Reaching impaired populations with HIV prevention programs: a clinical trial for homeless mentally ill African-American men.

This study tested an intervention to reduce sexual risk behaviors in a high risk impaired population: homeless African-American, Caucasian and Hispanic men with mental illness. In a comparison group clinical trial, men were assigned to an experimental cognitive-behavioral or a control intervention and followed up over 16 months. Men were recruited from a psychiatric program in two shelters for homeless men in Nashville, Tennessee. An ethnically mixed cohort of subjects (54% African-American, 42% Caucasian and 4% Hispanic) were included in the study. Most had a chronic psychiatric disorder and a co-morbid substance abuse disorder. The 257 participants who were sexually active (130 experimental, 127 control) prior to the trial were the main target of the intervention. An experimental intervention (SexG), adapted from Susser and Associates (51), comprised 6 group sessions. The control intervention was a 6-session HIV educational program. Sexual risk behavior was the primary outcome. The experimental and control groups were compared with respect to the mean score on a sexual risk index. Complete follow-up data were obtained on 257 men (100%) for the initial six-month follow-up. These individuals have been followed for the remainder of the 16-month follow-up. This intervention, (SexG), successfully reduced sexual risk behaviors of homeless mentally ill African-American, Caucasian and Hispanic men. Similar approaches may be effective in other impaired high-risk populations.

Differential N-demethylation of l-alpha-acetylmethadol (LAAM) and norLAAM by cytochrome P450s 2B6, 2C18, and 3A4.

Incubation of l-alpha-acetylmethadol (LAAM) or norLAAM with cDNA-expressed P450s 3A4, 2B6, and 2C18 produced significant N-demethylation products. P450s 2C19, 2C8, 3A5, 2C9, 3A7, 1A1, and 2D6 (norLAAM only), also produced detectable product. Coexpression of cytochrome b(5) enhanced LAAM N-demethylation, most dramatically for 3A4, but had marginal effects on norLAAM N-demethylation. Modeling total liver metabolism using immunoquantification and relative activity factors of P450s suggests contributions of P450 3A4 > 2B6 > 2C18, with the importance of 2B6 to 2C isozymes enhanced by relative activity factors. The ratio of dinorLAAM to norLAAM plus dinorLAAM formed from LAAM did not exceed 20%, and was isozyme and cytochrome b(5) coexpression dependent. This ratio decreased with concentration with 3A4, but was relatively constant for 2B6 and 2C18. The human liver microsomes substrate-concentration response was similar to cDNA-expressed 3A4, but the ratio was higher. Changes in the environment of cDNA-expressed 3A4 also effected the magnitude of the ratio, but not the concentration-dependent decrease. These studies show that the N-demethylation of LAAM and norLAAM is not restricted to P450 3A4, particularly P450s 2B6 and 2C18, and suggest that the mechanism of sequential metabolism for 3A4 differs from that of 2B6 and 2C18.

Intensive outpatient treatment of persons with mental retardation and psychiatric disorder: a preliminary study.

The impact of intensive outpatient mental health interventions (in a dual diagnosis clinic) on the hospitalization rate and length of stay was examined for 28 adults with mental retardation and severe psychiatric disorder. They were selected on the basis of frequent use of mental, medical, and social services. Charts were reviewed for the 12-month periods before and after referral to the program to compare service utilization. A single group pretest-posttest design with no control group was employed. Correlated t tests comparing the pre- and post-program number of hospitalizations and lengths of stay indicated significant decreases in both hospitalizations and lengths of stay after program entry, which may result in significant reductions in hospital costs.

Predicting treatment-seeking behavior: psychometric properties of a brief self-report scale.

Development of a brief instrument to assess attitudes toward treatment and predict treatment-seeking behavior among out-of-treatment substance misusers is described. Exploratory factor analysis of an initial pool of 41 items identified four subscales: Perceived need for treatment: perceived drug problem severity; motivation to quit; and negative attitudes toward treatment. Psychometric analyses of data from 535 substance misusers participating in an outreach intervention project provided substantial support for the reliability and construct validity of the first three subscales, and marginal support for the fourth. Evidence of predictive validity was provided by further analyses indicating significant relationships between the three primary scales and both treatment admissions and treatment-seeking during a 3-month follow-up period. The final instrument, the Treatment Attitude Profile (TAP), contains 25 items in a self-report format suitable for use with limited literacy populations in field or office settings.

Surface modification for controlled studies of cell-ligand interactions.

This work describes a method for coupling cell adhesion peptides to hydrophobic materials for the purpose of controlling surface peptide density while simultaneously preventing nonspecific protein adsorption. PEO/PPO/PEO triblock copolymers (Pluronic F108) were equipped with terminal pyridyl disulfide functionalities and used to tether RGD containing peptides to polystyrene (PS). The density of F108 on PS was 1.4 E5 +/- 2.12 E1 molecules/microm2. XPS and ToF SIMS indicated that the F108 coating was homogeneous and that the unmodified and activated F108 distributed evenly on PS. By mixing unmodified F108 with PDS-activated F108 prior to adsorption, it was possible to vary peptide density between 0 and 8.7 E4 +/- 2.66 E3 peptides/microm2, while otherwise, maintaining consistent surface properties. GRGDSY grafted PS supported cell attachment, spreading, and development of cytoskeletal structure, all of which were found to increase with increasing peptide density. Cell proliferation followed this same trend, however, maximal growth occurred at a submaximal peptide density. Cell aspect ratio varied in a biphasic manner with GRGDSY density. F108 coated PS and GRGESY grafted PS were inert to cell adhesion. Cells released from GRGDSY grafted PS upon addition of either a reducing agent or free GRGDSY, which indicates that cell-substrate interactions were mediated solely by the tethered peptides.

Older persons' opinions about life-sustaining procedures in the face of dementia.

OBJECTIVE: To investigate the attitudes of cognitively normal older adults toward various life-sustaining procedures in the face of dementia. METHODS: Participants were 84 cognitively normal men and women (70% response rate), 65 years and older, from a variety of urban and suburban settings, including private homes, assisted-living apartments, transitional care facilities, and nursing homes. In-person interviews were conducted with each participant to obtain information about demographic characteristics, life and health, and desire for various life-sustaining procedures for 4 hypothesized levels of dementia. RESULTS: Approximately three fourths of participants said they would not want cardiopulmonary resuscitation, use of a respirator, or parenteral or enteral tube nutrition with the milder forms of dementia, and 95% or more of participants would not want these procedures with severe dementia. In addition, only one third or fewer participants thought they would want to be hospitalized or given antibiotics if they were severely demented. Logistic regression analysis showed a relationship between participants' desire for life-sustaining procedures and having less education, greater independence, and a higher perceived quality of life. CONCLUSIONS: Most surveyed individuals did not desire life-sustaining treatments with any degree of dementia, and the proportion of individuals not desiring such treatments increased with the projected severity of dementia. These findings indicate a need for including dementia in advance directives planning.

HIV/AIDS mental health training for health care providers: an evaluation of three models.

Three models of continuing education--full-day, half-day, and brief workshop--for health providers treating patients with HIV/AIDS were compared on measures of effectiveness with regard to knowledge, attitude, and practice outcomes. Analyses of pre- and postintervention data from two years of training events suggest consistent, modest, program effects in the full-day and half-day approaches, specifically in the area of knowledge enhancement.

The needs of postbirth parents: an international, multisite study.

Health care reform has moved postbirth care into the community without assessment of how this may change parents' needs. Mother-father pairs (n = 117) in six sites in four countries were interviewed at 5 to 10 days postbirth and again between 6 and 8 weeks postbirth to determine their needs. Content analysis revealed both parents in all sites had a strong focus on self-needs throughout the postbirth period. Postpartum programs oriented solely to family-centered care may not meet the specific needs of contemporary parents.

Continuing medical education versus clinic-based STD and HIV education interventions for primary care service providers: replication and extension.

An evaluation of a 2-day sexually transmitted disease (STD) and HIV and AIDS curriculum for primary care providers is presented which compares large scale continuing medical education (CME) conferences with smaller clinic workshop (CW) models with regard to short-term (2-month) and long-term (10-month) program effects on STD and HIV knowledge, attitudes toward risk assessment, and frequency of both STD diagnosis and STD and HIV risk counseling. Data from interventions held in San Antonio, Texas (328 CME; 95 CW) replicate and extend earlier findings from a preliminary intervention, indicating nonsignificant CME-CW differences and dramatic and long-lasting gains from baseline among those with lower knowledge and experience levels preintervention. Similar program effect magnitudes were found for attitude and practice dimensions at 2 months postintervention, with the strongest consistent short and long-term program effects observed for STD and HIV knowledge among service providers.

A novel method for surface modification to promote cell attachment to hydrophobic substrates.

The ability to study and regulate cell behavior at a biomaterial interface requires strict control over material surface chemistry. Perhaps the greatest challenge to researchers working in this area is preventing the fouling of a given surface due to uncontrolled protein adsorption. This work describes a method for coupling peptides to hydrophobic materials for the purpose of simultaneously preventing nonspecific protein adsorption and controlling cell adhesion. A hexapeptide containing the ubiquitous RGD cell-adhesion motif was coupled to polystyrene (PS) via a polyethylene oxide (PEO) tether in the form of a modified PEO/PPO/PEO triblock copolymer. Triblocks were adsorbed onto PS at a density of 3.3 +/- (5.14 x 10(-4)) mg/m2 (1.4 x 10(5) +/- 2.12 x 10(1) molecules/microm2), which was determined by isotope 125I labeling. The peptide, GRGDSY, was activated at the N terminus with N-Succinimidyl 3-(2-pyridyldithio) propionate and coupled to immobilized triblocks where the terminal hydroxyls had been converted to sulfhydryl groups. Surface peptide density was measured by amino acid analysis and found to be 1.4 x 10(4) +/- 0.47 x 10(4) molecules/microm2. PS modified with PEO/PPO/PEO copolymers alone was found to be inert to cell adhesion both in the presence of serum proteins and when exposed to activated RGD peptide. In contrast, PS conjugated with RGD via endgroup-activated PEO/PPO/PEO copolymers supported cell adhesion and spreading. The surface coupling scheme reported here should prove valuable for studying cell-ligand interactions under simplified and highly controlled conditions.

The Health Belief Model and HIV risk behaviours: a causal model analysis among Anglos, African-Americans and Mexican-Americans.

A causal model of the Health Belief Model (HBM) is empirically evaluated which emphasizes possible indirect paths linking distal demographic and seriousness/susceptibility variables to HIV risk behaviours among Anglo, African-American, and Mexican-American adults. A specific focus of the paper is upon alcohol-related expectancies (anticipation of disinhibitory effects of alcohol upon sexual behavior) as a 'barrier' to preventive behaviours. Ethnic comparisons stem both from the paucity of available research on the HBM in minority populations and from recent questions regarding the applicability of rational models such as the HBM among minority groups. Analyses of data from a community sample of 1390 adults indicate relatively consistent direct effects of barriers for males and benefits for females upon HIV risk behaviors. The analyses suggest distinct paths operative among males and females. The susceptibility-barriers-risk behaviours path among males may suggest that alcohol-related expectancies (barriers in this model) may be more strongly related to risk behaviours among males than minority females.

Solitary drinking, social isolation, and escape drinking motives as predictors of high quantity drinking, among Anglo, African American and Mexican American males.

This paper addresses the phenomenon of 'solitary drinking', considering whether Anglo, African American and Mexican American male regular drinkers differ in the propensity to drink in solitary contexts and whether such differences may help to explain observed ethnic variation in patterns of heavy drinking. Further, the paper considers whether apparent relationships between solitary drinking and drinking patterns are explained by individual personality characteristics such as social isolation and/or by endorsement of 'escape drinking' motives. Data were analysed from a random community sample of 481 adult male regular drinkers in San Antonio, Texas, USA. Contingency table and logistic regression analyses indicated that initially observed ethnic differences in high quantity and high maximum drinking were largely eliminated by controls for education, escape motives and solitary drinking. Ethnic variation in the role of solitary drinking was suggested as well, with solitary drinking more strongly related to high quantity consumption, in particular, among African Americans than among Mexican Americans. The nature of the observed interactions suggests that fundamental differences between Anglos and African Americans in the roles of solitary drinking and escape drinking motives may underlie seemingly similar frequent, lower quantity drinking patterns in these groups that appear more frequently than among Mexican American males.

Career pathways and current practice patterns of clinical and counseling psychologists: a follow-up study of former interns.

The present study examined career pathways and current work patterns for 110 graduates of an internship program. Results show that the group trained after 1980 went into private practice more rapidly than those trained prior to 1980. Both groups do extensive psychological testing. Implications are discussed.

Alcohol use, liberal/conservative orientations, and ethnicity as predictors of sexual behaviors.

The present study examined relationships among ethnicity, gender, alcohol consumption, and sexual behaviors in a community survey sample of 1,392 adults. Predictors included liberal versus conservative orientations (sex role orientation, religiosity); traditional versus liberal attitudes regarding sexuality, typical alcohol consumption patterns, expectancies regarding alcohol's effect upon one's sexuality, and frequency of alcohol use before sex. Findings are consistent with other studies indicating more sex partners among males than females and among Blacks (particularly males) than Anglos. Blacks also reported less involvement in oral sex than Anglos and Mexican-Americans--although observed differences for oral sex were more characteristic of females and less characteristic of unmarried nondrinkers. Unmarried Mexican-American males reported somewhat, though not significantly, more partners than did Anglos. Unmarried Black males (particularly nondrinkers) also reported more frequent risky behaviors than did Anglos. Divorced Black female drinkers reported significantly less frequent risky behavior than their Anglo counterparts. Alcohol use-sexual relationships were independent of psychosocial background characteristics and situated drinking (drinking before sex) was more strongly related to sexual behavior dimensions than were general drinking patterns.

Adult children of alcoholic or mentally ill parents: alcohol consumption and psychological distress in a tri-ethnic community study.

Data from a racially and ethnically heterogeneous random community sample of 1,784 adults were used to compare effects of reported parental alcoholism, parental mental illness, both alcoholism and mental illness, or no parental pathology. No parental history differences were observed among males with regard to psychological distress (depression, anxiety, and somatization) or drinking patterns (drinking, quantity, frequency, or total weekly consumption). Among females, the parental-mental-illness-only group consistently reported more problems than did the no-pathology group on depression, anxiety, somatization, and drinking quantity, even after statistical controls for demographic factors, social desirability, and possible coping resources such as fatalism, religiosity, and self-esteem. While parental alcoholism appeared to have little impact upon psychological distress dimensions relative to the no pathology group, further analyses conducted separately for current drinkers vs. nondrinkers indicated consistently lower levels of depression, anxiety, and somatization among male nondrinkers than drinkers from families involving parental alcoholism. The specificity of these effects to males reporting parental alcoholism may reflect either the resilience of male Adult Children of Alcoholics (ACOAs) who do not drink and/or the role of drinking as a mediator of parental alcoholism. Possible reasons for the general lack of parental alcoholism and racial/ethnic differences are discussed.

Life stressors, drinking patterns, and depressive symptomatology: ethnicity and stress-buffer effects of alcohol.

This paper seeks to extend previous research on stress buffer effects of alcohol use using data from a tri-ethnic community sample of 1,784 respondents. Differences in buffer effects between Anglos, Blacks, and Mexican Americans are examined to explore possible racial/ethnic variation in the role or function of alcohol vis-à-vis life stress and depressive symptoms. Both acute life events and chronic financial stress are examined to clarify the conditions under which buffer effects are most and least salient in these groups. The findings indicate that alcohol buffer effects are most pronounced among males with regard to life event stress and depression. Ethnic differences in buffer effects were suggested among males for life events, though statistical controls for demographic factors, fatalism, and religiosity accounted for these differences. The implications of these findings are examined, and the paper generally highlights the need to view alcohol use and alcohol buffer effects in the context of more general coping orientations.

Acculturation and drinking patterns among U.S. Anglos, blacks, and Mexican Americans.

The relationship between acculturation, generational status/nativity and drinking patterns is examined using data from a 1988 community survey of 1286 adult regular drinkers (at least two drinks/month) in San Antonio, Texas. This sample includes 412 Anglo, 239 Black, and 635 Mexican American respondents, with Mexican Americans further classified into high, medium, and low acculturation groups using a language-use-based acculturation measure. This data set allows comparisons between racial/ethnic majority and minority groups with further comparisons between Black and Mexican American subgroups. These racial/ethnic and acculturation level comparisons highlight the effects of minority status and cultural differences between groups with regard to drinking patterns. Overall, the analyses indicate little evidence to support an 'acculturation stress' model of alcohol use, wherein the stresses of acculturation produce higher levels of alcohol consumption among moderately or higher acculturation groups. Generally, in our data, quantity and frequency consumption was somewhat higher among the least acculturated males and moderately acculturated females. Further analyses by generational status indicate heavier consumption patterns among second-generation individuals, especially among the less acculturated, though those differences were eliminated by controls. The findings highlight inadequacies of using generational status/nativity measures alone to assess acculturation level. Further, joint effects of acculturation level and generational status suggest the viability of a cultural marginality model of acculturation, though many of the effects of acculturation and generational status are explained by demographic and psychosocial factors.