Decreased re-conviction rates of DUI offenders with intensive supervision and home confinement.

BACKGROUND: In some jurisdictions, persons who are convicted of driving under the influence of alcohol (DUI) are allowed to serve some portion of their prison sentence under home confinement as part of Intensive Supervision Programs (ISPs) which include pre-release psycho-education and close post-release supervision. OBJECTIVES: Test the hypothesis that persons convicted of DUI offenses who have spent some portion of their sentence under home confinement, as compared to a historical comparison group, will exhibit a relatively low re-conviction rate. METHODS: Using administrative data for 1,410 repeat DUI offenders (302 members of the historical comparison group, 948 ISP members, and 160 persons who appear in both groups at different points in time), with a follow-up period of up to 3 years and 10 months, a marginal Cox model was employed to compare conviction rates of persons who experienced intensive supervision and home confinement with historical comparison group members. RESULTS: Persons with ISP + home confinement experience a re-conviction rate that is less than half that observed in the comparison group. Age, ethnicity (white vs. non-white), and gender are also significant predictors of re-conviction. CONCLUSION: Home confinement, in conjunction with psycho-education and other program elements, is one means of reducing the costs of incarceration. The results of this study suggest that, in addition to cost savings, states may realize a public safety benefit in the form of a reduction in DUI offense rates.

A daily process investigation of alcohol-involved sexual risk behavior among economically disadvantaged problem drinkers living with HIV/AIDS.

Alcohol use is believed to increase sexual risk behavior among people living with HIV/AIDS (PLWHA). As drinking and sexual risk acts often occur in the same social contexts, this association is difficult to confirm. In this study, electronic daily diaries were completed by 116 PLWHA over 5 weeks. This yielded a total of 1,464 records consisting of data pertaining to discrete occasions of anal and vaginal sex. Simultaneous within- and between-person multilevel analyses were conducted, including situational variables (partner type, partner serostatus, partner drinking) and individual difference variables (gender, level of alcohol dependence). The resulting model explains 27.5% of the variance and reveals that interactions among these situational and individual difference variables predict changes in the estimated rate of unprotected sex (US). Also, in defined contexts, the amount of alcohol consumed prior to sex significantly affects the rate of US among members of the sample. Implications are discussed.

Promoting a Sustainable Academic-Correctional Health Partnership: Lessons for Systemic Action Research.

In the United States, the phenomenon of mass incarceration has created a public health crisis. One strategy for addressing this crisis involves developing a correctional agency - academic institution partnership tasked with augmenting the quality and quantity of evidence-based healthcare delivered in state prisons and attracting a greater number of health professionals to the field of correctional health research. Using a Connecticut correctional agency - academic institution partnership as a case example, the present paper examines some of the key challenges encountered over the course of a 3-year capacity-building initiative. Particular attention is given to agency and institution characteristics both at the structural level and in terms of divergent stakeholder perspectives. The authors find that future partnership development work in this area will likely benefit from close attention to predictable sources of temporal variation in agency capability to advance project-related aims.

Why are you bringing up condoms now? The effect of message content on framing effects of condom use messages.

According to prospect theory (A. Tversky & D. Kahneman, 1981), messages advocating a low-risk (i.e., easy, low-cost) behavior are most effective if they stress the benefits of adherence (gain framed), whereas messages advocating a risky behavior are most effective if they stress the costs of nonadherence (loss framed). Although condom use is viewed as a low-risk behavior, it may entail risky interpersonal negotiations. Study 1 (N = 167) compared ratings of condom use messages advocating relational behaviors (e.g., discussing condoms) or health behaviors (e.g., carrying condoms). As predicted, loss-framed relational messages and gain-framed health messages received higher evaluations. Study 2 (N = 225) offers a replication and evidence of issue involvement and gender as moderators. Results are discussed with reference to the design of condom use messages.

Alcohol-involved sexual risk behavior among heavy drinkers living with HIV/AIDS: negative affect, self-efficacy, and sexual craving.

Evidence of the effects of negative affect (NA) and sexual craving on unprotected sexual activity remains scant. We hypothesized that NA and sexual craving modify the same day association between low self-efficacy to use condoms and unprotected anal or vaginal sex, and the same-day association between alcohol use during the 3 hours prior to sexual activity and unprotected sex. We used an electronic daily diary, drawing on a sample of 125 men and women recruited from an agency serving economically disadvantaged persons living with HIV/AIDS. Casual or steady partner type designation and perceived partner HIV serostatus were also examined. Findings support the hypothesized moderating effects of high NA and sexual craving on the association between low self-efficacy and unprotected sex, and the association between alcohol use and unprotected sex. Implications are discussed.

Alcohol, helping young adults to have unprotected sex with casual partners: findings from a daily diary study of alcohol use and sexual behavior.

PURPOSE: To examine the event-level association between alcohol consumption and the likelihood of unprotected sex among college-age young adults considering contextual factors of partner type and amount of alcohol consumed. METHODS: A 30-day, Web-based, structured daily diary was used to collect daily reports of sexual behaviors and alcohol use from 116 sexually active young adults, yielding 2,764 diary records. Each day we assessed the prior evening's behavior regarding alcohol consumption, opportunities for sex, sexual intercourse, condom use, and contextual factors including type of sexual partner. RESULTS: Based on multilevel models, drinking proximal to events of sexual intercourse increased the likelihood of unprotected sex with casual but not steady partners. For women there was a positive association between number of drinks and a greater likelihood of unprotected sex with casual partners but a negative association with steady partners. Drinking during situations involving opportunities for sex with casual partners increased the likelihood of sex. For women especially, drinking more increased the likelihood of sex occurring regardless of partner type. CONCLUSIONS: Failure to assess the contextual determinants of the alcohol-unprotected sex association may result in underestimates of the magnitude of this association. These data highlight an important area for intervention with young adults: reducing alcohol-involved sexual risk behavior with casual partners, especially among women.

Craving and self-efficacy in the first five weeks of methadone maintenance therapy: a daily process study.

OBJECTIVE: Among individuals initiating methadone maintenance therapy for heroin addiction, low craving and high self-efficacy are thought to predict treatment response; however, in the case of craving, findings have been inconsistent. This study will test two hypotheses: (1) craving and self-efficacy both predict treatment response and (2) withdrawal symptoms and sleep quality predict greater craving and greater self-efficacy, respectively. METHOD: An exploratory study using electronic diary data and multilevel models examined these hypotheses. A sample of 21 heroin users was recruited during the first 1-2 days of methadone maintenance therapy to take part in a 5-week diary study. Comparisons were made between days before participants reached a 70 mg or greater dose and subsequent days. This is in keeping with research showing that this dosage corresponds to optimal opioid receptor blockade. RESULTS: Analysis of 449 diary records nested within 21 participants showed a marked decline in heroin use on days subsequent to the 70 mg methadone dosage plateau. Controlling for methadone dosage plateau, the likelihood of heroin use was lower on days in which participants reported both high self-efficacy and low craving, as compared with other days. Support was found for hypothesized direct associations between craving and withdrawal symptoms and between self-efficacy and sleep quality. CONCLUSIONS: Consistent with a previously published theory, the effect of low craving on positive response to methadone maintenance therapy is evident on days distinguished by high self-efficacy. Also, improving patients' sleep quality may enhance the benefits of methadone maintenance therapy.

A brief individualized computer-delivered sexual risk reduction intervention increases HIV/AIDS preventive behavior.

PURPOSE: One objective of translational science is to identify elements of human immunodeficiency virus (HIV) risk-reduction interventions that have been shown to be effective and find new ways of delivering these interventions to the community to ensure that they reach the widest possible audience of at-risk individuals. The current study reports the development and evaluation of a computer-delivered, theory-based, individually tailored HIV risk-reduction intervention. METHODS: This study evaluated the effectiveness of a custom computerized HIV/AIDS risk reduction intervention at increasing HIV/AIDS preventive behaviors in a randomized trial with 157 college students. The intervention content and delivery were based on the Information-Motivation-Behavioral Skills Model of Health Behavior Change and used Motivational Interviewing techniques. Participants completed a baseline assessment of HIV prevention information, motivation, behavioral skills and behavior, attended two brief computer-delivered intervention sessions, and completed a follow-up assessment. RESULTS: As compared to the control group (a nutrition education tutorial), participants who interacted with the computer-delivered HIV/AIDS risk reduction intervention exhibited a significant increase in risk reduction behavior. Specifically, participants reported a greater frequency of keeping condoms available and displayed greater condom-related knowledge at a four-week follow-up session; among sexually active participants, there was a significant increase in self-reported condom use. CONCLUSIONS: Delivery of brief individually tailored HIV/AIDS risk reduction interventions via computer may be an effective HIV/AIDS prevention approach for adolescents. More research is needed to further support the effectiveness of this type of intervention and determine the generalizability of these findings to economically and educationally disadvantaged adolescents.