Depression, Executive Dysfunction, and Prior Economic and Social Vulnerability Associations in Incarcerated African American Men.

Low executive function (EF) and depression are each determinants of health. This study examined the synergy between deficits in EF (impaired cognitive flexibility; >75th percentile on the Wisconsin Card Sorting Test perseverative error score) and depressive symptoms (modified Centers for Epidemiologic Studies-Depression) and preincarceration well-being among incarcerated African American men ( N = 189). In adjusted analyses, having impaired EF and depression was strongly associated with pre-incarceration food insecurity (odds ratio [ OR] = 3.81, 95% confidence interval [CI] = [1.35, 10.77]), homelessness ( OR = 3.00, 95% CI [1.02, 8.80]), concern about bills ( OR = 3.76, 95% CI [1.42, 9.95]), low significant other support ( OR = 4.63, 95% CI [1.62, 13.24]), low friend support ( OR = 3.47, 95% CI [1.30, 9.26]), relationship difficulties ( OR = 2.86, 95% CI [1.05, 7.80]), and binge drinking ( OR = 3.62, 95% CI [1.22, 10.80]). Prison-based programs to treat depression and improve problem-solving may improve postrelease success.

Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users.

BACKGROUND: Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. OBJECTIVES: To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. METHODS: Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. RESULTS: Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. CONCLUSIONS: The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.

An exploration of alcohol use severity and route of drug administration among persons that use heroin and cocaine.

BACKGROUND: Alcohol use is prevalent among populations of persons that use illicit drugs. Problematic alcohol use among persons that use heroin and cocaine has been associated with poor treatment adherence, abstinence maintenance, and mental health concerns. Fully exploring how alcohol use severity interacts with route of administration (ROA) may be of notable importance in development of treatment protocols for persons that use heroin and cocaine. METHODS: Data from a neurological and sociobehavioral assessment of risk factors among injection and noninjection drug users known as the NEURO-HIV Epidemiologic Study was used in the analyses. Participants (N = 551) included those who reported their level of past-30-day alcohol use and past-6-month heroin and cocaine use. RESULTS: Multiple logistic regression analyses found that both problematic and moderate alcohol users were significantly less likely than abstainers to report injecting heroin and cocaine. Both problematic and moderate alcohol users were significantly more likely than abstainers to snort substances. CONCLUSIONS: Alcohol use may play a role in promoting or impeding the use of substances through certain ROAs. Treatment protocols that transition persons that use injection heroin and cocaine to noninjection use of these substances may be used in conjunction with treatments that reduce alcohol consumption as a means to reduce noninjection drug use.

Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs.

BACKGROUND: Recent studies have reported high rates of Trichomonas vaginalis among middle age and older adults. Though trichomoniasis risk factors in this age cohort remain largely unknown, illicit drug use has been associated with increased incidence of sexually transmitted infections (STIs). The number of mid-older adults using illicit drugs has increased significantly in recent years suggesting the need to understand the relationship between drug use and STIs in this age cohort. OBJECTIVES: This study examined the relationship between drug use, sexual-risk behaviors, and biologically confirmed T. vaginalis in a sample of mid-older and younger adults who reported recent drug use. METHODS: The cross-sectional design examined the relationship between past 6-month drug use, sexual risk-behaviors, and PCR-confirmed T. vaginalis in 264 adults age 18-64 who were recruited from Baltimore, Maryland. These relationships were also explored in the age-stratified sample among those 18-44 years ("younger") and individuals 45+ years ("mid-older"). RESULTS: Trichomoniasis prevalence did not differ significantly between younger (18.8%) and mid-older (19.1%) adults. Mid-older adults that tested positive for T. vaginalis were more likely to have used marijuana and crack in the past 6 months. Among younger adults, there were no associations between trichomoniasis and past 6-month drug use and sexual-risk behavior. CONCLUSIONS/IMPORTANCE: Age- and drug-related immune decline is hypothesized to contribute to increase susceptibility to T. vaginalis in mid-older adults. Broad screening for trichomoniasis, particularly among older adults who are often not regarded as at risk for STIs, is needed to control this often asymptomatic infection.

Increased risk for substance use and health-related problems among homeless veterans.

BACKGROUND AND OBJECTIVES: The first aim of this study was to compare self-reported causes of homelessness between veterans and nonveterans. A second aim examined whether homeless male veterans were more likely than homeless male nonveterans to experience current problems with addictions, mental health, and physical health. Additionally, a third aim was to compare frequency of emergency room visits and treatment needs between the two groups. METHODS: Secondary data analyses compared male homeless veterans and nonveterans (N = 353) enrolled in the Alachua County Point in Time study in central Florida. Participants completed a questionnaire on demographics and health variables. Additional questions included recent emergency room visits and medical or other needs not being met. RESULTS: Veterans reported higher rates of substance use and mental health problems as a primary cause of homelessness when compared to nonveterans. Homeless veterans were more likely than nonveterans to report current problems with addictions (OR = 6.29, 95% CI: 3.43-11.53, p < .001), mental health problems (OR = 4.12, 95% CI: 2.28-7.42, p < .001), and physical problems (OR = 1.83, 95% CI: 1.08-3.67, p < .01). Finally, over half of homeless veterans (53.1%) reported an ER visit in the past year compared to only 40.9% of nonveterans (OR = 1.73, 95% CI: 1.07-2.80, p < .05). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Veterans may be more likely to become homeless due to addiction and mental health and over half of homeless veterans are presenting to hospital emergency rooms. Given the greater utilization among homeless veterans, emergency rooms may serve as a prime opportunity to provide brief treatment and referrals for needed services.

Time Since Release from Incarceration and HIV Risk Behaviors Among Women: The Potential Protective Role of Committed Partners During Re-entry.

After release from incarceration, former female inmates face considerable stressors, which may influence drug use and other risk behaviors that increase risk for HIV infection. Involvement in a committed partnership may protect women against re-entry stressors that may lead to risky behaviors. This study measured the association between time since release from incarceration (1-6 months ago, and >6 months ago versus never incarcerated) and HIV risk behaviors and evaluated whether these associations differed by involvement in a committed partnership. Women released within the past 6 months were significantly more likely to have smoked crack cocaine, used injection drugs and engaged in transactional sex in the past month compared to never-incarcerated women and women released more distally. Stratified analyses indicated that incarceration within the past 6 months was associated with crack cocaine smoking, injection drug use and transactional sex among women without a committed partner yet unassociated with these risk behaviors among those with a committed partner.

Perceived barriers to treatment in a community-based sample of illicit-drug-using African American men and women.

This study examines perceived substance use treatment barriers in a community-based sample of 267 African Americans from Baltimore, MD. Both men and women endorsed "they can handle it alone" as a primary reason they were not currently in treatment. However, men were two times more likely (AOR = 2.29 CI = 1.05, 5.02) to endorse "concerns about losing family" as the reason they are not currently in treatment. The present study yields interesting findings among African Americans, which should be considered when creating interventions for particular groups of African Americans.

Age cohort differences in illicit drug use and hepatitis C among African American substance users.

Identifying prognostic indicators for undiagnosed Hepatitis C is crucial to attenuate the negative impact of this disease. This study explored the influence of recent and more distal injection drug use on biologically confirmed Hepatitis C infection among a sample (N = 260) of older and younger African Americans. Data from the baseline assessment of the NEURO-HIV epidemiologic study was analyzed using confounder adjusted regression techniques. Older adults were more likely to test positive for Hepatitis C (OR = 2.80, 95% CI = 1.53-5.11) due to lifetime injection drug use (AOR = 5.37, 95% CI = 3.10-9.28). Clinical implications are discussed.

ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: an accelerated gateway model.

The primary aims of the present study were to assess ADHD history as a risk factor for earlier initiation and current use of licit and illicit substances among a sample of drug using adults. It was hypothesized that ADHD history would accelerate the Gateway Theory of drug use. Participants included 941 drug-using African American and Caucasian individuals in Baltimore, Maryland. The sample consisted of 124 (13.2%) participants who reported a history of ADHD and 817 (86.8%) who reported no history of ADHD. The accelerated gateway hypothesis was supported, as a history of self-reported ADHD was significantly associated with younger ages of initiation for alcohol, cigarettes, marijuana, and cocaine use. Participants with a history of ADHD were also more likely to engage in recent HIV-risk behavior, such as injection drug use and needle sharing. This study provides compelling data in support of an accelerated gateway model for substance use related to ADHD history and increased problem severity in adulthood. Targeted substance use prevention and intervention may be beneficial for those with ADHD.

Younger versus older African Americans: patterns and prevalence of recent illicit drug use.

OBJECTIVES: The current study examined recent substance use among younger and older African Americans and factors associated with recent use. METHODS: The current study used a subset of African American men and women (N = 260) from the NEURO-HIV Epidemiological Study (Mage = 42, SD = 9.27; 59% female). Self-report of past 6 month substance use was evaluated for 21 different substances by routes of administration (ROA). RESULTS: Older adults were 1.9 times (AOR = 1.92, 95% CI = 1.13-3.26) more likely to have used crack in the past 6 months and half as likely to have used marijuana (AOR = .44, 95% CI = .25-.77). There were no significant differences for heroin use. DISCUSSION: Substance use at midlife may have significant implications for adverse social and health outcomes among African Americans. Findings support the need to better understand the developmental pathways of drug use and dependence among African Americans.

Self-reported lifetime marijuana use and interleukin-6 levels in middle-aged African Americans.

BACKGROUND: Research examining the relationship between marijuana and cytokine function has been well developed in the biochemical literature. However, scant literature exists regarding this relationship between inflammatory markers and marijuana use in public health or behavioral studies and is virtually nonexistent in non-neurologically compromised African American samples. METHODS: The current study examined the differences in serum interleukin-6 (IL-6), a proinflammatory cytokine, between non-drug users (n=78), marijuana only users (n=46) and marijuana plus other drugs users (n=45) in a community-based sample of middle aged African Americans. Participants included 169 African American adults (50.30% female), with a mean age of 45.68 years (SD=11.72 years) from the Washington, DC metropolitan area. Serum was drawn upon entry into the study and the participants completed a demographic questionnaire, which included questions regarding drug use history. RESULTS: After adjusting for demographic and physiological covariates, analysis of covariance revealed a significant difference between the three groups, F(2,158)=3.08, p=0.04). Post hoc analyses revealed lifetime marijuana only users had significantly lower IL-6 levels (M=2.20 pg/mL, SD=1.93) than their lifetime nonuser counterparts (M=3.73 pg/mL, SD=6.28). No other comparisons among the groups were statistically significantly different. CONCLUSION: The current findings extend previous cellular and biochemical literature, which identifies an inverse association between IL-6 and marijuana use. Examining this relationship in the psychological and behavioral literature could be informative to the development of clinical interventions for inflammatory diseases.

Injection and non-injection drug use and infectious disease in Baltimore City: differences by race.

PURPOSE: The current study examines differences in the prevalence of biologically-confirmed hepatitis C virus (HCV), HIV, and coinfection between Black and White adult cocaine/heroin users across three drug use subgroups identified in previous research (Harrell et al., 2012): non-injection smoking crack/nasal heroin users, heroin injectors, and polydrug injectors. RESULTS: 59% of the 482 participants in the study were male. Significant race differences emerged between drug use subgroup memberships. Non-injection smoking crack/nasal heroin users were predominantly Black (75%), while heroin injectors and polydrug injectors were predominantly White (69% and 72%, respectively). Polydrug injectors accounted for nearly three quarters of the HCV positive diagnoses in Whites. Though HIV disease status, stratified by race, did not differ significantly between drug use subgroups, the non-injection smoking crack/nasal heroin subgroup contained over half of the HIV positive diagnoses in the sample and was predominantly Black. Despite much lower rates of injection, Blacks (8%) had a higher prevalence of coinfection than Whites (3%; X(2) (2)=6.18, p=.015). CONCLUSIONS: The current findings are consistent with trends in the recent HIV transmission statistics where sexual activity has overtaken injection drug use as a HIV risk factor. The current findings also provide further support to the notion of injection drug use as an exceedingly high-risk behavior for HCV and coinfection, specifically those who are polysubstance injectors.

Binge drinking, stimulant use and HIV risk in a sample of illicit drug using heterosexual Black men.

BACKGROUND: Relatively little research has examined the effects of binge drinking and HIV risk in heterosexual Black men. Even less research has explored this relationship in illicit drug using heterosexual Black men who are at an elevated risk of contracting and transmitting HIV through various vectors, including risky sexual behavior, in the Black community. PURPOSE: The purpose of the current study is to examine the associations between binge drinking, drug use and HIV status in a community-based sample of 127 self-identified heterosexual Black men. RESULTS: Overall, 17% reported binge drinking in the past month. Both stimulant use (AOR 7.29; 95%; CIs, 2.07, 25.70), and binge drinking (AOR=5.28; 95% CIs, 1.34, 20.91) were associated with HIV status. CONCLUSION: These findings will inform prevention interventions to reduce the HIV risk among Black heterosexual men.

Cognitive performance profiles by latent classes of drug use.

BACKGROUND AND OBJECTIVES: The relationship between substance use and cognitive deficits is complex and requires innovative methods to enhance understanding. The present study is the first to use LCA to examine associations of drug use patterns with cognitive performance. METHODS: Cocaine/heroin users (N = 552) completed questionnaires, and cognitive measures. LCA identified classes based on past-month drug use and adjusted for probabilities of group membership when examining cognitive performance. Latent indicators were: alcohol (ALC), cigarettes (CIG), marijuana (MJ), crack smoking (CS), nasal heroin (NH), injection cocaine (IC), injection heroin (IH), and injection speedball (IS). Age and education were included as covariates in model creation. RESULTS: Bootstrap likelihood ratio test (BLRT) supported a 5-class model. Prevalent indicators (estimated probability of over 50%) for each class are as follows: "Older Nasal Heroin/Crack Smokers" (ONH/CS, n = 166.9): ALC, CIG, NH, CS; "Older, Less Educated Polysubstance" (OLEP, n = 54.8): ALC, CIG, CS, IH, IC, and IS; "Younger Multi-Injectors" (MI, n = 128.7): ALC, CIG, MJ, IH, IC, and IS; "Less Educated Heroin Injectors" (LEHI, n = 87.4): CIG, IH; and "More Educated Nasal Heroin" users (MENH, n = ALC, CIG, NH. In general, all classes performed worse than established norms and older, less educated classes performed worse, with the exception that MENH demonstrated worse cognitive flexibility than YMI. DISCUSSION AND CONCLUSIONS: This study demonstrated novel applications of a methodology for examining complicated relationships between polysubstance use and cognitive performance. SCIENTIFIC SIGNIFICANCE: Education and/or nasal heroin use are associated with reduced cognitive flexibility in this sample of inner city drug users.

HIV prevalence and risk behaviors among African American Women Who Trade Sex for Drugs Versus Economic Resources.

Trading sex for money, drugs, goods, services, or a place to stay is prevalent among women who use drugs and has been associated with women's risk of HIV acquisition. There is evidence that trading sex for drugs only may be associated with elevated risk of HIV compared with trading sex for money. The purpose of this study was to assess whether HIV risk behaviors and HIV prevalence differ among African American drug using women (N = 92) who traded sex for drugs only, traded sex for economic resources (defined as money, shelter, or other resources) only, or traded sex for both economic resources and drugs. In this study, lower rates of condom use and higher rates of HIV were found among women who traded sex for drugs only compared to women who traded sex for economic resources or for economic resources and drugs. These findings suggest that African American women who trade sex for drugs only represent an understudied yet highly vulnerable group.

Awareness of biologically confirmed HCV among a community residing sample of drug users in Baltimore City.

The present study sought to examine: (1) the prevalence and correlates of biologically confirmed Hepatitis C (HCV) and (2) the prevalence and correlates of prior HCV diagnosis and an unmet need for HCV treatment, among a community residing sample of drug users. The current study used a subset of HCV tested participants from the larger NEURO-HIV Epidemiologic Study from Baltimore, Maryland (M(age) = 34.81, SD = 9.25; 46% female). All participants were tested for HCV at baseline. Self-report was used to assess awareness of an HCV diagnosis and participation in treatment. Of the 782 participants tested for HCV, 19% reported having received an HCV diagnosis in the past while 48% tested positive for HCV. Only 6% reported having received treatment for any form of hepatitis. Of those who tested HCV positive, 63% reported never being diagnosed, and only 13% received any treatment for HCV. We found that only 35% of those who reported a prior HCV diagnosis received any treatment. The findings regarding lack of HCV awareness and diagnosis were considerable as expected. These deficits suggest that there are numerous gaps in patients' knowledge and beliefs regarding HCV that may interfere at multiple steps along the path from diagnosis to treatment. This study clearly demonstrates that a critical need exists to improve public knowledge of HCV risk factors, the need for testing, and the availability of effective treatment.

Latent class analysis of polysubstance use, sexual risk behaviors, and infectious disease among South African drug users.

BACKGROUND: HIV transmission risk among non-injection drug users is high due to the co-occurrence of drug use and sexual risk behaviors. The purpose of the current study was to identify patterns of drug use among polysubstance users within a high HIV prevalence population. METHODS: The study sample included 409 substance users from the Pretoria region of South Africa. Substances used by 20% or more the sample included: cigarettes, alcohol, marijuana and heroin in combination, marijuana and cigarettes in combination, and crack cocaine. Latent class analysis was used to identify patterns of polysubstance use based on types of drugs used. Multivariate logistic regression analyses compared classes on demographics, sexual risk behavior, and disease status. RESULTS: Four classes of substance use were found: MJ+Cig (40.8%), MJ+Her (30.8%), Crack (24.7%), and Low Use (3.7%). The MJ+Cig class was 6.7 times more likely to use alcohol and 3 times more likely to use drugs before/during sex with steady partners than the Crack class. The MJ+Cig class was 16 times more likely to use alcohol before/during sex with steady partners than the MJ+Her class. The Crack class was 6.1 times more likely to engage in transactional sex and less likely to use drugs before/during steady sex than the MJ+Her class. CONCLUSIONS: Findings illustrate patterns of drug use among a polysubstance using population that differ in sexual risk behavior. Intervention strategies should address substance use, particularly smoking as a route of administration (ROA), and sexual risk behaviors that best fit this high-risk population.

The role of drinking severity on sex risk behavior and HIV exposure among illicit drug users.

OBJECTIVES: The current study examined how drinking severity among injection and non-injection drug users is associated with sex risk behaviors and risk of HIV exposure. METHOD: The study is a secondary analysis of an investigation of risk factors among drug users in Baltimore known as the NEURO-HIV epidemiologic study. Participants (N = 557) completed an interview, self-reported 30-day alcohol use, lifetime injection and non-injection drug use, and provided blood samples to screen for HIV. Participants were grouped into one of three drinking severity conditions: abstinent (no reported alcohol use in prior 30 days), moderate alcohol use (≤30 drinks for females, or ≤60 drinks for males), or problematic alcohol use (>30 drinks for females, or >60 drinks for males). Drinking severity groups were significantly different on lifetime injection drug use, heroin injection, snorting/sniffing cocaine, and smoking crack. RESULTS: Logistic regression analyses found problematic alcohol users to be more likely than alcohol abstainers to inject drugs before or during sex (AOR = 5.78; 95% CI = 2.07-16.10), and more likely than moderate alcohol users to use alcohol before/during sex (AOR = 4.96; 95% CI = 2.09-11.81), inject drugs before/during sex (AOR = 2.96; 95% CI = 1.29-6.80), and to be HIV+ among Black participants (AOR = 2.72; 95% CI = 1.14-6.49). CONCLUSIONS: These results outline the necessity for research and clinical intervention among this population to reduce sex risk behaviors and potential HIV exposure, while highlighting the need to examine drinking severity as a predictor of sex risk behaviors.

Alcohol use, alcohol problems, and problem behavior engagement among students at two schools in northern Mexico.

This study examined the association between alcohol-use problem severity, defined by number of DSM-IV alcohol Abuse and Dependence symptoms and frequency of alcohol use, and problem behavior engagement among Mexican students. A confidential survey was administered to 1229 students in grades 7-12 at two schools in a northern border city in Mexico. Youths were categorized into five groups based on their alcohol use frequency and symptoms of DSM-IV alcohol Abuse and Dependence, specifically: no lifetime alcohol use, lifetime alcohol use but none in the past year, past year alcohol use, one or two alcohol Abuse or Dependence symptoms, and three or more alcohol Abuse or Dependence symptoms. The association between five levels of alcohol-use problem severity and three problem behaviors, lifetime marijuana use, lifetime sexual intercourse, and past year arrest/law trouble, was examined using chi-square or Fisher's exact tests. Several alcohol-use problem severity categories were significantly different with respect to rates of lifetime marijuana use, lifetime sexual intercourse, and past year arrest/law trouble. Higher alcohol-use problem severity was associated with greater endorsement of problem behaviors. Knowing about variations in adolescent alcohol use and alcohol problems may be instrumental in determining if youths are also engaging in a range of other risk behaviors. Considering varying levels of alcohol use and alcohol problems is important for effective targeted prevention and treatment interventions.

The Impact of Homelessness on Recent Sex Trade among Pregnant Women in Drug Treatment.

This study is a secondary data analysis aimed to examine the influence of recent homelessness on recent sex trade among pregnant women in drug treatment after controlling for psychiatric comorbidity, age, education, and race. Eighty-one pregnant women from a drug treatment program in Baltimore, Maryland attended an in-person interview and completed the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-IV for Axis I disorders, the HIV Risk Behavior Interview, and demographic questionnaires, which assessed psychiatric symptoms, recent homelessness, and sexual risk behavior respectively. Women who experienced recent homelessness had a 4.74 greater odds of having recently traded sex than women who had not been recently homeless, suggesting that homelessness uniquely influences sex trade beyond psychiatric status, which was also a significant correlate of recent sex trade. Addressing both homelessness and psychiatric problems may effectively reduce sex trade and risk for infectious diseases, which could adversely impact maternal and child health outcomes.