug Use, Humans, and 15 moreHealth Service utilization, Emergency Room, Health Services, Female, Male, Patient Admission, Medical Care, Adult, Public health systems and services research, Multivariate Regression, Health Care Provider, Health Care Costs, Illicit Drug Use, Ambulatory Care, and Managed Care Organization
ABSTRACT
Research Interests: Health Promotion, Poverty, Humans, Female, Feasibility Studies, and 12 moreFlorida, Mammography, Aged, Middle Aged, Adult, Public health systems and services research, Cost Benefit Analysis, Community Health Centers, Health Services Accessibility, Breast Neoplasms, mass Screening, and Paediatrics and reproductive medicine
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Crack cocaine causes blisters, sores, and cuts on the lips and in the mouths of persons who smoke it, and such sores may facilitate the oral transmission of HIV. We recruited young adults aged 18-29 years, who either were current regular... more
Crack cocaine causes blisters, sores, and cuts on the lips and in the mouths of persons who smoke it, and such sores may facilitate the oral transmission of HIV. We recruited young adults aged 18-29 years, who either were current regular crack smokers, or who had never smoked crack, from inner city neighborhoods in New York, Miami, and San Francisco. Participants were interviewed for HIV risk behaviors and history of recent oral sores and were tested for HIV, syphilis, and herpes simplex virus (HSV) antibodies. Among the 2,323 participants recruited, 1,404 (60%) were crack smokers. Crack smokers (10.0%) were more likely than nonsmokers (4.5%) to report having had oral sores in the past 30 days [prevalence odds ratio (POR) 2.4, 95% confidence interval (CI) 1.7-3.4]. Sores were also more prevalent among those who had ever injected drugs (14.3%) than among those who had not (6.7%; POR 2.3, 95% CI 1.7-3.4), and among those with HIV infection (14.3%) than among those without it (8.0%; POR 1.9, 95% CI 1.3-2.8). Among the 429 participants who reported receptive oral sex, those who reported oral sores were more likely than those who did not to have HIV infection, after other HIV risk factors were controlled for (adjusted POR 1.9, 95% CI 1.0-3.6). Our results confirm that crack smokers have a high prevalence of oral sores and provides evidence that these sores, although infrequently, may facilitate oral transmission of HIV.
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Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has... more
Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has led to significant gaps in ...
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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... more
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.
Research Interests: Logistic Regression, Drug Use, Humans, High School, New York City, and 15 moreProstitution, Female, Florida, Sexual Behavior, Hiv Infection, Risk factors, Crack Cocaine, Adult, Odds ratio, Risk Factors, Risk Behavior, Sexually Transmitted Disease, Logistic Models, Paediatrics and reproductive medicine, and HIV infections
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... more
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.
Research Interests: Drug Use, Humans, Female, Florida, Male, and 15 moreSexual Behavior, HIV Prevention, Hiv Infection, Evaluation Studies, Adult, Public health systems and services research, Sex Factors, Protective and Risk Factors, Risk Behavior, Homeless Persons, Risk and Protective Factors, High risk, Paediatrics and reproductive medicine, Residence Characteristics, and HIV infections
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... more
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.
Research Interests: Public Health, Drug Use, Prospective studies, Humans, Female, and 15 moreFlorida, Cohort Study, Behavior change, Crack Cocaine, African Americans, Condom use, Middle Aged, Adult, Odds ratio, Risk Behavior, Generalized estimating equation, Community health services, Hypothesis Test, Paediatrics and reproductive medicine, and HIV infections
Chronic drug users demonstrate a need for access to health care due to both acute health problems related directly to substance use and to other existing medical problems. This study attempts to examine how women differ from men in their... more
Chronic drug users demonstrate a need for access to health care due to both acute health problems related directly to substance use and to other existing medical problems. This study attempts to examine how women differ from men in their utilization of health services. Also, it analyzes how crack use affects men and women differentially. The study population is a community-based sample of 624, comprised equally of men and women, as well as crack users and non-users of crack. Results indicate that women utilized health care more than men; however, crack use among women appears to be an inhibitory factor in the utilization of health services by women.
Research Interests: Health Care, Adolescent, Drug Use, Humans, Needs Assessment, and 15 moreHealth Services, Female, Health Care Services, Florida, Male, Crack Cocaine, Access to Health Care, Adult, Health Problems, Public health systems and services research, Health Care Utilization, Logistic Models, Health Care Surveys, Paediatrics and reproductive medicine, and HIV infections
Correlates of crack cocaine use were studied among a targeted sample of migrant workers and their sexual partners (n = 571) in rural Southern Florida. Employment among men and recent drug-user treatment among men and women are positively... more
Correlates of crack cocaine use were studied among a targeted sample of migrant workers and their sexual partners (n = 571) in rural Southern Florida. Employment among men and recent drug-user treatment among men and women are positively related to crack use, as is involvement in crime and prostitution. Among women but not men, living with children is negatively related to crack use. Drug use and HIV prevention programs should intervene with individuals and their families and social groups. Migrant workers and their sexual partners also need effective drug-user treatment with long-term relapse prevention services.
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Most studies of unemployment among chronic drug users (CDUs) are drug-user treatment-based and there is little information on employment/unemployment among CDUs not in treatment. Between June 2003 and September 2004, 492 CDUs in... more
Most studies of unemployment among chronic drug users (CDUs) are drug-user treatment-based and there is little information on employment/unemployment among CDUs not in treatment. Between June 2003 and September 2004, 492 CDUs in Miami-Dade, Florida, were administered a quantitative survey at baseline and 6 months later; employment status was measured. Descriptive statistics showed that only 15% were employed at both periods, an equal percentage becoming employed and unemployed at 6 months. The majority of CDUs were unemployed at both time periods. Men were more likely than women to exhibit consistent employment over the two time periods. The study's limitations are noted and future research is suggested.
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The dual purpose of this study was to: (1) determine whether problematic drug users, defined through the Drug Abuse Screening Test (DAST-10), exhibited differences in health services utilization and cost relative to a combined group of... more
The dual purpose of this study was to: (1) determine whether problematic drug users, defined through the Drug Abuse Screening Test (DAST-10), exhibited differences in health services utilization and cost relative to a combined group of non-problematic drug users and non-drug users; and (2) assess whether the findings were similar to those for chronic drug users (CDUs) and injecting drug users (IDUs). Results showed that health services utilization and total cost were very similar for problematic drug users defined through quantity-frequency (i.e., CDU, IDU) and diagnostic (i.e., DAST-10) criteria. Findings suggest that quantity/frequency criteria for problematic drug use were reasonable approximations for diagnostic-based measures.
Research Interests: Psychology, Psychometrics, Public Health, Comparative Study, Drug Use, and 15 moreHumans, Substance Abuse, Health Service utilization, Substance Use, Health Services, Female, Florida, Male, Drug Addiction, Drug abuse, Psychological Tests, Cost Analysis, Adult, Substance use and misuse, and Substance-Related Disorders
This study compared rural and urban crack-using women and examined their responses to two interventions. A prospective cohort study design was employed to assess the effectiveness of standard and innovative HIV prevention interventions on... more
This study compared rural and urban crack-using women and examined their responses to two interventions. A prospective cohort study design was employed to assess the effectiveness of standard and innovative HIV prevention interventions on 541 urban and 268 rural women in Florida. Generalized estimating equation analysis, accounting for repeated measures, found that for combined urban and rural samples, the innovative intervention was more effective than the standard for a number of drug and sexual risk behaviors. However, the analysis indicated no significant differences in intervention efficacy between rural and urban women. The results imply that there is a need for similar HIV prevention services in both areas.
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Evaluation of recall and performance skills required to clean needles/ syringes was conducted in Dade County with 393 injecting drugs users (IDUs) in 1988-1989. The study was guided by a question of the extent of correct cleaning of... more
Evaluation of recall and performance skills required to clean needles/ syringes was conducted in Dade County with 393 injecting drugs users (IDUs) in 1988-1989. The study was guided by a question of the extent of correct cleaning of needles/syringes. A free recall procedure which combined cognitive and psychomotor testing provided a means of verifying knowledge and skills. The results show that injecting drug users were able to learn and retain knowledge and skills necessary to prevent risk of HIV infection by use of needles/syringes. Tests of knowledge and performance 6 months after training showed high retention of the material learned. The population at risk is capable of reducing the spread of HIV. The impact would be greater with perfect performance, but even with partial performance, some preventative impact could be assumed provided exposure time to bleach exceeds 30 seconds.
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The primary objective of this paper is to investigate the relationship between sustained illicit drug use and the utilization of primary preventive health care. Data from 1254 African-American, Hispanic/Latino, and non-Hispanic/Latino... more
The primary objective of this paper is to investigate the relationship between sustained illicit drug use and the utilization of primary preventive health care. Data from 1254 African-American, Hispanic/Latino, and non-Hispanic/Latino white men and women collected in 1996-1997 were analyzed to determine independent risk factors for the utilization of primary preventive health care that was not received as a result of seeking treatment for a specific health condition. When several demographic, health, and drug use variables were assessed in a logistic regression model, gender, ethnicity, health insurance status, drug use, and alcohol use were independently associated with primary preventive care. Women, Hispanic/Latinos, and persons who had health insurance were more likely to have received primary preventive health care while injection drug users, other sustained drug users, and "heavy" alcohol users were less likely to have used primary preventive health care services in the past year.
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This study sought to investigate treatment-seeking behaviors among drug users in rural populations and how they compare to their urban counterparts. Data for this analysis were drawn from the Miami and Immokalee sites of the National... more
This study sought to investigate treatment-seeking behaviors among drug users in rural populations and how they compare to their urban counterparts. Data for this analysis were drawn from the Miami and Immokalee sites of the National Institute on Drug Abuse's Cooperative Agreement Program for AIDS outreach/intervention research study targeting high-risk out-of-treatment injection drug users and crack smokers. Findings indicate that Miami subjects were 2.57 times more likely to have been in drug treatment compared to their rural counterparts. This differential may be explained in terms of the availability, accessibility, and acceptability of health care services.
Research Interests: Psychology, Humans, Chronic Disease, Female, Florida, and 15 moreMale, Confidence intervals, Crack Cocaine, Middle Aged, Adult, Odds ratio, Retrospective Studies, Substance use and misuse, Urban Population, Rural Health Services, Logistic Models, Drug treatment, Socioeconomic Factors, Health Care Surveys, and Rural Population
While the first decade of the AIDS epidemic was characterized by high prevalence rates of AIDS infection in urban areas, there is increasing recognition of the spread of HIV into rural communities in the United States. Data from the Miami... more
While the first decade of the AIDS epidemic was characterized by high prevalence rates of AIDS infection in urban areas, there is increasing recognition of the spread of HIV into rural communities in the United States. Data from the Miami CARES cohort collected on 3,555 chronic drug users from 1988 to 1994 provide a unique opportunity to assess sociodemographic characteristics, drug-using behaviors and HIV risk behaviors related to HIV seropositivity in three communities across the rural-urban continuum: Miami, Florida; Belle Glade, Florida and Immokalee, Florida. The three very different communities studied demonstrate that HIV is no respecter of ecological site. The spread of HIV between areas and within areas is specifically correlated with the risk factors including injection drug use, use of crack cocaine, exchange of sex for money, and the rates for sexually transmitted diseases. All of these factors are shown to increase the risk of HIV so that the constellation of these practices helps determine the differential rates and spread of HIV in the three different areas.
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Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of... more
Asian countries adjacent to the Golden Triangle and their neighbors have witnessed an evolution in "drug abuse" from traditional opium smoking to heroin eating, smoking, and finally heroin injection. A recent study of 630 heroin users was conducted in China's Yunnan Province, located close to the Golden Triangle. Data collected between August 1997 and February 1998 indicate injecting heroin users, in comparison to noninjectors, were more likely to have used drugs for a longer period of time, and to use drugs more frequently everyday. Other major differences existed between urban and rural subjects, especially highlighting differences between men and women. Women comprised a much higher proportion of urban subjects than rural subjects. Rural injectors were much more likely to be male, but urban injectors were almost evenly split between men and women. The emerging epidemic of heroin use in China and the continuing substance abuse problem in the United States provide an opportunity for collaborative research of mutual benefit.
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... First citation in article. Hubbard, Robert L., ME Marsden, J. Valley Rachal, Henrick J. Harwood, E. Cavenaugh, and H. Ginzburg. ... For their assistance in providing data for this analysis, we gratefully acknowledge Kenneth DeCerchio,... more
... First citation in article. Hubbard, Robert L., ME Marsden, J. Valley Rachal, Henrick J. Harwood, E. Cavenaugh, and H. Ginzburg. ... For their assistance in providing data for this analysis, we gratefully acknowledge Kenneth DeCerchio, Ronald Morrell, and Sen Yoni Musingo of the ...
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... The authors thank two anonymous referees for useful comments, Silvana Zavala for her excellent research assistance, M. Christopher Roebuck and Katherine McCollister for many helpful suggestions on earlier versions of the paper, and... more
... The authors thank two anonymous referees for useful comments, Silvana Zavala for her excellent research assistance, M. Christopher Roebuck and Katherine McCollister for many helpful suggestions on earlier versions of the paper, and Carmen Martinez for her ex-ceptional ...
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Research Interests: Breast Cancer, Health insurance, Logistic Regression, Humans, African American, and 15 moreCox Regression, Female, Aged, Middle Aged, Breast Cancer Screening, Early Detection, Adult, Cancer Registry, Confidence Interval, Florida Keys, Cohort Studies, Breast neoplasm, Health Services Accessibility, Breast Neoplasms, and mass Screening
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Miami is one of the major centers of illegal drug activity and has a significant proportion of AIDS cases among injection drug users (IDUs). Since Needle Exchange Programs (NEP) are illegal and therefore do not exist in the state of... more
Miami is one of the major centers of illegal drug activity and has a significant proportion of AIDS cases among injection drug users (IDUs). Since Needle Exchange Programs (NEP) are illegal and therefore do not exist in the state of Florida, other strategies must play a large role in reducing the transmission of HIV among IDUs. In order to effectively communicate with IDUs about needle safety, it is necessary to understand the practices and culture of IDUs, including where and how the needle/syringes are obtained and used. Data from recent studies conducted in Miami and other local sites indicate that IDUs inject frequently, averaging more than 1,000 per year, per person. While the vast majority of IDUs feel it is very important to clean needles and to use a needle only one time, these sentiments are not always practiced. Furthermore, data indicate that the context where shooting takes place must be considered in the planning of HIV risk reduction interventions. These findings suggest the importance of understanding patterns of drug use, attitudes toward intervention, and the cultural context where risky behaviors occur. Although Needle Exchange Programs are illegal in Florida, intervention programs must still stress the importance of using only new needles, but since new needles cannot always be obtained, IDUs should be taught and motivated not to use contaminated drug paraphernalia.
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Belle Glade, Florida, an agricultural community in the heart of the state's vegetable and sugar cane production areas, has the highest cumulative per capita incidence of AIDS in the United States. A risk reduction intervention... more
Belle Glade, Florida, an agricultural community in the heart of the state's vegetable and sugar cane production areas, has the highest cumulative per capita incidence of AIDS in the United States. A risk reduction intervention program was introduced to lessen unsafe AIDS-related behaviors and to generate data on the epidemiology of HIV infection. Initial attention focused on individuals who were believed to be at the core of the transmission pattern, injection drug users and their sexual partners. We found, however, that injection drug use was much less widespread than anticipated. Results suggested that the primary mode of HIV transmission is heterosexual intercourse-mediated by drug taking (particularly crack smoking) and a flourishing sex industry-a finding that is corroborated by the increased and disproportionate rate of heterosexual AIDS in Belle Glade. The prevalence and types of risk behaviors engaged in would not have been completely explained without the use of ethnographic methods including observation of, and lengthy interviews with, the populations at risk.
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Since crack cocaine appeared in urban areas in the United States in the mid-1980s, reports have suggested that crack smokers may be at increased risk of sexually transmitted diseases (STDs), including infection with HIV, because they have... more
Since crack cocaine appeared in urban areas in the United States in the mid-1980s, reports have suggested that crack smokers may be at increased risk of sexually transmitted diseases (STDs), including infection with HIV, because they have multiple sex partners, trade sex for money or drugs, and rarely use condoms. A cross-sectional survey is being conducted in urban neighborhoods in Miami, New York and San Francisco--where crack use is common--to explore these issues. Indigenous street outreach workers are recruiting men and women who are either current regular crack smokers or who have never smoked crack; each group is further stratified according to whether participants had ever injected drugs. Participants were interviewed about their sexual and drug-use practices. Overall, crack smokers, whether injectors or not, engaged in higher-risk sexual behaviors than nonsmokers, reported greater numbers of sex partners than nonsmokers, and were more likely than nonsmokers to have exchanged sex for money or drugs or to have had an STD. Differences between crack smokers and nonsmokers were generally greater among non-injectors than among injectors, and generally greater among women than among men. Condom use, although somewhat more common with paying than nonpaying partners, was infrequent overall. Most of the subjects had not been in substance abuse treatment in the preceding 12 months, and a majority had never been in substance abuse treatment. Education and prevention programs specifically targeted at crack smokers not currently in substance abuse treatment are needed to reach these high-risk persons.
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Data are analyzed from the Multicenter Study of Crack Cocaine and HIV Infection in Miami, Florida, examining interrelationships among use of crack cocaine, use of other drugs, sexual activity, and exchange of sex for money and drugs. This... more
Data are analyzed from the Multicenter Study of Crack Cocaine and HIV Infection in Miami, Florida, examining interrelationships among use of crack cocaine, use of other drugs, sexual activity, and exchange of sex for money and drugs. This study was designed to recruit two groups of approximately equal size: persons who reported current use of crack cocaine three or more times per week, and those who had never used crack. Participants (N = 641) were recruited in Miami. Participants' median age for first use of crack cocaine was higher than for use of alcohol, marijuana or powdered cocaine. It was also higher than participants' ages at first sexual activity, and somewhat higher than the median age for reporting initiation of trading sex for money or drugs. The median age of first crack use was lower among younger participants, suggesting that crack use in older participants followed quickly upon availability of the drug. Crack users reported reduced desire for sex and diminished ability to have sex after smoking crack. However, crack use was associated with increased sexual activity, trading sex for money or drugs, and sex with multiple partners. Participants who traded sex for money or drugs (traders) reported higher rates of condom use than nontraders; however, neither traders nor nontraders reported rates of condom use sufficient to substantially reduce the transmission of sexually transmitted diseases and HIV infection.
Research Interests: Psychology, Adolescent, Humans, Psychoactive Drugs, Prostitution, and 13 moreFemale, Florida, Male, Sexual Behavior, Hiv Infection, Crack Cocaine, Condom use, Adult, Public health systems and services research, Age Factors, Sexual Activity, Sexually Transmitted Disease, and Substance-Related Disorders
This article examines the multifaceted interactions among homelessness, HIV, substance abuse, and gender. Data were collected on 1,366 chronic drug users using a nationally standardized validated instrument within the Miami CARES project... more
This article examines the multifaceted interactions among homelessness, HIV, substance abuse, and gender. Data were collected on 1,366 chronic drug users using a nationally standardized validated instrument within the Miami CARES project of a multisite federally funded program. HIV testing accompanied by pretest and posttest counseling was conducted on-site by certified phlebotomists and counselors. In addition to descriptive analyses and corresponding tests of significance, logistic regression analyses were used to clarify the complex associations between the outcome variables of homelessness and HIV, recognizing difficulties of determining temporal sequence. HIV infection was found to be 2.35 times more prevalent among homeless women than homeless men and significantly higher for homeless women. The findings indicate that among women, homelessness and HIV have a highly interactive effect increasing the vulnerability of this population and thus rendering them an extremely important priority population on which to focus public health efforts and programs.
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Recent federal health financing and health care delivery programs have increased access to alcohol and other drug abuse treatment programs for low-income women, and have provided intervention and prevention services for their children and... more
Recent federal health financing and health care delivery programs have increased access to alcohol and other drug abuse treatment programs for low-income women, and have provided intervention and prevention services for their children and families. The Village South Families in Transition (FIT) in Miami, Florida, implemented a residential treatment program for women and their children that aims to decrease alcohol and other drug use, reduce reliance on social and health welfare systems, improve functioning in specific life-skill and vocational areas, improve parenting techniques and maternal/child relations, and provide intervention and prevention services for the clients' children in a safe and supportive environment. Program implementation required resolutions to numerous barriers, including securing a facility for women and children; recruiting, hiring and training of staff; establishing and maintaining community linkages; treatment considerations; balancing treatment versus evaluation/research; and critical decisions faced by treatment staff as they modify client-centered programs to incorporate gender-specific and family-centered programs.
Research Interests: Psychology, Family Therapy, Child Care, Psychoactive, Humans, and 15 moreChild, Models, Substance Abuse, Psychoactive Drugs, Child Abuse, Alcoholism, Female, Florida, Drug Addiction, Child custody, Health Care Delivery, Adult, Public health systems and services research, Low Income, and Residential Treatment Care
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The epidemiology of cocaine abuse and potential relationships of cocaine withdrawal to human immunodeficiency virus type 1 (HIV-1)-associated dementia (HAD) are discussed. Neuroendocrinological changes in HIV-1 infection of the central... more
The epidemiology of cocaine abuse and potential relationships of cocaine withdrawal to human immunodeficiency virus type 1 (HIV-1)-associated dementia (HAD) are discussed. Neuroendocrinological changes in HIV-1 infection of the central nervous system (CNS) are discussed with the relevant impact of cocaine abuse. HIV-1 load in the brain tissue of infected substance users is described along with possible associations with neuropathology and HAD. Finally, the molecular epidemiology and sequence heterogeneity of HIV-1 and their implications for neuropathogenesis are summarized. The complex context of addressing cocaine abuse in the setting of HIV-1 infection appears more tractable when decomposed into its components.
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Research Interests: Pain, Menopause, Anxiety, Humans, Caffeine, and 6 moreFemale, Breast, Menstrual Cycle, Mammography, Middle Aged, and ANXIETY
Research Interests: Haiti, Breast Cancer, Culture, Ethnic minorities, Acculturation, and 14 moreCommunity Based Participatory Research, Community Health Workers, Humans, Female, Florida, Immigrant, Mammography, Ethnic Groups, Cost Efficiency, Public health systems and services research, Prognosis, Ethnic Minorities, Rapid Assessment, and Breast Neoplasms
An Emerging Public Health Model for Reducing AIDS-Related Risk Behavior Among Injecting Drug Users and Their Sexual Partners Clyde B. McCoy, PhD James E. Rivers, PhD Elizabeth L. Khoury, RN, MA SUMMARY. An efficient and cost-effective... more
An Emerging Public Health Model for Reducing AIDS-Related Risk Behavior Among Injecting Drug Users and Their Sexual Partners Clyde B. McCoy, PhD James E. Rivers, PhD Elizabeth L. Khoury, RN, MA SUMMARY. An efficient and cost-effective public health model for ...
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Clyde B. McCoy, Norman L. Weatherby, Lisa R. Metsch, and James E. Rivers are affiliated with the Comprehensive Drug Research Center and Departments of Epidemiology and Sociology, University of Miami. H. Virginia McCoy is affili-ated with... more
Clyde B. McCoy, Norman L. Weatherby, Lisa R. Metsch, and James E. Rivers are affiliated with the Comprehensive Drug Research Center and Departments of Epidemiology and Sociology, University of Miami. H. Virginia McCoy is affili-ated with the Comprehensive ...
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Research Interests: Breast Cancer, Community Health, Community, Research, Humans, and 12 moreFemale, Florida, Cluster Analysis, Middle Aged, Adult, Public health systems and services research, Young Women, Consumer Participation, Environmental Pollutants, Community Based Organization, Epidemiologic Studies, and Breast Neoplasms
Interviews of low-income women in Miami, FL, addressed reproductive health issues in a stratified, network-referred sample of chronic drug users (CDUs) and socially and ethnically similar women who were not CDUs. Women who were not CDUs... more
Interviews of low-income women in Miami, FL, addressed reproductive health issues in a stratified, network-referred sample of chronic drug users (CDUs) and socially and ethnically similar women who were not CDUs. Women who were not CDUs were significantly more likely to report a regular source of health care than CDUs. About one third of each group reported experiencing reproductive health problems (other than pregnancy) in the 12 months preceding their interview. Chronic drug users were twice as likely to report that these problems remained untreated. Measures of use of preventive services (physical exam, breast exam, pelvic exam, family planning visit) consistently showed lower use by CDUs. A higher proportion of women who were not CDUs reported pregnancies in the 12 months preceding interview. The 32 pregnant CDUs were much less likely to have received prenatal care than the 42 pregnant women who were not CDUs. For women who reported a pregnancy in the year preceding interview, logistic regression analysis showed a strong and robust negative effect of being a CDU on receiving prenatal care even when the effects of having a usual source of care and having third-party coverage were controlled.
Research Interests: Poverty, Health Care, Health Services Research, Adolescent, Drug Use, and 15 moreHumans, Chronic Disease, Female, Florida, Logistic Regression Analysis, Family Planning, Adult, Heatlh services and reproductive health, Pregnant Women, Low Income, Behavioral Health Services, Preventive Health Services, Prenatal Care, Health Services Accessibility, and Interviews as topic
Cigarette smoking has been identified as an independent risk factor for many human diseases. However, the association between cigarette smoking and illegal drug use has not been thoroughly investigated. We have analyzed the 1994 National... more
Cigarette smoking has been identified as an independent risk factor for many human diseases. However, the association between cigarette smoking and illegal drug use has not been thoroughly investigated. We have analyzed the 1994 National Household Survey on Drug Abuse to clarify whether cigarette smoking has any effect on the initiation of illegal drug use. Data from 17,809 respondents completing the 1994 "new" (1994-B) questionnaire were analyzed. Logistic regression analyses were performed with the use of statistical package SUDAAN, taking into consideration the multistage sampling design. The results show that those who had smoked cigarettes were far more likely to use cocaine (OR = 7.5; 95% CI: 5.7-9.9), heroin (OR = 16.0; 95% CI: 6.8-37.9), crack (OR = 13.9; 95% CI: 7.9-24.5) and marijuana (OR = 7.3; 95% CI: 6.2-8.7). The associations are consistent across age-strata and remain after adjusting for race and gender. This study suggests that cigarette smoking may be a gateway drug to illegal drug use.
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Research Interests: Health Education, Multivariate Analysis, Humans, Behavior Therapy, Female, and 15 moreMale, Sexual Behavior, Gender Difference, Behavior change, Crack Cocaine, Condom use, Aged, Middle Aged, Questionnaires, Adult, Sex Factors, Analysis of Variance, Curriculum and Pedagogy, Condoms, and Cross Sectional Studies
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Research Interests: Demography, China, Hepatitis C, Drug Use, Hepatitis B, and 15 moreHumans, Female, Male, Disease Prevention, Detoxification, Risk factors, Questionnaires, Methadone, Adult, Cross Section, Risk Factors, Cross Sectional Studies, Psychology and Cognitive Sciences, Medical and Health Sciences, and HIV infections
... DETERMINANTS OF CONDOM USE AMONG AFRICAN AMERICANS WHO SMOKE CRACK COCAINE 23 ... A 26 year-old woman described one such situation in which she received $75, instead of her usual fee of $100 because she insisted on her patron wearing... more
... DETERMINANTS OF CONDOM USE AMONG AFRICAN AMERICANS WHO SMOKE CRACK COCAINE 23 ... A 26 year-old woman described one such situation in which she received $75, instead of her usual fee of $100 because she insisted on her patron wearing a condom. ...
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The optimum therapy for hairy cell leukemia (HCL) is controversial. Dramatic responses to interferon-alpha and 2'-deoxycoformycin overshadow the established role of splenectomy in HCL, and patients currently can avoid surgery... more
The optimum therapy for hairy cell leukemia (HCL) is controversial. Dramatic responses to interferon-alpha and 2'-deoxycoformycin overshadow the established role of splenectomy in HCL, and patients currently can avoid surgery altogether. A case is presented of clinical remission lasting 32 years after splenectomy--a prolonged normal life, without medication or medical intervention. When relapse occurred, the patient's response to interferon-alpha was prompt and predictable. Prognostic variables are an important consideration at the time of diagnosis in predicting the response to splenectomy.
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The 5-year survival of cancer of the breast in socioeconomically disadvantaged women is much too low because treatment is given for late stage disease. A screening mammography program at primary-care facilities for medically underserved... more
The 5-year survival of cancer of the breast in socioeconomically disadvantaged women is much too low because treatment is given for late stage disease. A screening mammography program at primary-care facilities for medically underserved women has markedly increased in situ and local stage of disease and decreased distant disease. This has produced an estimated 50% decrease in mortality and a significant decrease in treatment costs. Unacceptable delay from positive mammogram to biopsy and pathologic diagnosis remained, so a one-stop breast center was established to perform breast physical examination, screening mammography, biopsy, and pathologic interpretation at one site on one visit for optimal cost-effectiveness.
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A 6-year experience of providing mammograms to the socioeconomically disadvantaged in Dade County, Florida, through Primary Health Care Centers has defined a breast cancer control program that minimizes the barriers to early breast cancer... more
A 6-year experience of providing mammograms to the socioeconomically disadvantaged in Dade County, Florida, through Primary Health Care Centers has defined a breast cancer control program that minimizes the barriers to early breast cancer detection for these women. First, an education and recruitment phase that reaches into the community to solicit the target group: Recruitment is needed more than education. Second, a low-cost mammography service that also reaches into the community and makes it available, accessible, and acceptable. Third, a one-stop breast center that minimizes the barriers to diagnostic evaluation. Finally, a multidisciplinary evaluation and treatment planning program offers optimum treatment options to the patient with newly diagnosed breast cancer and an opportunity for bonding between her and the staff. A research overly has allowed data to be collected continuously and provides an evaluation of the effectiveness of the program. This program has saved lives by reducing the projected mortality rate and has saved money by reducing the cost of treatment through earlier diagnosis. All four components are essential to a breast cancer control program for the socioeconomically disadvantaged.
Research Interests: Poverty, Cancer, Breast Cancer, Health Education, Humans, and 13 moreFemale, Florida, Mammography, African Americans, Adult, Patient Care Team, Survival Rate, Cost Benefit Analysis, European Continental Ancestry Group, Health Services Accessibility, Breast Neoplasms, Neoplasm staging, and mass Screening
To explore cancer incidence among Hispanic women living in Dade County, Florida, data were analyzed from the statewide cancer registry. For all but three sites, Hispanics had lower rates of the 15 most prevalent cancers than... more
To explore cancer incidence among Hispanic women living in Dade County, Florida, data were analyzed from the statewide cancer registry. For all but three sites, Hispanics had lower rates of the 15 most prevalent cancers than non-Hispanics. However, higher rates of cancer among Hispanics were noted for cancers of the gallbladder, liver, and heart and soft tissue. Subgroups of women had significantly higher rates of cervical cancer and thyroid cancer. Lower rates among Hispanics were observed for cancers of the esophagus, vagina, breast, colon, buccal cavity and pharynx, and malignant melanoma. These data suggest that most cancer sites traditionally higher among US Latino women were not higher among Dade Hispanics, and that sites more common among non-Hispanics have not yet shown an increased incidence among Hispanic women in Dade County.
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This study investigates continuing risk behaviors among HIV-seropositive chronic drug users in Miami, Florida. Data were collected on 490 injecting and noninjecting seropositive drug users. Results indicate that from baseline to... more
This study investigates continuing risk behaviors among HIV-seropositive chronic drug users in Miami, Florida. Data were collected on 490 injecting and noninjecting seropositive drug users. Results indicate that from baseline to follow-up, HIV-seropositive injectors and non-injectors reported significant decreases of approximately 50% in risky sexual and injecting practices (IDUs only) associated with transmission of HIV. However, our findings also indicate
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Abstract. Six hundred and one injection drug users (IDUs) who attended drug treatment programs in Miami, Florida, were enrolled in a panel study to determine the prevalence and incidence of human immunodeficiency virus (HIV) and... more
Abstract. Six hundred and one injection drug users (IDUs) who attended drug treatment programs in Miami, Florida, were enrolled in a panel study to determine the prevalence and incidence of human immunodeficiency virus (HIV) and associated risk factors. A structured ...
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ABSTRACT
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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... more
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.
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We have limited information regarding the sexual risk behaviors of HIV-positive individuals in Argentina. It is important to understand these behaviors in order to develop strategies oriented at decreasing unsafe sex practices. A random... more
We have limited information regarding the sexual risk behaviors of HIV-positive individuals in Argentina. It is important to understand these behaviors in order to develop strategies oriented at decreasing unsafe sex practices. A random sample of 140 HIV-positive individuals was recruited from an HIV primary care clinic in Buenos Aires, Argentina, between August and September 2005. Participants responded survey questions regarding their sexual behaviors in the previous three months. Logistic regression analysis was used to determine factors associated with inconsistent condom use during vaginal, anal, and oral sex. Of the 140 participants surveyed, 69% were male, the mean age was 38 years old, 29% reported having less than a high school education, and 84% reported having engaged in vaginal, anal, and/or oral sex in the past 3 months. Of 53 participants who reported engaging in anal sex, 60% were men who have sex with men, and 40% were heterosexuals. Inconsistent condom use was reported by 31% of participants engaging in anal sex, 39% of participants engaging in vaginal sex, and 71% of participants engaging in oral sex. When adjusting for other factors, participants reporting symptoms of depression were 5.2 times more likely to use condoms inconsistently during vaginal sex, and 4.3 times more likely to use condoms inconsistently during anal sex compared to participants reporting no depression symptoms. Providers should assess sexual risk practices of HIV-positive individuals reporting symptoms of depression, and provide counseling regarding the importance of consistent condom use to those patients who are engaging in unsafe sex practices.
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Research Interests: Risk Taking, Humans, Female, Florida, Male, and 14 moreInjecting Drug Use, Follow-up studies, Heroin Dependence, Incidence, Adult, Public health systems and services research, Hiv seropositivity, Risk Behavior, Sexual Partners, Cross Sectional Studies, Sexual Risk Behavior, Unsafe Sex, Needle Sharing, and Cohort Studies
Numerous interventions have been developed and implemented to decrease risk behaviors which lead to HIV infection and transmission. These interventions have been differentially successful in reducing high risk behaviors in various... more
Numerous interventions have been developed and implemented to decrease risk behaviors which lead to HIV infection and transmission. These interventions have been differentially successful in reducing high risk behaviors in various populations. Testing and evaluation of the interventions have been subject to various degrees of rigor. The CDC recommends the use of interventions which have been rigorously tested and meet the standards for evidence based intervention rather than the continuation of the development of new interventions. Project RESPECT is an evidence based intervention that proved efficacious in increasing condom use among patients of STD clinics. We tested the efficacy of the RESPECT intervention against the NIDA standard intervention to determine if the RESPECT intervention was more effective in reducing high risk behaviors among drug users. Both interventions showed changes from baseline to follow-up; RESPECT was more effective than the NIDA standard intervention in reducing high risk sex behaviors.
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To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries. Collation and review of existing estimates of IDU... more
To provide global estimates of the prevalence of injecting drug use (IDU) and HIV prevalence among IDU, in particular to provide estimates for developing and transitional countries. Collation and review of existing estimates of IDU prevalence and HIV prevalence from published and unpublished documents for the period 1998-2003. The strength of evidence for the information was assessed based on the source and type of study. Estimates of IDU prevalence were available for 130 countries. The number of IDU worldwide was estimated as approximately 13.2 million. Over ten million (78%) live in developing and transitional countries (Eastern Europe and Central Asia, 3.1 million; South and South-east Asia, 3.3 million; East-Asia and Pacific, 2.3 million). Estimates of HIV prevalence were available for 78 countries. HIV prevalence among IDU of over 20% was reported for at least one site in 25 countries and territories: Belarus, Estonia, Kazakhstan, Russia, Ukraine, Italy, Netherlands, Portugal, Serbia and Montenegro, Spain, Libya, India, Indonesia, Malaysia, Myanmar, Nepal, Thailand, Viet Nam, China, Argentina, Brazil, Uruguay, Puerto Rico, USA and Canada. These findings update previous assessments of the number of countries with IDU and HIV-infected IDU, and the previous quantitative global estimates of the prevalence of IDU. However, gaps remain in the information and the strength of the evidence often was weak.
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HIV/AIDS transmission among drug users is associated with education, sex practices and substance use. This study examined 159 drugs users’ knowledge, beliefs and sex behavior related to HIV/AIDS risk in Costa Rica. Results showed... more
HIV/AIDS transmission among drug users is associated with education, sex practices and substance use. This study examined 159 drugs users’ knowledge, beliefs and sex behavior related to HIV/AIDS risk in Costa Rica. Results showed considerable use of marihuana, alcohol, crack and cocaine and a very low lifetime incidence of other drugs. All substance use patterns were higher than national averages. Respondents showed a high level of knowledge about HIV/AIDS transmission and prevention. However, there did not seem to be a relationship between knowledge and practice. Unprotected sex was common and having an HIV/AIDS test was not a regular practice. Knowledge about HIV/AIDS is not a determinant factor for condom use among this group. It is concluded that having the proper knowledge about transmission and prevention does not guarantee safe sex practices. Further research and public health evidence based practices for HIV/AIDS prevention should target drug user population.