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ABSTRACT: A randomized trial was conducted to test the effectiveness of couple-based HIV counseling and testing (CB-HIV-CT) and women-only relationship-focused HIV counseling and testing (WRF-HIV-CT) in reducing HIV risk compared to the National Institute on Drug Abuse HIV-CT standard intervention. Substance using HIV-negative women and their primary heterosexual partner (N = 330 couples) were randomized to 1 of the 3 interventions. Follow-up assessments measuring HIV risk behaviors and other relevant variables were conducted at 3- and 9-months postintervention. Repeated measures generalized linear mixed model analysis was used to assess treatment effects. A significant reduction in HIV risk was observed over the 9-month assessment in the CB-HIV-CT group compared to that of the control group (b = -0.51, t[527] = -3.20, P = 0.002) and compared to that of the WRF-HIV-CT group (b = -0.34, t[527] = -2.07, P = 0.04), but no significant difference was observed between WRF-HIV-CT and controls (b = -0.17, t[527] = -1.09, P = 0.28). A brief couple-based HIV counseling and testing intervention designed to address both drug-related and sexual risk behaviors among substance using women and their primary male partners was shown to be more effective at reducing overall HIV risk compared to a standard HIV-CT intervention in an urban setting.
Advances in preventive medicine. 01/2013; 2013:286207.
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ABSTRACT: Only lung cancer surpasses breast cancer as a cause of death from cancer. However, the burden of cancer is not borne equally across racial and ethnic groups. In the United States, African American women have significantly higher mortality rates from breast cancer than white women. Delayed follow-up of breast abnormalities and delays from diagnosis to treatment may contribute to higher mortality. This study examined factors associated with delays to diagnosis and treatment of breast cancer in a group of white and African American women. Identified from tumor registry records were 247 women with pathology-confirmed first primary in situ and invasive breast carcinomas with no known previous cancer diagnosis. Factors associated with delays from provider recognition of abnormality to breast cancer diagnosis (diagnostic delays) and from diagnosis to treatment (treatment delays) were determined using chi-square tests and logistic regression. Factors that were considered included age, race, stage of disease at diagnosis, tumor size, type of abnormality, type of medical service at presentation, and prior mammogram within the past two years. The proportion of women experiencing diagnostic delays was high, with more African American women experiencing delays than white women (34% versus 17%, respectively). African American and white women did not differ in distribution of stage of cancer at diagnosis. Significantly smaller tumor sizes were found in women experiencing diagnostic delays compared to those not experiencing delays. Conversely, women experiencing treatment delays were significantly older and had larger tumor sizes compared to those not experiencing delays. More African American women experienced delays in diagnosis; however these delays did not appear to affect outcomes. Older age as a significant factor in treatment delays suggests that comorbidities as well as other possible barriers to treatment warrant further investigation in older women. The reasons for racial disparities in breast cancer outcomes remain and call for further study.
Women & Health 12/2010; 50(8):705-18. · 1.00 Impact Factor
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ABSTRACT: Intranasal transmission of hepatitis C virus (HCV) via contaminated drug-sniffing implements is a potential but unconfirmed source of viral infection. We demonstrate the virological plausibility of intranasal transmission by confirming that blood and HCV RNA are present in the nasal secretions and drug-sniffing implements of HCV-infected intranasal drug users recruited from a community health clinic in New York City.
Clinical Infectious Diseases 11/2008; 47(7):931-4. · 9.15 Impact Factor
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ABSTRACT: Homeless youth are a diverse population of at risk adolescents and young adults who experience various negative health outcomes,
including drug dependence, drug overdose, infectious diseases, and victimization. Previous studies have been directed toward
understanding subgroups of homeless youth, such as injection drug users (IDUs) and young men who have sex with men (YMSM);
yet limited research has focused on describing homeless “travelers,” a migratory subgroup of homeless youth who move from
city to city. Based upon a larger three site study of young IDUs recruited in Los Angeles, New Orleans, and New York, a total
of 133 travelers were identified. A subsample of 56 travelers participated in follow-up interviews, and provided data points
for mapping. Travelers in all sites had extensive histories of criminal justice involvement and injection drug use. Four common
traveling routes within and across the United States were identified. Reasons for traveling often related to drug use, money-making
opportunities, and law enforcement. Risk-reduction services, such as shelters, syringe exchanges, or HIV/HCV testing, were
used infrequently or occasionally. Mapping data documents the mobility of young IDUs across both urban and rural areas, which
suggests that migration among IDUs across broad geographic regions may be a factor in the spread of blood-borne viruses.
09/2008: pages 65-83;
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ABSTRACT: Hepatitis C virus (HCV) is the most common bloodborne pathogen in the United States and is a leading cause of liver-related morbidity and mortality. Although it is known that HCV is most commonly transmitted among injection drug users, the role of sexual transmission in the spread of HCV remains controversial because of inconsistent findings across studies involving heterosexual couples.
A novel multilevel modeling technique designed to overcome the limitations of previous research was performed to assess multiple risk factors for HCV while partitioning the source of risk at the individual and couple level. The analysis was performed on risk exposure and HCV screening data obtained from 265 drug-using couples in East Harlem, New York City.
In multivariable analysis, significant individual risk factors for HCV included a history of injection drug use, tattooing, and older age. At the couple level, HCV infection tended to cluster within couples, and this interdependence was accounted for by couples' drug-injection behavior. Individual and couple-level sexual behavior was not associated with HCV infection.
Our results are consistent with prior research indicating that sexual contact plays little role in HCV transmission. Rather, couples' injection behavior appears to account for the clustering of HCV within heterosexual dyads.
The Journal of Infectious Diseases 07/2007; 195(11):1572-81. · 6.41 Impact Factor
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ABSTRACT: Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.
Health Education & Behavior 05/2007; 34(2):390-403. · 1.54 Impact Factor
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ABSTRACT: Ketamine, a dissociative anesthetic, has emerged as an increasingly common drug among subgroups of young injection drug users (IDUs) in cities across the United States. In-depth qualitative interviews were conducted with 213 young IDUs aged 16-28 years recruited in New York, New Orleans, and Los Angeles between 2004 and 2006. While some initiated injection drug use with ketamine, the drug was more frequently injected by IDUs with extensive polydrug using histories. IDUs initiating with ketamine commonly self-injected via an intramuscular mode of administration. The injection group provided crucial knowledge and material resources that enabled the injection event to occur, including ketamine, syringes, and injection skills. Injection paraphernalia was commonly shared during the first injection of ketamine, particularly vials of pharmaceutically-packaged liquid ketamine. Injection events infrequently occurred in a rave or club and more typically in a private home, which challenges ketamine's designation as a 'club' drug. The first injection of ketamine was a noteworthy event since it introduced a novel drug or new mode of administration to be further explored by some, or exposed others to a drug to be avoided in the future. Risk reduction messages directed towards young IDUs should be expanded to include ketamine.
Drug and Alcohol Dependence 04/2007; 87(2-3):183-93. · 3.38 Impact Factor
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ABSTRACT: In recent years, epidemiological monitoring data has indicated sharp increases in prescription drug misuse. Despite these increases, little is known about the context or patterns associated with prescription drug misuse, particularly among youth or young injection drug users (IDUs). A three-city study of 213 young IDUs found prescription drug misuse to be pervasive, specifically the use of opioids and benzodiazepines. Particular practices not commonly associated with prescription drugs were reported, such as sniffing, smoking, and injection. Associated health risks included initiation into injection drug use, polydrug use, drug overdose, and drug dependency. A greater awareness of the potential health risks associated with prescription drug misuse should be incorporated into services that target IDUs, including street outreach, syringe exchanges, and drug treatment.
Journal of drug issues 02/2007; 37(3):717-736. · 0.38 Impact Factor
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ABSTRACT: Several recent studies have utilized respondent-driven sampling (RDS) methods to survey hidden populations such as commercial sex-workers, men who have sex with men (MSM) and injection drug users (IDU). Few studies, however, have provided a direct comparison between RDS and other more traditional sampling methods such as venue-based, targeted or time/space sampling. The current study sampled injection drug users in three U.S. cities using RDS and targeted sampling (TS) methods and compared their effectiveness in terms of recruitment efficiency, logistics, and sample demographics. Both methods performed satisfactorily. The targeted method required more staff time per-recruited respondent and had a lower proportion of screened respondents who were eligible than RDS, while RDS respondents were offered higher incentives for participation.
Journal of Urban Health 12/2006; 83(6 Suppl):i29-38. · 2.13 Impact Factor
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ABSTRACT: Recent studies have revealed a variety of contexts involving HIV risk behaviors among women who exchange sex for money or drugs. Event analysis was used to identify the individual, relationship, and contextual factors that contribute to these high-risk sex exchange practices. Analyses were conducted on data obtained from 155 drug-using women who reported details of their most recent sex exchange event with male clients. The majority of sex exchange encounters (78%) involved consistent condom use. In multivariable analysis, protective behavior was associated primarily with situational and relationship variables, such as exchange location, substance use, sexual practices, and respondent/client discussion and control. In order to inform HIV prevention programs targeted to women sex exchangers, further research is needed on the contextual determinants of risk, especially with regard to condom-use negotiation and factors involving substance use that adversely affect women's ability to manage protective behavior in the context of sex exchange.
AIDS and Behavior 12/2006; 10(6):731-41. · 3.49 Impact Factor
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ABSTRACT: Effective on January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which allows syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to persons 18 years of age or older and permits the possession of those syringes for the purposes of injecting drugs.
To assess changes in receptive syringe sharing since the inception of the ESAP.
Sociodemographic characteristics and syringe use data regarding the last injection episode were combined from 3 projects (n = 1181) recruiting injection drug users in ongoing studies in Harlem and the Bronx in New York City from January 2001 through June 2003. These data were analyzed as serial cross sections by calendar quarter.
Receptive sharing decreased significantly over time, from 13.4% in the first quarter to 3.6% in the last quarter. Obtaining the last injection syringe from an ESAP source (mostly pharmacies) increased significantly over time, from 7.5% in the first quarter to 25.0% in the last quarter. In multiple logistic regression analysis, variables that were significantly associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with greater receptive sharing.
The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing.
JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2005; 39(4):471-7. · 4.43 Impact Factor
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ABSTRACT: This study examined sharing noninjection drug implements as a risk factor for hepatitis C (HCV) infection among women drug users (n = 123) with no history of drug injection. Participants were street-recruited from East Harlem, New York City, between October 1997 and June 1999. Participants were administered a survey measuring risk factors for HCV. Prevalence of HCV and HIV infections was 19.5% and 14.6%, respectively. Multiple logistic regression determined significant associations between sharing noninjection drug-use implements and HCV infection. "Ever shared both oral and intranasal noninjection drug implements" was independently associated with HCV infection [Odds ratio (OR) 2.83; Confidence interval (CI) 1.04, 7.72; p = 0.04]; "ever shared noninjected heroin implements with an injector" was a trend (OR 3.06; CI .85, 10.79; p = 0.08). The strongest association between sharing noninjection drug-use implements and HCV infection was found among HIV positive individuals (chi2 = 8.8, 1 d.f., p < 0.01). These findings, if supported by future research, indicate a need to reassess policies regarding HCV infection.
Substance Use & Misuse 01/2004; 39(2):211-24. · 1.10 Impact Factor
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ABSTRACT: Public health research involving social or kin groups (such as sexual partners or family members), rather than samples of unrelated individuals, has become more widespread in response to social ecological approaches to disease treatment and prevention. This approach requires the development of innovative sampling, recruitment and screening methodologies tailored to the study of related individuals.
In this paper, we describe a set of sampling, recruitment and screening protocols developed to enlist urban, drug-using, heterosexual couples into a public health research study. This population is especially hard to reach because they are engaged in illegal and/or stigmatized behaviors. The protocols were designed to integrate adaptive sampling, street- and referral-based recruitment, and screening procedures to verify study eligibility and relationship status.
Recruitment of heterosexual couples through one partner, preferably the female, can be an effective enlistment technique. Verification of relationship status is an important component of dyadic research. Comparison of parallel questionnaires administered to each member of a dyad can aid in the assessment of relationship status. However, multiple independent sources of information should be used to verify relationship status when available. Adaptive sampling techniques were effective in reaching drug-using heterosexual couples in an urban setting, and the application of these methods to other groups of related individuals in clinical and public health research may prove to be useful. However, care must be taken to consider potential sources of sampling bias when interpreting and generalizing study results.
BMC Medical Research Methodology 11/2003; 3:24. · 2.67 Impact Factor
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ABSTRACT: This study described the most recent injection events of injection-drug-using women, determined the prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV), and identified significant predictors of injection-related risk behaviors. After validation of drug use, 185 street-recruited women participated in structured interviews and were offered HIV, HBV, and HCV testing and counseling. Interview topics included (1) demographic characteristics, (2) characteristics of injection partners (IPs), and (3) relevant situation-specific factors. Prevalence was 28% for HIV infection, 80% for HBV, and 70% for HCV. Injection events were either solitary (n = 110) or social (n = 75). Most were safe, and 75% of syringes used were obtained from a syringe exchange. Inferential analyses identified two variables that independently predicted unsafe events: (1) respondent had injected previously with her IP, and (2) her IP was her spouse or primary heterosexual partner. Two trends were identified: Injection events in which women felt "very close" to their IP or reported lack of control over injection practices tended to be unsafe. Although most events were safe, safe practices were not adhered to with spouses or primary partners. Syringe exchanges should be supported and may be an ideal setting for interventions targeted to drug-injecting couples.
AIDS and Behavior 10/2003; 7(3):317-28. · 3.49 Impact Factor
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ABSTRACT: Abstract
Background
Public health research involving social or kin groups (such as sexual partners or family members), rather than samples of unrelated individuals, has become more widespread in response to social ecological approaches to disease treatment and prevention. This approach requires the development of innovative sampling, recruitment and screening methodologies tailored to the study of related individuals.
Methods
In this paper, we describe a set of sampling, recruitment and screening protocols developed to enlist urban, drug-using, heterosexual couples into a public health research study. This population is especially hard to reach because they are engaged in illegal and/or stigmatized behaviors. The protocols were designed to integrate adaptive sampling, street- and referral-based recruitment, and screening procedures to verify study eligibility and relationship status.
Discussion
Recruitment of heterosexual couples through one partner, preferably the female, can be an effective enlistment technique. Verification of relationship status is an important component of dyadic research. Comparison of parallel questionnaires administered to each member of a dyad can aid in the assessment of relationship status. However, multiple independent sources of information should be used to verify relationship status when available. Adaptive sampling techniques were effective in reaching drug-using heterosexual couples in an urban setting, and the application of these methods to other groups of related individuals in clinical and public health research may prove to be useful. However, care must be taken to consider potential sources of sampling bias when interpreting and generalizing study results.
BMC Medical Research Methodology. 01/2003;
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ABSTRACT: Using event analysis, this study describes the most recent sexual events of drug-using women and their male partners and identifies relationship-specific and event-specific determinants of condom use. Women drug users (n = 320) were recruited from the streets of East Harlem. After validation of drug use, they participated in structured interviews and were offered HIV testing and counseling. Interview topics included the following: (1) demographic characteristics of respondents, (2) relationship factors, including age difference, race/ethnicity concordance, and HIV serostatus of partners, and (3) event-specific factors, including sexual repertoire, communication about condom use, and perception of HIV risk. Univariate and multivariate analyses identified five major variables associated with event-specific condom use: (1) closeness to partner, (2) perceived dyadic serostatus, (3) sexual repertoire, (4) communication about condoms, and (5) perceived control of condom use. Behavioral interventions to reduce sexual risk should target dyads with long-standing sexual relationships and focus on the dynamics of the relationship, especially the issues of dyadic serostatus, intimacy, communication, and control.
AIDS and Behavior 11/2000; 4(4):329-340. · 3.49 Impact Factor
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ABSTRACT: Interventions targeting high-risk drug users have found reductions in HIV risk behaviors over time. It is important to determine whether these changes occur among both HIV+ and HIV– drug users. A total of 225 drug injectors (31% HIV+) and 316 crack users (15% HIV+) were administered a baseline interview, received HIV testing, received test results, and participated in a 6-month follow-up interview. Both HIV+ and HIV– subjects significantly reduced risk behaviors over time, with greater reduction in some behaviors (e.g., percent of injectors sharing drug injection paraphernalia, p .05) by HIV+ subjects. This finding supports the utility of HIV testing for high-risk drug users. Further research is needed to enhance understanding of risk behaviors and risk reduction among seropositives.
AIDS and Behavior 05/1998; 2(2):171-176. · 3.49 Impact Factor
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ABSTRACT: [describes the Harlem AIDS Project,] a research/demonstration project to assess the efficacy of an AIDS risk reduction intervention strategy, targeting intravenous drug users and their sexual partners, and incorporating special efforts to recruit women / [presents] preliminary data on the women in the sample [including] demographic characteristics of the women at risk, specific drug- and sex-related risk behaviours compared at baseline and follow-up, and several psychological variables that are hypothesized to have a relationship to AIDS risk behaviours / the women were primarily African American (71 per cent) and Hispanic (25 per cent) / the public health implications of this work with high-risk women will also be discussed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
10/1993;
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ABSTRACT: Hepatitis C virus (HCV) is a major cause of chronic liver disease in the United States and worldwide. It is primarily transmitted through blood-to-blood contact with an infected individual. HCV is hyperendemic among injection drug users (IDUs), who contract the virus through contaminated syringes and drug preparation equipment shared with other IDUs. The prevalence of HCV is also high, to a lesser degree, among noninjection drug users, many of whom report no identifiable HCV risk exposures. This article reviews the epidemiological and virological evidence bearing on a potential hidden source of HCV infection among noninjection drug users: namely, the oral or intranasal transmission of HCV through the sharing of noninjection drug-use implements such as pipes or straws. While there is some epidemiological evidence supporting both oral and intranasal HCV transmission, most studies are hampered by methodological limitations. Thus, there is a need for prospective studies designed specifically to examine these potential routes of transmission. Current biological evidence does not refute either oral or intranasal transmission as possible sources of HCV infection, although more research is needed in the areas of oronasal HCV pathogenesis and the detection of HCV RNA in the nasal mucosa of intranasal drug users.
Journal of psychoactive drugs 35(4):455-60. · 1.10 Impact Factor
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ABSTRACT: In the social and health sciences, data are often structured hierarchically, with individuals nested within groups. Dyads constitute a special case of hierarchically structured data with variation at both the individual and dyadic level. Analyses of data from dyads pose several challenges due to the interdependence between members within dyads and issues related to small group sizes. Multilevel analytic techniques have been developed and applied to dyadic data in an attempt to resolve these issues. In this article, we describe a set of analyses for modeling individual- and dyad-level influences on binary outcomes using SAS statistical software; and we discuss the benefits and limitations of such an approach. For illustrative purposes, we apply these techniques to estimate individual- and dyad-level predictors of viral hepatitis C infection among heterosexual couples in East Harlem, New York City.
Computational Statistics & Data Analysis.
