Effectiveness of Using Incentives to Improve Parolee Admission and Attendance in Community Addiction Treatment.

This study is a randomized effectiveness trial of the use of incentives to improve treatment utilization among parolees in community treatment. In prison, Admission phase parolees were randomized to Admission Incentive (N=31) or Education (N=29). Attendance phase parolees entering community treatment were randomized to Attendance Incentive (N=104) or Education (N=98). There was no main effect for incentives in either study phase. Neither admission to community treatment (Incentive 60%, Education 64%; p =.74), nor intervention completion (Incentive 22%; Education 27%; p =.46) appeared to be impacted. Time-in-treatment was predicted by age, first arrest age, and type of parole status (Cox regression p<.05), but not by treatment group. Providing incentives did not increase the likelihood that parolees enrolled in or stayed in community treatment. In light of this finding, criminal justice practitioners who are considering incentives to increase admission or retention should be aware that they may not produce the desired outcomes.

The relative effectiveness of women-only and mixed-gender treatment for substance-abusing women.

Following research indicating that the treatment needs of women are different from those of men, researchers and clinicians have argued that drug treatment programs for women should be designed to take their needs into account. Such programs tend to admit only women and incorporate philosophies and activities that are based on a social, peer-based model that is responsive to women's needs. To assess the relative effectiveness of women-only (WO) outpatient programs compared with mixed-gender (MG) outpatient programs, 291 study volunteers were recruited (152 WO, 139 MG), and a 1-year follow-up was completed with 259 women (135 WO, 124 MG). Using bivariate, logistic regression, and generalized estimating equation analysis, the following four outcomes were examined: drug and alcohol use, criminal activity, arrests, and employment. In both groups, women showed improvement in the four outcome measures. Comparison of the groups on outcomes yielded mixed results; women who participated in the WO treatment reported significantly less substance use and criminal activity than women in the MG treatment, but there were no differences in arrest or employment status at follow-up compared with those in the MG treatment.

Perceptions of need and help received for substance dependence in a national probability survey.

OBJECTIVE: Most individuals with alcohol or other substance use disorders do not seek help for these problems. This study examined the factors associated with perceptions of need for help and receipt of help among individuals with alcohol or other substance dependence disorders in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). METHODS: The 2001-2002 NESARC surveyed a representative sample of the noninstitutionalized population in the United States. Individuals with a past-year substance dependence diagnosis (N=1,602) were classified into one of three groups: received help in the past year (14.7%), perceived a need for help but did not receive it (8.5%), or perceived no need and received no help (76.8%). Multinomial logistic regression with population weights was used to examine the influence of predisposing, enabling, and need-related factors on help seeking in the past year. RESULTS: Factors that increased the receipt of help included older age, drug dependence (versus alcohol dependence only), longer time since the onset of dependence, co-occurring mood disorder, and more problems associated with substance use. Nonwhites were about twice as likely as whites (odds ratio=2.2) to perceive a need for help but not receive it. Similarly, more problems associated with substance use increased the odds of both receiving help and perceiving a need for help but not receiving it. None of the enabling characteristics were associated with help seeking or perceived need, after analyses controlled for predisposing and need-related factors. CONCLUSIONS: Increasing the recognition of problems associated with substance dependence, particularly alcohol, may facilitate help seeking, although barriers persist in regard to age and race-ethnicity.

Gender and comorbidity among individuals with opioid use disorders in the NESARC study.

This study examines gender differences in the association of lifetime mental and substance use disorders among individuals with opioid use disorders in the United States. The sample (N=578) is from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), which is a representative household survey. Bivariate analyses and logistic regression modeling were conducted. About 70% of the sample had a lifetime non-substance use Axis I disorder; women were about twice as likely as men to have either a mood or anxiety disorder. About half of the sample had a personality disorder, with women more likely to have paranoid disorder and men more likely to have antisocial personality disorder. Individuals with a lifetime mental disorder were about three times more likely than others to be dependent on other substances, independent of gender. The study demonstrated an inverse relationship between lifetime mental and other substance use disorders, with women having significantly higher odds for several of the mental disorders and men having greater odds of other substance use disorders.

Patterns in Relationship Violence Among African American Women: Future Research and Implications for Intervention.

The impact of intimate partner violence (IPV) on those most at risk, HIV-positive women of color, has received little attention. This study examined IPV in HIV-positive and HIV-negative African American women. Victim characteristics and factors contributing to IPV and psychological sequelae were identified. Structured interviews were administered and analyzed at baseline, at 6 months, and at 12 months. HIV-positive women were less educated, were less employed, had lower incomes, had more depressive symptoms at all time points, and were more likely to report IPV at baseline and 6 months compared to HIV-negative women. Among HIV-positive depressed women, those reporting IPV were more depressed than those without IPV. Suggestions for studies with couples examining relationship dynamics, including risks for IPV and HIV transmission, and for interventions are discussed.

Substance abuse and medication adherence among HIV-positive women with histories of child sexual abuse.

Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-making. Severity of CSA was significantly associated with substance use but not with adherence. Participants who had used hard drugs and who had lower self-esteem and adherence self-efficacy reported significantly lower levels of adherence. Additional research on how CSA experiences impact health behaviors is needed to help develop culturally congruent interventions to reduce risk behaviors and facilitate better medication adherence for this vulnerable population.

Strategies to recruit and retain older Filipino-American immigrants for a cancer screening study.

Recruitment and retention of subjects in cancer prevention, screening, and treatment trials is challenging, especially if subjects are low-income, from minority groups or immigrants with limited English fluency. This article describes our experiences in recruiting 530 female Filipino-American immigrants at community based organizations and churches for a randomized trial that assessed the effect of a small group educational session on breast and cervical cancer screening. We found that a personal invitation from either a female project liaison, a friend, or the Filipino project director were all successful strategies that resulted in over 80% attendance at an educational session that was offered as part of the study. Although non-attendees did not differ from attendees in demographic characteristics, they expressed significantly more barriers to participating in a health study. Attendance at the group session was a significant predictor of retention in the study. We were able to conduct telephone follow-up surveys among 88% of enrollees at 12 month follow-up and 76% at 24 month follow-up. Results and implications are discussed in the hope that they may facilitate future participation of Filipinos and other Asian immigrants in research.

Results of a randomized trial to increase breast and cervical cancer screening among Filipino American women.

BACKGROUND: This paper reports the first evaluation of an intervention to increase breast and cervical cancer screening among Filipino American women. METHODS: Filipino women over 40 years of age were recruited through nine community-based organizations and six churches in Los Angeles County. After completion of a short baseline interview, all women were invited to attend a group session with some of their peers and a female Filipino health educator. Women within each organization were randomized to receive a cancer screening module (intervention) or a physical activity module (control). Telephone follow-up interviews 12 months after the group session assessed the impact of the intervention. RESULTS: Of the 530 women invited, 444 (84%) attended a session. At baseline and follow-up, screening rates for breast and cervical cancer did not differ between study groups. Moderate increases in screening rates (9 to 12 percentage points) were observed in both arms of the study. Among relatively recent immigrants who had spent less than 10 years in the United States, mammography screening increased substantially more in the intervention arm than under the control condition (a 27 vs 6 percentage point increase, P<0.05). CONCLUSION: Our intervention was only effective in increasing cancer screening among relatively recent immigrants who had very low baseline screening rates.

Physical activity among older Filipino-American women.

Filipino women (N = 530, mean age 63 years, predominantly low income) were recruited through various community based organizations and churches in Los Angeles County. All women were randomly invited to attend a single group session with a Filipino health educator to discuss breast and cervical cancer screening or the health benefits of exercise. At 3 months after the group session, the exercise assessment tool used in the National Health and Nutrition Examination Survey III was completed by 487 women (92 percent retention rate). This paper describes the pattern of physical activity among older Filipino-American women and a physical activity intervention specifically designed for this group.

Pilot test of a single-session AIDS workshop for young Hispanic U.S. immigrants.

A multiple-session AIDS workshop poses a substantial burden on the provider and on the clients. Therefore, we developed and pilot-tested a single-session AIDS prevention workshop, using a before and after comparison in a one group design. Young Hispanic patients at an HIV testing clinic completed a baseline survey and were invited to attend a single-session 90-min AIDS prevention workshop. The goals of the workshop were to reinforce issues discussed in the individual HIV counseling session, and to encourage and practice condom carrying, negotiation and use. Forty-seven percent of the patients attended the workshop and evaluated it very positively. Sixty-eight percent of all patients completed a telephone interview 4 weeks later. The proportion of subjects who always carried condoms increased from 18% at baseline to 42% at 4-week follow-up (p < 0.0004). Stratified analyses showed that condom carrying increased significantly only in males and only in workshop attenders.