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Biomedical subjects

Grace L Reynolds

Publications and source records attributed to Grace L Reynolds.

12 recordsLinked to original sources
PubMed2007

Reliability and criterion-related validity of self-report of syphilis.

OBJECTIVE: To determine the test-retest reliability, sensitivity and specificity, and criterion-related validity of the Risk Behavior Assessment (RBA) syphilis questions. The RBA is a standardized instrument that has been used in several studies of STDs in drug users. METHODS: For the test-retest reliability study, 219 injection drug users completed the RBA twice within a 48-hour period. To determine criterion-related validity, 207 individuals, who also completed the RBA, were tested with the rapid plasma reagin test (RPR), and 206 individuals were also tested with the Serodia Treponema pallidum particle agglutination test (TP-PA). RESULTS: The test-retest reliability for the question "How many times have you been told by a doctor or a nurse that you had syphilis?" was 0.78. The test-retest reliability for the question "In what year were you last treated for syphilis?" was 0.89. For the comparison of self-report with the RPR test, the sensitivity of self-report was 46.2% and the specificity was 95.7%. For the comparison of self-report with the TP-PA test, the sensitivity of self-report was 37% and the specificity was 97.7%. CONCLUSIONS: Self-reports of syphilis infection history were found to have good reliability, excellent specificity, and moderate sensitivity. These characteristics need to be taken into account in any study using these self-report items.

Adult↗
PubMed2006

Internet access and use among homeless and indigent drug users in Long Beach, California.

There has been a growing interest in using the Internet to access a variety of populations for prevention education and health care. It is not clear that this is viable for homeless and other marginalized populations. The purpose of this study was to describe Internet access and use among a sample of homeless and indigent drug users. A brief questionnaire was developed to assess computer ownership, use, email, and Internet access and use. Participants were recruited through a community-based human immunodeficiency virus (HIV) prevention program. 265 participants completed the questionnaire. While 55% had ever used a computer in their lifetime, only 25% had ever owned a computer, 24% had ever had their own email account, 33% had access to a working computer in the last 30 days, 10% had sent or received email in the last 30 days, and 19% had surfed or accessed information on the Internet in the last 30 days. Logistic regression predicting lifetime use of a computer showed predictive factors of having completed high school (Odds Ratio [OR] = 4.5; 95% Confidence Interval [CI] = 2.41, 8.38) and number of days used amphetamines in the last 30 days, per 5 days of use (OR = 1.64; 95% CI = 1.18, 2.27). Inversely related were age, per 5 years of age (OR = 0.78; 95% CI = 0.65, 0.93) and number of days used marijuana in the last 30 days, per 5 days of use (OR = 0.97; 95% CI = 0.76, 0.99). Very low access and usage suggest that Internet-based public health education models be reexamined for this population. The association with amphetamine use may indicate a facilitating effect of amphetamine by heightening awareness and increasing wakefulness.

Access to Information↗
PubMed2006

Follow-up for medical care among drug users with hepatitis C.

Prevalence of hepatitis C (HCV) in injection drug users (IDUs) is high and once HCV has been detected, follow-up medical care is essential. Six hundred and one current and former IDUs who tested positive for HCV antibodies received referrals for medical care. Twenty-four percent (147) of participants returned to be interviewed regarding their medical follow-ups. Of these, only 42% (61) had sought additional medical care in the form of further liver or blood tests or liver ultrasound. Four variables predicted seeking medical care: (a) ever being in residential drug treatment, (b) ever trading sex for money, (c) self-reported homelessness, and (d) living in one's own apartment or house. Having income from a job was inversely associated with seeking medical care. Knowledge of HCV infection alone does not mean that IDUs will seek medical care. Additional education concerning medical care and treatment options are needed to address IDU needs.

Adult↗
PubMed2006

Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California.

This study examined the prevalence of hepatitis A (HAV), B (HBV), C (HCV), and Human Immunodeficiency Virus (HIV) co-infection among Injection Drug Users (IDUs) in Los Angeles County, California, and predictors of multiple infections in this population. Six hundred seventy-nine IDUs were recruited from October 2002 through June 2004. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were tested for hepatitis A, B, C and HIV.A linear regression model predicting the total number of infections (0 to 4 possible) was constructed. Significant associations were found between HAV and HBV infection, HAV and HCV infection, and HBV and HCV infection. Predictors of total co-infections included age of first injection, lifetime years in jail, and Hispanic ethnicity. Latinos had the highest proportion of HAV and HBV co-infection with HCV. The total number of co-infections, especially those co-infected with all three of the hepatitis infections, was unexpectedly high.

Adolescent↗
PubMed2006

Health services usage by Alaskan injection drug users.

OBJECTIVES: The purpose of this study was to explore health services usage among injection drug users in Anchorage, Alaska. DESIGN: 645 participants were recruited as part of a federally funded study of needle exchanges. They completed a health services usage questionnaire that elicited information on use of a health care provider (physician or nurse) and emergency room services. Chi-square and t-tests were used for the bivariate analyses, and multiple logistic regression was used to develop the final predictive models. RESULTS: The majority of respondents (n = 646) were male (77 percent). Race/ethnicity included 58 percent White, 22 percent Alaska Native, and 20 percent African American. The multivariate model predicting accessing a health care provider (HCP) included ever having had chlamydia (OR 2.7, CI 1.6, 4.5), current income from welfare or public assistance (OR 2.6, CI 1.7, 3.9), current income from disability (OR 5.0, CI 2.2, 11.4), current income from SSI (OR .30, CI .12, .77) and the number of days in the last 30 used opiates other than heroin (OR 1.04, CI 1.002, 1.078). The multivariate model predicting use of an emergency room (ER) was similar to that predicting use of an HCP, with the additional finding of a negative association between being African American and ER use. CONCLUSION: The role of public assistance benefits enabling access to health care for IDUs has policy implications. Large public programs, such as the Indian Health Service, paid for much of the health care received by the IDUs recruited as part of this study.

Adult↗
PubMed2006

Recreational Viagra Use and Sexual Risk among Drug Abusing Men.

Until recently, the Viagra connection to HIV was anchored in older adults. However, CDC investigation showed stability in 50+ HIV diagnoses on the heels of upward trends in risk indicators among men who have sex with men (MSM) and substance abusing populations. Signs have increasingly pointed to recreational drug use among younger populations, to which Viagra is being added to the mix. Currently, the field is still locating the substance abuse, sexual risk and age-related dimensions of Viagra misuse. Recent studies identify it primarily as substance abuse, but the majority reports a combination of risky sex and risky drug use. At the very least, Viagra appears related to the enhancement of sexual experience or performance, even when it is used to compensate for erectile dysfunction caused by other drugs-either illicit or prescribed (e.g., antidepressants and highly active antiretroviral therapy or HAART). The populations studied, however, frequently have limited the generalizability of findings. This report analyzes the relationship among Viagra, Club Drugs and HIV sexual risk behavior in drug using men with a sample diverse in sexual orientation and demographic scope. Participants were 640 males recruited from three HIV prevention programs in Los Angeles County. Mean age was 43.97 years, ranging from 18.7 to 70.3 with almost 25% over 50. Sexual orientation was 79% heterosexual, 8% bisexual and 12% gay. Racial composition was 45% white, 35% black and 19% Hispanic. NIDA's Risk Behavior Assessment and a Club Drug/Viagra addendum were used to collect socio-demographic, substance use and sexual risk data. Multiple logistic regression models were constructed along with chi-square tests of association and some t-tests. White race was a major risk factor. No age effect was found. MSM were more likely to use Viagra. Insertive anal sex was a significant co-factor among heterosexual Viagra users involved in transactional sex with women. In the overall sample and the subsets of heterosexual, MSM, younger and older men, predictive models all identified club or designer drugs as significant co-factors in the use of Viagra. Different patterns of drug co-factors were observed for each subset. We detected consistent positive associations between the use of Viagra and the use of amphetamines immediately before or during sex. Viagra use has moved into a new generational context and now complicates the sexual risk and intervention equations for all men, particularly MSM as well as more hidden subgroups.

Journal Article↗
PubMed2004

Nicotine dependence and HIV risk behaviors among illicit drug users.

This study was concerned with examining the relation between nicotine dependence and HIV risk behaviors in a sample of 297 out-of-treatment drug users. A number of significant relationships were found between nicotine dependence and HIV risk behaviors. Crack-smoking injectors were found to have a higher degree of nicotine dependence when compared with exclusive injectors or exclusive crack smokers. Participants' impulsivity may be one possible reason why nicotine dependence is related to HIV risk behaviors. The results also suggest that drug abuse programs make available smoking cessation programs.

Adolescent↗
PubMed2003

Use of emergency room services by out-of-treatment drug users in Long Beach, California.

The purpose of this study was to investigate the use of emergency room services among out-of-treatment drug users in Long Beach, CA. Primary data collection occurred between 1991-1996. The study setting was a community-based location through which out-of-treatment drug users were recruited using a standard research protocol. The original study randomized 1,728 participants into a standard or enhanced HIV prevention protocol. Data were collected longitudinally at two points in time, with 1,201 returning for follow-up interview. Standardized instruments were used at baseline and follow-up. Logistic regression and test-retest reliability were performed using the SAS System. Factors associated with emergency room use included income from public assistance sources, ever using other opiates, income less than 500 dollars in the last month, reporting White race/ethnicity, and HIV positive serostatus. Having income from public assistance programs is highly predictive of emergency room use in out-of-treatment drug users.

Adult↗
PubMed2002

Selection effect of needle exchange in Anchorage, Alaska.

Participation bias (selection bias) may be a problem in studies that attempt to evaluate the effects of needle-exchange programs (NEPs). The present study looked at only those injection drug users (IDUs) who were randomly placed in the needle-exchange condition in a two-arm randomized clinical trial of needle exchange. Time to follow-up between the experimental NEP condition (n = 296; median = 261 days) and pharmacy sales condition (n = 304; median = 256 days) was not statistically different [chi(2) (1, N = 600) = 0.42, P =.52]. Within the NEP condition, a similar analysis comparing time to follow-up between IDUs who used the NEP (n = 65; median = 199 days) and those who refrained from using the NEP (n = 231; median = 286 days) was highly significant, chi(2) (1, n = 296) = 17.3, P=.0001. The final logistic regression model predicting use of the NEP was the log 10 transformation of the number of times injected heroin in the last 30 days (odds ratio [OR ]=4.9, confidence interval [CI ]2.8, 8.9), ever injected amphetamine in the last 30 days (OR =4.9, CI 1.09, 22.5), and ever shared injection equipment in the last 30 days (OR =2.9, CI 1.5, 5.5). Within the NEP condition, follow-up rates differed between those who used the NEP and those who did not use it. Of drug users randomly assigned to an NEP, the ones who actually used the NEP had higher levels of drug use. Predictors of who used the NEP were consistent with the studies of Hagen et al. This study demonstrates that selection bias occurs among IDUs who use NEPs.

Alaska↗
PubMed2002

Needle and syringe cleaning practices among injection drug users.

Bleach-mediated disinfection (BMD) of needles and syringes (NS) has been advocated as a risk-reduction intervention against HIV among injection drug users (IDUs). The effect of needle exchange on the BMD practices of 176 NS-sharing IDUs was evaluated. IDUs were randomly assigned to either 1) Pharmacy Sales Condition, access to NS via legal sales of nonprescription NS; or 2) Needle Exchange Condition, with additional access to NS via an experimental needle exchange program. Repeated measures analysis revealed a main effect of time on BMD, no effect of assignment condition, and no time by assignment interaction. Logistic regression revealed IDUs who traded sex for money or drugs were less likely to practice BMD, and IDUs who reported a reduced number of sex partners were more likely to practice BMD. Future interventions should incorporate behavioral BMD components and address the concerns of those who trade sex for money or drugs.

Adolescent↗
PubMedDate not supplied

Using the quality of well-being scale to assess quality of life in out-of-treatment drug users.

The Quality of Well-Being Scale (QWB) was developed for use with diverse patient and general population samples. This study investigated its use with a sample of out-of-treatment drug users. The QWB was administered to 75 out-of-treatment drug users. A linear regression model was developed using the QWB score as the dependent variable and items from the Risk Behavior Assessment (RBA) as independent variables. The sample consisted of 18 women and 57 men. The mean QWB score was .703 (SD = .12, range .51 to 1.0). The final multivariate regression model included six variables: days used other opiates in the last 30, ever in outpatient drug free treatment, income in the past 30 days from welfare, the number of times gave sex for drugs in the past 30 days, ever being in prison/jail drug treatment, and the number of days in the last 30 used amphetamines. This model accounted for 85% of the variance in QWB scores. Different modalities of drug treatment appear to influence QWB scores in different ways. Outpatient drug free treatment was negatively associated with QWB score(s), while prison/jail drug treatment was positively associated with QWB scores.

Ambulatory Care↗