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Biomedical subjects

J McCusker

Publications and source records attributed to J McCusker.

At least 55 records · Page 3Linked to original sources
PubMed1995

Cocaine use and risky injection and sexual behaviors.

The association between cocaine use (crack and injection cocaine) and risky behaviors for human immunodeficiency virus (HIV) infection was investigated among participants in a multi-site study at drug treatment and non-drug treatment sites in Worcester, Massachusetts. Cocaine use was more prevalent among young, African-American men. Compared to heroin injectors cocaine injectors had higher risk injection and sexual behaviors. Among non-injectors, crack users were more likely to have multiple partners and receive money or drugs for sex. Cocaine use, either injected or smoked as crack, should be considered a high risk behavior for HIV infection.

Adult↗
PubMed1995

Psychiatric status and HIV risk reduction among residential drug abuse treatment clients.

We investigated the associations of psychiatric symptoms and diagnoses with HIV risk behaviors among 405 clients of two United States residential drug abuse treatment programs at admission and at follow-up. Measures of psychiatric status included the Beck Depression Inventory (BDI), selected diagnoses assessed with the Diagnostic Interview Schedule (DIS-III-R) and the Addiction Severity Index psychiatric composite score (ASI-P). Measures of risk behaviors included: drug injection risk (including sharing and bleaching of needles and syringes), multiple sexual partners and condom use. In multivariate analyses, the BDI at baseline and change in the BDI to follow-up were strongly associated with drug use at follow-up (both injection and non-injection), but not with other risk behaviors. In contrast, psychiatric diagnoses were not statistically associated with risk behaviors at follow-up when baseline behavior was controlled.

Adult↗
PubMed1995

The effectiveness of alternative planned durations of residential drug abuse treatment.

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.

Follow-Up Studies↗
PubMed1995

Outcomes of a 21-day drug detoxification program: retention, transfer to further treatment, and HIV risk reduction.

We investigated the outcomes of a 21-day inpatient drug detoxification and rehabilitation program including length of stay, transfer to further treatment, and HIV risky behavior. Clients (n = 567) were predominantly White, male, currently unemployed, and their treatment was not covered by third party payment. 78% were detoxified with methadone. The median length of stay was 18 days. Higher education, not living with spouse or children, English as primary language, admission during fall or winter months, and greater knowledge of HIV transmission were independent predictors of greater length of stay. Among those with follow-up (n = 450), 19% were transferred to residential drug-free programs and 7% to outpatient programs. Taking into account loss to follow-up, the overall rate of treatment transfer could be as low as 21%. Greater length of stay was associated with higher rates of transfer to residential treatment. Relapse rates to either any drug use or injection drug use were lower among subjects transferred to residential treatment than either clients transferred to outpatient programs or those with no further treatment. Among subjects who continued to inject drugs at follow-up, no reduction in HIV risky behaviors was found regardless of further treatment. We conclude that detoxification programs have the potential for reducing relapse to drug use when followed by residential drug-free treatment.

Adolescent↗
PubMed1995

The validity of behavioral data reported by injection drug users on a clinical risk assessment.

The validity of drug and sexual behavior data collected by drug user treatment staff using a short clinical risk assessment among 387 injection drug users is evaluated using in-depth, confidential interview process. Moderate to high agreement levels were found for most, but not all, variables. Participants consistently reported less risky behaviors on the clinical risk assessment than on the in-depth interview. More easily recalled information can be accurately gathered through a short clinical risk assessment. However, in-depth, confidential interviewing is important when gathering self-reports of the frequency of drug and sexual behaviors.

Adolescent↗
PubMed1994

The relationships of HIV status and HIV risky behavior with readiness for treatment.

We investigated the associations of self-reported HIV status and risky injection practices with dependent variables measuring readiness and motivation for treatment and depression among 550 clients at two residential drug abuse treatment programs. The results suggest that a positive HIV status may be associated with motivation for treatment independently of and more strongly than risky behavior. In multivariable analyses, HIV status was associated with a scale measuring cons of drug use (P = 0.006). Risky behavior was associated with the dependent variables only in univariate analyses. The univariate association between risky behavior and depression was confounded by social desirability bias. Further research is needed to determine whether HIV-related variables predict retention or outcome of treatment.

AIDS Serodiagnosis↗
PubMed1994

HIV-1 antibody testing among drug users participating in AIDS education.

This study aimed to identify factors which predict participation of drug users in HIV-1 antibody testing. The study was part of a randomized controlled trial of three small group AIDS educational programs, in a 21-day in-patient drug detoxification and rehabilitation program. Subjects (n = 497) were clients admitted to the program who consented to participate in the evaluation and who completed baseline data collection. All subjects received pre-test counseling. Testing was offered after 1 week in treatment; 52% decided to be tested. Factors which predicted participation in testing included: no previously reported positive result, a longer stay in treatment, a greater frequency of injection, a greater perceived probability of being infected, and the type of AIDS education. Both actual and perceived level of risk, and the type of AIDS education provided can affect participation in testing programs.

AIDS Serodiagnosis↗
PubMed1994

Human immunodeficiency virus type 1 antibody status and changes in risk behavior among drug users.

The associations of human immunodeficiency virus type 1 (HIV-1) antibody status and recent testing with risk behavior change were examined in a cohort of drug users enrolled in a randomized trial of acquired immunodeficiency syndrome (AIDS) education programs at a short-term inpatient detoxification facility. Four hundred ninety-seven subjects completed baseline interviews, and 402 (81%) of them had analyzable follow-up information. Changes in eight ordinal self-reported drug and sexual behaviors were assessed using the cumulative logit model for repeated ordinal response data. There was only limited evidence for differential behavior change by either perceived serostatus or recent testing, which was mainly confined to sharing of injection equipment among those who continued to inject, and condom use.

Adolescent↗
PubMed1994

The use of the CAGE questionnaire in a cohort of homosexually active men.

The prevalence and correlates of alcohol-related problems measured by the CAGE questionnaire were investigated in a population of 249 homosexually active men at a Boston community health center. Two hundred eight men (79.4%) reported alcohol use during the past 6 months and 22.9% (27.4% of alcohol users) were CAGE positive (two or more positive responses). Increased frequency of alcohol use was strongly associated with CAGE positivity (p < .001). Controlling for frequency of alcohol use, cigarette smoking was independently associated with a positive CAGE score. Other substance use and demographic variables were not independently associated with CAGE problems.

Adult↗
PubMed1994

Radioimmunoassay of hair for determination of cocaine, heroin, and marijuana exposure: comparison with self-report.

Radioimmunoassay of hair (RIAH) was compared with self-report for cocaine, heroin, and marijuana in two populations: 109 persons entering residential drug user treatment and 86 at follow-up posttreatment. Among treatment entrants, 89% of 87 RIAH cocaine-positives and 96% of 45 RIAH heroin-positives were confirmed by self-report. However, among those followed-up posttreatment, only 51% of 43 RIAH cocaine-positives and 67% of 18 RIAH heroin-positives were so confirmed. Whereas 95% of 104 self-reports of cocaine use in the combined population were confirmed by RIAH, only 69% of 80 self-reports of heroin use were. Self-report and RIAH for marijuana were weakly associated.

Adolescent↗
PubMed1993

Behavioral outcomes of AIDS educational interventions for drug users in short-term treatment.

This paper reports the behavioral outcomes of informational vs enhanced small-group educational interventions for drug users among 407 subjects in a short-term drug treatment program. Logistic regression was used to analyze drug use and sexual behaviors at the final follow-up visit. Among lower risk subjects, the enhanced intervention was more effective in reducing injection practices that produced risks in terms of human immunodeficiency virus infection; among those at highest risk, the informational interventions were more effective. The enhanced intervention was more effective than the informational interventions in reducing cocaine use at follow-up. No differential intervention effect on sexual risk behaviors was found.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Social network, support and influence: relationships with drug use and protective AIDS behavior.

One reason for difficulty in long-term maintenance of behavior changes by injection drug users (IDUs) is the concomitant support or distraction from the IDUs social environment. This study explored the relationship of social factors--e.g., encouragement from friends, beliefs about social norms--with drug injection behaviors. Subjects were clients in a short-term residential detoxification program. Self-reports of drug and AIDS-protective behaviors were gathered at baseline and at least 6 months following a trial of enhanced vs. informational educational interventions. Results provide support both for the general hypothesis about the influence of peers and drug-use partners prior and subsequent to detoxification and for the greater effectiveness of the enhanced intervention on social factors. Particularly important to improved drug use behavior were decreased number of friends who inject drugs (social network), increased number of people to talk with when upset (social support), and increased argument skills about safe drug use (social influence).

Acquired Immunodeficiency Syndrome↗
PubMed1992

Inter-organizational responses to AIDS: a case study of the Worcester AIDS Consortium.

This case study focuses on development and community coordination of AIDS-related services and on coalition building. Its subject is the Worcester (Massachusetts) AIDS Consortium. The objectives are to: (1) describe the environmental conditions and pre-existing networks which facilitated the formation of the Worcester AIDS Consortium; (2) articulate processes which occurred during the formative, organizational and operational phases of the Worcester AIDS Consortium's development; (3) explore social and community goals and Consortium activities; and (4) document Consortium accomplishments. Data were collected through key informant interviews and review of archival materials. Information about the Worcester AIDS Consortium experience is compared with concepts and principles suggested by organizational theories and frameworks.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Maintenance of behavioral change in a cohort of homosexually active men.

OBJECTIVES: To assess associations of perceptions of sexual behavior change with actual risk behaviors and psychosocial variables, and to determine whether perceptions of behavior change predict subsequent behavior. DESIGN: Cohort study of homosexually active men. SETTING: Community health center in Boston, Massachusetts, USA. PATIENTS, PARTICIPANTS: Two hundred and sixty-two cohort members who participated in follow-up in 1989 and who had at least one subsequent visit. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Composite risk behavior variable, based on unprotected anogenital contact and number of partners. RESULTS: Of the 96% who had effected behavior change, 47% perceived that they were able to maintain those changes consistently and 58% wanted to make more changes. Perceptions of consistent maintenance were associated with lower risk behavior, lower perceived riskiness of behaviors and susceptibility to AIDS, and fewer barriers to behavior change. Desire for more change was associated with increased behavioral effort, fewer barriers to condom use, and greater perceived riskiness of current behavior. Among those with lower risk behaviors, perceived inconsistent maintenance predicted relapse to more risky behavior at the following visit. CONCLUSIONS: Perceived maintenance of behavior change is potentially useful in identifying individuals at risk of relapse from safer sex.

Acquired Immunodeficiency Syndrome↗
PubMed1992

AIDS education for drug abusers: evaluation of short-term effectiveness.

BACKGROUND: Interventions are needed to assist drug abusers in reducing risky drug and sexual behavior. METHODS: A randomized controlled trial compared three small-group AIDS educational interventions among 567 clients of a 21-day inpatient drug detoxification program: a two-session informational intervention, given either during the first (early) or second (late) week of treatment; and a six-session enhanced intervention. Changes in knowledge, attitudes, and psychomotor skills were assessed before and after each intervention, and behavioral outcomes were assessed at follow-up 10 to 18 weeks after admission. RESULTS: Immediately after the interventions, enhanced group members reported significantly greater self-efficacy to talk themselves out of AIDS-risky behavior; other knowledge and attitude scales did not differ by intervention. At follow-up, significant reductions in risky drug use were reported by all groups. Enhanced group members reported significantly greater reduction in injection frequency than did late informational subjects. CONCLUSIONS: No beneficial effect was detected of delaying AIDS education for clients entering detoxification. At this early stage of follow-up, there is only weak evidence that an enhanced intervention improved outcomes.

Acquired Immunodeficiency Syndrome↗
PubMed1992

The validity of self-reported HIV antibody test results.

Three hundred twenty-six participants in a multisite study were initially tested for human immunodeficiency virus (HIV) antibody and later interviewed; 228 were recent drug injectors and 38 were HIV positive. Later, 264 (81%) correctly reported their test results, 9 (3%) gave incorrect results, and 53 (16%) said either that they had not been tested or that they did not know the results. The predictive values of positive and negative self-reports were 90% and 98%, respectively (P less than .01).

Bias↗