Rebecca C. Trenz

Latent classes of heroin and cocaine users predict unique HIV/HCV risk factors.

BACKGROUND Patterns of heroin and cocaine use vary and may be associated with unique risk factors for bloodborne infections. METHODS Latent class analysis identified sub-populations of 552 heroin and cocaine users in Baltimore, Maryland. Using latent class regression, these classes were analyzed for associations with demographic characteristics, risky behaviors, Hepatitis C, and HIV. RESULTS Three classes were found: Crack/Nasal-Heroin users (43.5%), Polysubstance users (34.8%), and Heroin Injectors (21.8%). Compared to Polysubstance users, Crack/Nasal-Heroin users were almost 7 times more likely to identify as Black (OR=6.97, 95% CI=4.35-11.2). Sharing needles was over 2.5 times more likely among Polysubstance users than among Heroin Injectors (OR=2.66, 95% CI=1.49-4.75). Crack/Nasal-Heroin users were 2.5 times more likely than Polysubstance users to exchange drugs for sex (OR=2.50, 95% CI=1.22-5.13). Crack/Nasal-Heroin users were less likely than Heroin Injectors to have Hepatitis C (OR=0.10, 95% CI=0.06-0.18), but no significant differences were found for HIV. CONCLUSIONS Subpopulations of cocaine and heroin users differed in demographic classifications, HIV-risk behaviors, and Hepatitis C infection. All subpopulations included substantial numbers of HIV-positive individuals. Findings provide further evidence that non-injection drug users face significant infectious disease risk.

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.

Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users.

BACKGROUND HIV transmission risk among non-injection drug users is high due to the co-occurrence of drug use and sexual risk behaviors. The purpose of the current study was to identify patterns of drug use among polysubstance users within a high HIV prevalence population. METHODS The study sample included 409 substance users from the Pretoria region of South Africa. Substances used by 20% or more the sample included: cigarettes, alcohol, marijuana and heroin in combination, marijuana and cigarettes in combination, and crack cocaine. Latent class analysis was used to identify patterns of polysubstance use based on types of drugs used. Multivariate logistic regression analyses compared classes on demographics, sexual risk behavior, and disease status. RESULTS Four classes of substance use were found: MJ+Cig (40.8%), MJ+Her (30.8%), Crack (24.7%), and Low Use (3.7%). The MJ+Cig class was 6.7 times more likely to use alcohol and 3 times more likely to use drugs before/during sex with steady partners than the Crack class. The MJ+Cig class was 16 times more likely to use alcohol before/during sex with steady partners than the MJ+Her class. The Crack class was 6.1 times more likely to engage in transactional sex and less likely to use drugs before/during steady sex than the MJ+Her class. CONCLUSIONS Findings illustrate patterns of drug use among a polysubstance using population that differ in sexual risk behavior. Intervention strategies should address substance use, particularly smoking as a route of administration (ROA), and sexual risk behaviors that best fit this high-risk population.

Cigarette smoking, illicit drug use, and routes of administration among heroin and cocaine users

Cigarette smoking is ubiquitous among illicit drug users. Some have speculated that this may be partially due to similarities in the route of administration. However, research examining the relationship between cigarette smoking and routes of administration of illicit drugs is limited. To address this gap, we investigated sociodemographic and drug use factors associated with cigarette smoking among cocaine and heroin users in the Baltimore, Maryland community (N=576). Regular and heavy cigarette smokers were more likely to be White, have a history of a prior marriage, and have a lower education level. Regular smoking of marijuana and crack was associated with cigarette smoking, but not heavy cigarette smoking. Injection use was more common among heavy cigarette smokers. In particular, regular cigarette smokers were more likely to have a lifetime history of regularly injecting heroin. Optimal prevention and treatment outcomes can only occur through a comprehensive understanding of the interrelations between different substances of abuse.

A Model of School Problems, Academic Failure, Alcohol Initiation, and the Relationship to Adult Heroin Injection

The current study uses structural equation modeling to investigate factors associated with alcohol initiation and injection heroin use. Baseline data from the NEURO-HIV Epidemiologic Study in Baltimore, Maryland, were used. Participants were 404 injection heroin users (Mage = 32.72) with a history of regular injection in their lifetime. Latent variables were created for self-reported school problems and academic failure. The final model indicated that greater school problems were associated with earlier alcohol initiation (ß = −0.22, p < .001) and earlier alcohol initiation was associated with greater frequency of recent heroin use (ß = −0.12, p < .05). Academic failure was directly related to greater frequency of recent heroin injection (ß = 0.15, p < .01). The results expand research investigating the relationship between adolescent behavior and illicit drug use in adulthood.

Younger Versus Older African Americans: Patterns and Prevalence of Recent Illicit Drug Use

Objectives: The current study examined recent substance use among younger and older African Americans and factors associated with recent use. Methods: The current study used a subset of African American men and women (N = 260) from the NEURO-HIV Epidemiological Study (Mage = 42, SD = 9.27; 59% female). Self-report of past 6 month substance use was evaluated for 21 different substances by routes of administration (ROA). Results: Older adults were 1.9 times (AOR = 1.92, 95% CI = 1.13–3.26) more likely to have used crack in the past 6 months and half as likely to have used marijuana (AOR = .44, 95% CI = .25–.77). There were no significant differences for heroin use. Discussion: Substance use at midlife may have significant implications for adverse social and health outcomes among African Americans. Findings support the need to better understand the developmental pathways of drug use and dependence among African Americans.

The Role of Drinking Severity on Sex Risk Behavior and HIV Exposure among Illicit Drug Users

OBJECTIVES The current study examined how drinking severity among injection and non-injection drug users is associated with sex risk behaviors and risk of HIV exposure. METHOD The study is a secondary analysis of an investigation of risk factors among drug users in Baltimore known as the NEURO-HIV epidemiologic study. Participants (N = 557) completed an interview, self-reported 30-day alcohol use, lifetime injection and non-injection drug use, and provided blood samples to screen for HIV. Participants were grouped into one of three drinking severity conditions: abstinent (no reported alcohol use in prior 30 days), moderate alcohol use (≤30 drinks for females, or ≤60 drinks for males), or problematic alcohol use (>30 drinks for females, or >60 drinks for males). Drinking severity groups were significantly different on lifetime injection drug use, heroin injection, snorting/sniffing cocaine, and smoking crack. RESULTS Logistic regression analyses found problematic alcohol users to be more likely than alcohol abstainers to inject drugs before or during sex (AOR = 5.78; 95% CI = 2.07-16.10), and more likely than moderate alcohol users to use alcohol before/during sex (AOR = 4.96; 95% CI = 2.09-11.81), inject drugs before/during sex (AOR = 2.96; 95% CI = 1.29-6.80), and to be HIV+ among Black participants (AOR = 2.72; 95% CI = 1.14-6.49). CONCLUSIONS These results outline the necessity for research and clinical intervention among this population to reduce sex risk behaviors and potential HIV exposure, while highlighting the need to examine drinking severity as a predictor of sex risk behaviors.

Competitive Swimmers' Perception of Motivational Climate and Their Personal Achievement Goals

The purpose of this study was to investigate the relationship of perceived motivational climate with personal achievement goals in competitive youth swimmers. A total of 119 competitive swimmers (mean age = 14.76) participated in this study. Participants completed the Perceived Motivational Climate in Sport Questionnaire-2 and the Achievement Goal Questionnaire-S. Overall, swimmers perceived the motivational climate on their team to be more mastery-oriented than performance-oriented. Regression analyses indicated that a mastery-oriented motivational climate was a positive predictor of mastery-approach goals and a negative predictor of mastery-avoidance goals. Perception of a performance-oriented motivational climate was a positive predictor of performance-approach goals. In addition, mastery-approach goals were positively related to satisfaction and persistence and negatively related to practice avoidance while mastery avoidance goals were negatively related to satisfaction.

An investigation of school-related variables as risk and protective factors associated with problematic substance use among vulnerable urban adolescents

Research has shown that early initiation of substance abuse has negative impacts on school performance and is predictive of substance abuse in adulthood. The aim of the present study was to evaluate the association between school-related variables and problematic substance use among adolescents in an urban setting. Adolescent participants (M age = 16.26, SD = 2.10; 65.3% male; 70.2% African-American) completed face-to-face interviews consisting of the Personal Experience Inventory (PEI) and a school-related questionnaire. Participants reported using alcohol to get drunk (44.9%), using marijuana (63.9 %) and other drugs to get high (19.8%). School-related risk and protective factors included: failed a class (61.8%), held back a grade (42.7%), sent to the principal (46.0%), family called for a conference (44.7%), suspended (39.0%), expelled (18.7%), and feeling good about school (61.3%) and teachers (66.1%). Having failed a class (AOR = 2.83), having been held back a grade (AOR = 4.68), and having been sent to the principal (AOR = 2.98) predicted problematic substance use. Feeling good about school (AOR = 0.39) and teachers (AOR = 0.27) was protective against problematic substance use. Findings demonstrate the importance of developing school-based targeted interventions for vulnerable youth.

Age Cohort Differences in Illicit Drug Use and Hepatitis C Among African American Substance Users

Identifying prognostic indicators for undiagnosed Hepatitis C is crucial to attenuate the negative impact of this disease. This study explored the influence of recent and more distal injection drug use on biologically confirmed Hepatitis C infection among a sample (N = 260) of older and younger African Americans. Data from the baseline assessment of the NEURO-HIV epidemiologic study was analyzed using confounder adjusted regression techniques. Older adults were more likely to test positive for Hepatitis C (OR = 2.80, 95% CI = 1.53–5.11) due to lifetime injection drug use (AOR = 5.37, 95% CI = 3.10–9.28). Clinical implications are discussed.