Assessing cognitive capacity for participation in a research study.

To give informed consent in research, persons must be mentally capable of understanding the study, risks, and benefits. An objective screening tool may assess cognitive capacity better than brief conversations or clinician input. The purpose is to explore the validity of the Mental Alternations Test (MAT) to assess the cognitive capacity of older (ages 50 years +) HIV+ persons (N = 81). Descriptive correlational quantitative method was used. About 12% of the sample was cognitively impaired. Contrary to expectations, primary language was the only variable with a significant relationship with the MAT (r = -.22, p = .02); there were no significant relationships between the MAT and age, education, alcohol, smoking, injection drug use, street or mind-altering drug use, physical functional status, depressive symptoms, comorbidities, or being diagnosed with AIDS. Our findings suggest caution in using the MAT as an instrument for assessing cognitive impairment in a linguistically diverse population.

Who wins in the status games? Violence, sexual violence, and an emerging single standard among adolescent women.

Throughout U.S. history, women have changed their sexual behaviors in response to, or as actors affecting, economic, political, and legal imperatives; to preserve health; to promote new relationship, identity or career paths; to assert a set of values; as a result of new reproductive technologies; or to gain status. In adjusting to pressures or goals, women have not always acted, or been able to act, in the interests of their own health, identity, or status. As this article will demonstrate, women, in the short or long run, may attempt to preserve status at the cost of other values such as health. This may occur through conscious and critical choice or through less conscious processes in reaction to relatively larger forces whose impact has not been critically analyzed. With the awareness in the 1980s in the United States of an emergent and incurable sexually transmissible infection, HIV, it would have been anticipated that a new sexual caution may have appeared. Yet, across several research projects in the late 1990s and into the 21st century, as our research team interviewed youth in a high HIV seroprevalence neighborhood in New York City about HIV prevention, we began to hear that a substantial minority of young women and men were participating in social settings for sexual behavior that (1) put youth at risk for HIV; (2) appeared to be motivated by acquisition of status ("props," "points"); and (3) offered few ways for women to win in these status games. We estimate from one random dwelling unit sample that about one in eight youth have been present in these settings and half of them have participated in risky sexual behavior in such settings. The settings are often characterized by men's publicly offhand attitudes toward sexual encounters, are organized around men's status maintenance, and evidence peer pressures that are poorly understood by both young men and women participants. To regain status, some women participants have adopted attitudes more characteristic of men.

Assessing self-management information needs of persons living with HIV/AIDS.

In order to maximize their health status, persons living with HIV/AIDS must use a variety of self-management strategies. They learn these strategies from many sources often based on a specific need or problem. Information needs can be addressed during health care appointments but time is often limited and spent on more acute issues such as symptom control or medication adherence. In order to assess information needs, a 76-item HIV+ Information for Self-Care Quiz was developed and piloted with two samples. Both samples (n = 50, 43) were predominantly people of color and male with a mean age of either 44 or 56 years, respectively. This paper describes the phases of development and offers suggestions for its use in clinical settings, research, and provider education. By using this quiz to determine preexisting knowledge level, interactions with the health care provider can be more focused to address knowledge gaps and less time could be spent teaching information that the client already knows.

Homelessness, substance misuse, and access to public entitlements in a soup kitchen population.

The study examined the effects of homelessness on access to public entitlements (Medicaid and food stamp programs) in a soup kitchen population. Data were collected between 1997 and 1999 from a sample of 343 adults at two soup kitchen sites in New York City. Five hypotheses, focusing on the effects of housing status (literal homelessness, unstable housing, and domiciled), frequency of drug/heavy alcohol use, drug/alcohol-user treatment history and childcare responsibilities on access to Medicaid and food stamp programs were tested. Multiple logistic regression analysis indicated that both literal homelessness and unstable housing were associated with less access to Medicaid and food stamps. Other significant findings were: current drug/alcohol-user treatment experience was associated with greater access to both Medicaid and food stamps, frequency of drug/heavy alcohol use was associated with less access to Medicaid only, and caring for children was associated with greater access to food stamps only. These findings support the crucial role of housing status in mediating access to entitlements, and the importance of drug/alcohol-user treatment involvement as a cue to seeking entitlements. The need to reduce health disparities through active and sustained outreach programs designed to enhance homeless persons' access to Medicaid and food stamp programs was discussed.

Drug problem recognition, desire for help, and treatment readiness in a soup kitchen population.

This study determined hypothesized predictors of three components of motivation for change--drug problem recognition, desire for help, and treatment readiness--in a high-risk, drug-using population. The sample consisted of 190 guests at two inner-city soup kitchens in Brooklyn, NY who reported drug/alcohol use and were not participating in substance dependency treatment. Ever receiving addiction treatment, having no trade/job skills, and more severe symptoms of depression were associated with greater drug problem recognition. More recent days of drug/alcohol use, intensive pattern of drug use, and greater problem recognition were associated with greater desire for help. Caring for children, more recent days of drug/alcohol use, physical health problems, and desire for help were the direct predictors of treatment readiness. Problem recognition had a strong indirect effect on readiness mediated through desire for help. Knowledge of a drug user's motivational state and the factors leading to it can help guide the development of more effective interventions.