RESUMEN
OBJECTIVE: The American Cancer Society and the National Cancer Institute launched and evaluated a personalized online program leveraging behavioral science principles to help people self-manage physical and emotional symptoms, improve communication skills, and lead healthier lives during and after a cancer diagnosis. METHODS: Cancer survivors were recruited from an academic medical and a community clinical setting (N = 40) to complete in-person user testing of the Springboard Beyond Cancer website, which included action decks and content to promote self-management. Action decks were printable or savable collections of information and action steps related to a cancer topic or treatment side effect. Participants performed structured tasks to evaluate the program's content and usability. Comments and reactions were recorded, and qualitative thematic analyses were conducted. RESULTS: Most participants successfully found information about fatigue (95%), pain (83%), sexual side effects (90%), and support groups (85%). Survivors, particularly those in treatment, found information on the site to be clear, concise, and meeting their needs. Use of action decks to create self-management plans was inconsistent. Survivors reported needing more instruction and support within the program on how to best utilize enhanced functionality in action decks to prioritize their most pressing concerns. CONCLUSIONS: Early stakeholder engagement throughout the multiple phases of prototyping and deployment are needed to fully maximize end user engagement. Providing actionable self-management content and activating tools to cancer survivors via an eHealth program is a feasible and scalable approach to increasing access to self-management tools and addressing cancer survivor needs.
Asunto(s)
Actividades Cotidianas/psicología , Supervivientes de Cáncer/psicología , Neoplasias/psicología , Autocuidado/métodos , Automanejo/psicología , Telemedicina , Femenino , Humanos , Masculino , Neoplasias/terapia , Dolor , Proyectos de Investigación , Grupos de Autoayuda , Apoyo SocialRESUMEN
PURPOSE AND OBJECTIVES: The human papillomavirus (HPV) vaccine is an effective but underused method for preventing multiple cancers, particularly cervical cancer. Although interventions have successfully targeted barriers to HPV vaccine uptake in various clinical settings, few studies have explored their implementation. Our study examines the delivery of the HPV VACs (Vaccinate Adolescents Against Cancer) Program and elicits information on barriers and facilitators to implementation. INTERVENTION APPROACH: The VACs Program pilot was a multilevel, evidence-based intervention conducted by the American Cancer Society in 30 federally qualified health centers (FQHCs) in the United States. EVALUATION METHODS: We conducted in-depth interviews (N = 32) by telephone with representatives of 9 FQHC partners. We structured the interview guides on Consolidated Framework for Implementation Research (CFIR) domains. We asked about project start-up activities, implementation strategy selection, policy- and practice-level changes, staffing structure, challenges, and key factors leading to project success. At least 2 researchers coded each interview transcript verbatim. RESULTS: Participants most frequently identified the electronic health record system, training and education, concrete tools and resources, and provider champions as facilitators to implementing HPV VACs. Limited staff resources, challenges of electronic health records, issues with state immunization registries, patient misinformation about vaccines and vaccine stigma, cultural/language barriers, competing priorities, levels of funding, staff buy-in, training needs, and low health literacy were identified as barriers. IMPLICATIONS FOR PUBLIC HEALTH: Providing appropriate training for FQHC staff members and providers along with technical assistance and facilitation tools were critical for increasing provider confidence in recommending HPV vaccine. Addressing capacity-building and implementation barriers in FQHCs can increase effective implementation of evidence-based interventions to increase HPV vaccination uptake and reduce the burden of future cancers.
Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/inmunología , Vacunación , Adolescente , Actitud del Personal de Salud , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Masculino , Atención Primaria de Salud , Administración en Salud Pública , Estados UnidosRESUMEN
Guided by the Consolidated Framework for Implementation Research (CFIR), this study aimed to identify factors that influence implementation of evidence-based provider and client-oriented strategies to promote colorectal cancer (CRC) screening in safety net health systems. Site visits and key informant interviews (n=33) were conducted with project leaders and staff in five health systems funded by an American Cancer Society grants program. Within- and cross-site analyses identified CFIR constructs that influenced implementation of provider and client-oriented strategies to promote CRC screening through colonoscopies and fecal immunochemical tests. Of the five CFIR domains, constructs within four CFIR domains (inner setting, outer setting, individual characteristics and process domains) were particularly salient in discussions of implementation while constructs within one CFIR domain (characteristics of the intervention) were not. This study provides a detailed description of how facilitating and inhibiting factors influenced the implementation of evidence-based practices related to CRC screening within safety net health systems. These findings can inform future efforts to promote evidence-based strategies to increase CRC screening rates in safety net health systems.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Investigación/organización & administración , Proveedores de Redes de Seguridad/organización & administración , Colonoscopía , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/métodos , Práctica Clínica Basada en la Evidencia , Heces/química , Humanos , LiderazgoRESUMEN
Objective: Effective smoking cessation interventions are needed to reduce tobacco-related disparities. Communication technology-based interventions are increasingly being employed to help smokers quit, with controlled research demonstrating efficacy of text messaging and email in increasing abstinence. Understanding preferences for such strategies among socioeconomically disadvantaged smokers can inform targeted intervention planning. The aims of this study were to: 1) examine socioeconomically disadvantaged smokers' use of and access to communication technology; and 2) elucidate preferences for receiving quitting information and support via email and text message. Design: This cross-sectional, mixed-methods study collected data from a self-administered survey and focus groups in September 2017. Participants: A community-based, sample of 15 predominantly African American, socioeconomically disadvantaged smokers aged 21-64 years. Results: Smartphone ownership was high, although use of communication-based cessation resources such as web sites and smartphone apps was low. Four themes emerged relevant to preferences for receiving quitting information and support via email and text message: access, appropriateness, intended use, and satisfaction. Although initially participants were mixed in their preferences for receiving emails vs texts, 80% preferred emails over texts when presented with sample emails and text messages containing cessation information. Conclusions: In this sample of socioeconomically disadvantaged smokers, emails were preferred over text messages for smoking cessation assistance. Although both email and text message strategies may be acceptable to socioeconomically disadvantaged smokers generally, issues such as access and intended use should be considered to inform specific disparity-reducing intervention approaches.
Asunto(s)
Correo Electrónico , Cese del Hábito de Fumar/métodos , Envío de Mensajes de Texto , Poblaciones Vulnerables/psicología , Adulto , Anciano , Estudios Transversales , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Propiedad , Pobreza , Teléfono Inteligente , Fumadores/psicología , Encuestas y Cuestionarios , Población Urbana , Adulto JovenRESUMEN
INTRODUCTION: Screening for colorectal cancer in average-risk adults is recommended beginning at age 50 years and continuing until age 75 years. This study was conducted to provide evidence for the effectiveness of an American Cancer Society grant program promoting colorectal cancer screening by implementing evidence-based interventions proven to increase screening rates. METHODS: Analysis compared colorectal cancer screening rates in 77 grant-funded federally qualified health centers between 2013 and 2015 to those of a sample of 77 nonfunded federally qualified health centers selected using a genetic matching technique. The Uniform Data System from 2013 to 2015 provided data used in the analysis performed in 2016. RESULTS: Funded grantees differed significantly from nongrantees on several indicators at baseline. Genetic matching resulted in good-quality matched samples. Both matched samples increased colorectal cancer screening rates over time. Grantees increased their colorectal cancer screening rates significantly more than nongrantees, especially between 2013 and 2014, where funded federally qualified health centers increased by 9% and nonfunded federally qualified health centers increased by 3%. Across the 3 years, increases were 12% and 9%, respectively. CONCLUSIONS: The findings suggest grant funding was effective in promoting improvements in colorectal cancer screening rates in funded federally qualified health centers, and these improvements exceed those of nonfunded federally qualified health centers. Funding that results in targeted, intensive efforts supported by technical assistance and accountability for data and reporting, can result in improved system policies and practices that, in turn, can increase screening rates among uninsured and underserved populations.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Organización de la Financiación/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Colonoscopía/economía , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/genética , Detección Precoz del Cáncer/economía , Medicina Basada en la Evidencia/estadística & datos numéricos , Femenino , Pruebas Genéticas/economía , Pruebas Genéticas/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Sangre Oculta , Atención Primaria de Salud/economía , Atención Primaria de Salud/métodos , Estados Unidos , Poblaciones Vulnerables/estadística & datos numéricos , Adulto JovenRESUMEN
INTRODUCTION: Cancer disparities continue to exist in the United States. Community health advisors (CHAs) can play a critical role in addressing cancer disparities. The American Cancer Society (ACS) implemented a 3-year pilot CHA program in the South based on an evidence-based program to increase breast cancer screening. STUDY DESIGN: Evaluation assessed the extent to which ACS successfully implemented the program. Quantitative data were tracked and reported by ACS staff, and qualitative data were collected through focus groups and interviews with volunteer participants. SETTING/PARTICIPANTS: The pilot was implemented in 28 communities in nine states. ACS staff recruited volunteer community network partners (CNPs) as local advisory groups, and volunteer CHAs to conduct outreach, education, and screening navigation. MEASURES: Outcome measures included number of individuals educated and screened, and number of communities reaching education and screening targets. Process measures included number of volunteers recruited, number of communities reaching recruitment targets, and implementation process, challenges, and successes. RESULTS: A total of 383 CHAs were recruited and recruitment goals were met in 68%; 31,439 individuals were educated, and 93% of communities reached education goals. In all, 5,056 individuals were screened, but screening goals were attained in only 36% of communities. CONCLUSION: This pilot demonstrates the ability of ACS to adapt and disseminate an evidence-based program to fit into its volunteer-based outreach model. ACS built community network partnerships, recruited a cadre of volunteers, and trained them to conduct education and screening navigation.
Asunto(s)
American Cancer Society/organización & administración , Agentes Comunitarios de Salud/organización & administración , Detección Precoz del Cáncer/estadística & datos numéricos , Promoción de la Salud/organización & administración , Salud Pública , Región de los Apalaches , Femenino , Humanos , Masculino , Objetivos Organizacionales , Proyectos Piloto , Investigación Cualitativa , Sudeste de Estados Unidos , Estados Unidos , VoluntariosRESUMEN
BACKGROUND: Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. METHODS: Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. RESULTS: Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. CONCLUSIONS: Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover, our analytic approach is similar to previous case studies using CFIR and hence could facilitate comparisons across studies.
Asunto(s)
Atención a la Salud/métodos , Detección Precoz del Cáncer/métodos , Práctica Clínica Basada en la Evidencia/métodos , Implementación de Plan de Salud/métodos , Atención Primaria de Salud/métodos , Femenino , Disparidades en el Estado de Salud , Humanos , Masculino , Proyectos de Investigación , Estados UnidosRESUMEN
International donors have increasingly shifted AIDS funding directly to community-based organizations (CBOs) with the assumption that responding to the epidemic is best achieved at the community level. The World Bank, ICF Macro, and the National Council for Population and Development in Kenya, conducted a study to evaluate the community response in Kenya. The study used a quasi-experimental design comparing seven study communities and seven comparison communities in Nyanza Province and Western Province. We examined the impact of CBO activity on individual and community-level outcomes, including HIV knowledge, awareness and perceptions, sexual risk behavior, and social transformation (gender ideology and social capital). The study consisted of two components: a household survey conducted in all 14 communities, and qualitative data collected in a subset of communities. Individuals in communities with higher CBO engagement were significantly more likely to have reported consistent condom use. Higher CBO engagement was associated with some measures of social capital, including participation in local and national elections, and participation in electoral campaigns. CBOs provide added value in addressing the HIV and AIDS epidemic in very targeted and specific ways that are closely tied to the services they provide (e.g., prevention education); thus, increasing CBO engagement can be an effective measure in scaling up prevention efforts in those areas.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Organizaciones sin Fines de Lucro/organización & administración , Evaluación de Programas y Proyectos de Salud/métodos , Asunción de Riesgos , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/psicología , Composición Familiar , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , Kenia/epidemiología , Modelos Logísticos , Masculino , Organizaciones sin Fines de Lucro/estadística & datos numéricos , Prevalencia , Investigación Cualitativa , Características de la Residencia , Conducta Sexual , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
This study examines patterns of substance use among youth served in systems of care, and how these patterns relate to diagnosis and other youth characteristics using latent class analysis. Results indicated a four-class solution with the four groups differing in their probabilities of reporting the use of 10 different substances. Class 1 was defined by high probabilities of all drug use. Class 2 had high probabilities of alcohol, tobacco, marijuana use, and low for other drugs. Class 3 had moderate probabilities of alcohol, tobacco, marijuana use, and low probabilities for other drugs. Class 4 had a high probability of tobacco use and no other drug use. Youth who had a mood disorder diagnosis, were male, older, White and had previously run away from home were significantly more likely to be in Class 1 relative to other classes. These differences have implications for prevention and treatment.
Asunto(s)
Salud Mental , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Niño , Femenino , Humanos , Masculino , Oportunidad Relativa , Probabilidad , Trastornos Relacionados con Sustancias/clasificación , Trastornos Relacionados con Sustancias/diagnóstico , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
This study examines substance use and sexual risk within the context of gender inequality among 163 women from an urban region of South Africa who were participating in a 2004-2006 study funded by the National Institute of Alcohol Abuse and Alcoholism. Items assessed patterns of substance use, gender inequality, risk communication, and psychological distress. Multivariate logistic regression analyses revealed that economic dependence on a main partner and traditional beliefs about a woman's right to refuse sex were associated with substance use prior to or during sex with that partner. The findings demonstrate that substance abuse prior to sex may reinforce traditional beliefs and that women with more progressive beliefs about gender ideology seem better able to control their substance use in risky environments.
Asunto(s)
Prejuicio , Trabajo Sexual/estadística & datos numéricos , Salud de la Mujer , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/psicología , Cocaína Crack/efectos adversos , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Drogas Ilícitas/efectos adversos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Asunción de Riesgos , Sexo Seguro/psicología , Sexo Seguro/estadística & datos numéricos , Trabajo Sexual/psicología , Conducta Sexual/psicología , Conducta Sexual/estadística & datos numéricos , Sudáfrica/epidemiología , Sexo Inseguro/psicología , Sexo Inseguro/estadística & datos numéricosRESUMEN
This article examines the influence of social support on crack use in a sample of 435 African American out-of-treatment crack users recruited through street outreach in Raleigh, North Carolina, between 2000 and 2002. Multivariate regression models indicated that social support was not a strong influence on crack use. For women, no social support variables predicted crack use, whereas for men, having a non-using partner was negatively associated with crack use. Findings indicate that existing social support is not strongly linked to drug use among African Americans, but African American men may be positively influenced by non-using sexual partners. Limitations of the sample and data are discussed. Further research is needed on the influence of social support for African American drug-using populations.
Asunto(s)
Negro o Afroamericano , Cocaína Crack , Apoyo Social , Trastornos Relacionados con Sustancias , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , North Carolina , Factores SexualesRESUMEN
BACKGROUND: Individual and sociocultural factors may pose significant barriers for drug abusers seeking treatment, particularly for African-American crack cocaine abusers. However, there is evidence that pretreatment interventions may reduce treatment initiation barriers. This study examined the effects of a pretreatment intervention designed to enhance treatment motivation, decrease crack use, and prepare crack abusers for treatment entry. METHODS: Using street outreach, 443 African-American crack users were recruited in North Carolina and randomly assigned to either the pretreatment intervention or control group. RESULTS: At 3-month follow-up, both groups significantly reduced their crack use but the intervention group participants were more likely to have initiated treatment. CONCLUSION: The intervention helped motivate change but structural barriers to treatment remained keeping actual admissions low. Policy makers may be interested in these pretreatment sites as an alternative to treatment for short term outcomes.
Asunto(s)
Negro o Afroamericano , Trastornos Relacionados con Cocaína/rehabilitación , Barreras de Comunicación , Cocaína Crack , Consumidores de Drogas , Accesibilidad a los Servicios de Salud , Adulto , Relaciones Comunidad-Institución , Femenino , Estudios de Seguimiento , Humanos , Masculino , North Carolina , Evaluación de Resultado en la Atención de Salud , Participación del Paciente , Evaluación de Programas y Proyectos de SaludRESUMEN
CONTEXT: While literature exists on sexual risks for HIV among rural populations, the specific role of stimulants in increasing these risks has primarily been studied in the context of a single drug and/or racial group. PURPOSE: This study explores the use of multiple stimulants and sexual risk behaviors among individuals of different races and sexual identities in rural North Carolina. METHODS: In-depth interviews were conducted with 41 individuals in 3 rural North Carolina counties between June 2004 and December 2005. Interviews were audiotaped, transcribed and reviewed for accuracy. Edited interviews were imported into Atlas.ti and askSam for analysis. FINDINGS: Along with marijuana, stimulants-including powder cocaine, crack, and methamphetamine-were the most frequently used illicit drugs in these counties. Powder cocaine use was more closely associated with white participants, crack with African Americans, and both were more commonly used by female participants. Participants reported 3 overlapping behaviors involving stimulant use that may be associated with increased risk of HIV infection: engaging in sex while using drugs, sex trading and group sex. Nearly half of participants reported engaging in group sex activity. CONCLUSIONS: HIV risk through injection appears to be low in these rural counties. However, nearly all study participants reported some form of sexual risk behavior that may increase transmission of HIV and other sexually transmitted infections. Further research is warranted focusing on the nexus between substance abuse and risky sexual behaviors.
Asunto(s)
Estimulantes del Sistema Nervioso Central , Infecciones por VIH/transmisión , Población Rural , Trastornos Relacionados con Sustancias/epidemiología , Sexo Inseguro , Adolescente , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , North Carolina/epidemiologíaRESUMEN
This article describes the secondary syringe exchange (SSE) practices of injection drug users (IDUs) attending 23 syringe exchange programs (SEPs) in the state of California during 2002 (n=539). The sample was primarily heroin injecting, about two thirds male, half White and half other racial/ethnic groups. Participants were interviewed with a structured questionnaire that included items on sociodemographic factors, drug use practices, sexual practices, use of SEP and other social services, and satisfaction with SEP services. Interviews lasted about 30 minutes. SSE was highly prevalent: 75% of IDUs reported participating in SSE in the 6 months before interview. Program characteristics, such as legal status, SSE policy, and exchange policy, did not affect the prevalence of SSE among SEP clients. Infectious disease risk behaviors were significantly more common among SSE participants than nonparticipants. SSE participants were more likely to share syringes (p<.001) and cookers (p<.001) in the previous 6 months. SSE was significantly associated with being stuck with another person's syringe (needle-stick), a little-discussed "occupational hazard" of this practice. In multivariate analysis, the adjusted odds ratio of needle-stick among SSE participants was 2.8 (95% confidence interval, 1.3, 6.0). The high prevalence of SSE and the infectious disease risk associated with it warrant additional research to determine the causality of these associations. In the interim, SEPs should consider reinforcing HIV prevention education messages and training IDUs who engage in SSE in safe handling of biohazardous materials.
Asunto(s)
Compartición de Agujas/estadística & datos numéricos , Programas de Intercambio de Agujas/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/prevención & control , Adulto , California/epidemiología , Demografía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES AND GOAL: The objectives of this study were to examine the association between individual and partnership characteristics with condom use, sexual concurrency, and discordance in monogamy perceptions among out-of-treatment, young adult, drug-involved couples to gain a better understanding of how discordance in monogamy beliefs may influence HIV/sexually transmitted infection risk. STUDY DESIGN: Data were collected from 94 predominantly black heavy alcohol and/or drug users (AOD) and their steady partners recruited through street outreach in Durham, North Carolina, and a methadone clinic in Raleigh, North Carolina. RESULTS: One third was wrong about partners' monogamy intentions. Greater lifetime number of substances, longer relationship duration, and at least weekly relationship conflict were associated with inconsistent condom use, and discordant monogamy beliefs were associated with consistent condom use. CONCLUSIONS: Many individuals misperceive their partners' monogamy intentions, although this misperception may be reflective of greater HIV/sexually transmitted infection protection. Interventions for couples should focus on strategies appropriate for committed long-term relationships, including increasing awareness of partner risk behavior, negotiating safety, and conflict resolution skills.
Asunto(s)
Alcoholismo , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Asunción de Riesgos , Parejas Sexuales , Abuso de Sustancias por Vía Intravenosa , Adolescente , Adulto , Condones , Femenino , Infecciones por VIH/etiología , Humanos , Masculino , Estado Civil , North Carolina/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/etiología , Enfermedades de Transmisión Sexual/prevención & control , Encuestas y Cuestionarios , Servicios Urbanos de SaludRESUMEN
Little is known about youths' experiences in residential adolescent treatment programs. To better understand the experiences of youth in such programs, the authors conducted a longitudinal qualitative study of 10 juvenile probationers in an adolescent therapeutic community (TC) treatment setting. Seven boys and three girls were recruited into the study upon their entry into the TC. Ages ranged from 14 to 17 years old; six youths were Hispanic, three were White, and one was African-American. Each participant completed between two and six audio-recorded interviews over the course of two years. We report on youth experiences in the TC as well as after discharge or drop out. Three issues were most salient in these interviews--the positive and negative influence of peers, youth appreciation of the family counseling component, and the need for improved methods to prevent running away from the program. Regarding running away, half of the youth in our sample who ran away regretted it, suggesting that with more focused intervention some of them might have been retained in the program.
Asunto(s)
Trastornos Relacionados con Sustancias/terapia , Adolescente , Consejo , Crimen , Familia , Femenino , Humanos , Entrevistas como Asunto , Estudios Longitudinales , Masculino , Educación del Paciente como Asunto , Conducta Sexual , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
Injection drug use continues to place women at risk for human immunodeficiency virus (HIV) through both risky injecting practices and risky sexual behavior with male injection drug users (IDUs). Although attendance at syringe-exchange programs (SEPs) is protective against HIV, a recent study found that women attending SEPs who exchanged syringes for other people (secondary exchange) were at greater risk for HIV seroconversion, potentially through risky sexual behavior. We examined this question in a sample of 531 IDUs (175 women and 356 men) attending 23 SEPs in California in 2001. Findings indicated that women were more likely than men to engage in secondary exchange and were more likely to have IDU sexual partners. In multivariate analysis among women, secondary exchange was independently associated with distributive syringe sharing, not engaging in receptive sharing, and not exchanging sex for money or drugs. Multivariate analysis among men found that having an IDU sexual partner was associated with secondary exchange. Women's sexual risk behavior was not associated with secondary exchange, and although women's secondary exchange was associated with individual protection for injection-related behaviors, it may increase network risk. More information on network members is needed to understand gender differences in secondary exchange.
Asunto(s)
Infecciones por VIH/prevención & control , Programas de Intercambio de Agujas , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , California , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Factores de Riesgo , Asunción de Riesgos , Factores Sexuales , Salud UrbanaRESUMEN
Substance-using intimate partners negatively influence individuals' substance abuse treatment engagement and drug use, but little else is known about effects of intimate relationships on treatment. We examine how relationship dynamics (power, control, dependence, insecurity and decision-making power) influence treatment engagement, and whether this differs by gender and partner drug use. Sixty-four heroin users (42 men, 22 women) receiving methadone detoxification treatment in Los Angeles were interviewed at treatment entry and submitted daily diaries of drug use throughout the 21-day treatment. Total number of reported heroin-free days in the first eight treatment days was the dependent variable. Bivariate analyses revealed, that compared to men, women were more likely to have substance-using partners, reported greater power over a partner and greater household decision-making power in their relationships. Multivariate analysis indicated that individuals whose partners had more control over them reported fewer days abstinent. Among individuals with heroin-using partners, greater household decision-making power was associated with more days abstinent, but there was no association for individuals with non-using partners. Relationship power dynamics may be important influences on the treatment process, and some dimensions of power may interact with partner drug use status.
Asunto(s)
Relaciones Interpersonales , Poder Psicológico , Parejas Sexuales/psicología , Trastornos Relacionados con Sustancias/terapia , Adulto , Factores de Edad , Toma de Decisiones , Femenino , Humanos , Los Angeles , Masculino , Factores Sexuales , Centros de Tratamiento de Abuso de Sustancias , Trastornos Relacionados con Sustancias/psicologíaRESUMEN
This study examined whether higher rates of depressive symptoms among amphetamine compared with cocaine users result from amphetamine use itself, polydrug use, or experiencing a major lifetime depressive episode and whether depressive symptoms among amphetamine users are more likely to persist 12 months after treatment. The association between amphetamine use and depressive symptoms disappears when controlling for polydrug use and lifetime major depressive episode. Polydrug use and lifetime depressive episode are significantly related to depressive symptoms in the year preceding treatment. Amphetamine use at intake does not predict depressive symptoms among individuals who are abstinent at follow-up, and amphetamine users are no more likely than cocaine users to report depression at a 12-month follow-up.