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Biomedical subjects

J C Anthony

Publications and source records attributed to J C Anthony.

At least 19 recordsLinked to original sources
PubMed1992

Prevalence of substance use among US physicians.

OBJECTIVE: To estimate the prevalence of substance use among US physicians. DESIGN: A mailed, anonymous, self-report survey that assessed use of 13 substances and permitted comparison with results of the National Household Survey on Drug Abuse. Rates of physician substance use were weighted to provide national prevalence estimates. PARTICIPANTS: A national sample of 9600 physicians, stratified by specialty and career stage, and randomly selected from the American Medical Association master file. The response rate after three mailings was 59%. Demographic characteristics of respondents closely reflected those of the US physician population. MAIN OUTCOME MEASURES: Subjects' self-reported use of 13 substances in their lifetime, the past year, and the past month; reasons for use; self-admitted substance abuse or dependence; and whether treatment was received. For controlled prescription substances, respondents were asked to report only use "not prescribed by another physician for a legitimate medical or psychiatric condition." RESULTS: Physicians were less likely to have used cigarettes and illicit substances, such as marijuana, cocaine, and heroin, in the past year than their age and gender counterparts in the National Household Survey on Drug Abuse. They were more likely to have used alcohol and two types of prescription medications--minor opiates and benzodiazepine tranquilizers. Prescription substances were used primarily for self-treatment, whereas illicit substances and alcohol were used primarily for recreation. Current daily use of illicit or controlled substances was rare. CONCLUSIONS: Although physicians were as likely to have experimented with illicit substances in their lifetime as their age and gender peers in society, they were far less likely to be current users of illicit substances. The higher prevalence of alcohol use among respondents may be more a characteristic of their socioeconomic class than of their profession. A unique concern for physicians, however, is their high rate of self-treatment with controlled medications--a practice that could increase their risk of drug abuse or dependence. Uniform national guidelines are needed to sensitize medical students and physicians to the dangers of self-treatment with controlled prescription substances.

Adult↗
PubMed1992

Psychopathology and attrition in the epidemiologic catchment area surveys.

This analysis shows the effect of sociodemographic variables and psychopathology on attrition in a 1-year follow-up of 10,167 household-residing respondents, aged 18-64 years, from four sites of the National Institute of Mental Health Epidemiologic Catchment Area Program. Attrition is defined in two ways: failure to locate (n = 1,035) and refusal to participate (n = 1,010). As compared with 8,122 respondents successfully interviewed after 1 year, those who are not located are more likely to be male, Hispanic, young, and unmarried. Refusers are older and more likely to be married and to have lower educational attainment than those successfully reinterviewed. After adjusting for sociodemographic variables, psychopathology had a small to moderate effect on attrition. Panic and depression were associated with failure to locate, but no diagnoses, or selected symptoms, were strongly or significantly associated with refusal to participate in the second wave.

Adolescent↗
PubMed1992

The risk of alcohol abuse and dependence in adulthood: the association with educational level.

In this analysis of prospectively gathered data, the authors sought to estimate the degree to which risk of alcohol abuse and dependence might be elevated among adults who attended but did not complete high school and among those who attended college without earning a degree. Study subjects were selected in 1980-1984 by taking probability samples of adult household residents at five sites of the Epidemiologic Catchment Area Program: New Haven, Connecticut; Baltimore, Maryland; St. Louis, Missouri; Durham-Piedmont, North Carolina; and Los Angeles, California. At baseline, participants completed standardized interviews that measured sociodemographic variables and assessed whether they had met diagnostic criteria for currently or formerly active alcohol abuse-dependence syndromes. The interviews were readministered 1 year later to identify incident cases among the 13,673 participants. After subjects were sorted into risk sets by age and residence census tract and after persons with a prior history of alcohol abuse or dependence were excluded, there were in 156 risk sets 160 incident cases and 526 subjects at risk for future occurrence of alcohol syndromes. Compared with adults who had earned a college degree, those who had attended high school without completion were at increased risk (relative risk (RR) = 6.23, 95 percent confidence interval (CI) 2.41-16.09) as were adults who had attended college without earning a degree (RR = 3.25, 95 percent CI 1.36-7.76). In contrast, risk of alcohol disorders among adults with a high school diploma but no college was not reliably greater than the level of risk for those with a college degree (RR = 1.88, 95 percent CI 0.79-4.47).

Adolescent↗
PubMed1992

Environmental risk factors for Alzheimer's disease: their relationship to age of onset and to familial or sporadic types.

Data from a case-control study of Alzheimer's disease (AD) were analysed in relation to age of onset and familial/sporadic status. The analyses were restricted to environmental exposures which might injure the brain. Later-onset AD was found to be positively associated with starvation/malnutrition and with nose-picking and negatively with analgesics, while earlier-onset was associated with physical underactivity and nervous breakdown more than 10 years before. Sporadic AD was associated with starvation/malnutrition and with head injury. These analyses merit replication in other large case-control studies of AD.

Age Factors↗
PubMed1992

Characteristics of intravenous drug users by history of arrest and treatment for drug use.

Typically, intravenous drug users are studied by drawing samples from drug treatment programs, from the criminal justice system, or by outreach into the street community via anthropological or ethnographic methods. Among 1405 subjects recruited through extensive community outreach, 46% reported no history of treatment for drug abuse and 16% said they had not been arrested in the preceding 10 years; 130 (9%) reported neither history. A history of arrest was higher among men and those with a history of: treatment for drug abuse, low educational attainment, having received public assistance, and unemployment. A history of drug treatment was higher among women and those of an older age with a history of: arrest, having received public assistance, and a greater duration and intensity of intravenous drug use. Intravenous drug users who had neither a history of arrest since 1977 nor of drug treatment were more likely to be women and more educated, to have not received public assistance, and to inject less than weekly. These data indicate that characteristics of intravenous drug users differ by history of arrest and treatment, substantiating reports of heterogeneity among intravenous drug users.

Black or African American↗
PubMed1992

Correlates of human immunodeficiency virus infection in intravenous drug users: are treatment-program samples misleading?

Using a community-based sample of 1632 intravenous drug users in Baltimore, Maryland, USA, this study evaluated a possible selection bias faced when studying risk factors for human immunodeficiency virus, type 1 (HIV-1) in intravenous drug users drawn solely from treatment programs. Consenting subjects, recruited by extensive distribution of brochures and word-of-mouth, underwent confidential interviews about drug use behaviors in a setting that was independent of community service agencies. Of 1632 subjects, 275 (17%) were currently enrolled in treatment programs. These subjects were similar in many respects to those not currently in treatment, including HIV-1 seroprevalence; however, they differed in that those not in treatment were more likely to be male, younger and black than those currently in treatment, and to have started injecting drugs more recently. However, associations between HIV-1 seropositivity and a series of demographic and drug-using characteristics were mostly similar in direction and magnitude among subjects currently in treatment and those not in treatment. These results suggest that one-time samples of drug users enrolled in treatment programs do not necessarily present a misleading picture of correlates of HIV-1 seropositivity.

Adult↗
PubMed1992

Measurement of HIV risk behaviors among intravenous drug users.

This paper reviews issues related to the measurement of drug use and other behaviors in studies of human immunodeficiency virus (HIV) infection in intravenous drug users. These issues include: (1) choice of variables, (2) study design, (3) time frame of measurement, (4) categories of measurement, (5) interviewer effects, and (6) validity of measurement. Difficulties and approaches for measuring drug use and other intimate behaviors in intravenous drug users are discussed. Attempts to come to terms with these measurement issues in the context of HIV infection in intravenous drug users should lead to the further development of methods for use in the general context of drug abuse research.

HIV Infections↗
PubMed1992

Alcoholism and occupations: a review and analysis of 104 occupations.

A review of the many attempts to establish an association between occupations and alcoholism reveals that most do not deal with data about clinically defined alcoholism but instead use data about cirrhosis mortality, self-reported alcohol problems, and frequent and heavy drinking. The present study establishes an association between occupations and diagnoses of Alcohol Dependence Disorder and Alcohol Abuse Disorder, using data from a large population-based household interview study. Statistical adjustment using logistic methods reveals that apparent associations between occupations and alcohol-related disorders previously reported in the literature are due to characteristics of those employed in various occupations. The prevalence of alcohol dependence and abuse in two high risk industries, construction and transportation, is confirmed. More than one in four construction laborers and one in five skilled construction trades workers received a DIS/DSM-III diagnosis related to alcohol abuse. In the transportation industry one in six heavy truck drivers and material movers received an alcohol diagnosis. Analyses of the data from individuals currently employed and not employed in their occupation reveals reduction in risk for those who leave some occupations and increased risk for those who leave other occupations. Evidence is presented that employment in some occupations may be protective for Alcohol Dependence. The findings support the view that occupation may be associated with Alcohol Dependence and Alcohol Abuse independent of demographic variations. Previously proposed explanatory models for associations between occupations and alcohol problems are called into question because they do not take into account the demographic characteristics and employment status of workers.

Adult↗
PubMed1992

Discriminant validity of a reduced set of Mini-Mental State Examination items for dementia and Alzheimer's disease.

Linear discriminant analysis was used to construct a series of discriminant functions including subsets of demographic variables and Mini-Mental State Examination item responses for a case series and a population sample. A 9-item discriminant function including the variables for time orientation, recall, calculation, copying a figure, age, writing, 3-step command, naming, and race distinguished demented subjects from community controls with 91% sensitivity and 88% specificity. The same discriminant function classified Alzheimer's disease patients and controls with 96% sensitivity and 98% specificity. This discriminant function has been cross-validated as a potential screening instrument for Alzheimer's disease in a community-based sample.

Aged↗
PubMed1992

Terminology for drug injection practices among intravenous drug users in Baltimore.

Terms for four discrete drug injection practices were obtained by presenting photographs and a brief description of practices to intravenous drug users who enrolled in a longitudinal study of HIV infection in Baltimore. The 2,921 respondents were predominantly male (81%) and Black (90%), the median age was 34 years (range: 18-68 years), and the median duration of intravenous drug use was 13 years (range 0-50 years). Forty-six different terms were used to characterize direct injection into a vein, 51 for the practice of repeatedly withdrawing and reinjecting one's own blood following injection of drug, 39 for subcutaneous injection, and 45 for transferring drug between different syringes. Terms tended to cluster by race and duration of drug use. These data indicate substantial variation in terminology for drug injection practices. Further, they augment prior research showing that photographs may be used as a useful aid in survey research on drug experiences in the population.

Adolescent↗
PubMed1992

Needle-cleaning practices among intravenous drug users who share injection equipment in Baltimore, Maryland.

In Baltimore, Maryland, between 1988 and 1989, 2,921 intravenous drug users were recruited into a study of drug injection practices and human immunodeficiency virus (HIV) infection. Sixty-three percent reported both current use and sharing of needles; almost all these (N = 1,757) reported using injection equipment immediately after it was used by another intravenous drug user. Of the 1,757, 62% said that they "typically" cleaned the used equipment with bleach or alcohol before injecting. These data suggest that information about disinfecting needles has disseminated into this population and identifies several groups to target for interventions.

Adult↗
PubMed1992

PAR village. Specialized intervention for cocaine abusing women and their children.

Operation PAR in St. Petersburg received National Institute on Drug Abuse support in 1989 and state and local appropriations to establish PAR Village, a research demonstration program for treatment of cocaine abusing women with young children. Adjacent to PAR's residential therapeutic community, it includes 14 housing units and a day-care center for infants and children. Women live with their children while receiving long-term residential care. The program is being systematically evaluated by researchers from the University of South Florida Department of Psychiatry and Behavioral Medicine. Retention in treatment and post-discharge outcomes of the women are compared with those involved in the standard program where children remain in the community with relatives or are placed in foster care. Preliminary results suggest the demonstration program increases retention in treatment.

Adolescent↗
PubMed1992

Epidemiological research on cocaine use in the USA.

In the study of cocaine, epidemiology offers a way to reckon the experience of human populations, from time to time, from region to region, from community to community, and from group to group. Continuing surveillance of cocaine experiences in diverse segments of the United States population has allowed us to plot the course of our most recent cocaine epidemic in more detail than in the past. Still, much remains to be learned about the dynamics of the cocaine epidemic before public health agencies or anyone else should ride to glory on the descending limb of this epidemic curve. Beyond basic surveillance, epidemiology has the capacity to teach us about the conditions under which human cocaine use starts, is maintained, and stops, including the array of perceived and actual consequences of cocaine use that may determine specific patterns of use. In this respect, there is some value in making a chronicle of cocaine users' life experiences, with a comparison to the life experiences of others. However, the perceptions of cocaine users do not always map onto observations made under controlled conditions of laboratory research. Finally, it is not essential for epidemiology to rely solely upon what individuals perceive and report as causal linkages between cocaine use and their other life experiences. One effective alternative is to use the epidemiological case-control method and related strategies to probe suspected causal linkages involving cocaine. As demonstrated in recent research, these strategies have a resolving power that goes beyond that of standard epidemiological survey reports. Of course, the resulting epidemiological evidence does not stand alone. Rather, it complements laboratory and clinical research, giving a more complete view of cocaine's impact on human health.

Cocaine↗
PubMed1991

New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1.

To examine whether recent intravenous use of cocaine might be associated with increased risk of human immunodeficiency virus type 1 (HIV) infection, the authors studied 2,597 active intravenous drug users: 2,399 with recent cocaine injection and 198 with recent injection of heroin or other drugs but not cocaine. These subjects were adult residents of Baltimore City and the surrounding Maryland counties, recruited via outreach into the community between February 1988 and March 1989. In contrast to the first report on the cocaine-HIV association, the present study sample was not recruited solely from drug treatment programs. In the present study, estimated HIV seroprevalence was 26.4% for recent cocaine injectors as compared with 10.6% among all other recent intravenous drug users; the relative odds estimate was 3.03. In the untreated segment of the sample, HIV seroprevalence was 26.0% for recent cocaine injectors as compared with 8.9% among others (relative odds (RO) = 3.61). The estimated degree of association did not change appreciably when multiple logistic regression was used to hold constant potentially confounding and/or mediating variables such as receptive anal intercourse, number of sex partners, and use of injection equipment obtained at shooting galleries (RO = 2.64). Augmenting these cross-sectional data, preliminary prospective data showed excess risk of HIV seroconversion among recent cocaine injectors (estimated relative risk = 2.11). While other research has examined the cocaine-HIV association, the present study differs in that it has allowed a test for whether the association was a spurious artifact of studying drug users recruited solely from drug treatment programs, a broad array of alternative determinants of HIV infection have been held constant, and the association has been examined with seroconversion data. The results lend support to the abiding concern about the risk of HIV infection among cocaine users.

Adolescent↗
PubMed1991

Developmental epidemiologically based preventive trials: baseline modeling of early target behaviors and depressive symptoms.

Describes a conceptual framework for identifying and targeting developmental antecedents in early childhood that have been shown in previous work to predict delinquency and violent behavior, heavy drug use, depression, and other psychiatric symptoms and possibly disorders in late adolescence and into adulthood. Criteria are described that guided choices of targets for two epidemiologically based, randomized preventive trials carried out in 19 elementary schools in the eastern half of Baltimore, involving more than 2,400 first-grade children over the course of first and second grades. Baseline models derived from the first of two cohorts show the evolving patterns of concurrence among the target antecedents. The central role of concentration problems emerged. From Fall to Spring in first grade, concentration problems led to shy and aggressive behavior and poor achievement in both genders and to depressive symptoms among girls. There was evidence for reciprocal relationships in girls. For example, depressive symptoms led to poor achievement in both girls and boys, whereas poor achievement led to depressive symptoms in girls but not boys, at least over the first-grade year. These results provide important epidemiological data relevant to the developmental paths leading to the problem outcomes and suggest preventive trials.

Adolescent↗
PubMed1991

Dementia: case ascertainment in a community survey.

The three-stage East Baltimore Mental Health Survey, conducted in 1981 as part of the Epidemiological Catchment Area Program, provided an opportunity to assess the prevalence of dementia and specific dementing disorders in a community-based, cross-sectional sample of the population. From the 3,841 households originally sampled, 810 individuals were selected for clinical psychiatric evaluation. Forty-one individuals were given a provisional diagnosis and referred to Stage 3 for differential diagnosis, with 32 individuals completing this evaluation. Thorough clinical evaluation of these cases resulted in an overall prevalence of dementia of 4.5% in those 65 years of age and older. The prevalence of specific dementing disorders was Alzheimer's disease (AD) (2.0%), Multi-Infarct Dementia (MID) (2.0%) and Mixed Dementia (MD) (0.5%). Prevalence increased with age for all dementias: Non-Whites had higher rates of dementia than Whites; females had higher rates of AD while males had higher rates of MID; and the prevalence of AD increased with increasing education, whereas the prevalence of MID decreased with increased education. Although this study includes only a small number of cases, necessitating some caution in interpreting the results, these figures do represent an estimate of the prevalence of severe dementing disorders and provide a basis for further community study.

Age Factors↗
PubMed1991

Suspected risk factors for depression among adults 18-44 years old.

We examined suspected risk factors for depression among adults ages 18-44 years. The subjects, selected by probability sampling for a multisite collaborative study, were interviewed at baseline and again at follow-up after one year. The risk of major depression was higher for women as compared with men (RR = 1.5), and for the maritally separated or divorced versus all other adults (RR = 1.9), but at lower levels for employed men and women as compared with the unemployed (RR = 0.6). Sex and marital separation or divorce also were associated with increased risk of a less specific and severe depressive syndrome; working for pay was associated with lower risk. In addition, risk of the depressive syndrome was lower for Hispanic Americans versus all other persons (RR = 0.3), and there was an important interaction of age and sex. With increasing age, women were at increasingly higher risk for the depressive syndrome, as compared with men. Finally, the risk of simple depression was higher for women than for men (RR = 1.8), but was not strongly associated with other suspected risk factors under study once sex was taken into account.

Adolescent↗