Andrea M. Fenaughty

Hepatitis C virus and depression in drug users

Objective:Clinical case studies have implicated depression as a possible side-effect of interferon treatment for the Hepatitis C virus (HCV). However, because these studies generally did not include a pretreatment assessment of depression, it cannot be definitively stated whether depression is a side-effect of interferon treatment, a syndrome coexisting with HCV, or a common characteristic of individuals who are vulnerable to HCV infection. To gather more information about this issue, self-reported depressive symptomatology of drug users with HCV who have not received interferon treatment was compared to that of uninfected drug users.Methods:Subjects were 309 drug users not currently in substance abuse treatment who were participating in a National Institute on Drug Abuse project. Subjects completed the Center for Epidemiological Studies-Depression (CES-D) instrument and provided a blood sample for HCV testing.Results:Serological findings revealed that 52.4% of the subjects tested positive for HCV antibodies. Of the HCV-positive subjects, 57.2% had significant depressive symptomatology, whereas only 48.2% of the HCV-negative subjects did, for an overall rate of 52.6%. The two groups also differed on two specific dimensions of depression, with the HCV-positive group scoring lower on the Positive Affect scale and higher on the Somatic/Retarded Activity scale.Conclusions:These findings reveal high levels of depressive symptomatology among drug users, as well as the possibility of a coexisting depressive syndrome with HCV infection. These findings raise the possibility that depression associated with interferon treatment may, at least partially, be accounted for by preexisting depression. Further research is needed to determine the nature and origins of depression in individuals in treatment with interferon for HCV with specific focus placed on determining the dimensions of depression associated with HCV infection and interferon treatment.

Needle exchange and injection drug use frequency: A randomized clinical trial

Despite a lack of evidence that needle exchange programs (NEPs) cause an increase in injection drug use, there are still concerns over fostering increased injection behavior with NEPs. The design was a randomized controlled trial conducted from May 1997 to June 2000 comparing injection drug users (IDUs) who are randomly assigned to have access to an NEP versus training in how to purchase needles and syringes (NS) at pharmacies. Of 653 IDUs recruited into the study, 600 were randomized: 426 were followed-up at 6 months, and 369 were followed-up at 12 months. Four hundred ninety were followed up at least once. There was no difference in the number of injections over time between the NEP and the Pharmacy Sales arms of the study or in the percentage of positive urine test results over time between the NEP and the Pharmacy Sales arms of the study for morphine and amphetamine. The decrease in the presence of cocaine was marginally greater between the arms of the study. The results do not support the hypothesis of NEPs causing an increase in injection drug use. This clinical trial provides the strongest evidence to date that needle exchanges do not produce this negative effect.

Management choice and adherence to follow-up after colposcopy in women with cervical intraepithelial neoplasia 1

Abstract OBJECTIVE: To determine women’s preference when given a choice of management between cryotherapy and cytology surveillance and to compare subsequent adherence to serial cytologic follow-up after being diagnosed with cervical intraepithelial neoplasia grade 1 (CIN1). METHODS: Two hundred nineteen low-income women with biopsy-proven CIN1 seen in a reproductive health clinic from August 1995 through December 1999 were offered cryotherapy or cytology surveillance, followed by cytologic testing every 4 months until three consecutive results were normal. Endpoints of the study were: successful completion of follow-up; transferred or referred out of clinic; or lost to follow-up. RESULTS: Ninety-four women (42.9%) chose cryotherapy, compared with 125 women (57.1%) who chose cytology surveillance (P CONCLUSION: Successful completion of a commonly recommended protocol for serial cytology follow-up was low. Management choice affected initial adherence but not adherence to long-term follow-up.

Substance use and memory for health warning labels.

This article reports the relationship between substance use and memory for health warnings for cigarettes, smokeless tobacco, and alcohol. Measures of substance use and recognition memory for warning labels were collected from 2 samples of college students (n = 288 and n = 243). It was hypothesized that if health warnings were noticed and remembered, then users, because they were often exposed to the warning labels, would have more accurate memory for the risks written on the containers of these products than nonusers. Prior research had not confirmed this relationship. In Study 1, a statistically significant correlation was obtained between use and recognition memory for both cigarettes and smokeless tobacco. The effects for cigarettes and smokeless tobacco were replicated in Study 2 and observed for alcohol as well.

High-Risk Sexual Behavior Among Drug Users: The Utility of a Typology of Alcohol Variables

Objectives: The purpose of this study was to develop a typology of drug users based on alcohol use variables and then determine the utility of this typology for predicting high‐risk sexual behavior, controlling for the personality traits of sensation seeking and risk proneness. Methods: A sample of 283 out‐of‐treatment drug users in Anchorage, Alaska, were interviewed regarding their alcohol and drug use, sexual behavior, sensation seeking, and risk proneness. The sample was 66% male; 44% white, 26% black, and 24% Native American; had a median age of 36 years; and a median monthly income of

Gonorrhea Among Drug Users: An Alaskan Versus a National Sample

500 to

Social Isolation and Domestic Violence Among Female Drug Users

999. Results: Cluster analyses of alcohol variables showed the presence of two clusters, one of which is characterized by relatively high alcohol consumption and early age of first alcohol use. This alcohol typology was significantly related to several sexual risk behaviors, including having sex with multiple partners without consistent condom use (χ2(1) = 10.47, p < .01), having sex with an injection drug user (IDU) without consistent condom use (χ2(1) = 4.87, p < .05), number of sex partners (t(281) = −2.16, p < .05), STD history (χ2(1) = 7.86, p < .01), and having traded sex for drugs or money recently (χ2(1) = 6.91, p < .01) or in ones lifetime (χ2(1) = 9.20, p < .01). All but one of these associations remained significant after controlling for sensation seeking and risk proneness. Conclusions: Among this sample of out‐of‐treatment drug users, a typology based on patterns of alcohol use was found to be associated with several measures of high‐risk sexual behavior. Drug users who were classified as high risk on the basis of their lifetime and current alcohol use patterns were found to be significantly more likely than low‐risk drug users to have engaged in risky sexual behavior. Risk proneness does not appear to account for this pattern of associations.

Sex partners of native American drug users

The study described here investigates the replicability of gender-specific risk profiles for gonorrhea based on an Alaskan sample compared to a U.S. national sample of drug users at risk for HIV infection. The Alaska sample (interviewed at a field station in Anchorage, Alaska; N=1,049) and the national sample (interviewed at 18 sites other than Alaska; N=17,619) consisted of cocaine smokers and injection drug users not in drug treatment. A history of gonorrhea infection was self-reported and coded as ever or never. The Anchorage and national risk profile for men included the following factors: (a) history of intranasal or parenteral cocaine use, (b) being black versus nonblack, (c) being older, (d) income from illegal activity, and (e) history of amphetamine use. The Anchorage and national risk profiles for women included the following factors: (a) trading sex for money, (b) being Native American versus non-Native American, and (c) trading sex for drugs. The Anchorage model for women included perceived homelessness as a factor, but it was not retained in the national model. The extent of the replicability of these models illustrates the generalizability of Alaskan findings to other U.S. drug-using populations. The authors also discuss the implications of these findings for disease prevention.

Seroconversion Issues Among Out-of-Treatment Injection Drug Users

The objective of this study was to examine the association between social isolation, domestic violence, and substance dependence among street-recruited female drug users. Hierarchical logistic regression was used to assess the independent contribution of social isolation and substance dependence to the likelihood that women will experience physical abuse. One hundred women (38.2%, N=262) reported at least one incident of physical violence perpetrated by her most-recent sexual partner. Controlling for substance dependence and relationship status (the only significantly associated demographic variable), women reporting indicators of social isolation were more likely to have been physically abused by their most-recent sexual partners than nonisolated women. Substance dependence was not related significantly to domestic violence. Providers who have contact with female drug users should be aware of the high domestic violence rates and work to counterbalance the isolation these women may experience.

Effects of neutral posture on muscle tension during computer use.

This study describes patterns of sexual behavior and condom use in a sample of Native American drug-using men and women (N = 114). Data are self-reports of sexual behavior in the last 30 days, including descriptions of the most recent sex partners up to five. These data provided information on 157 sex partner pairs, of which at least one partner was a drug user. Native American women (55%) were more likely than Native American men (23%) to report never using condoms for vaginal and anal sex in the last 30 days. Compared with other ethnic pair combinations, sex partner pairs composed of Native American women and white men (n = 18) were the least likely to use condoms (6% of pairs) and the most likely to report an injection drug user (IDU) sex partner (33% of pairs). These results suggest a potential vector of HIV and other sexually transmitted disease (STD) transmission between white male IDUs and Native American women and highlight the need for further qualitative and quantitative research to examine the factors underlying this pattern of sexual risk behavior.