Sexual risk typologies and their relationship with early parenthood and STI outcomes among urban African-American emerging adults: a cross-sectional latent profile analysis.

OBJECTIVES: Identifying sexual risk patterns associated with HIV/sexually transmitted infections (STI) and early parenthood within population subgroups is critical for targeting risk reduction interventions. METHODS: Latent Class Analysis (LCA) was used to identify sexual behaviour typologies to predict sexual risk outcomes among 274 (63% female) unmarried, sexually active African-American emerging adults (M age=19.31 years) living in disadvantaged urban neighbourhoods. Participants were enrolled in a larger cross-sectional observational study of risk and protective behaviours. LCA defined membership into discrete risk classes based on reported sex risk behaviours. RESULTS: Three groups were identified: The 'low contraception use' risk class (32%) had low rates of condom or other birth control use, moderate rates of sexual initiation before age 16 years, and the highest pregnancy/early parenthood and STI rates. The predominately male 'early sex' risk class (32%) had higher rates of early initiation and multiple partners, risks that were countered by higher contraception and condom use. Both these risk groups showed higher probability to use substances before sex relative to the 'low sex risk' class (36%), which showed low rates on all risk behaviours. CONCLUSIONS: LCA identified distinct risk clusters that predicted sexual health outcomes and can inform targeted interventions for a minority youth population disproportionately affected by HIV, other STIs, and early parenthood.

Interactive voice response self-monitoring to assess risk behaviors in rural substance users living with HIV/AIDS.

Community-dwelling HIV/AIDS patients in rural Alabama self-monitored (SM) daily HIV risk behaviors using an Interactive Voice Response (IVR) system, which may enhance reporting, reduce monitored behaviors, and extend the reach of care. Sexually active substance users (35 men, 19 women) engaged in IVR SM of sex, substance use, and surrounding contexts for 4-10 weeks. Baseline predictors of IVR utilization were assessed, and longitudinal IVR SM effects on risk behaviors were examined. Frequent (n = 22), infrequent (n = 22), and non-caller (n = 10) groups were analyzed. Non-callers had shorter durations of HIV medical care and lower safer sex self-efficacy and tended to be older heterosexuals. Among callers, frequent callers had lost less social support. Longitudinal logistic regression models indicated reductions in risky sex and drug use with IVR SM over time. IVR systems appear to have utility for risk assessment and reduction for rural populations living with HIV disease.

Public perceptions of substance abuse and how problems are resolved: implications for medical and public health services.

BACKGROUND: Increasing utilization and appeal of substance abuse services requires understanding public perceptions of substance abuse and problem resolution. METHOD: A statewide survey (N = 439) assessed public views of the prevalence of problems, service utilization, and outcomes using random digit dialing sampling. RESULTS: Compared with population data, the sample overestimated the prevalence of alcohol and drug problems, accurately gauged rates of help-seeking for substance-related problems, and underestimated rates of recovery, particularly natural resolutions without treatment. Perceived influences on help-seeking included extrinsic pressures like legal problems and wanting help with problems of living related to substance misuse. CONCLUSIONS: Substance abuse is less prevalent and less intractable than the public perceives, and natural resolutions are common, but appear to be largely hidden from the public view. Implications for reducing barriers and expanding services in healthcare and public health settings are discussed.

Utility of Respondent Driven Sampling to Reach Disadvantaged Emerging Adults for Assessment of Substance Use, Weight, and Sexual Behaviors.

Emerging adulthood often entails heightened risk-taking with potential life-long consequences, and research on risk behaviors is needed to guide prevention programming, particularly in under-served and difficult to reach populations. This study evaluated the utility of Respondent Driven Sampling (RDS), a peer-driven methodology that corrects limitations of snowball sampling, to reach at-risk African American emerging adults from disadvantaged urban communities. Initial "seed" participants from the target group recruited peers, who then recruited their peers in an iterative process (110 males, 234 females; M age = 18.86 years). Structured field interviews assessed common health risk factors, including substance use, overweight/obesity, and sexual behaviors. Established gender-and age-related associations with risk factors were replicated, and sample risk profiles and prevalence estimates compared favorably with matched samples from representative U.S. national surveys. Findings supported the use of RDS as a sampling method and grassroots platform for research and prevention with community-dwelling risk groups.

Social networks and substance use among at-risk emerging adults living in disadvantaged urban areas in the southern United States: a cross-sectional naturalistic study.

BACKGROUND AND AIMS: Substance use and risk-taking are common during emerging adulthood, a transitional period when peer influences often increase and family influences decrease. Investigating relationships between social network features and substance use can inform community-based prevention programs. This study investigated whether substance use among emerging adults living in disadvantaged urban areas was influenced by peer and family social network messages that variously encouraged and discouraged substance use. DESIGN: Cross-sectional, naturalistic field study. SETTING AND PARTICIPANTS: Lower-income neighborhoods in Birmingham, Alabama, USA with 344 participants (110 males, 234 females, ages 15-25 years; mean = 18.86 years), recruited via respondent-driven sampling. MEASUREMENTS: During structured interviews conducted in community locations, the Alcohol, Smoking and Substance Involvement Screening Test assessed substance use and related problems. Predictor variables were network characteristics, including presence of substance-using peers, messages from friends and family members about substance use and network sources for health information. FINDINGS: Higher substance involvement was associated with friend and family encouragement of use and having close peer network members who used substances (Ps < 0.001). Peer discouragement of substance use was associated with reduced risk (b = - 1.46, P < 0.05), whereas family discouragement had no protective association. CONCLUSIONS: Social networks appear to be important in both promoting and preventing substance use in disadvantaged young adults in the United States.

Religiosity, spirituality, and HIV risk behaviors among African American women from four rural counties in the southeastern U.S.

In a cross-sectional survey of 1,013 African American women from rural Alabama and North Carolina, we examined the relationship of (1) organizational religiosity (i.e., religious service attendance), (2) non-organizational religiosity (e.g., reading religious materials), and (3) spirituality with these outcomes: women's reports of their sexual behaviors and perceptions of their partners' risk characteristics. Women with high non-organizational religiosity, compared with low, had fewer sex partners in the past 12 months (adjusted prevalence ratio (aPR): 0.58, 95% confidence interval (CI): 0.42, 0.80) and were less likely to have concurrent partnerships (aPR: 0.47, 95% CI: 0.30, 0.73). Similar results were observed for spirituality, and protective but weaker associations were observed for organizational religiosity. Weak associations were observed between organizational religiosity, non-organizational religiosity, and spirituality with partners' risk characteristics. Further exploration of how religiosity and spirituality are associated with protective sexual behaviors is needed to promote safe sex for African American women.

Acute performance-impairing and subject-rated effects of triazolam and temazepam, alone and in combination with ethanol, in humans.

The acute behavioural effects of triazolam (0.125 and 0.25 mg), temazepam (15 and 30 mg), and placebo, alone and in combination with ethanol (0 and 0.5 g/kg), were assessed in 10 volunteers. Ethanol alone did not impair performance and produced only a few subject-rated drug effects. Triazolam and temazepam alone produced some performance impairment and a few subject-rated drug effects. These effects tended to be dose-dependent and were comparable for the two drugs across the range of doses tested. The triazolam-ethanol and temazepam-ethanol combinations produced robust performance impairment and sedative-like subject-rated drug effects that were similar in magnitude. The findings of the present study suggest that even a moderate amount of ethanol in combination with a clinical dose of triazolam or temazepam can cause performance impairment that might diminish an individual's ability to respond adequately to unexpected demands (e.g. smoke alarms or middle-of-the-night child care).

Temporal sequencing of alcohol-related problems, problem recognition, and help-seeking episodes.

Little is known about temporal relations between the development of alcohol-related problems, self-recognition of problems, and help seeking from professional and lay sources. The sequencing of these events was investigated retrospectively using a community sample of male and female problem drinkers (N= 101) who varied in their help-seeking histories [no assistance, Alcoholics Anonymous (AA)-only, or treatment-plus-AA] and current drinking status (resolved abstinent or nonresolved). The rank-order of events was similar across groups and gender. Problem recognition typically occurred early with the onset of pathological drinking and related psychosocial problems. Health problems and help seeking were late developments, if they occurred at all. Although the sequence order was similar across groups, the latency to help seeking varied; help seeking was more rapid among women, resolved participants, and participants who had sought help from both treatment and AA. The findings question conventional views that denial deters help seeking and suggest opportunities for screening and early intervention.

Time horizons and substance use among African American youths living in disadvantaged urban areas.

Transitioning from adolescence to full-fledged adulthood is often challenging, and young people who live in disadvantaged urban neighborhoods face additional obstacles and experience disproportionately higher negative outcomes, including substance abuse and related risk behaviors. This study investigated whether substance use among African Americans ages 15 to 25 (M=18.86 years) living in such areas was related to present-dominated time perspectives and higher delay discounting. Participants (N=344, 110 males, 234 females) living in Deep South disadvantaged urban neighborhoods were recruited using Respondent Driven Sampling, an improved peer-referral sampling method suitable for accessing this hard-to-reach target group. Structured field interviews assessed alcohol, tobacco, and illicit drug use and risk/protective factors, including time perspectives (Zimbardo Time Perspective Inventory [ZTPI]) and behavioral impulsivity (delay discounting task). As predicted, substance use was positively related to a greater ZTPI orientation toward present pleasure and a lower tendency to plan and achieve future goals. Although the sample as a whole showed high discounting of delayed rewards, discount rates did not predict substance use. The findings suggest that interventions to lengthen time perspectives and promote enriched views of future possible selves may prevent and reduce substance use among disadvantaged youths. Discontinuities among the discounting and time perspective variables in relation to substance use merit further investigation.

Telephone-based self-change modules help stabilize early natural recovery in problem drinkers.

OBJECTIVE: Self-guided attempts to resolve drinking problems are common, but little is known about the processes by which supportive interventions of lower intensity might promote resolution. This study investigated how brief supportive educational modules delivered as part of an interactive voice response self-monitoring (IVR SM) system helped stabilize initial resolution among otherwise untreated problem drinkers. METHOD: Recently resolved problem drinkers allocated to the intervention group of a randomized controlled trial were offered IVR access for 24 weeks to report daily drinking and hear weekly educational modules designed to support resolution. Using data from the 70 active IVR callers, hierarchical linear models evaluated whether module retrieval reduced subsequent alcohol consumption, including high-risk drinking, and whether module retrieval attenuated the effects on drinking of established proximal risk factors for relapse (e.g., urges, drug use, and weekends). The analyses controlled for initial resolution status (abstinence or low-risk drinking). RESULTS: Urges, drug use, and weekends were associated with increased drinking reports on the next IVR call (all ps < .01), whereas retrieving a module was associated with decreases in next-call drinking reports, including high-risk drinking episodes (p < .05). Module retrieval, however, did not reduce or buffer the effects of urges on drinking. Findings were similar across initially abstinent and low-risk drinkers. CONCLUSIONS: IVR-delivered supportive educational modules may help stabilize initial problem-drinking resolutions, but mechanisms of change deserve more study. The study adds to evidence of the co-occurring negative effects of multiple behavioral and environmental risk factors on the temporal patterning of post-recovery alcohol use.

Utility of an interactive voice response system to assess antiretroviral pharmacotherapy adherence among substance users living with HIV/AIDS in the rural South.

Promoting HIV medication adherence is basic to HIV/AIDS clinical care and reducing transmission risk and requires sound assessment of adherence and risk behaviors such as substance use that may interfere with adherence. The present study evaluated the utility of a telephone-based Interactive Voice Response self-monitoring (IVR SM) system to assess prospectively daily HIV medication adherence and its correlates among rural substance users living with HIV/AIDS. Community-dwelling patients (27 men, 17 women) recruited from a non-profit HIV medical clinic in rural Alabama reported daily medication adherence, substance use, and sexual practices for up to 10 weeks. Daily IVR reports of adherence were compared with short-term IVR-based recall reports over 4- and 7-day intervals. Daily IVR reports were positively correlated with both recall measures over matched intervals. However, 7-day recall yielded higher adherence claims compared to the more contemporaneous daily IVR and 4-day recall measures suggestive of a social desirability bias over the longer reporting period. Nearly one-third of participants (32%) reported adherence rates below the optimal rate of 95% (range=0-100%). Higher IVR-reported daily medication adherence was associated with lower baseline substance use, shorter duration of HIV/AIDS medical care, and higher IVR utilization. IVR SM appears to be a useful telehealth tool for monitoring medication adherence and identifying patients with suboptimal adherence between clinic visits and can help address geographic barriers to care among disadvantaged, rural adults living with HIV/AIDS.

Effects of interactive voice response self-monitoring on natural resolution of drinking problems: utilization and behavioral economic factors.

OBJECTIVE: Most problem drinkers do not seek help, and many recover on their own. A randomized controlled trial evaluated whether supportive interactive voice response (IVR) self-monitoring facilitated such "natural" resolutions. Based on behavioral economics, effects on drinking outcomes were hypothesized to vary with drinkers' baseline "time horizons," reflecting preferences among commodities of different value available over different delays and with their IVR utilization. METHOD: Recently resolved untreated problem drinkers were randomized to a 24-week IVR self-monitoring program (n = 87) or an assessment-only control condition (n = 98). Baseline interviews assessed outcome predictors including behavioral economic measures of reward preferences (delay discounting, pre-resolution monetary allocation to alcohol vs. savings). Six-month outcomes were categorized as resolved abstinent, resolved nonabstinent, unresolved, or missing. Complier average causal effect (CACE) models examined IVR self-monitoring effects. RESULTS: IVR self-monitoring compliers (≥70% scheduled calls completed) were older and had greater pre-resolution drinking control and lower discounting than noncompliers (<70%). A CACE model interaction showed that observed compliers in the IVR group with shorter time horizons (expressed by greater pre-resolution spending on alcohol than savings) were more likely to attain moderation than abstinent resolutions compared with predicted compliers in the control group with shorter time horizons and with all noncompliers. Intention-to-treat analytical models revealed no IVR-related effects. More balanced spending on savings versus alcohol predicted moderation in both approaches. CONCLUSIONS: IVR interventions should consider factors affecting IVR utilization and drinking outcomes, including person-specific behavioral economic variables. CACE models provide tools to evaluate interventions involving extended participation.

Predictors of utilization of an IVR self-monitoring program by problem drinkers with recent natural resolutions.

BACKGROUND: As part of a randomized controlled trial, problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response (IVR) self-monitoring (SM) system as a sobriety maintenance tool during early recovery when relapse risk is high. Because observed IVR utilization was variable, predictors of utilization were evaluated to inform knowledge of populations likely to access and use IVR services. METHODS: Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longstanding high-risk drinking practices and alcohol-related problems (M=16.58 years, SD=10.95). Baseline interviews assessed pre-resolution drinking practices and problems, and behavioral economic (BE) measures of reward preferences (delay discounting, pre-resolution monetary allocation). Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages. RESULTS: IVR use ranged from 0 to 100%. Frequent (n=28), infrequent (n=42), and non-caller (n=17) groups were identified. Non-callers tended to be younger and to report heavier pre-resolution drinking. Frequent callers (≥70% of IVR days) tended to be older, male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers. Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking. CONCLUSIONS: Characteristics common in the untreated problem drinker population were associated with higher IVR utilization. This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform.

The recovery spectrum: from self-change to seeking treatment.

Recent innovations in alcohol-focused interventions are aimed at closing the gap between population need and the currently uncommon use of alcohol treatment services. Guided by population data showing the heterogeneity of alcohol problems and the occurrence of natural remissions from problem drinking without treatment, alcohol services have begun to expand beyond clinical treatment to offer the untreated majority of individuals with alcohol-related problems accessible, less-intensive services that use the tools of public health practice. These services often are opportunistic, meaning they can be provided in primary-care or other unspecialized health care or community settings. They also can be delivered by nonspecialists, or can be used by people themselves to address problems with alcohol without entering the health care system. This developing spectrum of services includes screening and brief interventions, guided self-change programs, and telehealth options that often are targeted and tailored for high-risk groups (e.g., college drinkers). Other efforts aimed at reducing barriers to care and increasing motivation to seek help have utilized individual, organizational, and public health strategies. Together, these efforts have potential for helping the treatment field reach people who have realized that they have a drinking problem but have not yet experienced the severe negative consequences that may eventually drive them to seek treatment. Although the evidence supporting several innovations in alcohol services is preliminary, some approaches are well established, and collectively they form an emerging continuum of care for alcohol problems aimed at increasing service availability and improving overall impact on population health.

Agreement between prospective interactive voice response telephone reporting and structured recall reports of risk behaviors in rural substance users living with HIV/AIDS.

Sound measurement of risk behaviors is essential to guide tailored risk reduction strategies as HIV infection patterns shift toward rural minorities, particularly in the southeastern United States where HIV disease remains highly stigmatized. Interactive Voice Response (IVR) systems appear to enhance reports of sensitive behaviors and can support telehealth applications to extend the reach of care in rural, underserved areas. This study evaluated the feasibility and data quality of an IVR telephone reporting system with rural substance users living with HIV/AIDS. Community-dwelling patients were recruited from a nonprofit HIV medical clinic in rural Alabama (N = 35 men, 19 women). Participants engaged in daily IVR reporting of substance use and sexual practices for up to 10 weeks. IVR reports were compared with retrospective Timeline Followback (TLFB) interview reports for the same period. IVR and TLFB reports showed good to excellent agreement for summary measures of alcohol consumption and sexual activity. Agreements for illicit drug use reports were less satisfactory. Reports of monetary spending on alcohol and drugs were significantly higher on the IVR. Most individuals showed good agreements for reports of day-to-day alcohol and drug use and sexual practices. The study established the utility of IVR assessment with rural, disadvantaged adults living with HIV/AIDS who are priority targets for risk reduction interventions.

Increasing the appeal and utilization of services for alcohol and drug problems: what consumers and their social networks prefer.

BACKGROUND: A large gap exists in the United States between population need and the utilization of treatment services for substance-related problems. Surveying consumer preferences may provide valuable information for developing more attractive services with greater reach and impact on population health. METHODS: A state-level telephone survey using random digit dialling sampling methods assessed preferences for available professional, mutual help, and lay resources, as well as innovative computerized and self-help resources that enhance anonymity (N=439 households in Alabama). RESULTS: Respondents preferred help that involved personal contact compared to computerized help or self-help, but were indifferent whether personalized help was dispensed by professional or lay providers. Attractive service features included lower cost, insurance coverage, confidentiality, rapid and convenient appointments, and addressing functional problems and risks of substance misuse. Respondents in households with a member who misused substances rated services more negatively, especially if services had been used. CONCLUSION: The findings highlight the utility of viewing substance misusers and their social networks as consumers, and the implications for improving the system of care and for designing and marketing services that are responsive to user preferences are discussed.

An occupational exposure assessment of a perfluorooctanesulfonyl fluoride production site: biomonitoring.

This investigation randomly sampled a fluorochemical manufacturing employee population to determine the distribution of serum fluorochemical levels according to employees' jobs and work areas. Previous analyses of medical surveillance data have not shown significant associations between fluorochemical production employees' clinical chemistry and hematology tests and their serum PFOS and perfluorooctanoate (PFOA, C(7)F(15)COO(-)) concentrations, but may have been subject to nonparticipation bias. A random sample of the on-site film plant employee population, where fluorochemicals are not produced, determined their serum concentrations also. Of the 232 employees randomly selected for serum sampling, 186 (80%) employees participated (n=126 chemical plant; n=60 film plant). Sera samples were extracted using an ion-pairing extraction procedure and were quantitatively analyzed for seven fluorochemicals using high-pressure liquid chromatography electrospray tandem mass spectrometry methods. Geometric means (in parts per million) and 95% confidence intervals (in parentheses) of the random sample of 126 chemical plant employees were: PFOS 0.941 (0.787-1.126); PFOA 0.899 (0.722-1.120); perfluorohexanesulfonate 0.180 (0.145-0.223); N-ethyl perfluorooctanesulfonamidoacetate 0.008 (0.006-0.011); N-methyl perfluorooctanesulfonamidoacetate 0.081 (0.067-0.098); perfluorooctanesulfonamide 0.013 (0.009-0.018); and perfluorooctanesulfonamidoacetate 0.022 (0.018-0.029). These geometric means were approximately one order of magnitude higher than those observed for the film plant employees.