Periodontal status of current methamphetamine users.

BACKGROUND: Methamphetamine (MA) use is associated with extensive dental caries. The purpose of this study was to determine the prevalence and severity of periodontal disease in a convenience sample of MA users. METHODS: In this cross-sectional survey, MA users were recruited with a combination of snowball sampling and street outreach techniques. Three dentists, trained and calibrated to the oral assessments used in the National Health and Nutrition Survey, measured and recorded the participants' attachment loss, probing depth, and gingival recession. Concomitant interviews elicited psychological, substance use, medication, and dietary habits associated with MA use. RESULTS: Periodontal assessments were completed on 546 adults. More than 69% were cigarette smokers, and more than 55% were medium to high MA users. Classifying prevalence by means of the Centers for Disease Control and Prevention and the American Academy of Periodontology definitions, cigarette smokers and medium to high MA users had a high prevalence of periodontal disease. The defining features of the participants were being 30 years and older (average, 42.2 years) and having severe and moderate periodontitis. CONCLUSION: This is the first study to the authors' knowledge to systematically examine periodontal disease in a large population of current MA users. MA users in a Los Angeles urban setting had a high prevalence and severity of destructive periodontal disease. The frequency of MA use had a minimal impact on the severity of periodontal disease. PRACTICAL IMPLICATIONS: An MA user can be at high risk of developing periodontal disease. Knowing that behavioral factors, such as smoking and consuming sugary beverages, are more important than MA use will assist the clinician in managing the treatment of MA users.

Dental disease patterns in methamphetamine users: Findings in a large urban sample.

BACKGROUND: The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface. METHODS: Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease. RESULTS: On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance. CONCLUSIONS: MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive. PRACTICAL IMPLICATIONS: The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.

Alcohol and marijuana use outcomes in the Healthy Choices motivational interviewing intervention for HIV-positive youth.

Healthy Choices is a motivational interviewing intervention targeting multiple risk behaviors among HIV-positive youth. This study investigated the effects of this intervention program specifically on alcohol and marijuana use. Youth living with HIV (n = 143, mean age = 20.7, 51.5% male) were recruited from four sites in the United States, and randomly assigned to intervention or control conditions. The four-session intervention focused on two of three possible problem behaviors based on entry screening; this study focused on 143 HIV-positive youth who received the intervention for substance use. At 15-month follow-up past-week alcohol use was significantly lower for intervention youth than control youth (39.7% versus 53.6%, χ2 = 2.81, 0.05 < p < 0.01); developmental trajectory analysis demonstrated significant reductions in alcohol use, but more importantly the intervention was effective over time in significantly reducing the adolescent's probability of being classified into the high-risk trajectory group. The intervention was less effective in reducing marijuana use.

Randomized controlled trial of personalized motivational interventions in substance using patients with facial injuries.

PURPOSE: The proximate use of illicit drugs or alcohol (substance use) is the most common precipitator of facial injuries among socioeconomically disadvantaged populations. Reducing these risky behaviors could minimize adverse health sequelae and potential reinjury. The objective of our study was to test whether a culturally competent, personalized motivational intervention incorporated into surgical care could significantly reduce existing substance use behaviors in facial injury patients. PATIENTS AND METHODS: Substance-using subjects (n = 218) presenting with facial injuries to a level 1 trauma center were randomly assigned to either a personalized motivational intervention (PMI) condition or a health-information (HI) control condition. After a brief assessment of the individual's substance use severity and willingness to change these behaviors, both groups attended 2 counseling sessions with a trained interventionist. The PMI subjects (n = 118) received individualized, motivational interventions, whereas the HI subjects (n = 100) received only general health information. Both groups were reassessed at 6 and 12 months postinjury, and changes in substance-use patterns were measured to assess the effects of intervention. RESULTS: The PMI and HI groups were closely matched on their sociodemographic and substance use characteristics. Subjects in the PMI group showed statistically significant declines in drug use at both the 6- and 12-month assessments. The intervention's effect on lowering illicit drug use was greatest at the 6-month assessment but had weakened by the 1-year follow-up. The efficacy of the PMI was moderated by an individual's initial drug use severity; individuals with greater drug use dependency at baseline were seen to have larger intervention effects, as did individuals who were most aware of their drug problem and willing to change their substance use behaviors. Unlike illicit drug use, changes in alcohol use did not differ significantly between the intervention and control groups, irrespective of an individuals' recognition of the alcohol problem or willingness to take steps to address it. CONCLUSION: A culturally competent, motivational intervention integrated into the care of vulnerable patients with facial injury can reduce illicit drug use behaviors. Subgroups of injured patients appear to benefit most from such personalized motivational interventions. A better articulation of target populations, intervention content, and delivery would allow for directed interventions and an appropriate focusing of limited time and health care resources.

Substance use and facial injury.

Substance use is a major contributing factor to the interpersonal violence that accounts for a significant proportion of facial injuries among adults and adolescents; thus, violence is the main "pathway" through which substance use and injuries are linked. Beyond causality, substance use continues to influence recovery from the injury through its impact on the healing process (eg, patient noncompliance, suppression of T-cell counts, susceptibility to bacterial colonization, and protein production). Further exacerbating this issue are significant rates of injury recidivism and the lack of motivation to seek treatment for underlying substance-use problems. As a frontline care provider, the oral and maxillofacial surgeon has a responsibility to screen and refer patients for any needed specialty treatment (including substance-use treatment, violence reduction, and posttraumatic stress reduction). Recognizing and addressing these issues requires a paradigm shift that involves integration of multidisciplinary expertise.

Factors associated with orofacial injury and willingness to participate in interventions among adolescents treated in trauma centers.

PURPOSE: Assault is the most common cause of facial injuries in adolescents treated at inner-city trauma centers, yet little is known about the behavioral and environmental antecedents of these injuries or the willingness of such at-risk adolescents to participate in behavioral interventions to minimize reinjury. The purpose of this study was to identify possible risk and protective factors among adolescents with assault-related facial injury and to assess their willingness to participate in prospective observational research and behavioral interventions. PATIENTS AND METHODS: Interviews were conducted with 67 adolescents (range 14 to 20 yrs) who were treated in trauma centers for facial injuries. Most of these injuries were assault-related (59%), followed by motor vehicle or other accidents (29%), gunshot wounds (9%), and sports injuries (3%). The subjects were predominantly male (86%) and of ethnic minorities (91%). RESULTS: The adolescents showed high rates of intentional injuries in the past 6 months (56%), unhealthy alcohol use, and in more than half (55%) problem levels of substance use. Compared with those with unintentional injuries, adolescents who experienced assault-related injuries were more likely to report using alcohol, tobacco, and other substances. Although a significant segment of the sample (55%) had been arrested previously, no differences in arrest rates or types of crimes for which adolescents were arrested were observed by injury type. Most subjects were unwilling to participate in interventions that involved multiple sessions; however, greater family cohesion predicted the likelihood of being willing to participate. CONCLUSIONS: Most facial injuries in inner-city adolescents result from assault. Unhealthy alcohol use, problem levels of substance use behaviors, and family history of alcohol problems are associated markers of assault-related injuries that can be useful for risk assessment and targeted intervention. Interventions need to be brief if they are to engage these at-risk youth.

Accuracy of data collected by surgical residents.

PURPOSE: Clinician records are the primary information source for assessing the quality of facial injury care, billing, risk management, planning of health services, and health-system management and reporting. Inaccuracies obscure outcomes assessment and affect the planning of health services. We sought to determine the accuracy of the clinician collected data by comparing them to similar information elicited by professional interviewers. MATERIALS AND METHODS: We abstracted admissions data from the medical records of 185 patients treated for orofacial injury between January 2005 and January 2007. Clinician data on sociodemographics and substance use were compared with similar information elicited by trained research staff as part of a prospective study. RESULTS: The accuracy of the clinician data sets varied considerably depending on the variable. Concordance with the interviewer data sets was highest for age (paired t test P = .09), gender (kappa = 1), and ethnicity (kappa = .84) but dropped off considerably for marital status (kappa = .22) and alcohol (kappa = .18) and drug use (kappa = .16). The missing data per variable ranged from 4.5% (gender) to 46.9% (employment and education). CONCLUSIONS: Although more research is needed to evaluate the cause of inaccuracies and the relative contributions of patient, provider, and system level effects, it seems that significant inaccuracies in administrative data are common. In particular, patient information collected by surgical residents under-reports substance use behaviors. Interventions aimed at identifying the sources and correcting these errors are necessary.

Human papillomavirus infection and abnormal cytology of the anus in HIV-infected and uninfected adolescents.

OBJECTIVE: To examine the prevalence of and risk for anal human papillomavirus (HPV) infection and abnormal anal cytology in sexually active adolescents. DESIGN: Prevalence data from adolescents aged 13-18 years with and without HIV infection and with a history of high-risk sexual behavior. METHODS: HPV DNA was detected using amplification techniques. Abnormal anal cytology was defined as atypical squamous cell of undetermined significance or worse. RESULTS: Prevalence of anal HPV infection was similar in HIV-infected [28/58 (48%)] and uninfected [9/25 (36%)] boys (P = 0.3). but greater in HIV-infected [59/183 (59%)] than in uninfected [11/82 (13%)] girls (P < 0.001). Perianal warts were a risk for anal HPV in both boys [odds ratio (OR), 15.5; 95% confidence interval (CI), 1.6-149] and girls (OR, 9.9; 95% CI, 1.9-51.3). In subjects without anal warts, HIV infection was significant for girls (OR, 2.3; 95% CI, 1.1-4.9) and homosexual/bisexual orientation was significant for boys (OR, 5.2; 95% CI, 1.3-20.6). Abnormal anal cytology was more common among boys [32/77 (41.6%)] than girls [38/230 (16.5%)] (P < 0.001) and in addition to anal HPV, independent risk factors were positive HIV status in boys (OR, 6.5; 95% CI, 1.5-11.9) and number of partners within the past 3 months in girls (OR, 4.2; 95% CI, 1.5-11.9). CONCLUSIONS: Strong risk factors for abnormal anal cytology were HIV infection and anal HPV in boys and anal HPV and higher number of sexual partners for girls. The results suggest that anal cytology screening should be considered in HIV infected homosexual/bisexual males.