- I have enjoyed more than 50 years as an academic teacher and researcheredit
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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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.