B. Kathleen Jordan

The prevalence of lifetime and partial post-traumatic stress disorder in vietnam theater veterans

A complete understanding of the consequences of service in a war zone includes examining the lifetime and current prevalence of post-traumatic stress disorder (PTSD), and of partial PTSD. Cases of partial PTSD are persons who have clinically significant symptoms of PTSD, but who do not meet the full diagnostic criteria. The National Vietnam Veterans Readjustment Study (NVVRS) estimated the lifetime prevalence of PTSD to be 30.9% among male theater veterans, 26.% among females; lifetime prevalence of partial PTSD was an additional 22.5% and 21.2%, respectively; current prevalence of partial PTSD was 11.1% in males and 7.8% in females. NVVRS findings indicate that of the 1.7 million veterans who ever experienced significant symptoms of PTSD after the Vietnam war, approximately 830,000 (49%) still experience clinically significant distress and disability from symptoms of PTSD. The contribution of partial PTSD represents an estimated additional 350,000 veterans.

The prevalence of post-traumatic stress disorder in the Vietnam generation: A multimethod, multisource assessment of psychiatric disorder

Findings from the Congressionally mandated National Vietnam Veterans Readjustment Study indicate that nearly one-half million Vietnam veterans—15.2% of the men and 8.5% of the women who served in Vietnam—suffer from post-traumatic stress disorder (PTSD) fifteen or more years after their military service. Current PTSD prevalence rates for Vietnam veterans are significantly and substantially higher than the rates for their comparable Vietnam generation peers, which range from 0.3% to 2.5%. Additionally, the current prevalence rate among male Vietnam veterans was found to differ significantly among race/ethnicity subgroups: 27.9% among Hispanic men, 20.6% among black men, 13.7% among white/other men. Multivariate analyses indicated that although background factors are significantly related to the current prevalence of PTSD, the current prevalence is much higher among Vietnam veterans than among era veteran and civilian counterpart comparison groups even after background differences are taken into account. These analyses also demonstrated the important role of exposure to combat and other types of war zone stress in the current prevalence of the disorder.

Women Inmates' Risky Sex and Drug Behaviors: Are They Related?

The large concentration of female illicit drug users in state correctional facilities prompted an examination of the associations among different types of drug use and sexual risk factors related to human immunodeficiency virus (HIV) among women inmates. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these inmates, 651 had complete information on relevant characteristics. Of the women inmates, 73% had used drugs prior to incarceration; most women were crack smokers only (33%), followed by non-drug users (27%), other drug users (19%), crack-smoking injecting drug users (15%), and injecting drug users only (6%). Inconsistent condom use with multiple sex partners, a history of a diagnosed sexually transmitted disease (STD), a drug-injecting sex partner, or exchanging sex for money or drugs prior to incarceration were reported by 55% of the women. Sexual risk factors differed across different types of drug users, with crack-smoking injectors being placed at greatest potential risk for exposure to heterosexually transmitted HIV, followed by injecting drug users, crack smokers, and then other drug users. Given the differential associations between sexual risk factors and types of drug use, prison-based sexual-risk reduction strategies should be tailored to specific types of drug users. In times of limited resources, special attention should be given to crack smokers and/or drug injectors.

A clinical validation of the National Survey on Drug Use and Health Assessment of Substance Use Disorders

Alcohol and illicit drug abuse and dependence continue to be of great national concern in the United States, as is true in other nations. The National Survey on Drug Use and Health (NSDUH) provides national annual estimates of substance use and abuse/dependence among the U.S. civilian, noninstitutionalized population aged 12 years or older. We conducted a clinical validation study of the substance use disorder questions of the NSDUH instrument using a sample of 288 adults and adolescents recruited from the community and outpatient substance abuse treatment programs in North Carolina. Using the Structured Clinical Interview for DSM-IV (SCID-IV) for adults and the Pittsburgh Adolescent Alcohol Research Centers Structured Clinical Interview (PAARC-SCID) for adolescents, we computed the psychometric properties of the NSDUH questions. We found the level of agreement between the NSDUH and the SCID/PAARC-SCID interviews to be fair to moderate overall. There was somewhat better agreement for dependence than for abuse and for adults than for adolescents.

Preincarceration Risky Behaviors among Women Inmates: Opportunities for Prevention

This study examined the associations between preincarceration risky sex and drug behaviors and HIV status among incarcerated women. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these women, 700 granted permission to access their prison medical records and had complete information on relevant variables. Four percent of the women inmates were HIV positive. Over 80% of the women inconsistently used condoms during intercourse, and over 15% injected drugs, had a drug-injecting sex partner, and exchanged sex for money/drugs. The exchange of sex for money/drugs was associated with being HIV positive. The study findings suggest that prison-based HIV prevention programs should emphasize sexual and drug risk-reduction strategies as a means to reduce the heterosexual HIV risks facing women inmates once released back into the general community.