An ecological approach to addressing HIV/AIDS in the African American community.

The disproportionate impact of HIV/AIDS on African Americans is a significant public health challenge. The complex constellation of individual, social, and environmental factors influencing transmission, require ecological solutions that recognize these multiple levels of influence and actively involve communities. This article describes the formation of a community-based coalition and highlights three initiatives it has undertaken in the areas of mobile HIV testing, HIV education, and faith-based work to improve HIV services for African Americans.

Development of the pretreatment readiness scale for substance abusers: modification of an existing motivation assessment.

The Texas Christian University-Treatment Motivation Assessment (TCU-TMA) was originally developed to assess motivation among in-treatment opiod users. Numerous studies of in-treatment substance abusers in a variety of settings have confirmed the three factors present in the scale, including Problem Recognition, Desire For Help, and Treatment Readiness. The goal of the present study was to examine the factor structure of the TCU-TMA in a sample of 367 pretreatment substance abusers assessed at a centralized intake unit who had not yet entered treatment. Exploratory and confirmatory factor analyses led to the development of the Pretreatment Readiness Scale (PRS) that, like the TCU-TMA, contained Problem Recognition and Treatment Readiness factors. Desire for Change replaced Desire for Help in the new scale and Treatment Reluctance indicated mixed feelings about entering treatment. The implications of these findings on developing interventions for the pretreatment group will be discussed.

Understanding treatment readiness in recently assessed, pre-treatment substance abusers.

The goal of this study was to more fully understand readiness for treatment in a pre-treatment sample of 446 substance abusers. Structural Equation Modeling (SEM) was used to: (1) examine the relationships between readiness factors identified in the Pre-Treatment Readiness Scale; and (2) identify the effects of predisposing, illness, and inhibiting determinants on the factors. As with in-treatment samples, Problem Recognition was found to influence Treatment Readiness, although through a different intervening factor, Desire for Change rather than Desire for Help. A fourth factor, Treatment Reluctance, was also influenced by the Desire for Change factor. Fixed characteristics such as age and gender had minimal influences on readiness factors, as did inhibiting characteristics that reflected recent functioning. Illness characteristics including drug severity and perceived treatment barriers had a more robust influence on readiness factors. This study provides an increased understanding of readiness for treatment among pre-treatment substance abusers and also supported the construct validity of the Pre-Treatment Readiness Scale.

Treatment barriers identified by substance abusers assessed at a centralized intake unit.

The 59-item Barriers to Treatment Inventory (BTI) was administered to 312 substance abusers at a centralized intake unit following assessment but before treatment entry to assess their views on barriers to treatment. Factor analysis identified 25 items in 7 well-defined latent constructs: Absence of Problem, Negative Social Support, Fear of Treatment, Privacy Concerns, Time Conflict, Poor Treatment Availability, and Admission Difficulty. The factorial structure of the barriers is consistent with the findings of other studies that asked substance abusers about barriers to treatment and is conceptually compatible with Andersen's model of health care utilization. Factors were moderately to highly correlated, suggesting that they interact with one another. Selected characteristics were generally not predictive of barrier factors. Overall, results indicate that the BTI has good content validity and is a reliable instrument for assessing barriers to drug treatment. The potential utility of the BTI in assessment settings is discussed.