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To assess the prevalence of sex work and its associations with substance use among female bar/spa workers in the Philippines (N = 498), workers from 54 bar or spa venues in Metro Manila (2009-2010) were surveyed on demographics, drug/alcohol use, abuse history, and sex work. Their median age was 23 years and 35% engaged in sex work. Sex work was independently associated with methamphetamine use (19% vs 4%; adjusted odds ratio [AOR] =2.9, 95% confidence interval [CI] = 1.3-6.2), alcohol use with patrons (49% vs. 27%; AOR = 1.9, 95% CI = 1.1-3.4), and alcohol intoxication during sex (50% vs. 24%; AOR = 2.0, 95% CI = 1.2-3.5), but inversely associated with daily alcohol use (13% vs. 16%; AOR = 0.2, 95% CI = 0.1-0.5). Additional significant covariates included sexual abuse history, younger age, and not having a higher education. Findings suggest that interventions with sex workers in bars and spas should focus on methamphetamine use, alcohol use contexts, and violence victimization, to better meet the needs of this population.

It remains unclear if China's current HIV antibody testing algorithm misses a substantial number of HIV infected individuals. Of 196 specimens with indeterminate or negative results on HIV western blot (WB) retrospectively examined by HIV-1 nucleic acid test (NAT), 67.57% (75/111) of indeterminate WB samples, and 16.47% (14/85) of negative WB samples were identified as NAT positive. HIV-1 loads in negative WB samples were significantly higher than those in indeterminate WB samples. Notably, 86.67% (13/15) of samples with negative WB and double positive immunoassay results were NAT positive. The rate of HIV-1 infections missed by China's current HIV testing algorithm is unacceptably high. Thus, China should consider using NAT or integrating fourth generation ELISA into current only antibodies-based HIV confirmation. J. Med. Virol. 88:1462-1466, 2016. © 2016 Wiley Periodicals, Inc.

Summary. Background: It is probable that the variety and frequency of delayed adverse vascular events after splenectomy are underappreciated. Splenectomy is performed for a wide variety of conditions, and delayed postsplenectomy hazards are not often studied. Objective: To estimate the relative risk of adverse vascular events in members of hereditary spherocytosis families who have or have not had a splenectomy. Methods: Members of families in which hereditary spherocytosis exists were systematically questioned about adverse vascular events. Results: The cumulative incidence of arterial and venous events at age 70 years was greater in persons who had undergone a splenectomy for spherocytosis (arterial, 22% females, 32% males; venous, 20% females, 19% males) than in affected persons who did not undergo splenectomy (arterial, 3% females, 2% males; venous, 6% females, 4% males) or non-affected family members (arterial, 10% females, 17% males; venous, 4% females, 12% males). Affected subjects who undergo splenectomy are at greatly increased risk of arterial events as compared to affected subjects who do not undergo splenectomy [arterial, hazard ratio (HR) 7.2, 95% confidence interval (CI) 2.8–17.2; venous, HR 3.3, 95% CI 1.1–9.8]. Conclusion: There is a significant, long-lasting, increased risk of adverse arterial and venous thromboembolic events after splenectomy performed for hereditary spherocytosis. A review of the literature indicates that this is also true when splenectomy is performed for several other indications.

The 100% Condom Use Program (100% CUP) was evaluated in Wuhan, China. The program sought to increase knowledge of STI/HIV transmission, increase condom use rates, and reduce the prevalence of sexually transmitted infections (STIs) among sex workers (commercial sex workers (CSWs)), via condom availability and use policies in entertainment establishments and STI services including education and counseling. Entertainment establishment owners and CSWs participated in educational sessions and multiple community sectors were involved in the program. At baseline, 170 female CSWs were assessed, and 102 CSWs were assessed at the final 21-month follow-up. At 6-month follow-up, 95% of entertainment establishments were in compliance with 100% CUP policies. At 15 months, condoms were readily available in retail outlets, and condom use rates rose by 94.5%. Refractive rates of chlamydia and methodological limitations of the evaluation leave unanswered questions about the effectiveness of the program. Nonetheless, outcomes suggest that the 100% CUP may be a promising approach to HIV prevention in China.

The substance abuse field has identified a range of evidence-based substance abuse treatment approaches. Evidence-based approaches are those that have been shown, through carefully controlled and replicated research, to be efficacious or effective. These approaches have been articulated in National Institute on Drug Abuse (NIDA, 2000b) publications and on the NIDA Web site. Research literature, newsletters, and editorials aimed at providers of substance abuse treatment services have also articulated evidence-based approaches. Organizations serving large populations of substance-abusing clients need to be aware of evidence-based practices and use them when developing client service plans. One of the largest social services systems working with substance-abusing clients is the child welfare system. Child welfare agencies have become knowledgeable about substance abuse treatment, but relatively little is known about the extent to which child welfare practice remains current with advances in substance abuse practice. This study examines the extent to which methadone maintenance (MM) is discussed in the child welfare literature and broader social work literature, and the extent to which child welfare policies mention and recommend this treatment method. Why focus on MM as an evidence-based drug treatment practice? Briefly, we know that heroin-dependent women who are parents are likely to provide inadequate care to their children and may expose their family to drug-related violence (Schilling, Mares, & El-Bassel, 2003). The American Public Health Association (1997), NIDA (2000a, 2000b), the World Health Organization (WHO) (2001), Stimson, Des Jarlais, and Ball (1998), the Center for Substance Abuse Treatment (CSAT) (1999), and the Substance Abuse and Mental Health Services Administration (SAMHSA) (1999) identify MM as an effective treatment for heroin dependence. Many studies have shown that opiate-dependent individuals on MM are likely to exhibit reductions in HIV risk behavior and crime and violence and improvements in child rearing and employment (Kott, Habel, & Nottingham, 2001; see Sorensen & Copeland, 2000, for a review). Child welfare is arguably the practice arena most widely recognized as the domain of social workers. Social workers recognize the importance of their state-sanctioned roles in protecting children (Barth & Jonson-Reid, 2000). In this capacity, social workers are required to investigate the well-being of children who are thought to be in danger, make judgments about levels of risk, and recommend courses of action. Social workers who find evidence of abuse or neglect usually recommend some corrective action by parents. In most instances, family court judges accept all or some of these recommendations and stipulate that court sanctions, including removal of the child from the home, remain in effect until the parents at least partially complete a recommended course of action. Wielding considerable power in such matters, social workers make the initial judgment that a child is in danger. Social workers then make recommendations to the court based on their determination, through their own investigation and through assessments of mental health consultants, of the family deficits contributing to child maltreatment. Critical is the social worker's knowledge of optimal and available resources, services, supports, and treatments. In recent decades, parental substance abuse has been shown to be a large contributing factor in child maltreatment (Bays, 1990; Olsen, Allen, & Azzi-Lessing, 1996; Wolack & Magura, 1996). A National Institute of Mental Health (NIMH)-funded study found that substance abusers had three times the odds of committing physical abuse and neglect after controlling for social, demographic, and psychiatric variables (Chaffin, Kelleher, & Hollenberg, 1996). Another study found that more than three-quarters of state child protection administrators across the country reported substance abuse as one of the top two problems presented by their caseloads (Wiese & Daro, 1995). …

HIV may be transmitted in the process of sharing injected drugs, even if all participants have their own syringes. In an effort to gain understanding of the extent and predictors of drug sharing, data were obtained via personal interviews with 1,024 injection drug users from four neighborhoods in the South Bronx. The relationship between drug-sharing and demographic, sexual, and drug-related variables was first examined in a bivariate analysis, and then via multiple logistic regression. Individuals who split drugs were more likely to be female, have had sex with a casual partner, exchanged sex for drugs or other needs, recently smoked crack cocaine, and shared needles. They were less likely to live or inject at their own home or have used a new needle the last time they injected. In a final logistic model, correlates of drug sharing included trading sex, injecting outside one's home, and using borrowed, rented or shared needles. Despite the lack of significance for gender in the final logistic model, females were at high risk of drug sharing because they constituted the great majority of those who exchanged sex. Continuing research is needed to understand how drug-sharing contributes to the spread of HIV and other infections, as are studies of approaches to reducing drug sharing. Prevention strategists and outreach organizations should be aware of the HIV risks inherent in the widespread practice of drug sharing.

This objective of this study was to examine the association between a women's HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondent's demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.

This study investigated the utility and psychometric properties of the University of Rhode Island Change Assessment Scale (URICA) in a sample of 257 female inmates from a large urban prison. It addressed three major issues: (a) whether URICA captures stages of change among female offenders with a recent history of drug abuse; (b) whether distinct, reliable subgroup profiles would emerge from a cluster analysis of the URICA scale; and (c) whether women in these clusters would differ in their demographic characteristics, drug-use patterns, or psychological symptoms. Results indicate that the URICA is a useful, reliable, and valid tool to assess stages of change in drug-using incarcerated women. Consistent with other studies conducted with different populations, the scale yielded five distinct stages: precontemplation, contemplation, preparation, action, and maintenance. Cluster analysis using the hierarchical agglomerate method classified the subjects into five clusters, which correlated with subjects' psychological symptoms. Intervention implications of URICA are discussed.

This study examines the relationship between childhood abuse and partner abuse among a sample of predominantly African-American and Hispanic women, who were patients in methadone clinics in Harlem and the South Bronx. A structured questionnaire addressing demographics, psychosocial and physical health characteristics, depression, childhood abuse, and domestic violence was administered to 151 women. Over half of the women (60%, n = 98) reported lifetime physical, life-threatening, or sexual abuse by a spouse or boyfriend. Multiple logistic regression analysis was used to assess the associations between childhood physical abuse and abuse by a spouse or boyfriend and between childhood sexual abuse and abuse by a spouse or boyfriend. After controlling for potential confounders, women who reported childhood physical abuse were almost nine times more likely to report having been abused by a spouse or boyfriend (OR = 8.74, CI, = 3.25 to 23.57). Women who reported childhood sexual abuse were almost four times more likely to report having been abused by a spouse or boyfriend (OR = 3.93, CI = 1.46 to 10.59). Depression and need for social support were significantly associated with partner abuse, while current heroin use was inversely associated with partner abuse. The high rate of domestic violence and the strong association between childhood and partner abuse found in this study suggest areas for intervention in chemical dependency among women.

This investigation examines the relationship between psychological trauma and crack abuse among 158 women with a recent history of drug use who were incarcerated in a New York City jail facility. Interviewers obtained data on demographics, drug use, psychological trauma history, criminal history, social support, and coping behavior variables. Three-fourths of the total sample had used crack three or more times a week for a month in the past; a quarter had used other drugs, predominantly heroin, three or more times a week for a month in the past. Multiple logistic regression analysis was used to assess the association between adult psychological trauma variables (loss of custody of youngest child and lived in streets prior to arrest) and regular crack use in three sequential models. After adjusting for social support, coping behavior, demographics, and criminal history variables, women who had lost custody of their youngest child were 3.3 times more likely to be regular crack uses. Women who demonstrated more negative coping behavior and perceived themselves as having less emotional support were also more likely to be regular crack users. The association between childhood traumas (i.e., childhood sexual abuse, childhood physical abuse, parental alcohol abuse) and regular crack use was also assessed using multiple logistic regression; however, no significant associations were found between these childhood psychological traumas and regular crack use in both the unadjusted and adjusted models. Study findings underscore the importance of assessing environmental, interpersonal, and intrapersonal factors in tailoring treatment strategies for users of crack and other drugs.

This study identified predictors of reported sexual risk reduction among 109 female injection drug users enrolled in methadone clinics. Univariate analyses were used to examine the individual effects of each variable on the outcome of sexual behavior change over the past 6 months. Multiple logistic regression was then used to identify which of these variables were independently associated with such a change. Women with more than one sexual partner were more likely than women with one or no sexual partner to report changing their sexual behavior. African-American women were less likely than White Anglo or Latina women to report changing their sexual behavior. Women who held stronger beliefs that luck plays the largest role in getting AIDS were less likely to report changing their sexual behavior. Change in sexual behavior was associated with feeling comfortable asking partners to use condoms, higher depression scores, and loss of friends or family to AIDS. The observed relationship between personal susceptibility and depression suggests that risk reduction interventions should also address the depressive symptomatology associated with feelings of vulnerability.

In recent years many groups have become interested in the potential cost savings and efficacy of outpatient treatment for chemical dependency. This study was originally conceived to answer questions of both patients and staff concerning graduation and attrition rates in an evening outpatient alcohol treatment program. Of particular interest were gender effects, rates of attrition across two progressive program levels, and whether alcohol-only users and self-initiated clients fared better in treatment than did polysubstance users and patients who were referred by others. Medical records were available for 103 of the 107 treated patients, and of these, 27 remained in the program until graduation. Women were more likely to graduate and remain in the program longer than men. Alcohol users were more likely to graduate than subjects with additional substance use disorders. Graduation rates did not differ significantly between contact initiators and noninitiators; however, the former dropped out of treatment more quickly. The study is an example of the potential use of data obtained from an existing agency data base.

Heterosexual contact with drug users is a major route of AIDS transmission. This study of 135 male and 109 female methadone maintenance patients described subjects' sexual behavior, preventive practices and attitudes toward safer sex; explored ethnic-racial differences in high risk sexual behavior and attitudes; and examined the relationship between attitudes toward safer sex and frequency of condom use for men and women. Reported condom use was low, and it correlated with attitudes toward safer sex. Men tended to report higher rates of sexual risk-taking, although women reported more frequent sex with IV drug users. Study findings have implications for developing intervention strategies to reduce risk behavior associated with HIV transmission.

The University of Wisconsin Medical School established an alternative Independent Study Program (ISP) in the basic medical sciences in 1972. This program enabled class size to be increased without increasing laboratory teaching space, provided better education for students with diverse educational backgrounds, permitted individual progress, and promoted independent study. When compared to the most receptive oriented regular curriculum students (RCR) and those most discovery oriented (RCD), the preferred learning style of self-selected ISP students was more discovery or self-directed. They retained that style after graduation, while RCD students frequently became less discovery oriented. The ISP group was older, had more females, and had more advanced degrees. Although they had lower undergraduate grade point averages, they did well on the Verbal, General Information, Problem-Solving, and Quantitative sections of the MCAT. They also did well scholastically in Medical School, scored well on the National Boards Medical Examination, had the same distribution of residencies, and obtained the same quality of residency placement for medicine, surgery, and pediatrics. They have been very supportive of the program and feel that it was valuable in developing their abilities for continued self education.

This article depicts the changing demographic portrait of social work education in the United States from 1974 through 2000 and considers the demographic shifts in the profession of social work. During this period, BSW and joint MSW-BSW programs increased from 150 to 404, MSW programs increased from 79 to 139, and social work doctoral programs increased from 29 to 67. BSW graduates increased by 24 percent to almost 12,000, MSW graduates grew by almost 90 percent to over 15,000, and doctoral graduates increased by 44 percent to only 229. From 1974 to 2000, people of color represented increasing proportions of social work graduates to almost 30 percent of BSW graduates, 26 percent of MSW graduates, and 19 percent of social work PhD graduates. By 2000, the proportion of women earning social work degrees had grown to 88 percent at the BSW, 85 percent at the MSW, and 73 percent at the PhD levels, and women accounted for almost two-thirds of social work faculty. The most dynamic trends within the composition of the profession are the substantial increases in the proportion of women faculty, and among MSW graduates, a decrease in the proportion of men from 43 percent in 1960 to 15 percent in 2000. Findings suggest that issues of racial, ethnic, and gender representation in particular merit discussion within the profession.

Because anemic persons have lower cholesterol and whole blood viscosity than those who are not anemic, we hypothesized that subjects with hereditary spherocytosis who have not had the spleen removed should have fewer arteriosclerotic events than unaffected family members. We defined arteriosclerotic events as myocardial infarct, stroke, coronary artery surgery, and carotid artery surgery. We compared the rate of these events in affected-not splenectomized persons to the rate in unaffected family members. The relative risk of an arteriosclerotic event in hereditary spherocytosis patients with a spleen was one fifth that in unaffected family members. These data support the hypothesis that chronic anemia retards the development of arteriosclerosis. Spherocytosis is another example of an inherited condition that conveys an advantage in one system and a disadvantage in another.

This study examined the relationship between substance abuse treatment use, health services use, HIV status, and emergency room/hospital use for 507 injection drug users (IDUs). Logistic regression models showed that mental health status, severity of drug use and private health insurance were significantly associated with having used emergency room/hospital services in the past six months. History of substance abuse treatment use, positive HIV/AIDS diagnosis, mental health service use, ethnic/racial background, gender, age, education and homelessness were not significant at either the bivariate or the multivariate level. These results point to the need to improve mental health screening and referrals through emergency room medical systems. (Am J Addict 2005;14:268–280)

This article examines patterns of methadone maintenance treatment entry among 9018 adult women injection drug users (IDUs), with special attention to parental-status differences. The data originate from a statewide drug-treatment database covering all women IDUs who entered drug treatment in the State of Massachusetts over a four-year period. Through the use of logistic regression analysis, the study found that among these women IDUs, those who resided with their children were significantly more likely to enter methadone maintenance than women who were mothers but did not reside with their children. Mothers residing with their children were 73% more likely to enter methadone maintenance than mothers who do not reside with their children. The authors discuss specific programmatic and policy implications including the need to determine whether methadone maintenance should be promoted as an alternative drug treatment option in order to preserve family unification or promote family reunification.

A woman’s drug and alcohol use has been found to increase her risk of experiencing intimate partner violence (IPV). Objective The study describes the rates of lifetime and current IPV among women awaiting care in an emergency department and explores the association between IPV and having a drug abuse problem, and IPV and having an alcohol abuse problem, after controlling for demographic factors and history of childhood victimization. Methods Face-to-face interviews were conducted with 143 low-level triaged women recruited from an inner-city emergency department. Results Nearly one-half reported ever experiencing IPV, and over 18% reported IPV during the year before the interview. A higher proportion of abused women reported a history of regular crack, cocaine, or heroin use and visiting shooting galleries or crack houses. Participants who were physically abused by their partner during the past year (15%, n = 21) were more likely than nonabused women (85%, n = 122) to report higher scores on the Alcohol Use Disorders Identification Test (AUDIT) (4.9 vs. 2.4), a measure of alcohol-related problems, and the Drug Abuse Severity Test (DAST) (3.0 vs. 1.3), a measure of drug-related problems. Sexually abused women (6%, n = 9) were more likely than their counterparts (94%, n = 134) to have significantly higher AUDIT scores (6.4 vs. 2.5). The findings have implications for how the intersecting public health problems of IPV and substance abuse should be taken into consideration in research and patient care protocols in emergency departments.

Urine screening is a potentially useful tool for detecting drugs of abuse in treatment, criminal justice, and other human service settings. This article examines the relative accuracy and other features of three drug screening assays sold by commercial laboratories: (1) Abbott Diagnostics ADx machine and reagents; (2) ONTRAK, manufactured by Roche Diagnostics; and (3) EZ-SCREEN, manufactured by Environmental Diagnostics. Urine samples (n=345) were collected from indigent men and women in a work and life skills program, and tested for cocaine and opiates with each of the kits. The ADx fluorescent immunoassay was presumed to be the most sensitive and specific screening method, and comparisons with the two visually-determined test kits supported this assumption. Of the two visual test kits, ONTRAK was the more specific assay, and was lower in cost and simplest to perform. Decision makers could employ similar evaluative methods in selecting drug testing materials.

This study expands upon coupon distribution strategies used to measure male condom acquisition in HIV/AIDS prevention by incorporating both female and male condoms and examining factors related to coupon redemption among urban STD clinic patients.In this study, condom coupon redemption (CR) rates were examined for male and female condoms. The study also explored the relationship between demographic and sexual behavior characteristics and CR and describes male and female participants requesting female condoms. The participants of this study were 100 patients, 55 male and 45 female, recruited from STD clinics by means of posted advertisements. Logistic regression analysis was used to explore the association between sexual risk factors, unprotected sexual intercourse, recent multiple sexual partners, STDs, and CR. Demographic screening revealed that 39% of the 100 participants redeemed coupons and females were more likely to redeem coupons than males. No association was found between sexual risk behavior and CR. Redeemers were slightly less sexually active than nonredeemers. Among coupon redeemers, 65% of women and 44% of men reported that they used the female condom at least once and 64% said that the device was easy to insert. Non-Latino women were the predominant users of female condoms, and more Latino men requested female condoms. This study found that there was no association between sexual risk behaviors and CR. CR, incorporating both condom types, would then provide a stronger measure of consumer preference of one type over the other.

The correlates of high-risk women's intentions to use the female condom were investigated in a descriptive study involving 148 sexually active women from 3 US methadone clinics. 51% of women were Latina and 38% were African-American; the mean age was 39 years. Male condoms, douching, sterilization, and withdrawal were the most frequently used contraceptive methods in the 90 days preceding the study. 56% had heard of the female condom, but only 6% had used it. Of the 139 women who had never used the female condom, 32% indicated they intended to use it in the future. Such intention was significantly, positively correlated with age under 39 years, African-American ethnicity, and the belief the female condom offers users a sense of personal control over their sexuality. Those who intended to use the female condom were more likely to have previously used male condoms, believe their partners would be supportive of the device, think female condom use could be erotic and fun, feel confident in their ability to negotiate safer sex, and to welcome an additional option for practicing safer sex. They were also less likely than their counterparts, who did not intend to use a female condom, to believe use of this method would imply they had a sexually transmitted disease or were too eager to have sex. Compared with women who did not intend to use the female condom, those who did were more likely to discuss the device with at least 1 member of their social network. These findings confirm the necessity of considering gender relations and social networks in the design of female condom promotion strategies.

Despite a slowing of the rates of human immunodeficiency virus (HIV) infection among intravenous drug users, this group remains at high risk for contracting acquired immune deficiency syndrome (AIDS). Promising reports of safer drug use patterns among addicts notwithstanding (Coleman, Lodico, Evans, & DiClemente, 1992; Sorensen, Batki, Coates, & Gibson, 1988; Watters et al., 1988), untreated drug users continue to share needles (Neaigus et al., 1992; Ortiz et al., 1992; Robles, Matos, Cancel, & Colon, 1992). Moreover, there is as yet little evidence of sustained safer sexual practices among drug users and their partners (Abdul-Quader et al., 1992; El-Bassel et al., 1992). In an ongoing series of studies, the authors are testing a small-group skills-training approach to reducing HIV-risk behavior among methadone patients. Earlier reports of these investigations have described the study methodology and preliminary outcomes (El-Bassel & Schilling, 1992; Schilling, El-Bassel, Schinke, Gordon, & Nichols, 1991). This article describes the conceptual components and strategies of a skills-building intervention model consisting of 13 weekly sessions followed by six monthly booster sessions. Social workers, many trained in group work and cognitive-behavioral approaches, would be positioned to initiate, and possibly carry out, such groups in chemical dependency treatment settings. Methadone Maintenance Methadone maintenance has been shown to be an effective approach to treating large numbers of heroin addicts, thereby reducing the risk of HIV infection associated with the sharing of intravenous drug paraphernalia (Ball & Ross, 1991; Murphy & Rosenbaum, 1988; Sorensen et al., 1988). Paradoxically, studies in the past several years have at once revealed both the protective effects and critical shortcomings of methadone maintenance treatment programs (MMTPs). Opiate relapse, alcohol and cocaine use, program attrition, and sexual risk-taking all present serious challenges to such programs (Obuchowsky & Zweben, 1987; Roszell, Calsyn, & Chaney, 1986; Schilling, El-Bassel, Gilbert, & Schinke, 1991). These challenges underscore the need for enhancing the nonpharmacological services of methadone clinics (Rounsaville & Kleber, 1985; Sorensen, 1991; Weddington, 1991). Most methadone patients receive medication several times per week. Their attendance is usually predictable. Counseling services would seem to be a natural extension of MMTP programs, and indeed federal regulations require programs to provide supportive services along with medication. Unfortunately, MMTPs have always had limited counseling components, and resources for supportive programs, including social work services, have eroded in recent years (Ball & Corty, 1988; Hubbard et al., 1989). Even if AIDS were not a consideration, MMTPs might benefit from sociobehavioral interventions that help clients to anticipate relapse, avoid high-risk situations, and recover from temporary lapses (Stark, 1989; Weddington, 1991). The AIDS crisis brings the need for MMTP program enhancements to the foreground. In response to this need, we developed and tested a set of theoretically and empirically derived intervention strategies designed to reduce drug use and high-risk sexual behavior among MMTP patients. Theoretical and Empirical Foundations of Training The underpinnings of the intervention are drawn from social learning theory (Bandura, 1977), health behavior models (Bandura, 1977; Cronkite & Moos, 1984; Wesson, Havassy, & Smith, 1986), theories of expectancy (Christiansen & Goldman, 1983; Marlatt & Roshenow, 1980) and self-efficacy (Baer, Holt, & Lichtenstein, 1986; Bandura, 1977; Donovan & Chaney, 1985; Heather, Rollnick, & Winton, 1983), relapse prevention (Marlatt & Gordon, 1985; Nurco, Stephenson, & Hanlon, 1991; Wesson et al., 1986), problem solving (Larson & Heppner, 1989; Nezu & D'Zurilla, 1981; Platt, Taube, Metzger, & Duome, 1988), skills training (Hawkins, Catalano, Gilmore, & Wells, 1989; Zackon, McAuliffe, & Ch'ien, 1985), self-regulation (Rehm & Rokke, 1988), social support (Fraser & Hawkins, 1984; Wesson et al. …

This study examines the predictors of alcoholism among 201 patients from three methadone maintenance treatment programs (MMTPs) in New York City. Using the Michigan Alcohol Screening Test, one-fifth of the sample met criteria for alcohol dependence. Few subjects were currently enrolled in any form of chemical dependency treatment other than MMTP. Alcoholics started to use alcohol at an early age, and almost every alcoholic subject admitted to alcohol abuse before entering MMTPs. More alcoholics than nonalcoholics reported symptoms of somatization, obsessive-compulsive behavior, depression, phobic anxiety, and psychosis. Logistic regression indicated that alcoholism among MMTP patients was associated with years drinking, years of sharing needles, utilization of drug abuse detoxification but not alcohol detoxification, smaller increases in methadone dosage over time, and psychiatric symptomatology. Findings are discussed in terms of their implications for designing more efficacious treatment approaches for dually addicted patients in MMTPs.

Untreated substance users remain beyond the reach of most acquired immune deficiency syndrome (AIDS) prevention efforts. In an effort to describe the risk behavior and attitudes of this population, the authors conducted interviews with 148 drug users in an urban soup kitchen. The study focused on subjects' risk-taking and risk-reduction behavior related to injection drug use, perceived changes in risk behavior, perceived risk for contracting AIDS, and socioeconomic and attitudinal correlates of injecting and sharing needles. Study findings underscore the need for community-based AIDS prevention strategies to intervene with high-risk populations beyond the reach of drug treatment and AIDS prevention programs.

Purpose 1) To determine if there are significant differences in laboratory parameters and patient characteristics between patients with low erythrocyte (RBC) folate levels and those with normal RBC folate levels; 2) to determine the correlation between serum and RBC folate levels; 3) to determine if the RBC folate level changed the diagnosis, treatment, and outcome of these patients if the serum folate level was available. Patients and methods The study is a retrospective review of all inpatients and outpatients at a public teaching hospital who had an RBC folate level less than or equal to 175 ng/ml (N = 57) over the study period (69 months) and a blindly selected group of patients with RBC folate levels greater than 175 ng/ml (N = 53) during the same period. Results Patients with low RBC folate levels had higher mean corpuscular volume (MCV) and red cell distribution width (RDW) values and lower serum folate and B12 values than patients with normal RBC folate levels, but there was no difference in degree of anemia, presence of oval macrocytes and/or hypersegmented neutrophils on the peripheral blood smear, LDH, alcohol use, diet, or any other measured clinical parameter. Serum and RBC folate levels were highly correlated and a low RBC folate affected the clinical outcome of three patients (5% of the low RBC folate group). Conclusions Based upon these retrospective data and a review of the literature, we cannot define significant differences between patients with low RBC folate and randomly selected patients with normal RBC folate that could not have been equally well defined using serum folate values. The sensitivity and specificity of a low RBC folate level in the diagnosis of ill or healthy individuals are undefined, and until prospective studies utilizing some of the newer, more specific biochemical indicators of tissue folate are completed, the interpretation of low RBC folate levels will remain problematic.

The AIDS crisis, the increase in other sexually transmitted diseases (STDs), and the continuing problem of unwanted pregnancies, necessitate new methods of barrier protection. In 1988, Wisconsin Pharmacal began testing the safety and efficacy of a new female condom (Reality), a disposable, prelubricated, polyurethane device that is both a contraceptive and a barrier against STDs. The product requires no professional fitting and is inserted by the woman. Preliminary data from clinical and laboratory studies indicate that the female condom may be an effective barrier against STDs. A widespread use of the female condom, however, will depend on women's and men's initial attitudes, including culturally determined barriers to acceptance.

This paper reports an outcome study of coping skills intervention to help adolescents manage stress associated with the transition from elementary school to junior high. In a randomized design, sixth grade students from four elementary schools were pretested, then two schools each were assigned to an intervention condition and to a control condition. Intervention condition subjects received eight sessions of instruction and practice in coping skills intervention. Following intervention, all subjects were posttested. At posttest and relative to control condition subjects, intervention condition subjects scored more positively on measures of problem solving, assertive direct refusals, adequacy of information about junior high school, ability to handle stress, ability to deal with peer pressure, and general readiness for junior high school.

School health educators have devoted much attention to cigarette smoking. Recent years have seen the testing of interventions to prevent smoking. To date, controlled studies have not evaluated the added value of skills methods for preventing smoking. This article describes such an evaluation with sixth-grade students from two schools. Subjects were pretested and randomly assigned to receive conventional health education methods or to receive skills intervention. Both conditions included films, peer testimonials, discussions, and homework. Health education condition subjects additionally participated in oral quizzes, games, and debates. Skills condition subjects additionally learned problem-solving, self-instruction, and interpersonal communication methods. At postintervention, skills condition subjects, more than health education condition subjects, had better scores on measures of smoking-related knowledge, attitudes, and intentions. In addition, reported cigarette use, validated by biochemical data collection, was lower in the skills condition than in the health education condition at all postintervention measurements, including a 24-month follow-up. The article discusses the strengths, limits, and implications of the study for other smoking prevention efforts in schools.

This study evaluated cigarette smoking prevention methods with a sample of adolescent females and males. Arranged by school, 331 informed and consenting sixth graders were randomly divided into four groups: 1) pretest, skills-building methods, posttest; 2) pretest, discussion methods, posttest; 3) pretest and posttest; and 4) posttest only. All subjects were followed for 6 and 15 months after the posttest. Outcome results on measures of non-smoking intentions, attitudes, predictions, problem-solving abilities, and peer interactions favored subjects in the skills-building group when compared with subjects in the discussion and pretest-posttest control groups. Smoking rates at posttest and at both follow-ups were lower in the skills-building group than in the other three groups. Results from posttest-only subjects did not support pretest reactivity. The study's strengths and limits are discussed along with directions for future smoking prevention research.

This paper considers coping styles of mothers and fathers of handicapped children. Cautioning against stereotyping, the authors find that mothers and fathers differ in how they appraise and cope with the stress of rearing a developmentally disabled child. The need for systematic investigation of gender-related coping styles in families with handicapped children is discussed.

This study examined snuff and chewing tobacco use among Alaska Native and American Indian adolescents. Results show frequent and early use of smokeless tobacco products. Almost one fifth of all females and close to one half of all males had used snuff or chewing tobacco on more than 20 occasions. Weekly smokeless tobacco use was reported by 34% of all females and by 42.6% of all males. By product type, 32.6% of all subjects had used snuff and 27.8% had chewed tobacco in the past week. Among females, over one half of all subjects had used snuff or chewing tobacco before age 10 years. Among males, nearly one half of the subjects first used smokeless tobacco prior to 8 years of age. Few subjects had used cigarettes or other smoked tobacco products.

In a retrospective search for prognostic factors in 127 patients with chronic myelocytic leukemia we found that thrombocytopenic patients had a significantly shortened life-span. Patients with the Philadelphia chromosome lived longer and were significantly younger than those lacking it. Females lived longer than males. Numerous other single features failed to correlate significantly with survival, but several combinations of two did. Patients having a low hematocrit with a low white blood count had an impressively short life-span compared to all others. Those having a high cholesterol and a low uric acid survived significantly longer than all others.

OBJECTIVES: This study examines the relationship between sex trading and psychological distress and the implications of that relationship for prevention of human immunodeficiency virus among a sample of young women recruited from the streets of Harlem. METHODS: Interviews were conducted with 346 predominantly drug-using women, aged 18 to 29 years, of whom 176 had exchanged sex for money or drugs in the previous 30 days and were categorized as "sex traders." Psychological distress was measured by using the Brief Symptom Inventory. RESULTS: Sex traders scored significantly higher than non-sex traders on the General Severity Index and on eight of the nine subscales of the Brief Symptom Inventory. Multivariate analysis indicated that after adjustments were made for age; ethnicity; pregnancy; recent rape; perceived risk for acquired immunodeficiency syndrome; current, regular crack use; and current, regular alcohol use, sex traders scored 0.240 units higher on the General Severity Index than non-sex traders. CONCLUSIONS: Poor mental health and drug dependence may under-mine the motivation and ability of these sex traders to adopt safer sex behavior. Therefore, interventions need to be integrated with mental health services and drug treatment to reduce risk behavior in this population.

To the Editor.— Recent reports inJAMAand elsewhere are giving needed attention to the dangers and prevalence of smokeless tobacco use.1-3Perhaps most disquieting are patterns of snuff and chewing tobacco use among American adolescents.4Those who begin using smokeless tobacco early in life not only are at risk for tissue damage from snuff and chewing tobacco products but also may later meet their nicotine dependence through cigarettes and other smoked tobacco products. As such, we have become interested in the use of smokeless tobacco among a US adolescent population with early and extreme patterns of smokeless tobacco use— Native American adolescents. Presented here are data on snuff and chewing tobacco use reported by 168 Native American adolescents from Alaska and Washington state. The 77 females and 91 males, who had a mean age of 11.8 years, primarily resided on or near Indian reservations and Native villages.