Efficacy of a process improvement intervention on delivery of HIV services to offenders: a multisite trial.

OBJECTIVES: We tested a modified Network for the Improvement of Addiction Treatment (NIATx) process improvement model to implement improved HIV services (prevention, testing, and linkage to treatment) for offenders under correctional supervision. METHODS: As part of the Criminal Justice Drug Abuse Treatment Studies, Phase 2, the HIV Services and Treatment Implementation in Corrections study conducted 14 cluster-randomized trials in 2011 to 2013 at 9 US sites, where one correctional facility received training in HIV services and coaching in a modified NIATx model and the other received only HIV training. The outcome measure was the odds of successful delivery of an HIV service. RESULTS: The results were significant at the .05 level, and the point estimate for the odds ratio was 2.14. Although overall the results were heterogeneous, the experiments that focused on implementing HIV prevention interventions had a 95% confidence interval that exceeded the no-difference point. CONCLUSIONS: Our results demonstrate that a modified NIATx process improvement model can effectively implement improved rates of delivery of some types of HIV services in correctional environments.

Feeling good in your own skin: the influence of complimentary sexual stereotypes on risky sexual attitudes and behaviors in a community sample of African American women.

Although negative racial stereotypes may affect the mental and physical health of African Americans, little research has examined the influence of positive or complimentary racial stereotypes on such outcomes. More specifically, this study explored the relationship between African American women's endorsement of complimentary stereotypes about their sexuality and attitudes/behaviors that have been associated with sexual risk. Data were gathered from 206 African American women as part of the Black Women in the Study of Epidemics project. Multivariate regression models were used to examine associations between women's endorsement of complimentary stereotypes about their sexuality and selected sex-related attitudes and behaviors. Participants' endorsement of complimentary sexual stereotypes was significantly positively associated with beliefs that having sex without protection would strengthen their relationship (B = .28, SE = .10, p < .01) and that they could use drugs and always make healthy choices about using protection (B = .31, SE = .09, p < .01). Significant positive associations were also found between complimentary sexual stereotypes and the number of casual sexual partners women reported in the past year (B = .29, SE = .15, p = .05) as well as their willingness to have sex in exchange for money or drugs during that time (B = .78, OR = 2.18, p < .05). These findings suggest that endorsement of complimentary sexual stereotypes by African American women can lead to increased risk behavior, particularly relating to possible infection with HIV or other sexually transmitted infections.

Examination of an interventionist-led HIV intervention among criminal justice-involved female prisoners.

The purpose of this study was to examine the implementation, adherence and protocol fidelity for the Reducing Risky Relationships for HIV (RRR-HIV) study. The RRR-HIV study is a phase III trial of a randomized intervention to reduce human immunodeficiency virus (HIV) risk behaviors among incarcerated women in four US states: Connecticut, Delaware, Kentucky and Rhode Island. The intervention consists of five interventionist-led prison-based group sessions and a sixth individual community-based session. Data on adherence, implementation, acceptability and fidelity of the intervention were obtained from forms completed after the five prison-based sessions by both the interventionist and participant. Data from the sixth session were collected by the interventionist. Of the 363 women recruited to date, 173 (47.6%) have been randomly allocated to the experimental RRR intervention, of which implementation measures were available for 162 (93.6%). Almost three-quarters of women attended all five sessions, each of which lasted a median of 90 minutes, indicating successful implementation of the protocol across multiple study sites. Interventionists and participants alike reported that all of the topics for each session were discussed, suggesting adherence to the protocol. In addition, protocol interventionists indicated that more than 95% of the women were engaged/involved, interested, and understood the materials presented, indicating high levels of acceptability among the participants and fidelity to the intervention protocols. The majority of participants also answered all of the post-test questions correctly, which is another strong indicator of the fidelity to the intervention. Results suggest that the RRR-HIV study has been successfully implemented across multiple study sites. Adherence to the protocol, as well as protocol fidelity and acceptability, were also strong, which is essential to establish prior to examining outcome data.

Readiness to change as a predictor of drug-related behaviors in a sample of rural felony probationers.

OBJECTIVE: Relationships between readiness to change and common drug-related behaviors were explored in a sample (N = 776) of rural probationers in the state of Kentucky. METHODS: Self-reported data was gathered on measures of readiness to change, frequency of marijuana use, possession of drugs/related paraphernalia, and driving while under the influence of drugs/alcohol at time periods before and after arrest. RESULTS: Independent of the influence of demographic characteristics such as age, gender, race, and treatment history, increases in readiness to change scores were accompanied by reductions in all three drug-related behaviors. CONCLUSION: Readiness to change has important implications for treatment involving rural probationers.

Partner relationships and HIV risk behaviors among women offenders.

The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population. Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders. This study examines women's perceptions of their relationships using the Sexual Relationship Power Scale (Pulerwitz, Gortmaker, & DeJong 2000) and NIDA's HIV Risk Behavior Assessment (NIDA 1995). Data were collected from female inmates in four prisons as part of the Reducing Risky Relationships for HIV protocol being conducted through the NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Women reported whether they had engaged in five types of unprotected sex in the month prior to incarceration. Logistic regression models of the associations between relationship power and five types of unprotected sex revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors. Implications and findings are presented to add to understanding of partner relationships and HIV risk behaviors.

Racial differences in HIV/AIDS discussion strategies and sexual risk behaviors among drug-abusing female criminal offenders.

African-American female inmates are disproportionately affected by the human immunodeficiency virus (HIV), with heterosexual contact as the primary mode of transmission. This could be the result of racial differences in the strategies used by women to persuade a potential sexual partner to discuss HIV/AIDS and engage in condom use. Data were collected from 336 female inmates as part of the Reducing Risky Relationships for HIV (RRR-HIV) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses indicated that African-American drug-using women were more likely than Whites to use the rational, withdrawal, and persistence approaches to discuss HIV/AIDS with a sexual partner. Negative binomial regression models were used to identify which interpersonal discussion strategies were significant correlates of the number of the times White and African-American participants had unprotected vaginal sex in the 30 days before incarceration. Results from the multivariate model indicate that White women who are more likely to use the rational discussion strategy were 15% less likely to engage in unprotected vaginal sex; however, these findings were not replicated in the African-American sample. Findings add to the literature on racial differences in HIV/AIDS discussion strategies and sexual risk behaviors among drug-abusing female criminal offenders.

Male and Female Stimulant Use Among Rural Kentuckians: The Contribution of Spirituality and Religiosity.

This study describes gender-specific patterns of drug use among active rural stimulant users and examines religiosity and spirituality as factors that may be related to stimulant use among males and females. The study includes a sample of 225 active rural stimulant users from Kentucky who were recruited using respondent driven sampling and completed face-to-face interviews. Findings suggest gender specific patterns among active rural stimulant users, with females reporting more amphetamine use. In addition, bivariate findings indicate that there is an inverse relationship between spirituality, religiosity, and stimulant use (specifically methamphetamine and amphetamine use), particularly for males. However, when further examining this relationship in multivariate models controlling for age and race, few significant findings were noted for spirituality and religiosity in predicting gender-specific stimulant use patterns. These findings suggest that treatment interventions that incorporate spirituality and religiosity should not only be gender specific, but should also target clients differentially. Findings on the degree of reported spirituality and religiosity also suggest that religious and/or faithbased organizations could be utilized for drug use interventions for rural stimulant users.

Health, mental health, substance use, and service utilization among rural and urban incarcerated women.

Incarcerated women commonly report health, mental health, and substance use problems, yet there is limited research on service utilization before incarceration, particularly among women from urban and rural areas. This study includes a stratified random sample of 100 rural and urban incarcerated women to profile the health, mental health, substance use, and service utilization; examine the relationship between the number of self-reported problems and service utilization; and examine self-reported health and mental health problems in prison as associated with preincarceration health-related problems and community service utilization. Study findings suggest that health and mental health problems and substance use do not differ significantly among rural and urban women prisoners. However, there are differences in service utilization -- particularly behavioral health services including mental health and substance abuse services; urban women report more service utilization. In addition, rural women who reported using needed community services before prison also reported fewer health problems in prison. Implications for correctional and community treatment opportunities in rural and urban areas are discussed.

Effect of an organizational linkage intervention on staff perceptions of medication-assisted treatment and referral intentions in community corrections.

INTRODUCTION: Medication-assisted treatment (MAT) is effective for alcohol and opioid use disorders but it is stigmatized and underutilized in criminal justice settings. METHODS: This study cluster-randomized 20 community corrections sites to determine whether an experimental implementation strategy of training and an organizational linkage intervention improved staff perceptions of MAT and referral intentions more than training alone. The 3-hour training was designed to address deficits in knowledge, perceptions and referral information, and the organizational linkage intervention brought together community corrections and addiction treatment agencies in an interagency strategic planning and implementation process over 12 months. RESULTS: Although training alone was associated with increases in familiarity with pharmacotherapy and knowledge of where to refer clients, the experimental intervention produced significantly greater improvements in functional attitudes (e.g. that MAT is helpful to clients) and referral intentions. Corrections staff demonstrated greater improvements in functional perceptions and intent to refer opioid dependent clients for MAT than did treatment staff. CONCLUSION: Knowledge, perceptions and information training plus interorganizational strategic planning intervention is an effective means to change attitudes and intent to refer clients for medication assisted treatment in community corrections settings, especially among corrections staff.

Rural and Urban Differences in Kentucky DUI Offenders.

OBJECTIVES: : Recent national data suggest that the prevalence of driving under the influence (DUI) is higher in rural areas than in more urbanized areas of the United States. However, little is known about rural DUI offenders, particularly those living in very remote areas. This study was conducted to examine the similarities and differences between rural and urban DUI offenders. Based on recent research, it was expected that few differences would be found between rural and urban DUI offenders. METHODS: : This study examined a total of 21,135 substance abuse assessment records for persons convicted of DUI in Kentucky and who concluded treatment in 2005. Assessment records included demographic characteristics, Alcohol Use Disorders Identification Test scores, Drug Abuse Screening Test scores, and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision substance use disorder checklist. Beale codes based on county of residence were used to create comparison groups. RESULTS: : Positive, and statistically significant, associations were found between rurality and Drug Abuse Screening Test scores, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition substance abuse and dependence disorders, and rates of education/treatment noncompliance. Alcohol Use Disorders Identification Test scores were negatively associated with rurality. CONCLUSIONS: : The study suggests that the problem severity among DUI offenders may be greater in rural areas. Given the lack of treatment services in rural areas, practitioners may face greater challenges in assessing and providing appropriate treatment for this group of DUI offenders, which may put them at greater risk for continued impaired driving.

Measuring employment among substance-using offenders.

Employment has been identified as an important predictor of drug abuse treatment outcome; however, employment has been measured in a variety of different ways in the drug abuse literature and typically with community samples. The present IRB-approved study used factor analysis to identify commonalities among several employment measures collected from a sample of drug court offenders who entered one of two Kentucky drug courts between March 2000 and November 2002. Measures included demographics, employment, substance use, and criminality. The factor analysis produced four employment factors: status, earnings, duration, and stability. These factors had different correlation patterns with substance use and criminality. Study limitations are noted.