Mary Comerford

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.

The consistency of self-reported HIV risk behavior among injection drug users.

OBJECTIVES Most studies of risk factors for human immunodeficiency virus (HIV) rely heavily on retrospective self-reports. The degree to which these reports provide reliable information has received little research attention. The purpose of this study was to assess the extent to which the reliability of retrospective self-report data is affected over time. METHODS Data were examined from a longitudinal study of risk behaviors among injection drug users. Structured interviews were administered to 366 injection drug users who were asked to recall behaviors that they had reported 6, 12, or 18 months earlier. RESULTS Kappa coefficients showed moderate initial memory loss for injection and sexual risk behaviors. After 6 months, time had little effect on the ability of injection drug users to recall injection and sexual risk behaviors. For ordinal measures of risk, subjects who gave different reports over time were most likely to disagree by one response category. CONCLUSIONS These findings support the use of retrospective self-reports in assessing HIV risk behaviors among injection drug users. Retrospective inquiry is likely to remain an important method for collecting data over time.

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.

Prevalence and risk factors for HIV among sniffers, short-term injectors, and long-term injectors of heroin

Abstract The prevalence of HIV and associated risk behaviors were assessed among three groups of heroin users: long term injection drug users (LTIDUs). new injection drug users (NIDUs), and heroin sniffers (HSs) with no history of injection. HIV seroprevalence was similar among NIDUs (13.3%) and HSs (12.7%). LTIDUs had almost twice as high a level of HIV infection (24.7%). A fter including drug use and sex behavior variables in logistic regression models, both drug and sexual risk factors remained in the models. Attributable risk percent (APR) from injection for HIV infection among injection drug users was estimated to be 55.7% for LTIDUs and 5.8% for NIDUs. High-risk sex behavior plays an important role in the prevalence of HIV among drug users and accounts for nearly all the infection among NIDUs. Both injection and sexual risk behaviors need to be stressed in HIV prevention and intervention programs aimed at drug users.

First injection and current risk factors for HIV among new and long-term injection drug users.

The purpose of this paper is to estimate HIV seroprevalence and to examine the injection and sexual risk behaviours of a cohort of active new heroin injectors who have initiated injection within the past four years and to compare their risk behaviours with those of long-term heroin injectors who initiated injection prior to January 1, 1985. A stratified network-based sample was used to recruit injection drug users (IDUs) from the streets of Miami-Dade, Florida. New IDUs displayed a significantly lower HIV seroprevalence than long-term injectors (13.3 versus 24.7%). Both new and long-term drug injectors exhibited a high level of current HIV risk behaviour. While new injectors were more likely than long-term injectors to practise safer injection behaviours at the initial injection episode, the current risk behaviours of new and long-term injectors are similar.

PRIMARY PREVENTIVE HEALTH CARE AMONG INJECTION DRUG USERS, OTHER SUSTAINED DRUG USERS, AND NON-USERS

The primary objective of this paper is to investigate the relationship between sustained illicit drug use and the utilization of primary preventive health care. Data from 1254 African-American, Hispanic/Latino, and non-Hispanic/Latino white men and women collected in 1996–1997 were analyzed to determine independent risk factors for the utilization of primary preventive health care that was not received as a result of seeking treatment for a specific health condition. When several demographic, health, and drug use variables were assessed in a logistic regression model, gender, ethnicity, health insurance status, drug use, and alcohol use were independently associated with primary preventive care. Women, Hispanic/Latinos, and persons who had health insurance were more likely to have received primary preventive health care while injection drug users, other sustained drug users, and “heavy” alcohol users were less likely to have used primary preventive health care services in the past year. [Translations are provided in the International Abstracts Section of this issue.]

High risk sexual behaviours among heroin sniffers who have no history of injection drug use: Implications for HIV risk reduction

The purpose of this paper is to assess sexual behaviours which place heroin sniffers (HSs) at high risk for HIV infection. A stratified network-based sample was used to recruit HSs who had no history of injection drug use was recruited from the streets of South Florida, USA. HSs displayed a high HIV seroprevalence rate of 12.1%; women (18.1%) were more likely than men (8.7%) to test positive for HIV. Both men and women HSs engaged in considerable high risk sex behaviour, including high risk sex-exchange behaviour. The use of crack cocaine was associated with increased sex exchange behaviour among women. The need for intervention programs targeted toward HSs is discussed.

An Association between Bullying Behaviors and Alcohol Use among Middle School Students.

Although a high prevalence of bullying behaviors among adolescents has been documented, little is known about the association between bullying behaviors and alcohol use among perpetrators or victims. This study used data from a representative two-stage cluster random sample of 44, 532 middle school adolescents in Florida. We found a high prevalence of bullying behaviors (30% physical, 52% verbal, 12% cyber). A higher proportion of students (21%) who were involved in any type of bullying behavior used alcohol than students who were not involved (13%). Students involved in bullying behaviors as perpetrators or victims were significantly more likely to have used alcohol in the past-30-days than students who were not involved in bullying. Results suggest that bullying behaviors may be associated with alcohol use and that early evaluation of bullying behavior may be important as part of alcohol-use prevention programs among young adolescents.

Satisfaction with access to health care among injection drug users, other drug users, and nonusers.

This article examines the satisfaction of users of cocaine and/or opiates and non-drug users with access to the health care system. Data were obtained from a sample of 1,477 injection drug users, non-injection drug users, and non-drug users recruited from neighborhoods with high drug use. Multiple regression examined the relationship between satisfaction with access to health care and demographic, health status and health care utilization, ability to pay, and alcohol and drug use variables. Age, ethnicity, health status, having received health care in the last 12 months, not having received health care when needed, having received preventive health care, health insurance, and drug use were independently associated with satisfaction. Injection drug users and non-injection drug users were less satisfied with access to health care. The article discusses strategies to improve health care delivery to drug users.

Employment Among Chronic Drug Users at Baseline and 6-Month Follow-Up

Most studies of unemployment among chronic drug users (CDUs) are drug-user treatment–based and there is little information on employment/unemployment among CDUs not in treatment. Between June 2003 and September 2004, 492 CDUs in Miami–Dade, Florida, were administered a quantitative survey at baseline and 6 months later; employment status was measured. Descriptive statistics showed that only 15% were employed at both periods, an equal percentage becoming employed and unemployed at 6 months. The majority of CDUs were unemployed at both time periods. Men were more likely than women to exhibit consistent employment over the two time periods. The studys limitations are noted and future research is suggested. This study was IRB-approved and funded by the National Institute on Drug Abuse.