Improving access to health care for uninsured elderly patients.

The purpose of this article is to explore the barriers that the uninsured elderly population encounter when accessing health care in the United States. These barriers include, but are not limited to lack of transportation, insurance, or family support; the daunting complexity of the health care system; poverty; culture; poor patient-health care provider communications; race/ethnicity; and lack of health care professionals such as nurses and doctors with adequate geriatric preparation, or generalists who are undereducated in geriatrics. The number of health care professionals currently available to treat elderly persons in the United States is inadequate. The Federal government should take steps to develop solutions to improve access to health care and decrease health disparities for older adults. As a nation, we should be proactive in addressing these concerns instead of waiting for new barriers to arise that further limit access to health care for elderly patients and their families. In this article, we provide an assessment of the barriers that limit access to health care in the uninsured elderly population and suggest recommendations and possible solutions to eliminate or reduce these barriers.

Beliefs and social norms about sildenafil citrate (Viagra) misuse and perceived consequences among Houstonian teenage males.

In the current study, a qualitative approach was used to investigate relevant beliefs and norms associated with sildenafil citrate (Viagra) consumption, initiation, and perceived consequences. Focus groups were conducted with 43 young men aged 18 and 19 years who identified themselves as lifetime sildenafil citrate users. The majority of focus group participants believed that "curiosity" and "peer pressure" contributed to their initial use. Most revealed that they first heard about sildenafil citrate from television advertisements, family members, friends, or sporting events, and they were able to obtain the drug from their friends and family members or they stole it from their father or grandfather. These findings may highlight the relative importance of exposure to prescription drug messages among those to whom the message is not specifically targeted, that is, young men. It is possible that the sildenafil citrate television messages are recalled by not only older male audiences but also by teenagers and younger men, producing similar cognitive processing and curiosity in both age cohorts.

Cocaine use and syphilis trends: findings from the arrestee drug abuse monitoring (ADAM) program and syphilis epidemiology in Houston.

There has been speculation that trends in syphilis have been fueled by crack cocaine use. This study examined the data on syphilis notifications and arrestee drug abuse monitoring (ADAM) to ascertain the relationships between syphilis and cocaine use trends in three racial/ethnic groups. Syphilis notifications and data from the ADAM project were compared in Houston/Harris County, Texas, from 1991-1998 using a linear regression equation. Data indicated significant relationships between the data for cocaine use and syphilis in African Americans but not Hispanics or non-Hispanic whites. For African Americans, 58% of the variance between cocaine use and syphilis was explained. When data limited to jail syphilis notifications and ADAM cocaine in African Americans were examined, the association was stronger for males than for females. For African Americans, cocaine (probably crack cocaine) use trends were significantly associated with syphilis trends in this population. These data suggest that control of crack cocaine may have an impact on syphilis rates and that there may be close relationships between some STDs and drug abuse.

Prevalence of childhood sexual abuse among incarcerated males in county jail.

OBJECTIVE: The current study examined the prevalence and characteristics of childhood sexual abuse in a jailed-based population. METHODOLOGY: A retrospective, self-reported survey was administered over an 8-week period to a random sample of 100 men who were incarcerated in a county jail in Southeastern Texas. The survey included questions about childhood sexual experiences before and after puberty, drug history and use, and sexual risk-taking behaviors. RESULTS: Of the 100 male inmates who participated in this study, 59% reported experiencing some form of sexual abuse before puberty, and all such instances occurred before or at the age of 13 years. The first episode of childhood sexual abuse began at an average age of 9.6 years (SD = 2.4), and ended at an average age of 13.0 years (SD = 2.3). Kissing and touching without intercourse (64%) was the common pattern of sexual abuse experience reported. The total number of perpetrators was 165, with 10% male and 90% female. Friends (n = 72) and family (n = 56) were the most frequent perpetrators. CONCLUSION: Childhood sexual abuse may be more prevalent among inmates than among males in the general population. These results show a high percentage of inmates who report a history of childhood sexual abuse; this rate is higher than those reported by other studies for incarcerated males. The findings support the belief held by professionals in the criminal justice field that a significant number of incarcerated males may have been victims of sexual abuse.

A history of drug use and childhood sexual abuse among incarcerated males in a county jail.

This study explored the relationship between childhood sexual abuse and drug use among incarcerated males. A retrospective, self-reported survey was administered over an 8-week period (September and October 2001) to a random sample of 100 men who were incarcerated in a county jail. The survey included questions about childhood sexual experiences before and after puberty, drug history and use, and sexual risk-taking behaviors. Overall, 59% of this sample of male inmates reported some form of childhood sexual abuse, and all such instances occurred before or at the age of 13. Statistically significant relationships were found between drug use and childhood sexual abuse, with those who experienced childhood sexual abuse reporting drug use at percentages as much as 30% higher than those denying histories of childhood sexual abuse.

Developing holistic nursing interventions to improve adolescent health.

Adolescents learn health behaviors in a sociocultural context of community, family, and peers. Although many adolescents engage in behaviors that protect and promote health, others engage in behaviors that threaten or compromise their health. The purpose of this review article is to provide an overview of health-risk behaviors and the morbidities and mortalities of adolescence that are related to these behaviors. Interventions that address these health behaviors and outcomes are presented along with suggestions for a holistic nursing response to this important public health concern.

Comparing the validity of self-reported recent drug use between adult and juvenile arrestees.

A large body of literature has explored the validity of self-reported drug use among criminal populations. These works have typically revealed strong underreporting of recent illicit drug use. To date, however, no studies have compared the validity of self-reported drug-using behaviors between adult and juvenile offenders. The authors overcome this limitation by assessing the validity of self-reported recent drug use with data collected from 1,425 adult and 551 juvenile Los Angeles arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program in 1997. Kappa statistics were computed and tests for specificity and sensitivity were conducted utilizing urinalysis as the reference standard. Results suggest that adult arrestees are more inclined to underreport their recent use of illicit drugs. Implications for drug use research are assessed in light of the current findings.

Comparing drug use between welfare-receiving arrestees and non-welfare-receiving arrestees.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) symbolized a comprehensive change to the nation's welfare system. Despite several provisions within PRWORA that focus on the use of illegal drugs, few studies have attempted to identify the prevalence of illegal drug use among welfare recipients. Moreover, no scholarly works have compared rates of drug use in welfare-receiving populations to those of non-welfare-receiving populations with an objective measure of drug use. In the current study, urine specimens were collected from 1,572 arrestees interviewed through Houston's Arrestee Drug Abuse Monitoring (ADAM) Program in 1999. Drug positive rates are compared between welfare-receiving arrestees (n = 116), non-welfare receiving arrestees living below the poverty level (n = 539), and non-welfare receiving arrestees living above the poverty level (n = 917). Welfare-receiving arrestees were more likely to be female, older, less educated, and to test positive for opiates and benzodiazepines than the other subgroups. Implications for welfare reform policy are discussed in light of the current findings.

Exploring benzodiazepine use among Houston arrestees.

While marijuana and cocaine are the two most prevalent drugs among arrestees, benzodiazepine use has surpassed that of opiates in several jurisdictions across the United States. Despite this proliferation, few scholarly works have focused on benzodiazepine use among individuals under criminal justice supervision. In the present study, the authors used Chi-square statistics and logistic regression to identify significant associations between recent benzodiazepine use (as measured by urinalysis), demographic characteristics, and alcohol and other drug (AOD) use among a sample of 1,572 adult Houston arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program in 1999. Compared to nonusers, benzodiazepine-positive arrestees were more likely to be Black, less likely to have a high school diploma, and more likely to be arrested for a drug- or alcohol-related offense. Moreover, analyses indicated that recent barbiturate, heroin, PCP, and marijuana use, as measured by urinalysis, were the strongest predictors of recent benzodiazepine use. Policy implications are assessed in light of the current findings.