Drug Use and Multiple Sex Partners Among Homeless Ex-Offenders: Secondary Findings From an Experimental Study.

BACKGROUND: Transitioning into society after release from incarceration presents real challenges for male offenders; in California, up to 60% return to prison within 3 years after release. The risk for ongoing drug use and having sex with multiple partners is a significant challenge for ex-offenders preparing to enter the community. OBJECTIVES: The aims are to describe drug use and sexual behavior (sex with multiple partners) prior to incarceration and 6 and 12 months after study enrollment using data obtained as part of a randomized controlled trial. METHODS: This is a planned secondary analysis of data obtained as part of a randomized controlled trial designed to study the effects of intensive peer coaching and nurse case management, intensive peer coaching, and brief nurse counseling on hepatitis A and B vaccination adherence compared to a usual care control treatment that also included brief peer coaching and brief nurse counseling. Self-report data from subjects enrolled at one residential drug treatment facility in Los Angeles were captured at three time points: baseline and 6- and 12-month follow-up. RESULTS: Findings showed substantive and significant reductions in drug use and engaging in sex with multiple partners 6 months after enrollment into the study compared to the baseline data, but results did not differ by study condition. At 12-month follow-up, drug use and sex with multiple partners increased but remained less than at baseline levels. DISCUSSION: Sustaining reductions in drug use and engaging in sex with multiple partners remains a challenge after incarceration.

Impact of Community-Based Programs on Incarceration Outcomes Among Gay and Bisexual Stimulant-Using Homeless Adults.

This study was part of a randomized controlled trial designed to improve hepatitis knowledge and health promoting behaviors and subsequently decrease stimulant use and incarceration with 422 (G/B) homeless men between 18 and 46 years of age. Findings revealed that no significant program differences on incarceration in the 4 months following the intervention. However, younger participants (p = .010), and those with prior incarceration (p = .001) were at greater risk for incarceration at 4 months. An additional factor associated with incarceration at 4 months included living on the street for at least 1 week (p = .049).

A randomized clinical trial of tailored interventions for health promotion and recidivism reduction among homeless parolees: outcomes and cost analysis.

OBJECTIVES: This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. METHODS: The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. RESULTS: When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. CONCLUSIONS: In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.

BACKGROUND: Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. OBJECTIVES: The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. METHODS: A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. RESULTS: Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. DISCUSSION: Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

Unmet physical and mental healthcare needs among stimulant-using gay and bisexual homeless men.

The aim of this study was to gain a greater understanding of predictors of the unmet physical and mental healthcare needs of homeless, stimulant-using, gay and bisexual (G/B) men. This study correlated baseline self-reported unmet physical and mental healthcare needs among stimulant-using homeless G/B men (n = 422, 18-46 years of age). A structured questionnaire was administered at baseline and data were collected from October 2009 to January 2013. The study was approved by the University of California Human Subjects' Protection committee and the Friends Research Institute Human Research Protection Committee. Logistic regression revealed that those who self-reported ever being married, being in fair or poor health and in moderate-to-very severe pain, were more likely to experience unmet needs for physical health care. In terms of unmet mental health needs, those who self-reported moderate-to-very severe pain and/or those reporting having sex while high, were more likely to report unmet needs for mental health care. In contrast, those reporting receiving social support from others were less likely to have an unmet mental healthcare need. Research implications are discussed as they relate to access to healthcare needs among this vulnerable population.

Correlates of Heroin and Methamphetamine Use among Homeless Male Ex-Jail and Prison Offenders.

Homeless men exiting California State jails and prisons are a heterogeneous community with varied childhood, incarceration and drug use histories. This cross-sectional study assessed whether homeless men who were discharged from either jail or prison into a residential substance abuse treatment program, differed in terms of methamphetamine and heroin use. This study utilized baseline data collected on 540 recently paroled men randomized to one of three programs that assessed the impact of a peer coaching intervention on subsequent drug use and re-incarceration. We found that younger ex-offenders exiting prisons and jails were more likely to have used methamphetamine alone, whereas African American ex-offenders were less likely to have used methamphetamine alone when compared to other ethnic groups. Further, ex-offenders exiting jails and self-reporting use of heroin only at baseline were significantly more likely than their counterparts to have been removed from home before age 18. For men exiting jails, there was an association between lower self-esteem and having used methamphetamine but not heroin. However, having used both heroin and methamphetamine was associated with both violent crime and cognitive problems in both jail and prison samples. Our findings showcase the need to understand unique correlates of both heroin and methamphetamine as they relate to jail and prison populations.

Predictors of High Level of Hostility among Homeless Men on Parole.

High levels of hostility present a formidable challenge among homeless ex-offenders. This cross-sectional study assessed correlates of high levels of hostility using baseline data collected on recently-released male parolees (N=472; age 18-60) participating in a randomized trial focused on prevention of illicit drug use and recidivism. Predictors of high levels of hostility included greater depressive symptomatology, lower self-esteem, having a mother who was treated for alcohol/drugs, belonging to a gang, more tangible support, having used methamphetamine and having a history of cognitive difficulties. These findings highlight the need to understand predictors of hostility among recently released homeless men and how these predictors may relate to recidivism. Research implications are discussed as these findings will shape future nurse-led harm reduction and community-based interventions.

Correlates of serious violent crime for recently released parolees with a history of homelessness.

This study used baseline data on recently released paroled men who are homeless (N=157), residing in a residential drug treatment program, and enrolled in a longitudinal study to examine personal, developmental, and social correlates of parolees who are homeless and who have committed serious violent offenses. Having experienced childhood sexual abuse, poor parental relationships, and early-onset incarceration (prior to 21 years of age) were important correlates of serious violent crimes. These findings highlight the need for interventions that address offenders' prior adult and childhood victimization and suggest that policies for reentering violent offenders should encompass an understanding of the broader family contexts in which these patterns of maltreatment often occur.

Prevalence estimates of trafficking in persons using statistical definitions: a cross-sectional high-risk community survey in Cape Town, South Africa.

OBJECTIVES: Current research on trafficking in persons (TIP) relies heavily on legal and prosecutorial definitions. A public health approach has called for population-level assessment; however, identification of TIP victims lacks a standardised operational definition. This study applied the Prevalence Reduction Innovation Forum (PRIF) statistical definitions, developed by the US Department of State, to a community survey in Cape Town, South Africa. DESIGNS: A high-risk sampling strategy was used. TIP screening questions from two instruments were matched with PRIF domain indicators to generate prevalence estimates. Sensitivity, specificity and receiver operating characteristics analyses were conducted to assess the performance of the two screeners. SETTING: Cross-sectional survey conducted in Cape Town, South Africa, from January to October 2021. PARTICIPANTS: South Africans and immigrants from other nations residing in Cape Town and its surrounding areas, aged 18 or older, who met the study inclusion criteria for a set of experiences that were identified as TIP risk factors. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were PRIF lifetime and past 12-month TIP positivity. Secondary outcome measures included individual and summary measures from the two screeners. RESULTS: Our PRIF algorithm yielded a TIP lifetime prevalence rate of 17.0% and past 12-month rate of 2.9%. Summary measures from each TIP screener showed an excellent range of predictive utility. The summary screener measures yielded statistically significant differences among some demographic and background categories. Several screener items were shown less predictive of the PRIF statistical definition criteria than others. CONCLUSIONS: Prevalence estimates of probable TIP were higher than those reported elsewhere. Our TIP screeners yielded an excellent range of predictive utility for the statistical definitions, promising the potential for wider applications in global and regional TIP research and policymaking. A more systematic sampling strategy is needed even if statistical definitions become widely used.

A preliminary examination of offender needs assessment: are all those questions really necessary?

Criminologists generally agree that offender recidivism can be reduced by addressing the criminogenic needs of this population. Two prominent assessments of offender risks and needs are the Level of Service Inventory-Revised (LSI-R) and the Correctional Offender Management Profiling for Alternative Sanctions (COMPAS). Both predict recidivism, but they are largely based on data from records. In contrast, the determination of inmates' service needs is based on lengthy (and costly) offender interviews. In light of evidence that many correctional systems have not adopted standardized assessments of service needs-and that time burden and costs are typically cited as barriers, the present study examined whether interviews involving complex scales improve the accuracy of offender needs assessment relative to a few single-item measures. To test this, 75 California prison inmates were administered the LSI-R, COMPAS, and a set of four yes/no items asking if they needed help with substance abuse, vocational training, housing, and education. Approximately 70% to 90% of inmates identified as needing these services according to the LSI-R or COMPAS could have been identified using these four supplemental items, though specificity rates were low for the financial and housing domains. The results suggest that simpler, less costly approaches to offender needs assessment might be achievable.

Correlates of depressive symptoms among homeless men on parole.

This study describes correlates of high levels of depressive symptoms among recently paroled men in Los Angeles who reside in a community substance abuse treatment program and report homelessness. Cross-sectional data were obtained from male residents who were released on parole within the last 30 days (N =157) to assess parental relationship, self-esteem, social support, coping behaviors, drug and alcohol use behaviors, depressive symptoms, and sociodemographic information. Results indicated that 40% of the participants were classified as experiencing high levels of depressive symptoms (CES-D ≥ 10). Results of a logistic regression analysis showed that the following were predictors of depressive symptoms (p <.05): physical abuse in childhood, non-residential alcohol treatment, violent behaviors, low self-esteem, and disengagement coping. Being Mexican-American, Mexican, American Indian, or Asian, and not displaying cognitive problems was inversely related to depressive symptoms in the final model (B =-2.39, p <.05). Findings support proper use of both prison and community assessment services to at-risk individuals eligible for parole to increase self-esteem and coping.

Corporal punishment and adolescent aggression: An examination of multiple intervening mechanisms and the moderating effects of parental responsiveness and demandingness.

BACKGROUND: Research on generational transmission of violence in general suggests that corporal punishment leads to children's aggressive behavior. However, less clear is the intervening mechanisms that link corporal punishment with adolescent aggression and the moderation on the intervening mechanisms. OBJECTIVES: This study examined the mediating role of negative emotions, endorsement of violence, and low self-control in the association between parental corporal punishment and adolescent aggression and investigated whether the intervening mechanisms operated differently according to different levels of parental responsiveness and demandingness. PARTICIPANTS AND SETTING: Data from a sample (N = 1,635) of students in central China were used. The students were from 4 schools, aged between 12-18. METHODS: Conditional process analysis was performed to assess the moderated mediation. RESULTS: The relations of corporal punishment with adolescent aggression were partially mediated by adolescent's endorsement of violence (b = .027, p < .001), negative emotion (b = .028, p < .001), and low self-control (b = .008, p = .007). In addition, these indirect effects were moderated by parental responsiveness and demandingness. CONCLUSION: Our study adds further empirical credence in our collective effort to reduce adolescent aggressive behavior by banning corporal punishment as a disciplinary practice. Further, parenting programs by social welfare agencies should consider the important role of demandingness. Interventions could reduce adolescent aggression also by adolescent resilience development, improving one's self-control and management of negative emotion while cultivating moral beliefs disapprove of violence.

Illicit synthetic opioid consumption in Asia and the Pacific: Assessing the risks of a potential outbreak.

BACKGROUND: Illegally manufactured potent synthetic opioids (IMPSO) like fentanyl have contributed to rises in overdose deaths in parts of North America and Europe. While many of these substances are produced in Asia, there is little evidence they have entered markets there. We consider the susceptibility to IMPSO's encroachment in markets in the Asia-Pacific region. METHODS: Our analysis focuses on Australia, China, India, and Myanmar. Using a mixed-methods approach comprising interviews, literature review, and secondary data analyses, we examine factors facilitating or impeding incursion of IMPSO. Finally, we illustrate the potential for IMPSO fatalities in Australia. RESULTS: Australia reports some signs of three facilitating factors to IMPSO's emergence: 1) existing illicit opioid markets, 2) disruption of opioid supply, and 3) user preferences. The other three countries report only existing illicit opioid markets. While diverted pharmaceutical opioids are a noted problem in Australia and India, heroin is the dominant opioid in all four countries. There are divergent trends in heroin use, with use declining in China, increasing in India, and stable in Australia and Myanmar. If IMPSO diffused in Australia as in North America from 2014 to 2018, and our assumptions generally hold, deaths from IMPSO could range from 1500-5700 over a five-year period. CONCLUSIONS: This analysis and illustrative calculations serve as an early indication for policymakers. With the exception of Australia, many countries in the region fail to properly record overdose deaths or monitor changes in local drug markets. Early assessment and monitoring can give officials a better understanding of these changing threats.

What is the best choice for postoperative analgesia after major gynaecological oncology surgery?

Major gynaecological oncology surgery can be complex and extensive, with correspondingly high requirements for postoperative analgesia. Multiple options are available including intravenous, neuraxial and regional techniques. This article discusses the pros and cons of different anaesthetic modalities for postoperative analgesia.

Impact of Tailored Interventions to Reduce Drug Use and Sexual Risk Behaviors Among Homeless Gay and Bisexual Men.

A randomized controlled trial was conducted with homeless gay and bisexual men to assess the impact of two culturally sensitive intervention programs on reduction of drug use and risky sexual behavior. In this study, gay and bisexual men between 18 and 46 years of age were randomly assigned to one of two culturally sensitive behavioral intervention programs: a Nurse Case Management Plus Contingency Management (NCM + CM; n = 204) or a Standard Education Plus Contingency Management (SE + CM; n = 210) program. Regardless of group assignment, significant and clinically relevant reductions were observed in stimulant use over time. Multivariable predictors of stimulant use at 4- and 8-month follow-up evaluations were recent injection drug use, tested positive for HIV, or for use of amphetamine. Data revealed a significant linear decline over time for those who had sex with multiple partners. Furthermore, being HIV positive was associated with reporting multiple partners, while higher homophobia scores and having children were inversely related to reports of having sex with multiple partners at follow-up. Culturally sensitive approaches are needed to successfully reduce drug use and risky sexual activities among gay and bisexual populations.

Impact of an intervention for recently released homeless offenders on self-reported re-arrest at 6 and 12 months.

A randomized controlled trial was conducted with 600 paroled men, homeless prior to incarceration, to assess varying levels of peer-coach and nurse-partnered interventions on re-arrest at 6 and 12 months. Findings revealed that positive predictors of re-arrest at 12 months included having received social support from drug users and non-drug users, as well as having used marijuana at least once a week prior to their most recent incarceration. In terms of protective factors, those who participated in a substance abuse program contract within a residential drug treatment program or spent 90 days or greater in a residential drug treatment program were less likely to have been re-arrested within 12 months.

Correlates of self-reported incarceration among homeless gay and bisexual stimulant-using young adults.

Gay and bisexual (G/B) homeless adults face multiple challenges in life which may place them at high risk for incarceration. Yet, little is known about this understudied population in terms of risk for incarceration. Baseline data collected from a longitudinal study between October 2009 and March 2012 in Hollywood, California, explored correlates of self-reported incarceration among G/B homeless stimulant-using adults (N = 353). Findings revealed older age, less education, having children, as well as a history of injection drug use and being born in the United States were positively associated with incarceration. Moreover, having poor social support and having received hepatitis information were also correlated with a history of incarceration. Our findings help us gain a greater awareness of homeless G/B adults who may be at greater risk for incarceration, which may be used by health care providers to design targeted interventions for this underserved population.

Treatment or else: coerced treatment for drug-involved California parolees.

This study evaluated a community-based correctional program in California, in which parolees tested positive on illicit drugs were given the option of going into a treatment program or having their parole revoked and returned to prison in California. Two comparison groups were constructed to assess the treatment effect-a propensity-based comparison group extracted from the general parolee population and program dropouts. Although implicitly coercive, some parolees who finished the program were less likely to be reincarcerated 12 months following release than both comparison groups. However, the observed treatment advantage quickly eroded in the second observation year. Savings realized from the incarcerations avoided were more than enough to pay for the program. Findings from this study suggest that boosting participation in reentry services through coercive measures may yield currently unrealized individual and societal benefits. However, systemic efforts are needed to extend the short-term treatment effects. Design and data limitations in the study weaken the persuasiveness of these findings. Methodological implications and policy issues about coerced treatment are discussed.

Understanding correlates of hepatitis C virus infection among homeless recently paroled men.

This cross-sectional study assessed predictors of Hepatitis C virus (HCV) positivity with baseline data collected on recently released male parolees (N = 157) participating in a randomized trial focused on reduction of drug use, recidivism, and risk for hepatitis and HIV infections. In this sample, the prevalence of HCV was 25%. The logistic regression analysis revealed that being an injection drug user was significantly related to HCV infection. However, contrary to most of the current literature, being Black had significantly lower odds of contracting HCV than their White counterparts. Moreover, having lived on the streets, not being part of a close family in childhood, and being older were also associated with HCV infection. These findings highlight the need for skilled assessments that target the vulnerabilities of homeless adults, especially those who have been incarcerated. Understanding drug use patterns, childhood networks, and family relationships, may assist in the design of interventions to reduce risky drug use and address behaviors derived from disadvantaged childhood.

Correlates of risky alcohol and methamphetamine use among currently homeless male parolees.

Homeless men on parole are a hard-to-reach population with significant community reintegration challenges. This cross-sectional study describes sociodemographic, cognitive, psychosocial, and drug-related correlates of alcohol and methamphetamine use in 157 homeless male parolees (age range 18-60) enrolled in a substance abuse treatment center in Los Angeles, California. Logistic regression results revealed that being African American and older were negatively related to methamphetamine use, whereas being older and more hostile were related to riskier alcohol abuse. Findings from this study provide a greater understanding of correlates of methamphetamine and alcohol--two of the most detrimental forms of substances abused among currently homeless parolees.