Isaac D. Montoya

A comparative study of codes of ethics in health care facilities and energy companies

Though written corporate codes of ethics have been touted as a panacea for the embarrassments and uncertainties of the past two decades, the absence of clear evaluation procedures severely compromises their usefulness. An ethnographic study comparing development processes and compliance outcomes in large health care facilities and energy companies shows that neither of the two industries has encountered much success with a codes of ethics program. Companies that distribute copies of their code of ethics seldom ensure the process is completed or that employees understand the purpose of the document, and staff responsible for the code give it a low priority relative to their overall responsibilities. Contrary to expectations, health care facilities are no more likely to develop or implement codes of ethics effectively than are energy companies. More extensive research is needed in order to generate the data necessary for the development of realistic standards for the evaluation of codes of ethics.

Propofol-Related Infusion Syndrome in Intensive Care Patients

The Institute of Medicine has identified adverse drug events as factors that significantly contribute to increased patient morbidity and mortality. As critically ill patients receive numerous drugs to treat a multitude of complicated health problems, they are at high risk for adverse drug events. Sedation is often a key requirement for the optimal management of critical illness, and propofol, a common sedative, has many desirable characteristics that make it the ideal agent in numerous circumstances. However, over the last decade, increasing numbers of reports have described a potentially fatal adverse effect called propofol‐related infusion syndrome. Whether this adverse drug event is preventable is unclear, but recommendations have been proposed to minimize the potential for development of this syndrome. Research is under way to collect data on the use of propofol in intensive care units and on its prevalence.

A COMPARISON OF PSYCHOSOCIAL BARRIERS AMONG WELFARE RECIPIENTS: IMPLICATIONS FOR DRUG TREATMENT

Implementation of Temporary Assistance for Needy Families (TANF) presents welfare recipients with time-limited benefits and work requirements. However, it is estimated that over 140,000 welfare recipients meet the DSM-IV criteria for “drug dependence”. In this study, samples of chronic drug using and non-drug using female TANF recipients were compared with regard to: current employment, psychological functioning, self-perceived employment skills, barriers to employment, and need for help in seeking employment. It was found that non-drug using study participants were significantly more likely to be employed and reported significantly higher self-perceived work skills than users. Chronic users reported significantly greater barriers to seeking employment. [Translations are provided in the International Abstracts Section of this issue.]

Mental health, drug use, and the transition from welfare to work.

This study examines the effects of drug use and work requirements on psychological distress and employment among chronic drug-using and non-drug-using welfare recipients. Using a natural history design, 442 female Temporary Assistance for Needy Families (TANF) recipients (including 251 with chronic drug use problems) were interviewed every 4 months in order to assess changes in psychological functioning, employment status, and wages. Data from the first year (four waves) indicate that employment and wages increased substantially, though less so for drug users than non-drug users. Psychological distress decreased only slightly over the study period. Growth curve analyses show that drug use had no direct effect on wages; however, drug use did significantly increase psychological distress. Both the work mandate and psychological distress contributed to wages. The authors consider the implications of these trends for the mental health service needs of drug-using TANF recipients.

Social networks and forecasting the spread of HIV infection.

Summary: This study is an initial effort to use network data to forecast the spread of HIV in a large U.S. city. Data were collected from a sample of drug users and sociodemographically matched nonusers in low‐income areas of Houston, Texas. Two sample‐based HIV prevalence models and two sociological models were combined with three published biological models to yield forecasts of the growth of HIV seroprevalence. The forecasts predict a compounded annual growth in HIV of between 2.4% and 16.5% among low‐income residents of Houstons inner city. These results suggest that forecasts are most sensitive to the nature of the sociological model used. A random mixing model showed about a threefold overestimate of 20‐year projected seroprevalence compared with the empiric network data. Thus, the collection of additional social network data is probably the most important requirement for more accurate projections.

New frontiers and challenges in HIV research among older minority populations.

Summary: Older racial and ethnic minorities are a rapidly growing segment of the population. HIV infection disproportionately affects minorities of all ages, presenting new challenges in research, prevention, and treatment of HIV infection. Cultural characteristics coupled with changing values and age‐related beliefs can present some atypical challenges to HIV researchers and clinicians. Family relationships, language barriers, and the psychology of aging complicate these challenges even further. Older minorities also experience certain stigmas that the added burden of HIV infection only exacerbates. Effective research, prevention, and treatment must begin with sensitivity to the varied characteristics of older minorities.

Posttraumatic Stress Disorder Among Hispanic and African‐American Drug Users

Context: Treating high‐risk substance abusers who are members of minority groups may require varied protocols depending on differences among minority groups. Objectives: To explore cocaine abuse (CA)/dependence with physiological dependence (CDPD) and posttraumatic stress disorder (PTSD) diagnosis differences between out‐of‐treatment Hispanic and African American adults, in order to identify cultural differences in how experiences and attitudes affect cocaine use behaviors. Design, Setting, and Participants: This study uses data collected between February and November 2000, as part of a three‐year longitudinal study. A cohort of 347 out‐of‐treatment, Hispanic and African American cocaine‐using adults from the Houston metropolitan area were interviewed to measure differences between cocaine users who are dually diagnosed and those that are not. Main Outcome Measures: Meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for dual diagnoses of CA/PTSD or CDPD/PTSD. Results: For the dual diagnoses categories, 102 (29%) participants met the requirements for CA/PTSD or CDPD/PTSD. Logistic regression models were used, with CA/PTSD and CDPD/PTSD as the dependent variables. Age, race, gender, and income were used as the independent variables. Results indicate that individuals with higher income have a greater probability of developing CA/PTSD (β = 0.919, p < 0.05). For both dual diagnoses categories of CA/PTSD and CDPD/PTSD, results indicate that being female increases the likelihood of developing both of these dual diagnoses, (β = 2.106, p < 0.05) or (β = 2.510, p < 0.05). However, being an older female decreases the probability that an individual would develop these dual diagnoses (β = − 2.227, p < 0.05) (β = − 2.577, p < 0.05). Conclusions: No differences were found for race/ethnicity among the dually diagnosed Hispanics and African Americans, however, gender differences were found. Being female increases an individuals probability of developing a dual diagnosis of CA/PTSD or CDPD/PTSD. In addition to being female, being a young female further increases an individuals probability of being dually diagnosed.

Social network ties, self-efficacy, and condom use among women who use crack cocaine: a pilot study.

So far, attempts to change the sexual risk behavior of women who use crack cocaine have been less successful than efforts to change the needle risk behavior of injection drug users. Two theoretical areas that have shown some success in predicting behavior change among of out-of-treatment drug users are Banduras social cognitive theory (self-efficacy theory) and social network theory. According to Bandura, social networks are important sources of social support, and social support is vital to self-efficacy. Social network research also indicates that close bonds with network members may be a protective factor independently of self-efficacy. In order to test the feasibility of collecting such data, a pilot study was conducted with 60 women who used crack cocaine and who were not in treatment. Results of Pearson product-moment correlations indicated that self-efficacy (.7230) and number of very strong ties (.31252994) were positively correlated with condom use for women in the sample. In addition, the number of very strong ties (.3142) was significantly, if modestly, correlated with self-efficacy. Self-efficacy was

Labor Force Participation in a Sample of Substance Users

This paper reviews the microeconomic theory underlying the work/leisure tradeoff and how this tradeoff may be manifested among substance users. The effects of drug use, demographic factors, and income factors on the probability of labor force participation are analyzed in a sample of 687 male and 327 female drug users. The decision not to seek employment appears to be associated primarily with non-job-related sources of income (including illegal sources).

Determinants of HIV seroprevalence rates among sites participating in a community-based study of drug users

The National Institute on Drug Abuses National Cooperative Agreement Project is a nationwide study of the injection and sexual behaviors of three populations of out-of-treatment drug users: injecting drug users (IDUs) who did not smoke crack cocaine, non-injecting crack smokers, and those engaging in both types of use. The goal of the analyses we present was identification of subsets of behavioral variables that would, within each type of drug use, distinguish sites by HIV seroprevalence level. Among non-crack-smoking IDUs high seroprevalence rates were associated with race and sex, the overall frequency of injection, the frequency of cocaine injection, and geographic location. Among noninjecting crack smokers, cities were distinguished by the frequency of exchanging sex for money, the number of sex partners, the local seroprevalence rate among IDUs, and location. Among subjects engaging in both types of use, seroprevalence rates among sites was distinguished by the frequency of exchanging sex for drugs and location.