RESUMO
Blacks in the USA, including black men who have sex with men (MSM), tend to have stronger religious and spiritual affiliations compared with other racial/ethnic populations. HIV and STD incidence rates continue to rise among Black MSM. Using data from the CDC Brothers y Hermanos (ByHS) project, this study examined correlations between high-risk behavior, e.g., substance use and high-risk sexual behavior (e.g., condom use history, unprotected sexual intercourse, HIV infection status, and STD infection status) religiosity, spirituality, age, among Black MSM (N = 1141). This exploratory study examined whether religiosity and spirituality were associated with high-risk behavior and high-risk sexual behavior among Black MSM. Religiosity and spirituality indices were compiled from the ByHS data. The religiosity index was significantly associated with HIV infection and use of cocaine, crack, and poppers as well as marginally associated with ecstasy use. Spirituality was significantly associated with HIV infection status, STD infection status, alcohol use, and crack use. Given these relationships, current and future HIV prevention models targeting Black MSM should consider the potential importance of the roles of religiosity and spirituality in the lives of Black MSM to increase the efficacy of risk reduction interventions.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/estatística & dados numéricos , Religião , Sexo sem Proteção/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Idoso , Homossexualidade Masculina/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Philadelphia , Fatores de Risco , Assunção de Riscos , Espiritualidade , Sexo sem Proteção/psicologia , Adulto JovemRESUMO
HIV infection rates continue to disproportionately affect Black men who have sex with men (Black MSM) compared to other groups. Research has shown that higher rates of substance use and higher levels of depression are positively correlated with higher sexual risk behavior, and little research has examined relationships between high levels of religiosity and spirituality prevalent in Black culture and issues of substance use and depression among Black MSM. This study did just that and found a relationship between religiosity, spirituality, and risk behavior. These relationships suggest that future HIV prevention models might incorporate religiosity and spirituality to increase the efficacy of risk reduction interventions for Black MSM.
Assuntos
Negro ou Afro-Americano/psicologia , Transtorno Depressivo/psicologia , Homossexualidade Masculina/psicologia , Religião e Psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Transtorno Depressivo/complicações , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Assunção de Riscos , Parceiros Sexuais/psicologia , Espiritualidade , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto JovemRESUMO
UNLABELLED: Tanzania has the highest burden of cervical cancer in East Africa. This study aims to identify perceived barriers and facilitators that influence scale-up of regional and population-level cervical cancer screening and treatment programs in Tanzania. Convenience sampling was used to select participants for this qualitative study among 35 key informants. Twenty-eight stakeholders from public-sector health facilities, academia, government, and nongovernmental organizations completed in-depth interviews, and a seven-member municipal health management team participated in a focus group discussion. The investigation identified themes related to the infrastructure of health services for cervical cancer prevention, service delivery, political will, and sociocultural influences on screening and treatment. Decentralizing service delivery, improving access to screening and treatment, increasing the number of trained health workers, and garnering political will were perceived as key facilitators for enhancing and initiating screening and treatment services. In conclusion, participants perceived that system-level structural factors should be addressed to expand regional and population-level service delivery of screening and treatment. IMPLICATIONS FOR PRACTICE: Tanzanian women have a high burden of cervical cancer. Understanding the perceived structural factors that may influence screening coverage for cervical cancer and availability of treatment may be beneficial for program scale-up. This study showed that multiple factors contribute to the challenge of cervical cancer screening and treatment in Tanzania. In addition, it highlighted systematic developments aimed at expanding services. This study is important because the themes that emerged from the results may help inform programs that plan to improve screening and treatment in Tanzania and potentially in other areas with high burdens of cervical cancer.
Assuntos
Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/economia , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Tanzânia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/terapiaRESUMO
The misuse of prescription stimulants (MPS) is an emergent adverse health behavior among undergraduate college students. However, current research on MPS is largely atheoretical. The purpose of this study was to validate a survey to assess MPS-related theory of planned behavior (TPB) constructs (i.e. attitudes, subjective norms, and perceived behavioral control) and determine the relationship between these constructs, MPS-related risk factors (e.g. gender and class status), and current MPS (i.e. past 30 days use) among college students. Participants (N = 978, 67.8% female and 82.9% Caucasian) at a large public university in the southeastern USA completed a survey assessing MPS and MPS-related TPB constructs during fall 2010. To examine the relationship between MPS-related TPB constructs and current MPS, we conducted (1) confirmatory factor analyses to validate that our survey items assessed MPS-related TPB constructs and (2) a series of regression analyses to examine associations between MPS-related TPB constructs, potential MPS-related risk factors, and MPS in this sample. Our factor analyses indicated that the survey items assessed MPS-related TPB constructs and our multivariate logistic regression analysis indicated that perceived behavioral control was significantly associated with current MPS. In addition, analyses found that having a prescription stimulant was a protective factor against MPS when the model included MPS-related TPB variables.
Assuntos
Uso Indevido de Medicamentos sob Prescrição/psicologia , Psicometria/instrumentação , Estudantes/psicologia , Inquéritos e Questionários/normas , Adolescente , Adulto , Comportamento , Feminino , Humanos , Masculino , Teoria Psicológica , Universidades , Adulto JovemRESUMO
We assessed the occurrence of co-morbid psychiatric disorders (i.e., problem drinking, anxiety, and depression) among college students who met the threshold for disordered gambling. The participants included a large sample of undergraduate students (n = 1,430) who were enrolled in an introductory health course at a large, southeastern university in Spring 2011 and completed an online assessment that included scales to assess disordered gambling, problem drinking, anxiety, and depression. We calculated screening scores, computed prevalence rates for each disorder, and calculated Pearson correlations and Chi square tests to examine correlations and co-morbid relationships between the four disorders. Analyses indicated that all disorders were significantly associated (p < .01) except for disordered gambling and anxiety. Because college students who experience disordered gambling (and other psychiatric disorders) are at increased risk of experiencing co-occurring disorders, it might be useful for college health professionals to concurrently screen and intervene for co-occurring disorders.
Assuntos
Alcoolismo/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Jogo de Azar/epidemiologia , Jogo de Azar/psicologia , Estudantes/psicologia , Adolescente , Comorbidade , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência , Estudantes/estatística & dados numéricos , Universidades , Adulto JovemRESUMO
The authors examine both the alcohol consumption pattern of freshmen students during their first semester and the degree to which social modeling of peer behavior impacts consumption. A total of 534 students, residing on campus, were prospectively examined at four 30-day intervals. Data were evaluated on the basis of age, gender, and the effects of time using generalized estimating equations (GEEs). Results reflected nonsignificant increases in the amount of alcohol consumed; however, affiliations with alcohol-consuming peer groups was significantly associated with increased alcohol consumption. The mean number of drinks consumed in the past 30 days remained the same for whites (χ(2) = 3.35, 3 df, P = .3411) but increased slightly for blacks (χ(2) = 7.99, 3 df, P = .0462). Prevention programs should include screening for growth in alcohol consumption among first-year university students, and such screenings should include the extent and nature of affiliation with peers who consume alcohol.
Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Grupo Associado , Estudantes/psicologia , Consumo de Bebidas Alcoólicas/etnologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Análise Multivariada , Fatores Sexuais , Sudeste dos Estados Unidos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
ObjectiveTo estimate the incidence of mobile device use among street-crossing pedestrians and explore differences by sex and intersection type at a large public South-eastern university in the United States.ParticipantsAll instances of campus pedestrians crossing the street during the observation period (N = 4,878).MethodsVideo recordings of crosswalk activity at four locations were analyzed for pedestrian use of a mobile device while crossing.ResultsDevice use while crossing was observed 1,201 (24.6%) times. Of male crossing instances, 277 (16.8%) were coded as using a device. Of female instances, 924 (28.6%) were coded as using a device. Differences in device use while crossing were found between sexes and some intersection types.ConclusionsThis study estimates mobile device use while crossing the street and suggests differences by sex and intersection type. Future research should focus on improving understanding of the problem and evaluation of interventions to address the issue.
Assuntos
Pedestres , Acidentes de Trânsito/prevenção & controle , Computadores de Mão , Feminino , Humanos , Masculino , Assunção de Riscos , Segurança , Estudantes , Universidades , CaminhadaRESUMO
BACKGROUND: Few validated measures exist to capture the context and consequences of specific drinking events among college students. OBJECTIVES: This study sought to describe the development and validation of the Retrospective Alcohol Context Scale (RACS), a 30-day measure of drinking context among college students. METHODS: A sample of 169 college students completed daily alcohol assessments for 30 days and completed the RACS at follow-up. RESULTS: The RACS captured fewer negative consequences than daily assessments; however, high agreement was observed on context variables. CONCLUSION: Results support the validity of the RACS as a measure of drinking context among college students. The RACS may be most useful when information about drinking needs to be collected under limited time and resources. SCIENTIFIC SIGNIFICANCE: Further research is needed to examine the RACS among more diverse, probability samples and over longer time periods.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Coleta de Dados/métodos , Estudantes/estatística & dados numéricos , Adolescente , Consumo de Bebidas Alcoólicas/psicologia , Feminino , Seguimentos , Humanos , Masculino , Psicometria/métodos , Distribuição Aleatória , Estudantes/psicologia , Universidades/estatística & dados numéricos , Adulto JovemRESUMO
Every year, thousands of pedestrians are killed and tens-of-thousands are nonfatally injured as a result of traffic crashes. The year 2016 holds the record for the most pedestrians killed in one year since 1990. Mobile device use while crossing the street has been associated with unsafe crossing behaviors and gait abnormalities, potentially increasing the risk of pedestrian injury or death. Expanding upon the small body of literature, the present study utilized the theory of planned behavior to guide the development of a questionnaire used to collect data from 480 adults on predictors of intentions to use a mobile device while crossing the street. Questionnaire development involved one round of expert panel review (N = 4), subsequent pilot testing of a revised questionnaire, and a test-retest reliability assessment. Results demonstrate that attitude toward the behavior, subjective norm, and perceived behavioral control significantly predicted the intention to use a mobile device while crossing the street in this population. Such a questionnaire can be used in the design and evaluation of TPB-based interventions to decrease distracted mobile device use while crossing the street.
Assuntos
Telefone Celular/estatística & dados numéricos , Pedestres/psicologia , Teoria Psicológica , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Intenção , Masculino , Pedestres/estatística & dados numéricos , Análise de Regressão , Reprodutibilidade dos Testes , Assunção de Riscos , Inquéritos e Questionários , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to identify the relationship between work-related, individual, and environmental factors and self-reported standing time during the workday. DESIGN: Cross-sectional study design. SETTING: Participants were recruited from a large, public university in the southeastern United States. MEASURES: Data were collected through an 87-item online survey using previously validated scales that assessed workplace standing time, demographic variables, work-related psychosocial factors, and workplace environment factors. ANALYSIS: One-way analysis of variance, Pearson correlation coefficients, and nonparametric tests were used to determine univariate relationships between standing time and independent work-related variables and demographic factors. RESULTS: Mean standing time among the sample (n = 502) was 72.49 minutes (standard deviation = 73.48) daily. There was a significant relationship between standing time and barrier self-efficacy for standing at work, self-regulation strategies, social norms, local connectivity in the workplace, overall connectivity in the workplace, and proximity of coworkers. Standing time was significantly higher for men, employees with an advanced degree, employees with a standing desk, and faculty. CONCLUSION: Health promotion researchers and practitioners should consider factors at multiple levels of influence when designing studies to explore workplace sedentary behavior. The findings regarding variations in workplace behavior by employee subgroups should be taken into consideration when designing future studies in the workplace.
Assuntos
Comportamento Sedentário , Posição Ortostática , Local de Trabalho/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
Excessive alcohol consumption is a predominant health concern on college campuses in the United States. A stepwise multiple regression analysis was used to examine the predictive values of demographic factors in relation to alcohol subscales (Drinking Context Scale, College Alcohol Problems Scale-revised, and Social Modeling Scale) with the outcome of number of drinking days in the past 30 days among a sample (n = 224) of first-year college students. The final model predicted 37.5% of the variability in drinking days in the past month. All variables, except for race, were significantly associated with the outcome (p < .05).
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Grupo Associado , Estudantes/estatística & dados numéricos , Universidades , Adulto , Feminino , Humanos , Masculino , Prevalência , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
PURPOSE: The purpose of this study was to explore the relationship between ecological factors and occupational sedentary behavior (SB). DESIGN: Cross-sectional online survey. SETTING: Participants were employees recruited from a large, public university in the Southeastern United States from August to November 2016. PARTICIPANTS: The final sample included 527 (56% response rate) employees. MEASURES: Data were collected through an 87-item survey using previously validated scales that assessed occupational SB, perceived behavioral control, barrier self-efficacy, self-regulation strategies, organizational social norms, office environment, and worksite climate. ANALYSIS: One-way analysis of variance analyses were used to determine differences in occupational SB by demographic factors. A multivariate regression model was used to determine significant ecological determinants of occupational SB. RESULTS: Mean SB was 342.45 (standard deviation = 133.25) minutes. Significant differences in SB were found by gender, education, and employment classification. Barrier self-efficacy and workplace connectivity, which evaluates the spatial layout of the office setting that may impact mobility within the workplace, were significant predictors of SB in the multivariate model. CONCLUSION: Results from this study provide new information regarding the potential impact of workplace barriers and connectivity on occupational SB. The findings from this study support the inclusion of intervention modalities to minimize workplace barriers and increase workplace connectivity to increase workplace mobility and decrease SB.
Assuntos
Meio Ambiente , Comportamento Sedentário , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Ocupacional , Autoeficácia , Fatores Sexuais , Normas Sociais , Fatores Socioeconômicos , Sudeste dos Estados Unidos , UniversidadesRESUMO
Four successive randomized clinical trials studying contingency management (CM), involving various treatment arms of drug-abstinent housing and work therapy and day treatment (DT) with a behavioral component, were compared on common drug abstinence outcomes at 2 treatment completion points (2 and 6 months). The clinical trials were conducted from 1990 to 2006 in Birmingham, Alabama, with a total of 644 homeless persons with primary crack cocaine addiction. The meta-analysis utilized the weighted least squares approach to integrate data encompassing 9 different treatment arms to assess the effects of CM and DT (neither, DT only, CM only, and CM = DT) on a common estimate of prevalence of drug abstinence. Taken together, the results show much stronger benefits from CM = DT and from CM only than for DT alone. Throughout all of the Birmingham Homeless Cocaine Studies, the CM = DT consistently produced higher abstinence prevalence than did no CM.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/reabilitação , Cocaína Crack , Hospital Dia , Pessoas Mal Alojadas/psicologia , Reforço por Recompensa , Alabama , Transtornos Relacionados ao Uso de Cocaína/psicologia , Terapia Combinada , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Little research has been reported on the risky behaviors of pre-driving adolescents revolving around alcohol use, in particular impaired driving behaviors, which in general have been shown to be higher in rural areas. This study investigated the prevalence of drinking while driving and riding with a drinking driver among 290 middle school students in a Mississippi Delta area middle school. Just under half (45.3%) responded that at least once in the past 30 days they had ridden with a drinking driver and 17% indicated they had driven an automobile after drinking alcohol. The prevalence of underage drinking, driving under the influence of alcohol, and riding with a drinking driver among our sample of middle school students is alarming. This study shows alcohol-related driving behaviors are not solely performed by those who are legally licensed to drive, but simply by those who have access to vehicles. The authors recommend that prevention programs focusing on reducing the incidence of impaired driving should start in early adolescence.
Assuntos
Comportamento do Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Condução de Veículo , Assunção de Riscos , Adolescente , Criança , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Mississippi/epidemiologia , Áreas de Pobreza , Prevalência , População Rural , EstudantesRESUMO
The present study sought to test the feasibility of measuring quantity and frequency of self-reported alcohol consumption among college students using the Handheld Assisted Network Diary (HAND) by comparing results to a retrospective Timeline Followback (TLFB). A total of 40 undergraduate college students completed a HAND assessment during the two-week study period and completed a TLFB at follow-up. The HAND recorded similar levels of alcohol consumption compared to the TLFB. There were no significant differences in overall alcohol consumption, drinks per drinking day, or heavy drinking days between the two methods of assessment. Handheld computers may represent a useful tool for assessing daily alcohol use among college students.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Computadores de Mão , Software , Estudantes/psicologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Cooperação do Paciente , Projetos Piloto , Estudantes/estatística & dados numéricosRESUMO
OBJECTIVE: The purpose of this study was to test Theory of Planned Behavior (TPB) constructs in predicting human papillomavirus (HPV) vaccination behavioral intentions of vaccine-eligible college men. PARTICIPANTS: Participants were unvaccinated college men aged 18-26 years attending a large public university in the southeastern United States during Spring 2015. METHODS: A nonexperimental, cross-sectional study design was employed. Instrumentation comprised a qualitative elicitation study, expert panel review, pilot test, test-retest, and internal consistency, construct validity, and predictive validity assessments using data collected from an online self-report questionnaire. RESULTS: The sample consisted of 256 college men, and the final structural model exhibited acceptable fit of the data. Attitude toward the behavior (ß = .169) and subjective norm (ß = 0.667) were significant predictors of behavioral intention, accounting for 58% of its variance. CONCLUSIONS: Practitioners may utilize this instrument for the development and evaluation of TPB-based interventions to increase HPV vaccination intentions of undergraduate college men.
Assuntos
Atitude Frente a Saúde , Comportamentos Relacionados com a Saúde , Vacinas contra Papillomavirus/uso terapêutico , Teoria Psicológica , Estudantes/psicologia , Adolescente , Adulto , Estudos Transversais , Humanos , Masculino , Autorrelato , Sudeste dos Estados Unidos , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Universidades/organização & administração , Universidades/estatística & dados numéricos , Vacinação/psicologia , Vacinação/estatística & dados numéricosRESUMO
OBJECTIVE: Behaviors of weight conscious drinkers (BWCD) include disordered eating, excessive physical activity (PA), and heavy episodic drinking. Considering that approximately 25% of the college students report BWCD, it is important to investigate what characteristics increase the likelihood of college students engaged in BWCD for both moderate and vigorous PAs. PARTICIPANTS: A total of 510 college students were recruited from a large, public southeastern university. METHODS: Participants completed a cross-sectional survey during the spring 2015 semester. RESULTS: Of 510 respondents, 11.2% reported moderate PA-based BWCD and 14.7% reported vigorous PA-based BWCD. Weight loss intention, BMI and Greek affiliation predicted both moderate and vigorous BWCD. CONCLUSIONS: Study findings suggest that Greek-affiliated students and students with weight loss intentions might be at an increased risk for BWCD. Along with promoting lower levels of alcohol consumption, college practitioners should consider discussing issues of weight and body image with college students as they relate to maladaptive drinking behavior.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Estudantes/estatística & dados numéricos , Redução de Peso , Consumo de Bebidas Alcoólicas/psicologia , Peso Corporal , Comorbidade , Estudos Transversais , Exercício Físico , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Fatores de Risco , Universidades , Adulto JovemRESUMO
Drinking and driving is perhaps the most serious problem associated with heavy drinking among college students in the United States. In this study, the authors examined drinking locations prior to impaired driving in a college student sample. They administered the Impaired Driving Assessment to 91 college students identified as high risk for drinking and driving. Participants reported an average of 7.98 (SD = 7.67) impaired driving episodes during the past 5 weeks. Using a random effects model, the authors found that location was a significant predictor of blood alcohol content (BAC), F(6,89.6) = 3.62, p = 0.0029. After drinking alcohol at a party, students' average estimated BAC prior to driving (geometric M = 0.089) was significantly greater than all other drinking locations (geometric M = 0.033). The findings of this study provide insight into drinking locations prior to impaired driving and can be used by college health practitioners to develop appropriate interventions to reduce the magnitude of this problem.
Assuntos
Intoxicação Alcoólica/prevenção & controle , Condução de Veículo , Estudantes , Universidades , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Estados UnidosRESUMO
Diversion is defined as the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace. Persons with legal prescriptions often give away or sell their medications to others. The misuse of prescription stimulant medications continues to be a problem on college campuses and a need to understand how students are obtaining stimulant medications exists. The object of the study was to identify the prevalence, correlates, and motivations associated with diversion of prescription stimulants among current prescription holders. A large sample of undergraduates (n = 1,022) between the ages of 18 and 24 enrolled at a large public university in the southeastern United States completed an in class questionnaire. Among those respondents, we identified 151 current stimulant prescription holders and analyzed the prevalence, motivations, and correlates associated with lifetime and current diversion. Overall, 58.9% of current prescription holders had given away or sold their stimulant medication during their lifetime. Those with a history of nonmedical use of prescription stimulants were almost 5 times more likely to divert their medication during their lifetime. The majority of those engaging in lifetime and current diversion medication did so infrequently. The most common motivations reported for both lifetime and current diversion were "to make extra money" and to "help during a time of high academic stress." Students who reported a history of prescription misuse were also more likely to engage in current diversion. Diversion-related behaviors should be explored further and programs aimed at the reducing these behaviors should be considered.
Assuntos
Estimulantes do Sistema Nervoso Central/uso terapêutico , Motivação , Desvio de Medicamentos sob Prescrição , Estudantes , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Universidades , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Feminino , Humanos , Masculino , Prevalência , Adulto JovemRESUMO
Abstinence, employment, and homelessness treatment outcomes at 12-month follow-up are presented from a study comparing behavioral day treatment plus abstinence-contingent housing and work therapy with behavioral day treatment only among homeless persons who abuse crack cocaine. Within-group improvements were revealed, but group differences for drug abstinence found in J. B. Milby et al. (2000) failed to persist at 12 months. Drug use measurement and treatment termination explanations are discussed. Within- but not between-group differences were found for employment and homelessness outcomes at long-term follow-up. Research extending abstinence contingencies and continuous drug use monitoring is recommended. Questions about effectiveness of contingency management alone, role of coexisting psychiatric disorders on treatment outcome, and individualized treatment dosing are offered.