Search

HIV-infected women with excessive alcohol consumption are at risk for adverse health outcomes, but little is known about their long-term drinking trajectories. This analysis included longitudinal data, obtained from 1996 to 2006, from 2,791 women with HIV from the Women's Interagency HIV Study. Among these women, the proportion in each of five distinct drinking trajectories was: continued heavy drinking (3 %), reduction from heavy to non-heavy drinking (4 %), increase from non-heavy to heavy drinking (8 %), continued non-heavy drinking (36 %), and continued non-drinking (49 %). Depressive symptoms, other substance use (crack/cocaine, marijuana, and tobacco), co-infection with hepatitis C virus (HCV), and heavy drinking prior to enrollment were associated with trajectories involving future heavy drinking. In conclusion, many women with HIV change their drinking patterns over time. Clinicians and those providing alcohol-related interventions might target those with depression, current use of tobacco or illicit drugs, HCV infection, or a previous history of drinking problems.

We evaluated pain frequency and severity in 339 women enrolled in the Women's Interagency HW Study (WIHS). Among these, 63% were 39 years of age or younger, 17% were white, 54% African American, and 29% Hispanic; 32% did not complete high school; 58% had a CD4 less than 200; 65% had clinical AIDS; 60% were on highly active antiretroviral therapy (HAART); and 32% had a viral load of 50,000 or more. Data were collected between 1996 and 1998. Within the past 6 months 190 (56%) women experienced pain 6 or more days and 168 (50%) women indicated pain severity scores of 4 or 5 (5-point scale). Pain frequency and pain severity were not associated with age, education, ethnicity, current therapy, or location of the WIHS site. Pain frequency and severity were related to lower CD4 count, higher depression, with a history and longer duration of smoking and use of marijuana. Severity was associated with a history of crack/cocaine or heroin use or with injection drug use as the transmission category. In the multivariate models, pain severity was related to CD4 count and depression and to current tobacco use but not to crack, cocaine, heroin, or marijuana use. Pain frequency was related to depression and to former tobacco, crack, cocaine, heroin, or marijuana use but not to current use. The long-term effects of tobacco use may be to increase pain experience but women may also smoke tobacco or use other substances to give mild pain relief. Pain is frequent and often severe among women with HIV requiring medical management.

Objectives. We used longitudinal data to examine the roles of 4 dimensions of patient satisfaction as both predictors and outcomes of use of highly active antiretroviral therapy (HAART) among women in the United States with HIV/AIDS. Methods. Generalized estimating equations were used to analyze time-lagged satisfaction-HAART relationships over 8 years in the Women's Interagency HIV Study. Results. Multivariate models showed that, over time, HAART use was associated with higher patient satisfaction with care in general, with providers, and with access/convenience of care; however, patient satisfaction was not associated with subsequent HAART use. Symptoms of depression and poor health-related quality of life were associated with less satisfaction with care on all 4 dimensions assessed, whereas African American race/ethnicity, illegal drug use, and fewer primary care visits were associated with less HAART use. Conclusions. Our findings suggest that dissatisfaction with care is not a reason for underuse of HAART among women with HIV and that providers should not be discouraged from recommending HAART to dissatisfied patients. Rather, increasing women's access to primary care could result in both increased HAART use and greater patient satisfaction. doi: 10.2105/AJPH.2005.061929)

Background: The evidence that drug treatment programs are associated with changes in sexual behavior and, thus, have prevention benefits beyond addiction is inconclusive. We examined whether entry into drug treatment was associated with subsequent alterations in sexual behavior among a group of drug-using women. Methods: Data were collected semiannually via structured interviews over 8 years. Generalized estimating equations evaluated the relationship between self-reported drug treatment at each visit and sexual abstinence and consistent condom use in the subsequent 6-montb period. Results: In this sample (N = 1,658; mean age, 37.3 years; 57.5% African American; 80.3% HIV positive; 49.6% crack/cocaine users), 40% reported being in a variety of drug treatment programs. Those undergoing drug treatment (vs. those not) were less likely to become sexually active (adjusted odds ratio [AOR], 0.83; 95% confidence interval [CI], 0.76-0.91); this association was unchanged when the frequency of attendance and number of different drug treatment programs were evaluated. Drug treatment was not associated with subsequent consistent condom, regardless of frequency of attendance, but involvement in at least three treatment programs was (AOR, 1.40; 95% CI, 1.00 1.97). Conclusions: Additional efforts are needed to integrate effective sexual risk reduction programs into drag treatment settings; expanding access to different types of drug treatment modalities may be indicated. Keywords: Human immunodeficiency virus; Substance use; Drug abuse treatment: Sexual activity; Condom use; Abstinence; Women

A study is conducted to view the importance of intervention provided to the patients focusing on antiretroviral therapy (ART) adherence or safer sex. The study suggests that a brief ART adherence intervention delivered by primary care providers each time they saw patients might help their patients to maintain high levels of ART adherence.

The relationship between unprotected anal or vaginal sex (UAV) and active antiretroviral therapy (ART) use and adherence in a cross-sectional survey conducted in 874 sexually active patients at 6 public HIV clinics is examined in California. These relationships persisted in most stratified analysis for both ART use and adherence but in multivariate analysis only for ART use.

The distribution of unprotected anal and vaginal sex (UAV) and nondisclosure (ND) among categories of HIV-positive men and women based on relationship factors are examined. It is found that the number of sex partners, type of relationship, and perceived HIV serostatus of a partner influence sexual behaviors and may be an efficient and effective basis for tailoring prevention messages.

Objectives. We examined associations between depressive symptoms and AIDS-related mortality after controlling for antiretroviral therapy use, mental health treatment, medication adherence, substance abuse, clinical indicators, and demographic factors. Methods. One thousand seven hundred sixteen HIV seropositive women completed semiannual visits from 1994 through 2001 to clinics at 6 sites. Multivariate Cox and logistic regression analyses estimated time to AIDS-related death and depressive symptom severity. Results. After we controlled for all other factors, AIDS-related deaths were more likely among women with chronic depressive; symptoms, and symptoms were more severe among women in the terminal phase of their illness. Mental health service use was associated with reduced mortality. Conclusions. Treatment for depression is a critically important component of comprehensive care for HIV-seropositive women, especially those with end stage disease.

The current study sought to identify classes of growth trajectories of adolescent alcohol use and to examine the predictors and outcomes associated with the classes. Alcohol use was assessed from Grades 7 to 12 in a school-based sample. Latent growth mixture modeling was used, and results indicated 5 discrete longitudinal drinking patterns. The 2 most common drinking patterns included occasional very light drinking from Grades 7 to 12 and moderate escalation in both quantity and frequency of alcohol use. One group drank infrequently but at high levels throughout the study period. Another group exhibited rapid escalation in both quantity and frequency. The final group started at high levels of frequency and quantity in Grade 7 and showed rapid de-escalation in frequency. Emotional distress and risk taking distinguished the classes, and all classes, particularly rapid escalators, showed elevated levels of alcohol-related problems relative to occasional very light drinkers.

Objectives. This study identified behavioral and psychosocial/interpersonal factors in young adolescence that are associated with handgun carrying in later adolescence. Methods. A sample of 2200 high school students was surveyed at 9th grade and again at 12th grade. Results. Multivariate logistic regression analyses indicated that measures of risk-taking preference, depression, stress, temper, and drug use assessed while the students were in 9th grade were predictive of handgun carrying in 12th grade for both male and female students. Conclusions. These findings suggest the need for a comprehensive approach to prevention that focuses on both individual and interpersonal factors associated with adolescents' decision to carry a handgun. (Am J Public Health. 1998;88:960-963)

It is estimated that from 2 to 6 million children under the age of 13 have no after-school adult supervision, so they essentially care for themselves. The majority of these children are adolescents. In a survey of almost 4,000 ninth-graders, a relationship was noted between unsupervised after-school care and an increased incidence of cigarette, alcohol and marijuana use, depression, risk-taking and poorer school performance. Problem behavior occurred less among those who were supervised at home than among those who were unsupervised, but it increased among adolescents at a neighbor's home, at school or on the a job. Those who "hung out" were especially likely to exhibit problem behavior. Girls who were supervised were less likely to engage in problem behavior than boys, but removal of supervision led to behavior problems for them as well., Objective. To examine the relationship between parental monitoring and six negative behaviors: cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Design. Survey of 3993 ninth-grade students in six school districts in southern California. Subjects. The sample consisted of 1930 boys and 2063 girls, self-classified as non-Hispanic white (32%), African-American (13%), Hispanic (46%), or Asian (9%). Results. A relationship was found between unsupervised care after school and susceptibility to cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Adolescents who were unsupervised at home were slightly more likely to engage in problem behavior than those who were supervised at home. Adolescents at a neighbor's house, at school, or at a job and especially those who -hang out- were most likely to engage in problem behavior. Risk was higher if the parent had an unengaged parenting style. Although girls were less likely than boys to engage in problem behavior when supervised, as supervision decreased they were significantly more likely to have each of these problems. Family structure had little impact on risk. Conclusions. Self-care, especially when it occurs outside of the home, is associated with substance use, risk taking, depressed mood, and lower academic grades. Pediatrics 1993;92:32-38; after-school care, alcohol, marijuana, smoking, cigarettes, depression, risk-taking behavior, academic performance, adolescence.

The relationship between social environmental variables and psychological, physical, and speech dysfunction after laryngectomy surgery was examined. The relationships between these categories of dysfunction and the following three social environmental factors were examined: (1) acceptance and emotional support from family and friends; (2) disease-specific support from peers who have had the same surgical intervention and from professionals; and (3) socioeconomic status (SES). Data were collected from 60 total laryngectomy patients and average of 24.3 months after surgery. the type of support provided was different for each source of support, family-friend or peer-professional. Interpersonal support from family and friends was strongly associated with psychosocial and physical dysfunction but had a weaker association with speech adjustment. Diseases-specific support from speech therapists and other laryngectomees was a weaker predictor of dysfunction but a stronger predictor of communication adaptation. SES was not predictive of dysfunction or communication adaptation. Thus different sources of social support can make specific contributions to minimizing physical and psychosocial dysfunction and acquiring skills to overcome the limitations imposed by the surgery.

Increasing numbers of children are caring for themselves after school because no adult supervision is available. This trend is a result of the growing number of single-parent families and families where both parents work. Approximately two to six million children under the age of 13 regularly care for themselves and are often referred to as 'latchkey children'. Various studies have investigated the effects of this pattern; while academic performance and self-esteem did not differ between latchkey children and controls, some latchkey children were more depressed and fearful than children who had adult supervision. This study surveyed 4,932 eighth-graders on substance use which was compared with time these children were home alone. Self-care was a significant risk factor for drinking alcohol and smoking cigarettes and marijuana. The students without supervision for 11 or more hours a week had twice the risk of substance use when compared with children who never took care of themselves. This association was not altered by socioeconomic status, stress, or extracurricular activities. Risk-taking and having friends who were smokers are factors that might explain the relationship between self-care and substance use in these children. Eighth graders who chose friends who smoked and who sought situations in which they would be offered cigarettes may have been motivated by a desire to express feelings of independence and maturity. (Consumer Summary produced by Reliance Medical Information, Inc.)