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Jepsen D, Healy KV, Bernard M, Markert J, Brzank PJ. Patterns of Sexual Risk Behaviors and Sexuality-Related Risk Factors among Young Adults in Germany: Implications for Prevention and Therapy. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2671-2688. [PMID: 38816590 PMCID: PMC11219385 DOI: 10.1007/s10508-024-02877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 06/01/2024]
Abstract
Sexual risk behavior (SRB) includes behavioral (sex without contraception, sexualized substance use, sex work, sexual partner violence, other sexual activities that harm oneself or others) and affective subtypes (sexuality-related feelings of shame/guilt, relationship impairments) and leads to psychosocial and health-related consequences. Young adults comprise a vulnerable group regarding the development of SRB. The study aimed to identify SRB patterns among young adults and their relation to sexuality-related risk factors. A cross-sectional online survey measured behavioral and affective aspects of SRB with nine items. Latent class analysis was conducted to identify patterns of SRB. Gender, sexual orientation, age of first intercourse, number of sexual partners, hypersexuality, and sexual dysfunction were captured as risk factors via multinomial logistic regression. Within this convenience sample (n = 609; nfemale = 365; nmale = 245; Mage = 23.1 years), the SRB patterns unremarkable (67%; low values in all SRB subtypes), shame-ridden (17%; high values in sexual feelings of shame/guilt) and risky sexual behavior (16%; high values in all subtypes of SRB, especially sexualized drug use) were identified. The shame-ridden and risky patterns were strongly associated with higher hypersexuality values, the risky pattern moreover with being non-heterosexual, of younger age at first sexual experience, and a higher number of sexual partners. Male and sexual minority participants demonstrated SRB more often than females and heterosexuals. Within prevention and treatment of SRB, it seems beneficial to address sexuality-related feelings of shame/guilt and addictive patterns (concerning sexual behaviors/substances) via gender- and diversity-sensitive measurements.
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Affiliation(s)
- Dennis Jepsen
- Institute of Medical Sociology, Interdisciplinary Center of Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany.
| | - Karl Vince Healy
- Institute of Medical Sociology, Interdisciplinary Center of Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany
| | - Marie Bernard
- Institute of Medical Sociology, Interdisciplinary Center of Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany
| | - Jenny Markert
- Institute of Medical Sociology, Interdisciplinary Center of Health Sciences, Martin Luther University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany
| | - Petra J Brzank
- Institue of Social Medicine, Rehabilitation Sciences and Healthcare Research, University of Applied Sciences Nordhausen, Nordhausen, Germany
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Hatch MA, Wells EA, Masters T, Beadnell B, Harwick R, Wright L, Peavy M, Ricardo-Bulis E, Wiest K, Shriver C, Baer JS. A randomized clinical trial evaluating the impact of counselor training and patient feedback on substance use disorder patients' sexual risk behavior. J Subst Abuse Treat 2022; 140:108826. [PMID: 35751944 DOI: 10.1016/j.jsat.2022.108826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/22/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION High risk sex-such as sex with multiple partners, condomless sex, or transactional or commercial sex-is a risk factor in individuals with substance use disorders (SUDs). SUD treatment can reduce sexual risk behavior, but interventions to reduce such behavior in this context have not been consistently effective. This study sought to determine if the impact of treatment on sexual risk behavior can be increased. METHODS In a nested 2 × 2 factorial repeated measures design, we examined outcomes of two interventions: training for counselors in talking to patients about sexual risk; and availability to both counselors and patients of a personalized feedback report based on patient self-report of sexual behavior. Counselors received either a brief, information-based, Basic Training, or a multi-session, skills-based Enhanced Training. Their patients completed an audio-assisted computerized assessment of sexual behavior and received either No Feedback or a Personalized Feedback Report (PFR). Four hundred seventy six patients participated. Patient follow-up occurred 3- and 6-months postbaseline. Primary patient outcome measures were Number of Unsafe Sex Occasions (USO) and whether patients reported talking about sex in counseling sessions (Discussed Sex), both in the past 90 days. Secondary outcomes included Number of Sexual Partners, Sex Under the Influence of Substances, and Perceived Condom Barriers. RESULTS Patients of Enhanced-condition counselors compared to those of Basic-condition counselors were more likely to report talking about sex with their counselor at 6-month follow-up. Personalized feedback also increased the likelihood of reporting counselor discussions at 6-month follow-up. Neither the training nor the feedback condition affected USO, Number of Partners, or Sex Under the Influence. DISCUSSION We discuss why these two interventions apparently altered counselor-patient communication about sexual risk behavior without affecting the behavior itself.
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Affiliation(s)
- Mary A Hatch
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States; University of Washington School of Medicine, Department of Psychiatry & Behavioral Sciences, 1959 NE Pacific St., Seattle, WA 98195, United States.
| | - Elizabeth A Wells
- Emeritus, University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, United States
| | - Tatiana Masters
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Blair Beadnell
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Robin Harwick
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Lynette Wright
- University of Washington Addictions Drug & Alcohol Institute, 1107 NE 45th St., Suite 120, Seattle, WA 98105, United States
| | - Michelle Peavy
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - Esther Ricardo-Bulis
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - Katerina Wiest
- CODA, Inc., 1027 E. Burnside St., Portland, OR 97214, United States
| | - Carrie Shriver
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA 98134, United States
| | - John S Baer
- University of Washington Department of Psychology, Guthrie Hall, Seattle, WA 98195-1525, United States
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Yamada R, Shimane T, Kondo A, Yonezawa M, Matsumoto T. The relationship between severity of drug problems and perceived interdependence of drug use and sexual intercourse among adult males in drug addiction rehabilitation centers in Japan. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:5. [PMID: 33413509 PMCID: PMC7791778 DOI: 10.1186/s13011-020-00339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Consuming drugs in conjunction with sexual intercourse may shape the perceived interdependence of drug use and sexual intercourse (PIDS). Additionally, the severity of drug problems may have a significant impact on PIDS. However, this relationship remains unverified. Therefore, this study investigates whether the severity of drug problems is associated with PIDS among adult males in drug addiction rehabilitation centers (DARC) in Japan. METHODS This study was a secondary analysis of the "DARC Follow-Up Study in Japan" conducted by the National Center of Neurology and Psychiatry in 2016, in which participants from 46 facilities completed a self-report questionnaire. A total of 440 males with drug dependence were included in the analysis. We analyzed participants' demographic characteristics, history of sexually transmitted disease diagnoses, and responses to questions related to drug use (e.g., primary drug use and PIDS). Additionally, we measured the severity of drug problems using the Japanese version of the Drug Abuse Screening Test-20 (DAST-20). RESULTS The median age of the participants was 42 years. The median DAST-20 score was 14.0, the primary drug was methamphetamine (61.4%) and new psychoactive substances (NPS: 13.6%). Multivariate analysis indicated that participants' experiences with unprotected sexual intercourse ("mostly a non-condom user": adjusted odds ratio (AOR) = 4.410), methamphetamine use (AOR = 3.220), new psychoactive substances use (AOR = 2.744), and the DAST-20 score (AOR = 1.093) were associated with PIDS. CONCLUSIONS This study indicated that the frequency of unprotected sexual intercourse under the influence of drugs, methamphetamine and NPS use were strongly associated with PIDS. The severity of drug problems was also significantly associated with PIDS. It is necessary to develop culturally appropriate treatment programs adapted to the needs of patients who experience strong PIDS.
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Affiliation(s)
- Risa Yamada
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Takuya Shimane
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Ayumi Kondo
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Masako Yonezawa
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Toshihiko Matsumoto
- Department of Drug Dependence Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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Burlew AK, McCuistian C, Lanaway D, Hatch-Maillette M, Shambley-Ebron D. One size does not fit all: A NIDA CTN inspired model for community engaged cultural adaptation. J Subst Abuse Treat 2020; 112S:28-33. [PMID: 32220407 PMCID: PMC8784174 DOI: 10.1016/j.jsat.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 11/26/2022]
Abstract
The NIDA National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) is devoted to the development of effective interventions for people who use substances across a variety of populations. When positive outcomes of a particular intervention do not generalize to other groups, adaptation may improve effectiveness for a different target group. However, currently limited information is available for involving community participation in cultural adaptation. The current paper illustrates the evolution of our methodology for community engaged cultural adaptation by describing a series of sexual health and substance use interventions. We highlight the transition from minimal community involvement (the Delphi process), to moderate community involvement (theater testing), to full community engagement in cultural adaptation. Ultimately, the results of these three projects led to the development of Community Collaborative Cultural Adaptation, a novel and concrete approach to cultural adaptation. This approach emphasizes the advantage of establishing academic/community partnerships for cultural adaptation to increase the effectiveness and sustainability of interventions.
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Affiliation(s)
| | | | - Danni Lanaway
- University of Cincinnati, 2600 Clifton Ave, Cincinnati, OH 45221, USA.
| | - Mary Hatch-Maillette
- University of Washington Alcohol & Drug Abuse Institute, 1107 NE 45th St., Suite 120, Seattle, WA 9810, USA.
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Hatch-Maillette MA, Harwick R, Baer JS, Wells EA, Masters T, Robinson A, Cloud K, Peavy M, Wiest K, Wright L, Dillon K, Beadnell B. Increasing substance use disorder counselors' self-efficacy and skills in talking to patients about sex and HIV risk: A randomized training trial. Drug Alcohol Depend 2019; 199:76-84. [PMID: 31026713 PMCID: PMC6759210 DOI: 10.1016/j.drugalcdep.2019.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND People with substance use disorder (SUD) experience increased risk for HIV, Hepatitis C, and sexually transmitted illnesses via risky sex. This high-risk population would benefit from sexual risk reduction interventions integrated into SUD treatment. However, many SUD counselors report lack of skill or confidence in addressing sexual risk with patients. METHODS This study was part of a larger nested 2 × 2 factorial repeated measures design, which compared two levels of counselor training (Basic-2 h versus Enhanced-10 h plus ongoing coaching). We determined whether counselors receiving Enhanced training addressing their motivation, confidence and skills (a) increased knowledge about sexual issues; (b) increased self-efficacy to discuss sex with patients; and (c) improved skills in discussing sex as part of SUD treatment, compared with those receiving shorter information-based training. Counselors providing individual therapy at two opioid treatment programs (OTP) and two psychosocial outpatient programs in the United States were eligible. Randomization occurred after Basic training. Measures included self-report (self-efficacy and knowledge) and blinded coding of standardized patient interviews (skill). RESULTS Counselors receiving Enhanced training (n = 28) showed significant improvements compared to their Basic training counterparts (n = 32) in self-efficacy, use of reflections, and use of decision-making and communication strategies with standardized patients. These improvements were maintained from post-training to 3-month follow-up. No adverse effects of study participation were reported. CONCLUSIONS Results suggest that counselors can improve their knowledge, self-efficacy and skill related to sexual risk conversations with patients based on modest skills-based training.
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Affiliation(s)
- Mary A Hatch-Maillette
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA, 98105, USA.
| | - Robin Harwick
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
| | - John S Baer
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA; VA Puget Sound Healthcare System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Elizabeth A Wells
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA; Emeritus, University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA, 98105, USA
| | - Tatiana Masters
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
| | - Audra Robinson
- Department of Psychology, University of Washington, 119A Guthrie Hall Box 351525, Seattle, WA, 98195, USA
| | - Kasie Cloud
- CODA, Inc., 1027 E. Burnside St., Portland, OR, 97214, USA
| | - Michelle Peavy
- Evergreen Treatment Services, 1700 Airport Way South, Seattle, WA, 98134, USA
| | | | - Lynette Wright
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
| | | | - Blair Beadnell
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Suite 120, Seattle, WA, 98105, USA
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Stacy AW, Nydegger LA, Shono Y. Translation of basic research in cognitive science to HIV-risk: a randomized controlled trial. J Behav Med 2019; 42:440-451. [PMID: 30554300 PMCID: PMC10676008 DOI: 10.1007/s10865-018-9999-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
Many people enrolled in drug diversion programs are not receiving evidence-based prevention for HIV or hepatitis. This study translated basic research from cognitive science to increase screening for infection and condom use in this population. A parallel three-condition randomized trial was conducted in a drug diversion sample (N = 358), comparing a memory practice condition with two active control conditions. Outcomes were condom use frequency and testing for infection (hepatitis B/C, HIV). At 3-month follow-up, participants in the memory practice condition were at least twice as likely (OR = 2.10 or greater, p < .01) to self-report testing compared to those in the control conditions and also reported more frequent condom use compared to a health education condition [B = .37, t(1) = 2.02, p = .02]. Basic research on memory can be effectively translated to brief interventions on infection screening and risk prevention in existing drug diversion programs.
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Affiliation(s)
- Alan W Stacy
- School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA, 91711-3475, USA.
| | - Liesl A Nydegger
- Department of Kinesiology and Health Education, University of Texas, 2109 San Jacinto Blvd., Stop D3700, Austin, TX, 78712, USA
| | - Yusuke Shono
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1100 NE 45th Street, Suite 300, Box 354944, Seattle, WA, 98195-4944, USA
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Newville H, Sorensen JL, Hatch-Maillette M, Calsyn DA. Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment. JOURNAL OF SEX RESEARCH 2018; 55:1056-1064. [PMID: 28513227 PMCID: PMC5916504 DOI: 10.1080/00224499.2017.1321101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index-Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.
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Affiliation(s)
- Howard Newville
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
| | - James L. Sorensen
- Department of Psychiatry, University of California, San Francisco, San Francisco CA
| | - Mary Hatch-Maillette
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle WA
| | - Donald A. Calsyn
- Alcohol & Drug Abuse Institute, University of Washington, Seattle WA
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle WA
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Abstract
Excessive zeros are common in practice and may cause overdispersion and invalidate inferences when fitting Poisson regression models. Zero-inflated Poisson regression models may be applied if there are inflated zeros; however, it is desirable to test if there are inflated zeros before such zero-inflated Poisson models are applied. Assuming a constant probability of being a structural zero in a zero-inflated Poisson regression model, the existence of the inflated zeros may be tested by testing whether the constant probability is zero. In such situations, the Wald, score, and likelihood ratio tests can be applied. Without specifying a zero-inflated Poisson model, He et al. recently developed a test by comparing the amount of observed zeros with that expected under the Poisson model. In this paper, we develop a closed form for the test and compare it with the Wald, score, and likelihood ratio tests through simulation studies. The simulation studies show that the test of He et al. is the best in controlling type I errors, while the score test generally has the least power among the tests. The tests are illustrated with two real data examples.
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Affiliation(s)
- Yi Tang
- Department of Mathematics, Tulane University, New Orleans, LA, USA
| | - Wan Tang
- Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University New, Orleans, LA, USA
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9
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He H, Zhang H, Ye P, Tang W. A test of inflated zeros for Poisson regression models. Stat Methods Med Res 2017; 28:1157-1169. [PMID: 29284370 DOI: 10.1177/0962280217749991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Excessive zeros are common in practice and may cause overdispersion and invalidate inference when fitting Poisson regression models. There is a large body of literature on zero-inflated Poisson models. However, methods for testing whether there are excessive zeros are less well developed. The Vuong test comparing a Poisson and a zero-inflated Poisson model is commonly applied in practice. However, the type I error of the test often deviates seriously from the nominal level, rendering serious doubts on the validity of the test in such applications. In this paper, we develop a new approach for testing inflated zeros under the Poisson model. Unlike the Vuong test for inflated zeros, our method does not require a zero-inflated Poisson model to perform the test. Simulation studies show that when compared with the Vuong test our approach not only better at controlling type I error rate, but also yield more power.
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Affiliation(s)
- Hua He
- 1 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Hui Zhang
- 2 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Peng Ye
- 1 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,3 School of Statistics, University of International Business and Economics, Beijing, China
| | - Wan Tang
- 4 Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Wendt DC, Gone JP. Group Therapy for Substance Use Disorders: A Survey of Clinician Practices. JOURNAL OF GROUPS IN ADDICTION & RECOVERY 2017; 12:243-259. [PMID: 30546274 PMCID: PMC6289265 DOI: 10.1080/1556035x.2017.1348280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Substance use disorder (SUD) treatment is typically delivered in group format, but clinical research focuses on individual therapy. This exploratory study narrows this gap through a survey of 566 SUD group clinicians in the United States, concerning most commonly used group practices, attitudes about evidence-based treatments (EBTs), and beliefs about addiction. Clinicians reported high use of open groups, moderately high utilization of EBT practices, and moderate use of questionable practices. Clinicians' attitudes about EBTs and beliefs about addiction were correlated with the use of certain EBTs and questionable practices. Strategies for implementation of EBTs in group settings are discussed.
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11
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Tang W, He H, Wang WJ, Chen DG. Untangle the Structural and Random Zeros in Statistical Modelings. J Appl Stat 2017; 45:1714-1733. [PMID: 30906098 DOI: 10.1080/02664763.2017.1391180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Count data with structural zeros are common in public health applications. There are considerable researches focusing on zero-inflated models such as zero-inflated Poisson (ZIP) and zero-inflated Negative Binomial (ZINB) models for such zero-inflated count data when used as response variable. However, when such variables are used as predictors, the difference between structural and random zeros is often ignored and may result in biased estimates. One remedy is to include an indicator of the structural zero in the model as a predictor if observed. However, structural zeros are often not observed in practice, in which case no statistical method is available to address the bias issue. This paper is aimed to fill this methodological gap by developing parametric methods to model zero-inflated count data when used as predictors based on the maximum likelihood approach. The response variable can be any type of data including continuous, binary, count or even zero-inflated count responses. Simulation studies are performed to assess the numerical performance of this new approach when sample size is small to moderate. A real data example is also used to demonstrate the application of this method.
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Affiliation(s)
- W Tang
- Department of Global Biostatistics & Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA70122, USA
| | - H He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA70122, USA
| | - W J Wang
- Brightech International, LLC, New Jersey, NJ 08873, USA
| | - D G Chen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC27599, USA.,Department of Biostatistics, University of North Carolina at Chapel Hill, NC 27517, USA.,Department of Statistics, University of Pretoria, South Africa
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Kidd JD, Tross S, Pavlicova M, Hu MC, Campbell ANC, Nunes EV. Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network. Subst Use Misuse 2017; 52:858-865. [PMID: 28426361 PMCID: PMC5710008 DOI: 10.1080/10826084.2016.1264971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. OBJECTIVES The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. METHODS Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. RESULTS When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.
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Affiliation(s)
- Jeremy D Kidd
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Susan Tross
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Martina Pavlicova
- c Department of Biostatistics , Columbia University Mailman School of Public Health , New York , New York , USA
| | - Mei-Chen Hu
- b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Aimee N C Campbell
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
| | - Edward V Nunes
- a Department of Psychiatry , New York State Psychiatric Institute , New York , New York , USA.,b Department of Psychiatry , Columbia University College of Physicians and Surgeons , New York , New York , USA
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Pan Y, Metsch LR, Wang W, Wang KS, Duan R, Kyle TL, Gooden LK, Feaster DJ. Gender Differences in HIV Sexual Risk Behaviors Among Clients of Substance Use Disorder Treatment Programs in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1151-1158. [PMID: 26892100 PMCID: PMC6261376 DOI: 10.1007/s10508-015-0686-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial and negative binomial models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their non-primary partners (IRR = 1.80, 95 % CI 1.21-2.69) and condomless anal sex acts (IRR = 1.74, 95 % CI 1.11-2.72), but fewer condomless sex partners (IRR = 0.87, 95 % CI 0.77-0.99), condomless vaginal sex acts (IRR = 0.83, 95 % CI 0.69-1.00), and condomless sex acts within 2 h of using drugs or alcohol (IRR = 0.70, 95 % CI 0.53-0.90). Gender-specific intervention approaches are called for in substance use disorder treatment.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work at Florida International University, Miami, FL, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | | | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
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Hatch-Maillette MA, Beadnell B, Campbell ANC, Meade CS, Tross S, Calsyn DA. Heterosexual Anal Sex Among Men and Women in Substance Abuse Treatment: Secondary Analysis of Two Gender-Specific HIV-Prevention Trials. JOURNAL OF SEX RESEARCH 2017; 54:33-41. [PMID: 26820608 PMCID: PMC4965331 DOI: 10.1080/00224499.2015.1118426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Receptive anal sex has high human immunodeficiency virus (HIV) transmission risk, and heterosexual substance-abusing individuals report higher anal sex rates compared to their counterparts in the general population. This secondary analysis evaluated the effectiveness of two gender-specific, evidence-based HIV-prevention interventions (Real Men Are Safe, or REMAS, for men; Safer Sex Skill Building, or SSSB, for women) against an HIV education (HIV-Ed) control condition on decreasing unprotected heterosexual anal sex (HAS) among substance abuse treatment-seeking men (n = 171) and women (n = 105). Two variables, engagement in any HAS and engagement in unprotected HAS, were assessed at baseline and three months postintervention. Compared to the control group, women in the gender-specific intervention did not differ on rates of any HAS at follow-up but significantly decreased their rates of unprotected HAS. Men in both the gender-specific and the control interventions reported less HAS and unprotected HAS at three-month follow-up compared to baseline, with no treatment condition effect. The mechanism of action for SSSB compared to REMAS in decreasing unprotected HAS is unclear. More attention to HAS in HIV-prevention interventions for heterosexual men and women in substance abuse treatment is warranted.
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Affiliation(s)
- Mary A. Hatch-Maillette
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Blair Beadnell
- School of Social Work, University of Washington, Seattle, WA
| | - Aimee N. C. Campbell
- Columbia University Medical Center, New York State Psychiatric Institute and Mount Sinai St. Lukes Hospital, New York, NY
| | - Christina S. Meade
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Susan Tross
- Columbia University Medical Center, New York State Psychiatric Institute and Mount Sinai St. Lukes Hospital, New York, NY
| | - Donald A. Calsyn
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- In memory of, deceased February 3, 2013 during the preparation of this manuscript
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15
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Feaster DJ, Parish CL, Gooden L, Matheson T, Castellon PC, Duan R, Pan Y, Haynes LF, Schackman BR, Malotte CK, Mandler RN, Colfax GN, Metsch LR. Substance use and STI acquisition: Secondary analysis from the AWARE study. Drug Alcohol Depend 2016; 169:171-179. [PMID: 27837708 PMCID: PMC5140686 DOI: 10.1016/j.drugalcdep.2016.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 10/17/2016] [Accepted: 10/23/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics. METHODS A secondary analysis of Project AWARE was performed based on 5012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender. RESULTS Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates. CONCLUSIONS Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.
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Affiliation(s)
- Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Carrigan L Parish
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, Miami Research Center, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Lauren Gooden
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, Miami Research Center, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Tim Matheson
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, San Francisco, CA 94102, USA.
| | - Pedro C Castellon
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, Miami Research Center, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Rui Duan
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Yue Pan
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Louise F Haynes
- Medical University of South Carolina, Addiction Sciences Division, 67 President Street, Charleston, SC 29425, USA.
| | - Bruce R Schackman
- Weill Cornell Medical College, Department of Healthcare Policy and Research, 425 East 61st St., New York, NY, USA.
| | - C Kevin Malotte
- California State University, Long Beach, Department of Health Sciences, Center for Health Care Innovation, 5500 Atherton St., Long Beach, CA, USA.
| | - Raul N Mandler
- National Institute of Health, National Institute on Drug Abuse, 6000 Executive Boulevard, Rockville, MD 20852, USA.
| | - Grant N Colfax
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, San Francisco, CA 94102, USA.
| | - Lisa R Metsch
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 W 168th St., 9th Floor, New York, NY 10032, USA.
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16
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Lindblad R, Hu L, Oden N, Wakim P, Rosa C, VanVeldhuisen P. Mortality Rates Among Substance Use Disorder Participants in Clinical Trials: Pooled Analysis of Twenty-Two Clinical Trials Within the National Drug Abuse Treatment Clinical Trials Network. J Subst Abuse Treat 2016; 70:73-80. [PMID: 27692192 DOI: 10.1016/j.jsat.2016.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/28/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most substance use disorders (SUD) treatment clinical trials are too short and small to reliably estimate the incidence of rare events like death. OBJECTIVE The aim of this study is to estimate the overall mortality rates among a SUD treatment-seeking population by pooling participants from multiple clinical trials conducted through the National Institute on Drug Abuse (NIDA)-sponsored National Drug Abuse Treatment Clinical Trials Network (CTN). PARTICIPANTS Drug and or alcohol users (N=9866) who sought treatment and participated in one of the twenty-two CTN trials. MEASUREMENTS Data were collected through randomized clinical trials in national community treatment programs for SUD. Pooled analysis was performed to assess age- and gender-standardized mortality rate(s) (SM rate(s)), and mortality ratio(s) (SM ratio(s)) of CTN trial participants compared to the U.S. general population. RESULTS The age- and gender-SM rate among CTN trials participants was 1403 (95% CI: 862-2074) per 100,000 person years (PY) compared to 542 (95% CI: 541-543) per 100,000 PY among the U.S. general population in 2005. By gender, age-adjusted SM ratio for female CTN trial participants was over five times (SM ratio=5.35, 95% CI: 3.31-8.19)), and for male CTN trial participants, it was over three times (SM ratio=3.39, 95% CI: 2.25-4.90) higher than their gender comparable peers in the U.S. general population. CONCLUSIONS Age and gender-standardized mortality rates and ratios among NIDA CTN SUD treatment-seeking clinical trial participants are higher than the age and gender comparable U.S. general population. The overall mortality rates of CTN trial participants are similar to in-treatment mortality reported in large U.S. and non-U.S. cohorts of opioid users. Future analysis with additional CTN trial participants and risk times will improve the stability of estimates, especially within subgroups based on primary substance of abuse. These SUD mortality rates can be used to facilitate safety monitoring within SUD clinical trials.
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Affiliation(s)
| | - Lian Hu
- The Emmes Corporation, Rockville, MD, United States
| | - Neal Oden
- The Emmes Corporation, Rockville, MD, United States
| | - Paul Wakim
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Carmen Rosa
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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Chen T, Wu P, Tang W, Zhang H, Feng C, Kowalski J, Tu XM. Variable selection for distribution-free models for longitudinal zero-inflated count responses. Stat Med 2016; 35:2770-85. [PMID: 26844819 DOI: 10.1002/sim.6892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 11/08/2022]
Abstract
Zero-inflated count outcomes arise quite often in research and practice. Parametric models such as the zero-inflated Poisson and zero-inflated negative binomial are widely used to model such responses. Like most parametric models, they are quite sensitive to departures from assumed distributions. Recently, new approaches have been proposed to provide distribution-free, or semi-parametric, alternatives. These methods extend the generalized estimating equations to provide robust inference for population mixtures defined by zero-inflated count outcomes. In this paper, we propose methods to extend smoothly clipped absolute deviation (SCAD)-based variable selection methods to these new models. Variable selection has been gaining popularity in modern clinical research studies, as determining differential treatment effects of interventions for different subgroups has become the norm, rather the exception, in the era of patent-centered outcome research. Such moderation analysis in general creates many explanatory variables in regression analysis, and the advantages of SCAD-based methods over their traditional counterparts render them a great choice for addressing this important and timely issues in clinical research. We illustrate the proposed approach with both simulated and real study data. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tian Chen
- Department of Mathematics and Statistics, University of Toledo, Toledo, 43606, OH, U.S.A
| | - Pan Wu
- Value Institute, Christiana Care Health System, John H Ammon Medical Education Center, Newark, 19718, DE, U.S.A
| | - Wan Tang
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, U.S.A
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, 38105, TN, U.S.A
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, 14642, NY, U.S.A
| | - Jeanne Kowalski
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, U.S.A
| | - Xin M Tu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, 14642, NY, U.S.A.,Department of Psychiatry, University of Rochester, Rochester, 14642, NY, U.S.A
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18
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Campbell ANC, Brooks AJ, Pavlicova M, Hu MC, Hatch-Maillette MA, Calsyn DA, Tross S. Barriers to Condom Use: Results for Men and Women Enrolled in HIV Risk Reduction Trials in Outpatient Drug Treatment. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2016; 15:130-146. [PMID: 27766067 PMCID: PMC5067067 DOI: 10.1080/15381501.2016.1166090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
HIV transmission often occurs through heterosexual high-risk sex. Even in the era of HIV combination prevention, promoting condom use, and understanding condom barriers, remain priorities, especially among substance-dependent individuals. Men and women (N=729) in outpatient drug treatment participated in a five-session gender-specific risk reduction group or one-session HIV Education group. Condom barriers (Motivation, Partner-related, Access/Availability, Sexual experience) were assessed at baseline and 6-month follow-up. Completing either intervention was associated with fewer motivation and partner-related barriers. Among women, reductions in motivation and sexual experience barriers were associated with less sexual risk with primary partners. Condom barriers are important to gender-specific HIV prevention; given limited resources, brief interventions maximizing active components are needed.
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Affiliation(s)
- Aimee N C Campbell
- Columbia University College of Physicians & Surgeons, Department of Psychiatry; New York State Psychiatric Institute, New York, NY; St. Luke's Roosevelt Hospital, Mount Sinai Health System, Department of Psychiatry, New York, NY
| | - Audrey J Brooks
- University of Arizona, Arizona Center for Integrative Medicine, Tucson, AZ
| | - Martina Pavlicova
- Columbia University Medical Center, Department of Biostatistics, New York, NY
| | - Mei-Chen Hu
- Columbia University College of Physicians & Surgeons, Department of Psychiatry
| | - Mary A Hatch-Maillette
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Donald A Calsyn
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Susan Tross
- Columbia University College of Physicians & Surgeons, Department of Psychiatry; St. Luke's Roosevelt Hospital, Mount Sinai Health System, Department of Psychiatry, New York, NY; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY
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19
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Tang W, Lu N, Chen T, Wang W, Gunzler DD, Han Y, Tu XM. On performance of parametric and distribution-free models for zero-inflated and over-dispersed count responses. Stat Med 2015; 34:3235-45. [PMID: 26078035 DOI: 10.1002/sim.6560] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 02/15/2015] [Accepted: 05/26/2015] [Indexed: 11/07/2022]
Abstract
Zero-inflated Poisson (ZIP) and negative binomial (ZINB) models are widely used to model zero-inflated count responses. These models extend the Poisson and negative binomial (NB) to address excessive zeros in the count response. By adding a degenerate distribution centered at 0 and interpreting it as describing a non-risk group in the population, the ZIP (ZINB) models a two-component population mixture. As in applications of Poisson and NB, the key difference between ZIP and ZINB is the allowance for overdispersion by the ZINB in its NB component in modeling the count response for the at-risk group. Overdispersion arising in practice too often does not follow the NB, and applications of ZINB to such data yield invalid inference. If sources of overdispersion are known, other parametric models may be used to directly model the overdispersion. Such models too are subject to assumed distributions. Further, this approach may not be applicable if information about the sources of overdispersion is unavailable. In this paper, we propose a distribution-free alternative and compare its performance with these popular parametric models as well as a moment-based approach proposed by Yu et al. [Statistics in Medicine 2013; 32: 2390-2405]. Like the generalized estimating equations, the proposed approach requires no elaborate distribution assumptions. Compared with the approach of Yu et al., it is more robust to overdispersed zero-inflated responses. We illustrate our approach with both simulated and real study data.
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Affiliation(s)
- Wan Tang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, U.S.A
| | - Naiji Lu
- Department of Management, Harbin Institute of Technology, Harbin, China
| | - Tian Chen
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, U.S.A
| | - Wenjuan Wang
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, U.S.A
| | - Douglas David Gunzler
- Center for Health Care Research & PolicyCase Western Reserve University, Cleveland, OH, U.S.A
| | - Yu Han
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, U.S.A
| | - Xin M Tu
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, U.S.A.,Department of PsychiatryUniversity of Rochester, Rochester, NY, U.S.A.,Center of Excellence for Suicide PreventionCanandaigua VA Medical Center, Canandaigua, NY, U.S.A
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20
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Hartzler B, Beadnell B, Calsyn DA. Use of sexual risk assessment and feedback at intake to promote counselor awareness of subsequent client risk behavior during early treatment. Subst Use Misuse 2014; 49:1270-7. [PMID: 24597915 PMCID: PMC4154598 DOI: 10.3109/10826084.2014.891622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Sexual risk is an important, oft-neglected area in addiction treatment. OBJECTIVES This report examines computerized sexual risk assessment and client feedback at intake as means of enhancing counselor awareness of client risk behavior during early treatment, as well as any clinical impact of that counselor awareness. METHODS In 2009-2011, new clients at both opiate treatment and drug-free treatment programs endorsed in a computer-assisted assessment at intake 90-day retrospective indices for: being sexually active, having multiple partners, having sex under drug influence, and inconsistently using condoms. Clients were randomly assigned in a 2:1 ratio to receive or not receive a personal feedback report, and those receiving a report chose if a counselor copy was also distributed. Ninety days later, retained clients (N = 79) repeated the assessment and their counselors concurrently reported perceptions of recent client risk behavior. RESULTS Based on client reports, pretreatment risk behaviors were prevalent among men and women and remained so during treatment. A general linear model revealed greater counselor awareness of subsequent client risk behavior with mutual distribution of intake feedback reports to client and counselor, and at the opiate treatment program. A repeated-measures analysis of variance indicated that counselor awareness did not predict change in temporally stable patterns of sexual risk behavior. CONCLUSIONS/IMPORTANCE: Findings document that computerized intake assessment of sexual risk and mutually distributed feedback reports prompt greater counselor awareness of clients' subsequent risk behavior. Future research is needed to determine how best to prepare counselors to use such awareness to effectively prompt risk reduction in routine care.
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Affiliation(s)
- Bryan Hartzler
- 1Alcohol and Drug Abuse Institute, University of Washington, Seattle, Washington, USA
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21
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Nelson LE, Walker JJ, DuBois SN, Giwa S. Your blues ain't like mine: considering integrative antiracism in HIV prevention research with black men who have sex with men in Canada and the United States. Nurs Inq 2014; 21:270-282. [PMID: 24894761 DOI: 10.1111/nin.12055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
Abstract
Evidence-based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, PsychInfo, MEDLINE and the CDC compendium of evidence-based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM.
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22
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Edelman EJ, Chantarat T, Caffrey S, Chaudhry A, O’Connor P, Weiss L, Fiellin DA, Fiellin LE. The impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected, opioid-dependent patients. Drug Alcohol Depend 2014; 139:79-85. [PMID: 24726429 PMCID: PMC4029496 DOI: 10.1016/j.drugalcdep.2014.03.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid dependence is a major risk factor for HIV infection, however, the impact of buprenorphine/naloxone treatment on HIV risk behaviors among HIV-infected opioid-dependent patients is unknown. METHODS We conducted a longitudinal analysis of 303 HIV-infected opioid-dependent patients initiating buprenorphine/naloxone treatment. Outcomes included self-reported past 90-day needle-sharing and non-condom use. We assessed trends over the 12 months using the Cochran-Armitage trend test. Using generalized estimating equations, after multiple imputation, we determined factors independently associated with needle-sharing and non-condom use, including time-updated variables. We then conducted a mediation analysis to determine whether substance use explained the relationship between time since treatment initiation and needle-sharing. RESULTS Needle-sharing decreased from baseline to the fourth quarter following initiation of buprenorphine/naloxone (9% vs. 3%, p<0.001), while non-condom use did not (23% vs. 21%, p=0.10). HIV risk behaviors did not vary based on the presence of a detectable HIV-1 RNA viral load. Patients who were homeless and used heroin, cocaine/amphetamines or marijuana were more likely to report needle-sharing. Heroin use fully mediated the relationship between time since treatment initiation and needle-sharing. Women, patients who identified as being gay/lesbian/bisexual, those married or living with a partner and who reported heroin or alcohol use were more likely to report non-condom use. Older patients were less likely to report non-condom use. CONCLUSIONS While buprenorphine/naloxone is associated with decreased needle-sharing among HIV-infected opioid-dependent patients, sexual risk behaviors persist regardless of viral load. Targeted interventions to address HIV risk behaviors among HIV-infected opioid-dependent populations receiving buprenorphine/naloxone are needed.
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Affiliation(s)
- E. Jennifer Edelman
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | | | - Sarah Caffrey
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510
| | - Amina Chaudhry
- Chase Brexton Health Care, 1111 North Charles Street, Baltimore, MD 21201
| | - Patrick O’Connor
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510
| | - Linda Weiss
- New York Academy of Medicine, 1216 5 Avenue, New York, NY 10029
| | - David A. Fiellin
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
| | - Lynn E. Fiellin
- Yale University School of Medicine, PO Box 208025, New Haven, CT 06510,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT
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23
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O'Grady CL, Surratt HL, Kurtz SP, Levi-Minzi MA. Nonmedical prescription drug users in private vs. public substance abuse treatment: a cross sectional comparison of demographic and HIV risk behavior profiles. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:9. [PMID: 24495784 PMCID: PMC3915073 DOI: 10.1186/1747-597x-9-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/12/2013] [Indexed: 11/10/2022]
Abstract
Background Little is known regarding the demographic and behavioral characteristics of nonmedical prescription drug users (NMPDUs) entering substance abuse treatment settings, and information on the HIV-related risk profiles of NMPDUs is especially lacking. Participation in substance abuse treatment provides a critical opportunity for HIV prevention and intervention, but successful initiatives will require services appropriately tailored for the needs of NMPDUs. Methods This paper compares the HIV risk profiles of NMPDUs in public (n = 246) and private (n = 249) treatment facilities. Participants included in the analysis reported five or more recent episodes of nonmedical prescription drug use, a prior HIV negative test result, and current enrollment in a substance abuse treatment facility. A standardized questionnaire was administered by trained interviewers with questions about demographics, HIV risk, and substance use. Results Private treatment clients were more likely to be non-Hispanic White, younger, and opioid and heroin users. Injection drug use was higher among private treatment clients, whereas public clients reported higher likelihood of trading or selling sex. Public treatment clients reported higher rates of HIV testing and availability at their treatment facilities compared to private clients. Conclusions Findings suggest differing demographics, substance use patterns, profiles of HIV risk and access to HIV testing between the two treatment samples. Population tailored HIV interventions, and increased access to HIV testing in both public and private substance treatment centers, appear to be warranted.
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Affiliation(s)
- Catherine L O'Grady
- ARSH: Center for Applied Research on Substance Use and Health Disparities, Nova Southeastern University, 2 NE 40th Street, Suite 404, Miami, FL 33137, USA.
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Crits-Christoph P, Gallop R, Sadicario JS, Markell HM, Calsyn DA, Tang W, He H, Tu X, Woody G. Predictors and moderators of outcomes of HIV/STD sex risk reduction interventions in substance abuse treatment programs: a pooled analysis of two randomized controlled trials. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2014; 9:3. [PMID: 24433412 PMCID: PMC3929547 DOI: 10.1186/1747-597x-9-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Abstract
Background The objective of the current study was to examine predictors and moderators of response to two HIV sexual risk interventions of different content and duration for individuals in substance abuse treatment programs. Methods Participants were recruited from community drug treatment programs participating in the National Institute on Drug Abuse Clinical Trials Network (CTN). Data were pooled from two parallel randomized controlled CTN studies (one with men and one with women) each examining the impact of a multi-session motivational and skills training program, in comparison to a single-session HIV education intervention, on the degree of reduction in unprotected sex from baseline to 3- and 6- month follow-ups. The findings were analyzed using a zero-inflated negative binomial (ZINB) model. Results Severity of drug use (p < .01), gender (p < .001), and age (p < .001) were significant main effect predictors of number of unprotected sexual occasions (USOs) at follow-up in the non-zero portion of the ZINB model (men, younger participants, and those with greater severity of drug/alcohol abuse have more USOs). Monogamous relationship status (p < .001) and race/ethnicity (p < .001) were significant predictors of having at least one USO vs. none (monogamous individuals and African Americans were more likely to have at least one USO). Significant moderators of intervention effectiveness included recent sex under the influence of drugs/alcohol (p < .01 in non-zero portion of model), duration of abuse of primary drug (p < .05 in non-zero portion of model), and Hispanic ethnicity (p < .01 in the zero portion, p < .05 in the non-zero portion of model). Conclusion These predictor and moderator findings point to ways in which patients may be selected for the different HIV sexual risk reduction interventions and suggest potential avenues for further development of the interventions for increasing their effectiveness within certain subgroups.
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Fisher WA, Fisher JD, Shuper PA. Social Psychology and the Fight Against AIDS. ADVANCES IN EXPERIMENTAL SOCIAL PSYCHOLOGY 2014. [DOI: 10.1016/b978-0-12-800284-1.00003-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Calsyn DA, Peavy M, Wells EA, Campbell ANC, Hatch-Maillette MA, Greenfield SF, Tross S. Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers. Am J Addict 2013; 22:150-7. [PMID: 23414501 DOI: 10.1111/j.1521-0391.2013.00312.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND For substance abuse treatment-seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills. OBJECTIVE This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills. METHODS Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior. RESULTS Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners. CONCLUSIONS Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms. SCIENTIFIC SIGNIFICANCE Results provide additional information about the treatment and prevention needs of treatment-seeking men and women.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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Calsyn DA, Hatch-Maillette MA, Meade CS, Tross S, Campbell ANC, Beadnell B. Gender differences in heterosexual anal sex practices among women and men in substance abuse treatment. AIDS Behav 2013; 17:2450-8. [PMID: 23321947 DOI: 10.1007/s10461-012-0387-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heterosexual anal intercourse (HAI) is an understudied risk behavior among women and men in substance abuse treatment. Rates of HAI for women (n = 441) and men (n = 539) were identified for any, main and casual partners. More men (32.8 %) than women (27.1 %) reported engaging in HAI in the previous 90 days. These rates are higher than those reported for both men (6.0-15.9 %) and women (3.5-13.0 %) ages 25-59 in the National Survey of Sexual Health and Behavior. Men were significantly more likely to report HAI with their casual partners (34.1 %) than women (16.7 %). In a logistic regression model generated to identify associations between HAI and variables previously shown to be related to high risk sexual behavior, being younger, bisexual, and White were significantly associated with HAI. For men, having more sex partners was also a significant correlate. HAI is a logical target for increased focus in HIV prevention interventions.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute and the Department of Psychiatry and Behavioral Sciences, University of Washington, 1107 NE 45th St., Ste. 120, Seattle, WA 98105, USA.
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Meade CS, Bevilacqua LA, Moore ED, Griffin ML, Gardin JG, Potter JS, Hatch-Maillette M, Weiss RD. Concurrent substance abuse is associated with sexual risk behavior among adults seeking treatment for prescription opioid dependence. Am J Addict 2013; 23:27-33. [PMID: 24313238 DOI: 10.1111/j.1521-0391.2013.12057.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 12/06/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Increasingly, new HIV infections among people who use drugs are attributed to sexual risk behavior. However, HIV prevention research targeting persons with opioid dependence continues to focus on drug injection practices. Moreover, despite the rising prevalence of prescription opioid dependence in the United States, little is known about HIV risk in this population. METHODS This study examined the prevalence of sexual risk behavior among patients with opioid dependence who primarily use prescription opioids for non-medical purposes. As part of a multi-site clinical trial, participants (N = 653) completed a baseline assessment that included the Risk Behavior Survey. RESULTS In the past month, 74% were sexually active. Of these, most had opposite sex partners (97.3%) and vaginal intercourse (97.1%); anal intercourse was uncommon (3.1%). The majority reported unprotected intercourse (76.5%), but few had multiple partners (11.3%). Unprotected intercourse was associated with history of other substance dependence (adjusted odds ratio [AOR] = 1.73), and having multiple partners was associated with concurrent cocaine use (AOR = 2.54). Injection drug use in the past month was rare (2.5%). CONCLUSIONS While the majority of sexually active participants engaged in unprotected intercourse, the proportion with multiple sex partners was low relative to other samples of persons who use illicit drugs. Among persons with non-medical prescription opioid dependence, those who concurrently use other substances may be at elevated risk for HIV infection. Comprehensive assessment of substance abuse history among individuals dependent upon prescription opioids is critical for identifying patients who may require additional clinical interventions to reduce HIV sexual risk behavior.
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Affiliation(s)
- Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Global Health Institute, Durham, North Carolina
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Hatch-Maillette M, Burlew AK, Turnbull S, Robinson M, Calsyn DA. Measuring fidelity to a culturally adapted HIV prevention intervention for men in substance abuse treatment. J Subst Abuse Treat 2013; 45:363-9. [PMID: 23810229 DOI: 10.1016/j.jsat.2013.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 05/15/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
Abstract
A fidelity measure was developed for use with Real Men Are Safe-Culturally Adapted (REMAS-CA), an HIV prevention intervention for ethnically diverse men in substance abuse treatment. The aims of this analysis were to: 1) assess the reliability of the Fidelity Rating and Skill Evaluation (FRASE); 2) measure improvement in therapist competence and adherence over time while delivering REMAS-CA; and 3) identify which modules of REMAS-CA were most difficult to deliver. Results showed that, 1) the FRASE was a reliable instrument; 2) therapists achieved adequate adherence and competence after training and demonstrated significant improvement over time in Global Empathy; and 3) Sessions 4 and 5 of REMAS-CA contained the most challenging modules for therapists to deliver. Recommendations for future REMAS-CA therapist trainings and fidelity monitoring are made.
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Lyons T, Madkins K, Karia P, Garner G. Intimate Strangers? Social Networks in HIV Prevention Groups for Drug Users. ACTA ACUST UNITED AC 2013; 8:129-148. [PMID: 24003323 DOI: 10.1080/1556035x.2013.764207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Group substance abuse treatment relies for its effectiveness on relationships formed within group sessions, but few studies have explored the importance of these relationships for group HIV prevention interventions for drug users. We survey the literature on group HIV prevention interventions, particularly for men of color, and analyze qualitative data from a pilot intervention for out-of-treatment, drug using men who have sex with men. We find that many participants were acquainted prior to the intervention, and formed relationships which they attempted (often unsuccessfully) to maintain after the intervention was over.
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Affiliation(s)
- Thomas Lyons
- HIV/AIDS Research and Policy Institute, Chicago State University, 9501 S. King Dr., Chicago, IL 60628
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Calsyn DA, Burlew AK, Hatch-Maillette MA, Beadnell B, Wright L, Wilson J. An HIV prevention intervention for ethnically diverse men in substance abuse treatment: pilot study findings. Am J Public Health 2013; 103:896-902. [PMID: 23488494 DOI: 10.2105/ajph.2012.300970] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined the acceptability, participants' receptivity, and effectiveness of a culturally adapted version of Real Men Are Safe (REMAS-CA), an HIV prevention intervention for men in substance abuse treatment. METHODS In 2010 and 2011, we compared participants who attended at least 1 (of 5) REMAS-CA session (n = 66) with participants in the original REMAS study (n = 136). Participants completed an assessment battery at baseline and at 3-month follow-up with measures of substance abuse, HIV risk behaviors, perceived condom barriers, and demographics. We conducted postintervention focus groups at each clinic. RESULTS Minority REMAS-CA participants were more likely to have attended 3 or more sessions (87.0%), meeting our definition of intervention completion, than were minority participants in the REMAS study (75.1%; odds ratio = 2.1). For REMAS-CA participants with casual partners (n = 25), the number of unprotected sexual occasions in the past 90 days declined (6.2 vs 1.6). Among minority men in the REMAS study (n = 36), the number of unprotected sexual occasions with casual partners changed little (9.4 vs 8.4; relative risk = 4.56). CONCLUSIONS REMAS-CA was effective across ethnic groups, a benefit for HIV risk reduction programs that serve a diverse clientele.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
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Campbell ANC, Tross S, Calsyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:333-48. [PMID: 23731423 PMCID: PMC3694750 DOI: 10.1080/19371918.2013.774665] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Social workers are often on the front lines of the HIV/AIDS epidemic delivering prevention education and interventions, offering or linking individuals to HIV testing, and working to improve treatment access, retention, and adherence, especially among vulnerable populations. Individuals with substance use disorders face additional challenges to reducing sexual and drug risk behaviors, as well as barriers to testing, treatment, and antiretroviral therapy adherence. This article presents current data on HIV transmission and research evidence on prevention and intervention with substance abusers and highlights how individual social workers can take advantage of this knowledge in practice and through adoption and implementation within organizations.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Yu Q, Chen R, Tang W, He H, Gallop R, Crits-Christoph P, Hu J, Tu XM. Distribution-free models for longitudinal count responses with overdispersion and structural zeros. Stat Med 2012; 32:2390-405. [PMID: 23239019 DOI: 10.1002/sim.5691] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 10/31/2012] [Indexed: 11/10/2022]
Abstract
Overdispersion and structural zeros are two major manifestations of departure from the Poisson assumption when modeling count responses using Poisson log-linear regression. As noted in a large body of literature, ignoring such departures could yield bias and lead to wrong conclusions. Different approaches have been developed to tackle these two major problems. In this paper, we review available methods for dealing with overdispersion and structural zeros within a longitudinal data setting and propose a distribution-free modeling approach to address the limitations of these methods by utilizing a new class of functional response models. We illustrate our approach with both simulated and real study data.
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Affiliation(s)
- Q Yu
- Department of Biostatistics and Computational Biology, University of Rochester, 601 Elmwoord Ave, Rochester, NY 14642, USA.
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Neurological function, information-motivation-behavioral skills factors, and risk behaviors among HIV-positive alcohol users. AIDS Behav 2012; 16:2297-308. [PMID: 22767030 DOI: 10.1007/s10461-012-0246-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to examine neurological impairment in combination with information-motivation-behavioral skills (IMB) variables. The study tests the role of IMB variables as mediators of antecedent variables of demographics, life stress, social support, and neurological impairment with outcome measures of HIV preventive and risk behaviors in a sample of HIV-positive, alcohol-using adults (n = 250) with a history of alcohol abuse/dependence. Neurological impairment was measured with the Color Trails Test (CTT). Average performance on the CTT by the sample was substantially worse than established norms. In a directional latent variable model, neurological impairment directly predicted lower transmission knowledge scores and poorer performance on an observational condom skills assessment. Greater neurological impairment was significantly associated with greater age. Future interventions geared toward HIV+ adults who use alcohol should take into consideration HIV-related and age-related neurological functioning which may impede the facilitation of safe sex behaviors.
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Wilson ME, Kinlock TW, Gordon MS, O'Grady KE, Schwartz RP. Postprison release HIV-risk behaviors in a randomized trial of methadone treatment for prisoners. Am J Addict 2012; 21:476-87. [PMID: 22882399 PMCID: PMC3422766 DOI: 10.1111/j.1521-0391.2012.00250.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND This secondary analysis examined the impact of methadone initiated in prison on postrelease HIV risk behaviors. The parent study was a three-group randomized clinical trial in which participants received drug abuse counseling in prison and were randomly assigned to: (1) passive referral to substance abuse treatment upon release; (2) guaranteed methadone treatment admission upon release; and (3) methadone in prison and guaranteed continuation of methadone upon release. METHODS Participants were 211 adult males with preincarceration histories of opiate dependence. The AIDS Risk Assessment was administered at baseline (in prison) and at 1-, 3-, 6-, and 12-month postrelease. Data were analyzed for the entire sample (N = 211) as well as the subsamples who reported injecting drugs in the 30 days prior to incarceration (n = 131) and who reported having unprotected sex in that time frame (n = 144) using generalized linear mixed model on an intent-to-treat basis. RESULTS There were no significant changes in sex- or drug-risk by Condition over Time. There were significant Time and Condition main effects for the total sample as well as the injector subsample for drug-risk behaviors. There were no significant Condition main effects for HIV sex-risk behaviors, but there were significant Time main effects. CONCLUSIONS Methadone initiated in prison or immediately postrelease is associated with reduced HIV drug-risk compared to counseling in prison without methadone and passive referral to treatment at release. Participation in several drug- and sex-risk behaviors also showed significant declines during the postrelease time periods.
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Affiliation(s)
- Monique E Wilson
- Friends Research Institute, Inc., Baltimore, Maryland 21201, USA.
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Campbell ANC, Tross S, Hu MC, Pavlicova M, Nunes EV. Predictors of relationship power among drug-involved women. AIDS Behav 2012; 16:1532-41. [PMID: 22614746 DOI: 10.1007/s10461-012-0208-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Gender-based relationship power is frequently linked to women's capacity to reduce sexual risk behaviors. This study offers an exploration of predictors of relationship power, as measured by the multidimensional and theoretically grounded sexual relationship power scale, among women in outpatient substance abuse treatment. Linear models were used to test nine predictors (age, race/ethnicity, education, time in treatment, economic dependence, substance use, sexual concurrency, partner abuse, and sex role orientation) of relationship power among 513 women participating in a multi-site HIV risk reduction intervention study. Significant predictors of relationship control included having a non-abusive male partner, only one male partner, and endorsing traditional masculine (or both masculine and feminine) sex role attributes. Predictors of decision-making dominance were interrelated, with substance use × partner abuse and age × sex role orientation interactions. Results contribute to the understanding of factors which may influence relationship power and to their potential role in HIV sexual risk reduction interventions.
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Robertson AA, St Lawrence JS, McCluskey DL. HIV/STI Risk Behavior of Drug Court Participants. JOURNAL OF OFFENDER REHABILITATION 2012; 51:453-473. [PMID: 23658472 PMCID: PMC3645928 DOI: 10.1080/10509674.2012.702715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Drug abusing offenders have high rates of HIV and other sexually transmitted infections (STI). To date, the HIV/STI prevention needs of offenders in drug court programs have been ignored. This multi-method study employed interviews to assess drug court professionals' perceptions of the need for an HIV risk reduction intervention to be integrated into the services provided to drug court participants. Then, surveys were completed by 235 drug court participants to assess whether their sexual risk behaviors affirmed the need for such an intervention. The survey also assessed demographic characteristics, drug use prior to program entry, HIV knowledge, and condom attitudes. The relationship between duration in the drug court program and sexual risk behavior was also examined. Implications for the development and delivery of HIV risk reduction interventions within drug court programs are discussed.
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Affiliation(s)
- Angela A Robertson
- Social Science Research Center, Mississippi State University, Starkville, Mississippi, USA
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Metsch LR, Feaster DJ, Gooden L, Matheson T, Mandler RN, Haynes L, Tross S, Kyle T, Gallup D, Kosinski AS, Douaihy A, Schackman BR, Das M, Lindblad R, Erickson S, Korthuis PT, Martino S, Sorensen JL, Szapocznik J, Walensky R, Branson B, Colfax GN. Implementing rapid HIV testing with or without risk-reduction counseling in drug treatment centers: results of a randomized trial. Am J Public Health 2012; 102:1160-7. [PMID: 22515871 DOI: 10.2105/ajph.2011.300460] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effectiveness of risk reduction counseling and the role of on-site HIV testing in drug treatment. METHODS Between January and May 2009, we randomized 1281 HIV-negative (or status unknown) adults who reported no past-year HIV testing to (1) referral for off-site HIV testing, (2) HIV risk-reduction counseling with on-site rapid HIV testing, or (3) verbal information about testing only with on-site rapid HIV testing. RESULTS We defined 2 primary self-reported outcomes a priori: receipt of HIV test results and unprotected anal or vaginal intercourse episodes at 6-month follow-up. The combined on-site rapid testing participants received more HIV test results than off-site testing referral participants (P<.001; Mantel-Haenszel risk ratio=4.52; 97.5% confidence interval [CI]=3.57, 5.72). At 6 months, there were no significant differences in unprotected intercourse episodes between the combined on-site testing arms and the referral arm (P=.39; incidence rate ratio [IRR]=1.04; 97.5% CI=0.95, 1.14) or the 2 on-site testing arms (P=.81; IRR=1.03; 97.5% CI=0.84, 1.26). CONCLUSIONS This study demonstrated on-site rapid HIV testing's value in drug treatment centers and found no additional benefit from HIV sexual risk-reduction counseling.
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Affiliation(s)
- Lisa R Metsch
- Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Calsyn DA, Burlew AK, Hatch-Maillette MA, Wilson J, Beadnell B, Wright L. Real men are safe-culturally adapted: utilizing the Delphi process to revise real men are safe for an ethnically diverse group of men in substance abuse treatment. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:117-31. [PMID: 22468973 PMCID: PMC4247752 DOI: 10.1521/aeap.2012.24.2.117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Real Men Are Safe (REMAS) was effective at reducing the number of unprotected sexual occasions for men in substance abuse treatment compared to an HIV education control intervention. Utilizing a modified Delphi process, modules from REMAS were compared to similar-content modules from other CDC-approved, culturally tailored HIV prevention interventions. Utilizing ratings and recommendations obtained from an independent expert panel, REMAS was subsequently revised to be more culturally adapted for an ethnically diverse group of men. Ratings suggested REMAS was culturally fair, but that in certain areas the culturally tailored interventions were more in tune with African American and Hispanic men. Revisions to REMAS include an added focus on how culture, social norms, and upbringing affect a man's sexual behavior and relationships.
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Affiliation(s)
- Donald A Calsyn
- Alcohol & Drug Abuse Institute, Department of Psychiatry & Behavioral Sciences at the University of Washington, Seattle 98105, USA.
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Mitchell SG, Kelly SM, Brown BS, O'Grady KE, Schwartz RP. HIV sex-risk behaviors among in- versus out-of-treatment heroin-addicted adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:328-33. [PMID: 22243486 DOI: 10.3109/00952990.2011.643993] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Relatively limited empirical evidence exists comparing the impact on HIV sex risk behavior for patients admitted to methadone treatment programs (MTPs) as compared with nontreatment seekers. METHODS This longitudinal cohort study examined HIV sex-risk behavior among 164 out-of-treatment heroin-dependent adults recruited from the street and 351 newly admitted MTP patients. The AIDS Risk Assessment was administered at baseline, 6 months, and 12 months. Generalized linear mixed model and generalized estimating equation analyses were used to examine the changes in sex risk behavior over time. RESULTS The participants mean age was 41.5 years, 74.8% were African-American, 24.3% were White, and 54.4% were men. There were no significant differences between the groups in age, race, or gender. At baseline, the out-of-treatment group compared with the in-treatment group reported more sex partners (p < .001) and higher frequency of sex (p = .001). There was a group x time interaction for three of the sex-risk items and the out-of-treatment group reported having significantly more sex partners at both follow-up time points and having significantly more frequent unprotected sex while high at 6 months (all values of p < .01). CONCLUSIONS Nontreatment seekers are at higher HIV risk than those entering MTPs and should be a focus of sex-risk reduction interventions, even if they are not interested in treatment at that time.
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Greenfield SF, Rosa C, Putnins SI, Green CA, Brooks AJ, Calsyn DA, Cohen LR, Erickson S, Gordon SM, Haynes L, Killeen T, Miele G, Tross S, Winhusen T. Gender research in the National Institute on Drug Abuse National Treatment Clinical Trials Network: a summary of findings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:301-12. [PMID: 21854272 DOI: 10.3109/00952990.2011.596875] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The National Institute of Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (CTN) was established to foster translation of research into practice in substance abuse treatment settings. The CTN provides a unique opportunity to examine in multi-site, translational clinical trials, the outcomes of treatment interventions targeting vulnerable subgroups of women; the comparative effectiveness of gender-specific protocols to reduce risk behaviors; and gender differences in clinical outcomes. OBJECTIVES To review gender-related findings from published CTN clinical trials and related studies from January 2000 to March 2010. METHODS CTN studies were selected for review if they focused on treatment outcomes or services for special populations of women with substance use disorders (SUDs) including those with trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors; or implemented gender-specific protocols. The CTN has randomized 11,500 participants (41% women) across 200 clinics in 24 randomized controlled trials in community settings, of which 4 have been gender-specific. RESULTS This article summarizes gender-related findings from CTN clinical trials and related studies, focusing on trauma histories, pregnancy, co-occurring eating and other psychiatric disorders, and HIV risk behaviors. CONCLUSIONS These published studies have expanded the evidence base regarding interventions for vulnerable groups of women with SUDs as well as gender-specific interventions to reduce HIV risk behaviors in substance-using men and women. The results also underscore the complexity of accounting for gender in the design of clinical trials and analysis of results. SCIENTIFIC SIGNIFICANCE To fully understand the relevance of gender-specific moderators and mediators of outcome, it is essential that future translational studies adopt more sophisticated approaches to understanding and measuring gender-relevant factors and plan sample sizes that are adequate to support more nuanced analytic methods.
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Calsyn DA, Campbell AN, Tross S, Hatch-Maillette MA. Is monogamy or committed relationship status a marker for low sexual risk among men in substance abuse treatment? Clinical and methodological considerations. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:294-300. [PMID: 21854271 DOI: 10.3109/00952990.2011.596874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HIV prevention interventions often promote monogamy to reduce sexual risk. However, there is little consensus about how to define monogamy. OBJECTIVE To determine the extent to which recent monogamy and/or being in a committed relationship serve as markers for low sexual risk among men in substance abuse treatment. METHODS Participants were 360 men enrolled in the National Institute on Drug Abuse Clinical Trials Network "Real Men Are Safe" protocol who completed all assessments (baseline, 3 months, and 6 months). Self-reported behaviors included number of sexual partners, type of relationships, frequency of vaginal/anal intercourse, and percentage of condom use. RESULTS The rate of self-reported monogamy in the prior 90 days was stable across assessments (54.2%, 53.1%, 58.3%). However, at each assessment 7.5-10% of monogamous men identified their partner as a casual partner, and only 123 (34.2%) reported being monogamous at every assessment. Of these, 20 (5.6%) reported being monogamous with different partners across assessments. Men with both committed relationship and casual partners reported more condom use with their committed relationship partners than men with only a committed relationship partner. CONCLUSION Clinicians and researchers should consider individual relationship context and behavior and avoid assuming that recent monogamy or being in a committed relationship denotes low risk. SCIENTIFIC SIGNIFICANCE This study provides evidence that, in male drug users, monogamy does not necessarily reflect low sexual risk. Rather, "monogamous" men actually encompass various combinations of partner types and levels of risk behavior that are unstable, even over brief time periods. Clinicians and researchers must take these variations into account.
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Tross S, Campbell ANC, Calsyn DA, Metsch LR, Sorensen JL, Shoptaw S, Haynes L, Woody GE, Malow RM, Brown LS, Feaster DJ, Booth RE, Mandler RN, Masson C, Holmes BW, Colfax G, Brooks AJ, Hien DA, Schackman BR, Korthuis PT, Miele GM. NIDA's Clinical Trials Network: an opportunity for HIV research in community substance abuse treatment programs. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:283-93. [PMID: 21854270 DOI: 10.3109/00952990.2011.596977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND/OBJECTIVES HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. RESULTS While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. CONCLUSION/SIGNIFICANCE While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.
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Affiliation(s)
- Susan Tross
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY 10032, USA.
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Burlew K, Larios S, Suarez-Morales L, Holmes B, Venner K, Chavez R. Increasing ethnic minority participation in substance abuse clinical trials: lessons learned in the National Institute on Drug Abuse's Clinical Trials Network. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2011; 17:345-56. [PMID: 21988575 PMCID: PMC3427793 DOI: 10.1037/a0025668] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Underrepresentation in clinical trials limits the extent to which ethnic minorities benefit from advances in substance abuse treatment. The objective of this article is to share the knowledge gained within the Clinical Trials Network (CTN) of the National Institute on Drug Abuse and other research on recruiting and retaining ethnic minorities into substance abuse clinical trials. The article includes a discussion of two broad areas for improving inclusion-community involvement and cultural adaptation. CTN case studies are included to illustrate three promising strategies for improving ethnic minority inclusion: respondent-driven sampling, community-based participatory research, and the cultural adaptation of the recruitment and retention procedures. The article concludes with two sections describing a number of methodological concerns in the current research base and our proposed research agenda for improving ethnic minority inclusion that builds on the CTN experience.
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Affiliation(s)
- Kathleen Burlew
- Department of Psychology, University of Cincinnati, OH 45221, USA.
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Hendriksen ES, Krishnan AKS, Vallabhaneni S, Johnson S, Raminani S, Kumarasamy N, Solomon S, Mayer KKH, Safren SS. Primary prevention lessons learned from those with HIV in Chennai, India. Sex Health 2011; 8:199-206. [PMID: 21592434 DOI: 10.1071/sh10015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 09/09/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND As each HIV-infected individual represents a breakdown of HIV primary prevention measures, formative data from representative individuals living with HIV can help shape future primary prevention interventions. Little is known about sexual behaviours and other transmission risk factors of high-risk group members who are already HIV-infected in Chennai, India. METHODS Semi-structured qualitative interviews were conducted with 27 HIV-infected individuals representing each high-risk group in Chennai (five men who have sex with men (MSM), five female commercial sex workers (CSW), four truckers and other men who travel for business, four injecting drug users (IDU), five married male clients of CSW, and four wives of CSW clients, MSM, truckers, and IDU). RESULTS Themes relevant to HIV primary prevention included: (1) HIV diagnosis as the entry into HIV education and risk reduction, (2) reluctance to undergo voluntary counselling and testing, (3) gender and sexual roles as determinants of condom use, (4) misconceptions about HIV transmission, and (5) framing and accessibility of HIV education messages. CONCLUSIONS These qualitative data can be used to develop hypotheses about sexual risk taking in HIV-infected individuals in South India, inform primary prevention intervention programs, and improve primary prevention efforts overall.
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Burlew AK, Weekes JC, Montgomery L, Feaster DJ, Robbins MS, Rosa CL, Ruglass LM, Venner KL, Wu LT. Conducting research with racial/ethnic minorities: methodological lessons from the NIDA Clinical Trials Network. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:324-32. [PMID: 21854274 PMCID: PMC3445256 DOI: 10.3109/00952990.2011.596973] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Multiple studies in the National Institute on Drug Abuse Clinical Trials Network (CTN) demonstrate strategies for conducting effective substance abuse treatment research with racial/ethnic minorities (REMs). OBJECTIVES The objectives of this article are to describe lessons learned within the CTN to (1) enhance recruitment, retention, and other outcomes; (2) assess measurement equivalence; and (3) use data analytic plans that yield more information. METHOD This article includes background information and examples from multiple CTN studies on inclusion, measurement, and data analysis. RESULTS AND CONCLUSIONS Seven recommendations are included for conducting more effective research on REMs.
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Affiliation(s)
- A Kathleen Burlew
- Department of Psychology, University of Cincinnati, OH 45221-0376, USA.
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Tai B, Sparenborg S, Liu D, Straus M. The National Drug Abuse Treatment Clinical Trials Network: forging a partnership between research knowledge and community practice. Subst Abuse Rehabil 2011; 2:21-8. [PMID: 24474852 PMCID: PMC3846299 DOI: 10.2147/sar.s16756] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The National Drug Abuse Treatment Clinical Trials Network (CTN) has faced many challenges over its first eleven years. This review explores some of these challenges and the paths the CTN took to meet these challenges, including: designing clinical trials that reflect the CTN's mission and changing public health needs, finding the synergies in the varied expertise of clinical treatment providers and academic researchers, promoting evidence-based practices and expanding the Network into mainstream medical practices to reach a broader patient population. Included in this exploration are specific examples from CTN clinical trials.
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Affiliation(s)
- Betty Tai
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USA
| | - Steven Sparenborg
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USA
| | - David Liu
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USA
| | - Michele Straus
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, USA
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Calsyn DA, Baldwin H, Niu X, Crits-Christoph P, Hatch-Maillette MA. Sexual risk behavior and sex under the influence: an event analysis of men in substance abuse treatment who have sex with women. Am J Addict 2011; 20:250-6. [PMID: 21477053 DOI: 10.1111/j.1521-0391.2011.00123.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine if there is evidence for a causative link between sex under the influence of drugs or alcohol and risky sex for men in substance abuse treatment. Men in treatment participating in a multisite HIV prevention protocol who reported on baseline, 3, or 6 months computerized assessments the details of their most recent sexual events, and who reported having sexual events under the influence and not under the influence, and who reported most recent events that did and did not include condom use served as participants (n = 37). Safe sex was not significantly more likely to happen when participants were under the influence of drugs or alcohol during their most recent sexual event (48.3%) than when they were not under the influence (49%, p = .82). In this high-risk in treatment sample, a causative link between sex under the influence of drugs or alcohol and sexual risk behavior was not supported.
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Affiliation(s)
- Donald A Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Seattle, WA 98105, USA.
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Calsyn DA, Hatch-Maillette MA, Doyle SR, Cousins S, Chen T, Godinez M. Teaching condom use skills: practice is superior to observation. Subst Abus 2011; 31:231-9. [PMID: 21038177 DOI: 10.1080/08897077.2010.514241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Men exposed to a condom skills practice exercise were hypothesized to perform better on condom skills measures than those exposed only to a demonstration or to no intervention. As part of a larger National Institute on Drug Abuse (NIDA) Clinical Trials Network HIV Prevention protocol, men in substance abuse treatment were administered male and female condom use skills measures (MCUS, FCUS) at preintervention, 2 weeks, 3 months, and 6 months postintervention. The MCUS and FCUS scores were compared for 3 intervention exposure groups (demonstration only [DO, n = 149], demonstration plus practice [D+P; n = 112], attended no sessions [NS, n = 139]) across the 4 assessment time points using a mixed effects linear regression model. There is a statistically significant intervention group-by-time effect (P < .0001) for both the MCUS and FCUS. Post hoc, pairwise linear trends across time indicated that for both the MCUS and the FCUS, the D+P group is significantly superior to the DO group and the NS group.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98105, USA.
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