RESUMEN
Although it is an effective HIV prevention method, pre-exposure prophylaxis (PrEP) is underutilized in the Southern US. Many people who use drugs (PWUD) have increased susceptibility to HIV which could be lessened by using PrEP. Potential barriers to PrEP use include lack of awareness of PrEP, low knowledge about HIV prevention, low self-efficacy for HIV prevention, inaccurate risk perceptions, and anticipated stigma. The current study examined predisposing, enabling, and reinforcing factors that may predict interest in PrEP. The purpose of the current study was to explore factors associated with interest in and willingness to use daily oral and long acting injectable PrEP among sexually active adult PWUD. The data were collected from adult participants (n = 270) residing in Harris County, TX, who self-reported problematic substance use and who reported oral, anal, or vaginal sex in the six months prior to completing the survey. The survey was distributed and completed online via Qualtrics Panels in March of 2022 and included measures of PrEP and HIV knowledge, PrEP stigma, sexual health self-efficacy, experiences of discrimination, health literacy, and medical mistrust. The majority of participants reported circumstances or behaviors that increased their susceptibility to HIV. Findings indicated that PrEP user stereotypes and PrEP anticipated disapproval by others were associated with interest in using daily oral PrEP and willingness to use long acting injectable PrEP. These results provide insight into reasons for low PrEP uptake among PWUD who live in a high HIV prevalence jurisdiction. Implications for HIV prevention intervention are discussed.
RESUMEN
BACKGROUND: Cisgender (cis) Black women in the USA are more likely to become HIV positive during their lifetime than other women. We developed and implemented a behavioral intervention, Increasing PrEP (iPrEP), the first pilot randomized controlled trial (RCT) aimed at motivating cis Black women to be willing to use PrEP for HIV prevention and attend an initial PrEP clinic visit following an emergency department visit. METHODS: Eligible participants were Black cisgender women ages 18-55 years who acknowledged recent condomless sex and substance use. Participants were randomized to iPrEP or usual care (UC). iPrEP is a survey-based intervention designed to raise awareness and knowledge about PrEP. Participants completed an assessment of knowledge of and willingness to use PrEP before and after the intervention, then received a warm-hand off with referral to a local PrEP clinic. Enrolled participants were followed for 6 months. RESULTS: Forty enrolled participants were ages 18-54 years. Education levels varied evenly between some high school education and graduate education. Most participants were single (n = 25) or married (n = 7). Twenty-two participants were employed full-time. Pre-test results indicated that 21 of 40 participants had heard of PrEP. All participants identified PrEP as a daily HIV prevention medication. For those randomized to iPrEP, the odds of knowing about PrEP at post-test, when controlling for baseline, were higher relative to UC (OR = 5.22, 95%CrI = 0.50, 94.1]. iPrEP did not have any effect on willingness relative to UC. The estimate for iPrEP on willingness is marginally higher (4.16 vs. 4.04; i.e., 0.12 points higher); however, the posterior probability of 67.9% does not suggest a strong degree of evidence in favor of an effect. During the post-test, those receiving iPrEP were less ready to take PrEP than those receiving UC. CONCLUSIONS: Findings suggest that iPrEP increased knowledge about the PrEP medication but had a negative impact on readiness to take PrEP relative to UC. It is imperative that future research among cisgender Black women carefully considers the content provided in interventions designed to increase PrEP use, balancing the benefits of PrEP with the side effects and daily pill burden. TRIAL REGISTRATION: clinicaltrial.gov Identifier: NCT03930654, 29/04/2019.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Femenino , Humanos , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Masculino , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Profilaxis Pre-Exposición/métodos , Proyectos Piloto , Fármacos Anti-VIH/uso terapéutico , Sexo Inseguro , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Comprimidos , Homosexualidad MasculinaRESUMEN
Background: Although exposure to potentially traumatic events (PTEs) for Black and Latinx may be comparable or lower than their White counterparts, type of trauma experiences differ such as more interpersonal trauma and violence reported by Black people, who also experience higher rates of PTSD. In this retrospective study, we examined the association between use of particular substances and various PTEs and the race/ethnicity-group differences for this association. Methods: One-hundred seventy-nine participants recruited from an outpatient substance use disorder program from February 2018 to October 2020 completed measures on lifetime trauma history and current/past cocaine, cannabis, and alcohol misuse. Bayesian generalized linear modeling with horseshoe prior was used to predict substance misuse using 17 PTEs, then PTEs were ranked and examined by racial/ethnic group. Results: No PTEs were associated with substance misuse across all four r/e groups. Transportation accident, natural disaster, war exposure, and other stressful events were associated with substance misuse across two or three r/e groups. Notably, the three PTEs involving interpersonal violence in our study (weapon assault, physical assault, and sexual assault) were only associated with substance misuse (posterior probability ≥70%) for Latinx participants. Conclusion: The relational nature of interpersonal/violent traumas may make them particularly salient for Latinx people where interpersonal relationships are prioritized. These types of traumas may also be viewed as an extension of discrimination and exclusion, two longstanding, intractable issues for people of color in the US, making them even more damaging. Furthermore, lack of resources may limit options for coping, resulting in substance use problems.
Asunto(s)
Cannabis , Trastornos por Estrés Postraumático , Trastornos Relacionados con Sustancias , Humanos , Estudios Retrospectivos , Teorema de Bayes , Violencia , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method, but it has been underutilized by women. Anticipated stigma regarding use of PrEP is a contributing factor in the underutilization of this prevention strategy. The current study explored the relationships among PrEP stigma, sex risk (i.e., inconsistent condom use, condomless sex with persons of unknown serostatus, or sex in exchange for money or drugs), substance use, attitudes toward HIV testing, and medical mistrust. Participants were 106 primarily ethnic-minority women who reported recent substance use and agreed to participate in a study exploring HIV prevention attitudes. Within this sample, the majority of participants had one or more CDC-defined PrEP indications. Findings indicate that medical mistrust was associated with perceived PrEP stereotypes and HIV testing attitudes. These results provide some insight into reasons for low PrEP uptake among women at risk for HIV. Implications for HIV prevention with women are discussed.
Asunto(s)
Infecciones por VIH , Profilaxis Pre-Exposición , Trastornos Relacionados con Sustancias , Continuidad de la Atención al Paciente , Femenino , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Humanos , Autoinforme , ConfianzaRESUMEN
Exchange sex places individuals with cocaine use disorder (CUD) at particularly high risk for deleterious safety and health outcomes. A substance use treatment provider who is aware of a patient's exchange sex behavior is better able to provide appropriate screening, care, and/or referral to risk reduction services. However, little is known about exchange sex, especially purchasing, among treatment-seeking adults with CUD.The current study examined the prevalence and correlates of sex selling and sex purchasing among treatment-seeking men and women with CUD (n = 109; ClinicalTrials.gov #NCT02896712). Separate binary logistic regressions via backward elimination were used to identify best fitting models for sex selling and sex purchasing.Over 41% of participants endorsed exchange sex within the last 30 days; 20.2% reported selling sex and 30.3% reported purchasing sex. Sex selling and sex purchasing rates differed by gender and race. Number of sexual partners (OR = 5.83, 95% CI = 2.07-16.43), concern about contracting HIV/AIDS (OR = 2.01, 95% CI = 1.31-3.44), cumulative interpersonal trauma exposure (OR = 1.82, 95% CI = 1.20-2.77), years using cocaine (OR = 1.11, 95% CI = 1.03-1.20), drug-related problem days (OR = 1.07, 95% CI = 1.00-1.14), and sexual preference (OR = 9.50, 95% CI = .69-130.35) were retained in the final model estimating sex selling (Nagelkerke R2 = .56). In the final sex purchasing model (Nagelkerke R2 = .46), gender (OR = 36.17, 95% CI = 2.96-441.75), number of sexual partners (OR = 6.28, 95% CI = 2.69-14.66), number of convictions (OR = 1.13, 95% CI = 1.02-1.25), and drug-related problem days (OR = 0.96, 95% CI = .92-1.01) were retained.Predictive models in this study identified distinct sets of variables related to sex selling and purchasing. Findings may be used to improve identification of exchange sex in the substance use treatment setting and referral to targeted interventions to reduce associated risk.
Asunto(s)
Cocaína , Infecciones por VIH , Trastornos Relacionados con Sustancias , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Prevalencia , Asunción de Riesgos , Conducta Sexual , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
BACKGROUND: The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously. OBJECTIVES: The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity. RESULTS: Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression. CONCLUSION: Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.
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Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Trastornos Relacionados con Sustancias/terapia , Depresión/complicaciones , Depresión/epidemiología , Diagnóstico Dual (Psiquiatría) , Humanos , Prevalencia , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/epidemiología , Resultado del TratamientoRESUMEN
Multiple studies confirm that African Americans are less likely than non-Hispanic whites to receive needed mental health services. Research has consistently shown that African Americans are under-represented in outpatient mental health treatment settings and are over-represented in inpatient psychiatric settings. Further, African Americans are more likely to receive a diagnosis of schizophrenia and are less likely receive an affective disorder diagnosis during inpatient psychiatric hospitalization compared to non-Hispanic white patients, pointing to a need for examining factors contributing to mental health disparities. Using Andersen's Behavioral Model of Health Service Use, this study examined predisposing, enabling and need factors differentially associated with health service utilization among African American and non-Hispanic white patients (n=5183) during psychiatric admission. We conducted univariate and multivariate logistic regression analyses to examine both main effects and interactions. In the multivariate model, African American race at admission was predicted by multiple factors including younger age, female gender, multiple psychiatric hospitalizations, elevated positive and negative symptoms of psychosis, a diagnosis of schizophrenia and substance use, as well as having housing and commercial insurance. Additionally, screening positive for cannabis use at intake was found to moderate the relationship between being female and African American. Our study findings highlight the importance of examining mental health disparities using a conceptual framework developed for vulnerable populations (such as racial minorities and patients with co-occurring substance use).
Asunto(s)
Negro o Afroamericano/etnología , Disparidades en Atención de Salud/etnología , Hospitales Psiquiátricos/normas , Admisión del Paciente/normas , Población Urbana , Población Blanca/etnología , Adulto , Negro o Afroamericano/psicología , Femenino , Humanos , Masculino , Servicios de Salud Mental/normas , Servicios de Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Trastornos Psicóticos/etnología , Trastornos Psicóticos/terapia , Grupos Raciales/etnología , Grupos Raciales/psicología , Esquizofrenia/etnología , Esquizofrenia/terapia , Trastornos Relacionados con Sustancias/diagnóstico , Población Blanca/psicología , Adulto JovenRESUMEN
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
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Terapia Conductista , Recompensa , Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/terapia , Trastornos Relacionados con Sustancias/psicología , Terapia Conductista/métodos , Animales , Conducta Adictiva/terapiaRESUMEN
Prescribed opioids are a mainstay pain treatment after traumatic injury, but a subgroup of patients may be at risk for continued opioid use. We evaluated the predictive utility of a traditional screening tool, the Opioid Risk Tool (ORT), and two other measures: average in-hospital milligram morphine equivalents (MME) per day and an assessment of opioid demand in predicting pain outcomes. Assessments of pain-related outcomes (pain intensity, interference, injury-related stress, and need for additional pain treatment) were administered at 2 weeks and 12 months post-discharge in a sample of 34 patients hospitalized for traumatic injury. Bayesian linear models were used to evaluate changes in responses over time as a function of predictors. High-risk ORT, higher MME per day, and greater opioid demand predicted less change in outcomes over time. This report provides first evidence that malleable factors of opioid and opioid demand have utility in predicting pain outcomes following traumatic injury.
Asunto(s)
Analgésicos Opioides , Dolor , Heridas y Lesiones , Humanos , Masculino , Analgésicos Opioides/uso terapéutico , Analgésicos Opioides/efectos adversos , Femenino , Adulto , Heridas y Lesiones/complicaciones , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Dolor/etiología , Dimensión del Dolor , Medición de Riesgo , Teorema de Bayes , Trastornos Relacionados con Opioides , Adulto JovenRESUMEN
OBJECTIVE: Prescription opioids are an effective pain treatment strategy but can lead to long-term opioid misuse. Identifying at risk patients during hospitalization can inform the development of prevention interventions post-discharge. Using the Opioid Risk Tool (ORT) as a screening measure, this study predicted factors associated with pain and opioid use at 2 weeks post-discharge in trauma patients. DESIGN: A quality improvement prospective study design was used. SETTING: Participant recruitment took place at an inpatient Level 1 trauma center in Houston, Texas. PARTICIPANTS: Participants (n = 103) were patients admitted to the adult trauma service. Patients completed the ORT in the hospital and a survey at 2 weeks post-discharge. MAIN OUTCOME MEASURE: The survey assessed pain intensity and interference, injury-related stress, medication use, and need for additional pain treatment. Wilcoxon-Mann-Whitney U test, the Spearman rank-order correlation, and chisquare test of independence tested the ORT as a predictor of follow-up outcomes. Post hoc analyses relied on logistic and quantile regression. RESULTS: The ORT identified 15.5 percent of patients at high risk for opioid-related aberrant behavior. Survey results indicated high percentages of patients reporting moderate to severe pain (79.6 percent), pain interference (77.9 percent), taking pain pills (59.6 percent), experiencing stress (76.9 percent), and needing pain treatment (52.4 percent). The ORT predicted injury-related stress with the high-risk category having higher stress levels than low risk (Z = 2.518, p = 0.012). CONCLUSION: Risk of opioid misuse assessed in hospitalized trauma patients was associated with injury-related stress reported post-discharge. This highlights the importance of including stress assessments in follow-up appointments.
Asunto(s)
Analgésicos Opioides , Trastornos Relacionados con Opioides , Adulto , Cuidados Posteriores , Analgésicos Opioides/efectos adversos , Humanos , Trastornos Relacionados con Opioides/diagnóstico , Dolor/tratamiento farmacológico , Alta del Paciente , Estudios ProspectivosRESUMEN
Opioid misuse and opioid-related death are a growing public health concern. One population of interest is recent trauma and/or surgery patients, who are at increased risk of developing an opioid use disorder (OUD). Although a variety of assessments have been developed to screen for risk of opioid misuse, each has limitations and prediction needs improvement. One promising measure is drug demand, a behavioral economic measure assessing drug consumption at different price points. In the current proposal, we assessed the utility of a brief assessment of opioid demand. Demand and various pain-related self-report measures among trauma-surgery patients (N = 103) were assessed at 4 weeks post-discharge. Opioid demand was significantly associated with self-report measures of pain and amount of morphine milligram equivalents (MME) received during the hospital stay. The current result support the utility of the opioid demand as an adjunctive and complementary measure to assess risk of opioid misuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Asunto(s)
Servicios Médicos de Urgencia , Trastornos Relacionados con Opioides , Cuidados Posteriores , Analgésicos Opioides/uso terapéutico , Humanos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Alta del PacienteRESUMEN
Prior research has identified perceived discrimination as being a contributing factor in health and mental health disparities. However, there is little research on the relationship between perceived discrimination and behaviors such as hazardous alcohol and illicit substance use and risky sexual behaviors that put people at risk for negative health consequences including HIV. The current research explores the role that cultural factors may play in a tendency for individuals to engage in unhealthy behaviors or an ability to avoid them. A total of 266 college students who self-identified as Black or African American were surveyed on measures of familial ethnic socialization, perceived discrimination, emotion regulation, substance use, and risky sexual behaviors. Findings indicate that perceived discrimination and emotion regulation-suppression were associated with higher levels of hazardous alcohol use, and that emotion regulation-cognitive reappraisal was associated with lower levels of illicit substance use. Implications for intervention and prevention in African American college students are discussed.
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Negro o Afroamericano/psicología , Racismo/psicología , Asunción de Riesgos , Estudiantes/psicología , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Regulación Emocional , Femenino , Humanos , Masculino , Factores Protectores , Socialización , Estudiantes/estadística & datos numéricos , Estados Unidos , Universidades , Adulto JovenRESUMEN
OBJECTIVE: To examine ethnic identity and ethnic socialization as potential protective factors for risk behaviors among US college students. PARTICIPANTS: Participants were 398 African American and Afro-Caribbean students recruited from 30 colleges and universities during September 2008-October 2009. METHODS: Data on hazardous alcohol use, substance use, sexual behaviors, ethnic identity, and ethnic/racial socialization were collected. Hierarchical linear and negative binomial regression analyses were conducted to determine the degree to which ethnic identity and ethnic/racial socialization predicted the risk behaviors. RESULTS: Ethnic Identity affirmation, belonging, and commitment (EI-ABC) significantly predicted lower substance use and hazardous alcohol use. Ethnic/racial socialization was not a significant predictor of substance use or sexual risk behaviors. CONCLUSIONS: Components of ethnic identity are potentially protective against alcohol and substance use behaviors. Additional research is recommended to determine effective intervention strategies.
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Negro o Afroamericano/psicología , Conductas de Riesgo para la Salud , Factores Protectores , Conducta Sexual/etnología , Trastornos Relacionados con Sustancias/etnología , Adolescente , Adulto , Etnicidad/psicología , Femenino , Humanos , Masculino , Asunción de Riesgos , Autoimagen , Estudiantes/psicología , UniversidadesRESUMEN
U.S. Hispanics, now the single largest minority group in the country, face unique mental health disparities. The current study utilizes Andersen's Behavioral Model of Health Service Use to examine ethnic disparities in receiving a schizophrenia or mood disorder diagnosis at psychiatric hospital admission. Our retrospective cohort study examined electronic health record data at an academic safety-net psychiatric hospital for adult patients (nâ¯=â¯5571) admitted between 2010 and 2013. Logistic regression with block-wise entry of predisposing, enabling and need variables was used to examine ethnic disparities in receiving a schizophrenia diagnosis at admission. The block of need factors was the strongest predictor of receiving a schizophrenia diagnosis compared to predisposing and enabling factors. Compared to non-Hispanic whites, Hispanics and African Americans had a greater likelihood of receiving a schizophrenia diagnosis at admission. Additionally, patients diagnosed with schizophrenia had elevated positive and negative symptoms and were more likely to be male, single/unmarried, homeless, high inpatient service utilizers, involuntarily hospitalized, and to exhibit functional impairment at psychiatric hospital admission. To address elevated positive and negative symptoms of schizophrenia, functional impairment, social withdrawal, and high inpatient service utilization, promising psychosocial interventions should be adapted for racial and ethnic minority populations and utilized as an adjuvant to antipsychotic medication.
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Etnicidad , Hospitales Psiquiátricos/tendencias , Trastornos del Humor/etnología , Admisión del Paciente/tendencias , Proveedores de Redes de Seguridad/tendencias , Esquizofrenia/etnología , Centros Médicos Académicos/tendencias , Adulto , Estudios de Cohortes , Etnicidad/psicología , Femenino , Personas con Mala Vivienda/psicología , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Humor/diagnóstico , Trastornos del Humor/psicología , Estudios Retrospectivos , Esquizofrenia/diagnósticoRESUMEN
We examined ethnic identity in relation to hazardous alcohol use, illicit drug use, and risky sexual behavior in 266 college students recruited on the campus of a historically Black college/university (HBCU). Participants were primarily African American students participating in HIV education and prevention outreach efforts. Data regarding prevalence of substance use, binge drinking, and sexual risk behaviors are reported. Results found no relationship among the risk variables and ethnic identity. HIV knowledge score results demonstrated a need to continue HIV education to include the less publicized facts about HIV transmission. Results are discussed in terms of implications for prevention efforts with African American college students.