Susan D. Chandler

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey

BackgroundUkraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV.MethodsA sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]).ResultsHIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV-positive person. More than half (51.1%) reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not.ConclusionHarm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine.

Social networks and substance use among at‐risk emerging adults living in disadvantaged urban areas in the southern United States: a cross‐sectional naturalistic study

BACKGROUND AND AIMS Substance use and risk-taking are common during emerging adulthood, a transitional period when peer influences often increase and family influences decrease. Investigating relationships between social network features and substance use can inform community-based prevention programs. This study investigated whether substance use among emerging adults living in disadvantaged urban areas was influenced by peer and family social network messages that variously encouraged and discouraged substance use. DESIGN Cross-sectional, naturalistic field study. SETTING AND PARTICIPANTS Lower-income neighborhoods in Birmingham, Alabama, USA with 344 participants (110 males, 234 females, ages 15-25 years; mean = 18.86 years), recruited via respondent-driven sampling. MEASUREMENTS During structured interviews conducted in community locations, the Alcohol, Smoking and Substance Involvement Screening Test assessed substance use and related problems. Predictor variables were network characteristics, including presence of substance-using peers, messages from friends and family members about substance use and network sources for health information. FINDINGS Higher substance involvement was associated with friend and family encouragement of use and having close peer network members who used substances (Ps < 0.001). Peer discouragement of substance use was associated with reduced risk (b = - 1.46, P < 0.05), whereas family discouragement had no protective association. CONCLUSIONS Social networks appear to be important in both promoting and preventing substance use in disadvantaged young adults in the United States.

Time horizons and substance use among African American youths living in disadvantaged urban areas

Transitioning from adolescence to full-fledged adulthood is often challenging, and young people who live in disadvantaged urban neighborhoods face additional obstacles and experience disproportionately higher negative outcomes, including substance abuse and related risk behaviors. This study investigated whether substance use among African Americans ages 15 to 25 (M=18.86 years) living in such areas was related to present-dominated time perspectives and higher delay discounting. Participants (N=344, 110 males, 234 females) living in Deep South disadvantaged urban neighborhoods were recruited using Respondent Driven Sampling, an improved peer-referral sampling method suitable for accessing this hard-to-reach target group. Structured field interviews assessed alcohol, tobacco, and illicit drug use and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task). As predicted, substance use was positively related to a greater ZTPI orientation toward present pleasure and a lower tendency to plan and achieve future goals. Although the sample as a whole showed high discounting of delayed rewards, discount rates did not predict substance use. The findings suggest that interventions to lengthen time perspectives and promote enriched views of future possible selves may prevent and reduce substance use among disadvantaged youths. Discontinuities among the discounting and time perspective variables in relation to substance use merit further investigation.

Sexual risk typologies and their relationship with early parenthood and STI outcomes among urban African–American emerging adults: a cross-sectional latent profile analysis

Objectives Identifying sexual risk patterns associated with HIV/sexually transmitted infections (STI) and early parenthood within population subgroups is critical for targeting risk reduction interventions. Methods Latent Class Analysis (LCA) was used to identify sexual behaviour typologies to predict sexual risk outcomes among 274 (63% female) unmarried, sexually active African–American emerging adults (M age=19.31 years) living in disadvantaged urban neighbourhoods. Participants were enrolled in a larger cross-sectional observational study of risk and protective behaviours. LCA defined membership into discrete risk classes based on reported sex risk behaviours. Results Three groups were identified: The ‘low contraception use’ risk class (32%) had low rates of condom or other birth control use, moderate rates of sexual initiation before age 16 years, and the highest pregnancy/early parenthood and STI rates. The predominately male ‘early sex’ risk class (32%) had higher rates of early initiation and multiple partners, risks that were countered by higher contraception and condom use. Both these risk groups showed higher probability to use substances before sex relative to the ‘low sex risk’ class (36%), which showed low rates on all risk behaviours. Conclusions LCA identified distinct risk clusters that predicted sexual health outcomes and can inform targeted interventions for a minority youth population disproportionately affected by HIV, other STIs, and early parenthood.

Predictors of utilization of an IVR self-monitoring program by problem drinkers with recent natural resolutions

BACKGROUND As part of a randomized controlled trial, problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response (IVR) self-monitoring (SM) system as a sobriety maintenance tool during early recovery when relapse risk is high. Because observed IVR utilization was variable, predictors of utilization were evaluated to inform knowledge of populations likely to access and use IVR services. METHODS Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longstanding high-risk drinking practices and alcohol-related problems (M=16.58 years, SD=10.95). Baseline interviews assessed pre-resolution drinking practices and problems, and behavioral economic (BE) measures of reward preferences (delay discounting, pre-resolution monetary allocation). Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages. RESULTS IVR use ranged from 0 to 100%. Frequent (n=28), infrequent (n=42), and non-caller (n=17) groups were identified. Non-callers tended to be younger and to report heavier pre-resolution drinking. Frequent callers (≥70% of IVR days) tended to be older, male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers. Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking. CONCLUSIONS Characteristics common in the untreated problem drinker population were associated with higher IVR utilization. This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform.

Utility of Respondent Driven Sampling to Reach Disadvantaged Emerging Adults for Assessment of Substance Use, Weight, and Sexual Behaviors

Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial “seed” participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.

Selecting Communication Channels for Substance Misuse Prevention with At-Risk African-American Emerging Adults Living in the Southern United States.

ABSTRACT Natural health information sources used by African-American emerging adults were investigated to identify sources associated with high and low substance-related risk. Participants (110 males, 234 females; M age = 18.9 years) were recruited using respondent-driven sampling, and structured interviews assessed substance use, sources of health information, and preferences for help. Friends and social network sites were associated with higher risk, whereas teachers/schools were associated with lower risk (ps < .025). Despite risks associated with friends, more participants preferred receiving help from friends than the other sources. The findings inform targeted prevention messages that are sensitive to contextual and audience characteristics.