Incidence of diabetes mellitus in a population-based cohort of persons with chronic hepatitis B virus infection.

To investigate the effect of hepatitis B virus (HBV) infection on the development of diabetes mellitus (DM), we compared DM incidence and characteristics of Alaska Native persons with and without HBV infection. From 1990 to 2010, there were 52 incident DM cases among 1309 persons with infection vs 4557 DM cases among 85 698 persons without infection (log-rank test, P = 0.20). Compared to infected persons without DM, those with DM were significantly older (57.0 vs 47.4 years, P < 0.001) and had higher body mass index (34.5 vs 28.4 kg/m(2) , P < 0.001). Genotype, immune active disease and the presence of cirrhosis were not associated with DM. In this population-based cohort with over 20 years of follow-up, there was no effect of HBV infection on DM development.

Brief report on the effect of providing single versus assorted brand name condoms to hospital patients: a descriptive study.

OBJECTIVES: This study examined condom acquisition by persons in a hospital setting when single versus assorted brand name condoms were provided. METHODS: Condom receptacles were placed in exam rooms of two clinics. During Phase 1, a single brand name was provided; for Phase 2, assorted brand names were added. Number of condoms taken was recorded for each phase. RESULTS: For one clinic there was nearly a two-fold increase in number of condoms taken (Phase 1 to Phase 2); for the second clinic there was negligible difference in number of condoms taken. CONCLUSIONS: The provision of assorted brand name condoms, over a single brand name, can serve to increase condom acquisition. Locations of condoms and target population characteristics are related factors.

Evaluation of the response to a booster dose of hepatitis B vaccine in previously immunized healthcare workers.

INTRODUCTION: Hepatitis B vaccination is recommended for all healthcare workers (HCW) at risk of exposure to infectious body fluids. However, the absolute duration of protection from immunization is unknown. The purpose of this randomized comparison trial was to determine how previously immunized HCW respond to different booster doses of hepatitis B vaccine. METHOD: Adult HCW (n=59) were classified by level of hepatitis B surface antigen (anti-HBs), either <10 milli-International Units per milliliter (mIU/ml) or 10-50 mIU/ml. Participants were then randomized to receive a 2.5 or 10 microg dose of hepatitis B vaccine. Evaluation of anti-HBs levels were conducted 10 to 14 days, one month and one year postbooster. RESULTS AND DISCUSSION: All participants responded to the booster dose with increased anti-HBs levels. At 14 days, mean anti-HBs levels were significantly higher for those with higher levels at baseline (P=0.004) and those receiving the 10 microg dose (P=0.016). At one month, those with higher anti-HBs levels at baseline and those receiving the 10 microg dose were significantly higher (P<0.01 for both). At one year, the increase for the higher dose was no longer statistically significant when examined by itself (P=0.081); statistical significance (P=0.021) was achieved after adjusting for anti-HBs level at baseline. For all participants, the geometric mean anti-HBs level was 2618 mIU/ml at 14 days, 2175 mIU/ml at one month and 88.9 mIU/ml at one year. At all time points the increase in anti-HBs levels represented an increase over the geometric mean baseline level of anti-HBs (7.4 mIU/ml). Hepatitis B immunized adults responded to a booster dose of hepatitis B vaccine from 3 to 13 yr postvaccination series. Data support current recommendations that immunized HCW do not require periodic antibody testing or vaccine boosters.

Telephone survey of Alaskan pharmacists' nonprescription needle-selling practices.

OBJECTIVES: To determine the availability of nonprescription needles and syringes (NS) through pharmacy sales and to assess the impact of pharmacy policies and municipal paraphernalia laws on pharmacists' selling practices. DESIGN: Telephone survey of all pharmacies in Alaska's four largest cities. SETTING: Anchorage, Fairbanks, Juneau, and Ketchikan, Alaska. SUBJECTS: A single pharmacist from each pharmacy represented in the cities' phone books. MAIN OUTCOME MEASURES: Reports of (1) pharmacies' policies and individual pharmacists' procedures regarding the nonprescription sale of NS, (2) pharmacists' selling practices, and (3) identification of conditions that may affect pharmacists' decisions to sell nonprescription NS. RESULTS: Response rate of 86% (37/43); 77% of pharmacists reported selling at least one nonprescription NS in the last month. Store policy was related to selling practices; however, there was no difference in selling practices between a city with a paraphernalia law and cities without such laws. Logistic regression revealed pharmacists were more likely to sell NS if they worked in chain pharmacies and estimated that a high number of other local pharmacists sell nonprescription NS. CONCLUSION: NS are available through nonprescription sales in Alaskan pharmacies. The majority of pharmacies have store policies that permit pharmacists to sell nonprescription NS, either in all cases or at their discretion. Municipal paraphernalia laws do not determine the selling practices of individual pharmacists.

Alaska Native drug users and sexually transmitted disease: results of a five-year study.

Although Alaska has one of the highest rates of alcohol consumption in the U.S., there are very few reports of other drug use in Alaska. This five-year NIDA-funded study sampled out-of-treatment injection drug users (IDUs) and crack cocaine smokers in Anchorage, Alaska. This paper is a summary of results comparing risk behavior for HIV and sexually transmitted disease infection among Alaska Natives (n=216) to non-Natives (primarily Blacks n=394 and Whites n=479) from this study. IDUs and crack cocaine smokers were recruited using a targeted sampling plan. All subjects tested positive to cocaine metabolites, or morphine, using urinalysis, or had visible track marks. Several analyses of this database have indicated that Alaska Native women are at high risk for gonorrhea infection. They are also at risk for HIV infection due to high rates of behavior related to blood-borne disease transmission. We have also found that White men who have sex with both White and Alaska Native women are significantly less likely to use condoms with the Alaska Native women. HIV preventive education efforts aimed at Alaska Native women need to be implemented on a major scale.

Sex partners of Alaskan drug users: HIV transmission between white men and Alaska Native women.

This study describes patterns of sexual behavior and condom use in a sample of 1125 Black, White, and Alaska Native drug users. Data are self-reports of recent sexual behavior, including descriptions of (up to) the five most recent sex partners. This provided information on 1116 sex partner pairs, of which at least one partner was a drug user. Sex partner pairs involving a White man and an Alaska Native woman were frequently reported. Level of condom use within these pairs was significantly lower than within all other pairs. The implications of a potential vector of HIV transmission from White, drug using men to Alaska Native women are discussed.

Gonorrhea among drug users: an Alaskan versus a national sample.

The study described here investigates the replicability of gender-specific risk profiles for gonorrhea based on an Alaskan sample compared to a U.S. national sample of drug users at risk for HIV infection. The Alaska sample (interviewed at a field station in Anchorage, Alaska; N=1,049) and the national sample (interviewed at 18 sites other than Alaska; N=17,619) consisted of cocaine smokers and injection drug users not in drug treatment. A history of gonorrhea infection was self-reported and coded as ever or never. The Anchorage and national risk profile for men included the following factors: (a) history of intranasal or parenteral cocaine use, (b) being black versus nonblack, (c) being older, (d) income from illegal activity, and (e) history of amphetamine use. The Anchorage and national risk profiles for women included the following factors: (a) trading sex for money, (b) being Native American versus non-Native American, and (c) trading sex for drugs. The Anchorage model for women included perceived homelessness as a factor, but it was not retained in the national model. The extent of the replicability of these models illustrates the generalizability of Alaskan findings to other U.S. drug-using populations. The authors also discuss the implications of these findings for disease prevention.

Sex partners of Native American drug users.

This study describes patterns of sexual behavior and condom use in a sample of Native American drug-using men and women (N = 114). Data are self-reports of sexual behavior in the last 30 days, including descriptions of the most recent sex partners up to five. These data provided information on 157 sex partner pairs, of which at least one partner was a drug user. Native American women (55%) were more likely than Native American men (23%) to report never using condoms for vaginal and anal sex in the last 30 days. Compared with other ethnic pair combinations, sex partner pairs composed of Native American women and white men (n = 18) were the least likely to use condoms (6% of pairs) and the most likely to report an injection drug user (IDU) sex partner (33% of pairs). These results suggest a potential vector of HIV and other sexually transmitted disease (STD) transmission between white male IDUs and Native American women and highlight the need for further qualitative and quantitative research to examine the factors underlying this pattern of sexual risk behavior.

Cocaine smokers and injection drug users in Alaska: what distinguishes Native Americans from non-Native Americans?

Demographic and behavioral characteristics were modeled for distinguishing Native American drug users from non-Native American drug users in Anchorage, Alaska. Data were collected using a structured interview administered to participants (n = 1,091) who smoked cocaine, injected drugs, or both. Multivariate analyses were performed using logistic regression modeling. Four characteristics distinguish Native Americans (n = 223) from non-Native Americans (n = 868). Native Americans were more likely to have used marijuana at an earlier age and to have less than high school education; they were less likely to have ever used heroin and cocaine together, and to have used a condom during sex. Results are useful for administering interventions, data collection, and targeting hidden populations.

Assessing reading level of drug users for HIV and AIDS prevention purposes.

Using the short form of the Woodcock Reading Mastery Test-Revised and the reading subtest of the Wide Range Achievement Test-Revised, the reading abilities of 284 male and 128 female drug users from five sites across the United States were evaluated. All subjects were participants in a National Institute on Drug Abuse HIV/AIDS prevention project aimed at intravenous drug users and cocaine smokers. Results revealed differences in reading abilities among ethnic groups with Native and white subjects having significantly higher reading levels than Hispanic and black subjects. Significant site differences were revealed, with mean grade equivalent scores ranging from 2.7 to 10.1 grades. Across all subjects, the average grade equivalent reading level was 5.8 to 7.7, indicating that the subjects read below the level of 81.5% to 93% of the general population. We provide implications for development of educational materials that are accessible for this population.

Reading abilities of drug users in Anchorage, Alaska.

Evaluated the reading abilities of 122 male and fifty-nine female intravenous and other drug users in Anchorage, Alaska. Reading abilities were assessed through the Reading subtest of the Wide Range Achievement Test-Revised and the short Form of the Woodcock Reading Mastery Test-Revised. Results indicated that men and Black subjects reported the highest levels of schooling completed. However, no differences were revealed across gender and ethnicity in actual reading levels. Among all subjects, the average reading ability was between 8.5 and 8.7 grade level. These scores place the average subject reading at a level lower than approximately 76 percent of the general population. Implications are provided for development of educational materials accessible for this population.