Duane C. McBride

Health Care Need and Utilization: A Preliminary Comparison of Injection Drug Users, Other Illicit Drug Users, and Nonusers

This paper investigates the relationship between chronic drug use and the health care system. Data from 536 African-American, Hispanic, and non-Hispanic White men and women were analyzed to determine independent risk factors for three outcome variables: 1) Need for health care treatment, 2) Utilization of health care treatment, and 3) Failure to receive needed treatment. Nine independent demographic, health, and drug-use history variables were assessed in logistic regression models. Chronic drug users were more likely in the past year to need health care treatment, were as likely to receive some health care treatment, and were more likely not to receive needed treatment than were nonusers.

A Comparison of the Need for Health Care and Use of Health Care by Injection-Drug Users, Other Chronic Drug Users, and Nondrug Users

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.

Immigration and HIV among Migrant Workers in Rural Southern Florida

We studied HIV seropositivity among a targeted sample of migrant workers who used drugs, primarily crack cocaine, and their sexual partners in rural southern Florida from 1993 to 1995. We enrolled men and women who were born in the United States (n = 369) or in other countries (n = 174). Overall, 11.2% of the sample were HIV positive, including 18% of Blacks from the United States, and about 8% of non-Hispanic whites from the United States, Blacks from the Caribbean, and persons from Central or South America. No Hispanics from the United States or the Caribbean, but 3.4% of Hispanics from Mexico, were HIV positive. In logistic regression analyses, race/ethnicity, gender, and age were most highly associated with HIV seropositivity. Immigration status, current drug use, and current sexual activity were not related to HIV seropositivity. HIV prevention programs must help reduce heterosexual transmission of HIV associated with drug use both locally and where migrants travel and work.

Depression, drug use, and health services need, utilization, and cost

The objective of this study is to examine the relationship between depression and drug use and potential ramifications of that relationship on the health services needs, utilization, and costs of chronic and injecting drug abusers. A network-based sample of 1,330 injecting and other chronic drug users, as well as non-drug using neighborhood controls, was obtained within Dade County, Florida. Using the Health Services Research Model as an analytical framework, results show that drug users had significantly higher levels of depression than non-drug users from similar neighborhoods. In addition, it was found that depression was significantly associated with perceptions of poor health, increased health problems, and perceived limitations on even light physical activity among both drug users and non-users. Among drug users, depression was also significantly related to not receiving needed care, lack of treatment adherence, use of the emergency room for primary care or any reason, hospital admissions, and any use of outpatient or private clinic services. Results from logistical regression analysis show that even when controlling for relevant issues such as sociodemographic, economic, and drug use variables, depression retains an independent and significant relationship with health services need and utilization. Differences in the cost of health care utilization between depressed and non-depressed samples are also estimated. Implications of this study point to the need to consider screening and treatment for depression within health system structures in order to improve cost-effective access to needed services among drug using populations.

The Social Ecology of Drug Treatment

The examination of clients and staff members perceptions of treatment environments is an area in which insufficient research has taken place. This study reports the results of an attempt to evaluate perceptions of treatment environments within the Comprehensive Drug Program of Dade County (Miami) Florida. The Moos Community Oriented Programs Environment Scale (COPES) was given in a self-administered form to a sample of 238 clients and fifty-five staff members in eight treatment programs. Analysis revealed that the perceptions of drug clients toward their treatment environments were generally more positive than those of clients in other types of medical and psychiatric treatment and that perceptions tended to vary directly with the extent and continuity of contact between clients and staff members. Finally, it is suggested that the evaluation of perceptions of treatment environments be made an essential aspect of treatment evaluation.

An analysis of the accessibility and nonaccessibility of patients in a follow-up study.

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.

Victim survey research: Implications for criminal justice planning

Abstract The historic use of offense reports by police agencies for decision making is examined in the light of another data source — victim surveys. Survey information data can be used to: (1) more reliably estimate the extent and distribution of crime in a community; (2) evaluate the effectiveness of innovative programs; (3) develop police-sponsored public education programs; (4) describe the characteristics of victims and high crime areas; (5) sensitize police to the needs of the victim; and (6) develop police training programs that include dealing with the victim.

Multidisciplinary Approach to HIV/AIDS: Historical Perspective

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.