Biomedical subjects

Michael D Stein

Publications and source records attributed to Michael D Stein.

At least 19 recordsLinked to original sources

PubMed2026

Yoga MAT: A factorial randomized study using the Multiphase Optimization Strategy to develop a multicomponent yoga intervention for people with chronic pain taking medications for opioid use disorder.

BACKGROUND: People taking medications for opioid use disorder (MOUD) commonly experience chronic pain. Yoga interventions show promise for decreasing pain-related disability in other populations. More time spent in yoga practice may improve pain-related outcomes. METHODS: The Multiphase Optimization Strategy (MOST) provided the framework for developing an optimized yoga intervention package. In a 2x2x2x2 factorial experiment, we evaluated four candidate intervention components which, when added to a weekly yoga class, might increase yoga engagement. The primary outcome was minutes per week of yoga practice (classes and other yoga practice) over the 12-week intervention period. We sought to determine which combination of intervention components was associated with the most yoga practice for people with chronic pain taking buprenorphine or methadone as MOUD. RESULTS: We enrolled 192 adults. There was a significant main effect for Component "B" (having two private sessions with a yoga teachers; IRR = 1.10, 90%CI 1.02; 1.18), and a synergistic interaction between Components "B" and "D" (D was financial incentives for attending class; IRR = 1.11, 90%CI 1.02; 1.19). This combination of these two components (without other potential components) was associated with the second highest model-predicted mean minutes of yoga per week (157.1min; 90% CI = 120.1-194.0) which was only 4min less than the combination including all four components. CONCLUSIONS: We identified a combination of intervention components as the optimized intervention. A next step will be to test the effect of this optimized intervention on pain and substance use outcomes in a randomized controlled clinical trial.

Humans↗

PubMed2007

A telephone-based intervention for depression in HIV patients: negative results from a randomized clinical trial.

To determine if a telephone support behavioral intervention improves depressive symptoms among HIV positive outpatients, we enrolled 177 persons with Beck Depression Inventory (BDI) scores scores of >/=10. Participants were randomized to receive up to 12 scheduled psycho-educational calls over 6 months or to an assessment-only control condition. Co-enrolled informal caregivers of HIV patients received the same telephone intervention in parallel. Among the 160 (90.4%) participants who were re-interviewed at 6 months, 56% were male, and 41% were Caucasian, with a mean baseline BDI score of 22.7. Overall, participants' mean BDI scores improved 5.3 points from baseline, but intervention group differences on depression outcomes including 50% or greater reduction in BDI scores and depression remission were not statistically significant. In the full cohort, men were significantly more likely to improve than women. We conclude that a psycho-educational telephone support intervention did not reduce depressive symptoms for HIV patients more than an assessment-only control condition.

Adult↗

PubMed2006

Training primary care clinicians in maintenance care for moderated alcohol use.

OBJECTIVE: To evaluate whether training primary care clinicians in maintenance care for patients who have changed their drinking influences practice behavior. DESIGN: We randomized 15 physician and 3 mid-level clinicians in 2 primary care offices in a 2:1 design. The 12 intervention clinicians received a total of 2 (1/4) hours of training in the maintenance care of alcohol problems in remission, a booster session, study materials and chart-based prompts at eligible patients' visits. Six controls provided usual care. Screening forms in the waiting rooms identified eligible patients, defined as those who endorsed: 1 or more items on the CAGE questionnaire or that they had an alcohol problem in the past; that they have "made a change in their drinking and are trying to keep it that way"; and that they drank <15 (men) or <10 (women) drinks per week in the past month. Exit interviews with patients evaluated the clinician's actions during the visit. RESULTS: Of the 164 patients, 62% saw intervention clinicians. Compared with patients of control clinicians, intervention patients were more likely to report that their clinician asked about their alcohol history (odds ratio, 2.8; 95% confidence interval, 1.3, 5.8). Intervention clinicians who asked about the alcohol history were more likely to assess prior and planned alcohol treatment, assist through offers for prescriptions and treatment referral, and receive higher satisfaction ratings for the visit. CONCLUSIONS: Systemic prompts and training in the maintenance care of alcohol use disorders in remission might increase primary care clinicians' inquiries about the alcohol history as well as appropriate assessment and intervention after an initial inquiry.

Alcoholism↗

PubMed2006

Reproductive health care and family planning needs among incarcerated women.

OBJECTIVES: Women in correctional institutions have substantial reproductive health problems, yet they are underserved in receipt of reproductive health care. We assessed the level of risk for sexually transmitted diseases (STDs) and the reproductive health needs of 484 incarcerated women in Rhode Island to plan an intervention for women returning to the community. METHODS: We used a 45-minute survey to assess medical histories, pregnancy and birth control use histories, current pregnancy intentions, substance use during the past 3 months, histories of childhood sexual abuse, and health attitudes and behaviors. RESULTS: Participants had extremely high risks for STDs and pregnancy, which was characterized by inconsistent birth control (66.5%) and condom use (80.4%), multiple partners (38%), and a high prevalence of unplanned pregnancies (83.6%) and STDs (49%). Only 15.4% said it was not likely that they would have sexual relations with a man within 6 months after release. CONCLUSION: Reproductive health services must be offered to incarcerated women. Such interventions will benefit the women, the criminal justice systems, and the communities to which the women will return.

Adult↗

PubMed2006

Improving birth control service utilization by offering services prerelease vs postincarceration.

OBJECTIVES: We examined whether incarcerated women would substantially increase birth control initiation if contraceptive services were available within the prison compared with after their release back into the community. METHODS: During phase 1 of the study, a nurse educator met with women at the Rhode Island Adult Correctional Institute and offered them referrals for contraceptive services at a community health clinic after their release. During phase 2, contraceptive services were offered to women during their incarceration. RESULTS: The majority of the participants (77.5%) reported a desire to initiate use of birth control methods. Within 4 weeks of their release, 4.4% of phase 1 participants initiated use of a contraceptive method, compared with 39.1% of phase 2 participants (odds ratio [OR]=14.6; 95% confidence interval [CI]=5.5, 38.8). CONCLUSIONS: Provision of contraceptive services to women during their incarceration is feasible and greatly increases birth control initiation compared to providing services only in the community.

Adult↗

PubMed2006

HIV and HCV testing for young drug users in Rhode Island.

Young injection drug users (IDU) are at risk for both human immunonodeficiency virus (HIV) and Hepatitis C infections (HCV). Rates of HIV testing have been widely documented, but limited information exists regarding HCV screening rates. Among a community sample of 86 IDUs, aged 18-25 years in Rhode Island, 87.2% reported ever testing for HIV versus 51.2% for HCV (p < .001). Young injectors were under-screened for HCV compared with the far less prevalent HIV infection.

Adolescent↗

PubMed2006

Correlates of condom use and reasons for condom non-use among drug users.

Two hundred and seventy-seven drug using adults were interviewed regarding details of their most recent sexual encounter. Demographic, attitudinal, and context variables were associated with condom use and non-use. Greater perceived risk of STDs/HIV and positive attitudes toward condoms' effect on sexual pleasure were associated with greater likelihood of reporting condom use. Common reasons for not using condoms included lower perceived risk of contracting HIV/STDs, negative attitudes toward condoms' effect on pleasure, and lack of condom availability. Tailoring messages to modifiable perceptions of risk and condom attitudes may be useful in reducing sexual risk among drug-using individuals.

Adolescent↗

PubMed2006

Do mechanisms that link addiction treatment patients to primary care influence subsequent utilization of emergency and hospital care?

BACKGROUND: Patients with drug use disorders are heavy users of emergency department (ED) and inpatient hospital care. This study examines whether formal mechanisms to link addiction treatment patients to primary medical care, either directly on site or by off-site referral-when compared with an absence of said mechanisms-might reduce these patients' use of ED and hospital services after substance abuse treatment. METHODS: We used longitudinal data from 6 methadone maintenance programs with 232 patients, 24 outpatient nonmethadone programs with 1202 patients, and 14 long-term residential programs with 679 patients in the National Treatment Improvement Evaluation Study. Multivariate logistic models controlling for health status and medical service utilization before treatment examined whether provision of medical services on- or off-site during treatment linkage led to reduced use of ED and hospital services in the year after treatment compared with no such provision. RESULTS: On-site delivery of primary care reduced subsequent ED and hospital use among patients in methadone maintenance and long-term residential compared with the nonlinkage condition but not in outpatient nonmethadone programs. Off-site referral for medical care reduced subsequent ED visits but not hospitalizations in long-term residential programs. CONCLUSIONS: These findings suggest that for some treatment modalities, stronger primary care linkage mechanisms decrease subsequent utilization of expensive ED and hospital services. Future study should examine the cost implications of these strong linkage mechanisms and ways to strengthen linkages to off-site medical care.

Adult↗

PubMed2006

A smoking cessation intervention for the methadone-maintained.

AIM: To test, in combination with the nicotine patch, the incremental efficacy of a maximal, tailored behavioral treatment over a minimal treatment for smoking cessation. DESIGN: Randomized clinical trial with 6-month follow-up. SETTING: Five methadone maintenance treatment centers in Rhode Island. PARTICIPANTS: Three hundred and eighty-three methadone-maintained smokers. INTERVENTION: Participants were assigned randomly to nicotine patch (8-12 weeks) plus either (1) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session and a relapse prevention follow-up session (Max) or (2) brief advice using the National Cancer Institute's 4 As model (Min). An intent-to-treat analysis with those lost to follow-up assumed to smoke was used. MEASUREMENTS: Carbon monoxide (CO)-confirmed 7-day point smoking cessation prevalence at 3 and 6 months, and self-reported numbers of cigarettes smoked per day. FINDINGS: Participants had a mean age of 40 years, were 53% male, 78% Caucasian, smoked 26.7 (+/- 12.2) cigarettes/day and had a mean methadone dose of 95.5 mg. At 3 months, 317 (83%) were re-interviewed; at 6 months, 312 (82%) were re-interviewed. The intent-to-treat, 7-day point prevalence estimate of cessation was 5.2% in the Max group and 4.7% in the Min group (P=0.81) at 6 months. In logistic models with treatment condition, age, gender, race, Fagerström Test for Nicotine Dependence and cigarettes per day as covariates, males were more likely to be abstinent at 3 months (OR 4.67; P=0.003) and 6 months (OR 4.01; P=0.015). CONCLUSION: A tailored behavioral intervention did not increase quit rates over patch and minimal treatment. Smoking cessation rates in methadone-maintained smokers are low, with men having greater success.

Adult↗

PubMed2006

Nicotine replacement therapy: patterns of use after a quit attempt among methadone-maintained smokers.

AIM: To determine the association between daily smoking and use of nicotine replacement therapy (NRT), and to determine predictors of greater NRT use among methadone-maintained smokers. INTERVENTION: Assignment to free nicotine patch (8 to 12 weeks) plus either (1) a baseline-tailored brief motivational intervention, a quit date behavioral skills counseling session, and a relapse prevention follow-up session (max), or (2) brief advice using NCI's 4 A's model (min). SETTING: Five methadone maintenance treatment centers. PARTICIPANTS: Of the 383 methadone-maintained smokers enrolled, 309 (80.6%) set a specific quit date (received NRT) and were located for assessments. Participants were 51.8% male, 78.6% Caucasian, and smoked 26.6 (SD=12.2) cigarettes/day. OUTCOME: Use of NRT and smoking behaviors during the 180-day follow-up period assessed by the Timeline follow-back method. FINDINGS: On the day following their quit day, 86.4% of participants used NRT. The percentage of participants using NRT was 52.3%, 27.1%, and 10.4% on day 30, day 60, and day 90, respectively. Participants used NRT on 44.1% of the days through the 90 days of the treatment protocol. The estimated odds of smoking abstinence was 7.1 (P<.001) times higher on days when NRT was used than on days when NRT was not used, and cigarettes/day was also significantly lower on NRT days (14.93 vs 4.65; P<.001). CONCLUSION: Nicotine replacement therapy use was inconsistent following an initial quit attempt among methadone-maintained smokers. On days when NRT was used, individuals were likely to smoke at reduced levels or not at all.

Administration, Topical↗

PubMed2006

Pregnancy attitudes and contraceptive plans among women entering jail.

Unplanned pregnancies are an important and costly public health problem. Women entering jail are at particularly high risk for unplanned pregnancies when they leave jail, given the high rates of poverty, substance abuse and sexually transmitted infections (STIs) in this population, all of which are associated with unplanned pregnancies. Attitudes toward pregnancy vary substantially, influencing openness of incarcerated women to starting a birth control method. This study was conducted as part of a Title X service evaluation and examined varying attitudes towards pregnancy and associated plans to use contraceptives. The current study included 223 women entering jail who were, under 36 years of age, fertile, sexually active with men, and not planning to become pregnant in the near future. Nearly half of the women had negative pregnancy attitudes (PAs), indicating that they did not want to become pregnant, while 41.3% endorsed ambivalent PAs. Compared to those with ambivalent PAs, those with Negative PAs were more likely to report a previous unplanned pregnancy (90.6% vs. 75.4%), a previous pregnancy termination (40.0% vs. 22.8%), and recent consistent use of contraceptives (37.0% vs. 21.7%). Women with negative PAs were significantly more likely to want to start or to continue a birth control method compared to those with ambivalent PAs (66% vs. 47%). Tailoring services to women's specific pregnancy attitudes during periods of incarceration may aid in preventing unplanned pregnancies in populations of high-risk women.

Abortion, Induced↗

PubMed2005

Adversity among drug users: relationship to impulsivity.

Illicit substance users experience adverse life events, but few studies have examined the role of impulsivity in these events. The present investigation sought to establish a link between negative life experiences and a trait measure of impulsivity and demonstrate that this association remains even accounting for potential confounds. Participants were 330 heroin and cocaine users recruited from the community for a health service research study. Participants completed a structured interview that assessed topics including drug and alcohol use, impulsivity, and negative life events. This group of drug users reported high rates of adverse life events in the 6 months prior to the assessment. No specific substance abuse/dependence diagnosis or combination of diagnoses was associated with adversity. Number of substance-related diagnoses was associated with adverse life events, but not when adjusting for impulsivity. Experience of these events was significantly associated with impulsivity (p<.001), above and beyond the shared relation with demographic variables, substance abuse and dependence, and number of substance-related diagnoses. These findings document the high frequencies of recent adverse life events among illicit drug users and indicate that trait impulsivity is associated with increased risk of these life events.

Adult↗

PubMed2005

Correlates of motivation to quit smoking in methadone-maintained smokers enrolled in a smoking cessation trial.

Cigarette smoking is a clear problem among methadone-maintained persons, yet little is known about factors that may be associated with their motivation to quit smoking. A sample of 255 smokers, enrolled in a smoking cessation research protocol, completed measures of their smoking motivation, smoking habit, quitting history, and intent to quit in the future. Both zero-order correlational and multivariate linear regression analyses indicated that only number of cigarettes smoked per day and expectancies for success with smoking cessation were associated significantly with motivation to quit smoking. These results have implications for understanding motivational processes among methadone-maintained smokers and may help in the design of interventions that will assist this population with quitting smoking.

Adult↗

PubMed2005

Reductions in HIV risk behaviors among depressed drug injectors.

OBJECTIVE: To determine if, by reducing depressive symptoms, combined psychotherapy and pharmacotherapy reduces HIV drug risk behavior compared to an assessment-only condition for active drug injectors over 9 months. DESIGN: Randomized controlled trial. SETTING: Outpatient academic research office. PATIENTS: Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with depressive features persisting for at least 3 months, or major depression plus dysthymia. In addition, participants had a Hamilton Rating Scale for Depression (MHRSD) score > 13. INTERVENTION: Psychotherapy (8 sessions of cognitive behavioral therapy) plus antidepressant pharmacotherapy over 3 months. MAIN OUTCOME MEASURES: HIV Risk Assessment Battery (RAB) drug scale scores measured at three, six and nine months, and depression remission (MHRSD score < or = 8). RESULTS: Participants (n= 109) were 64% male, 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Overall, study retention at nine months was 89%. Reported HIV drug risk scores decreased sharply over the first 3 months and continued to decline throughout the follow-up period. Between group differences were not significant in the intention-to-treat analysis. However, highly adherent participants had significantly lower HIV drug risk scores at 3 months (p<05), but not 6 and 9 months. Depression remission was significantly associated with lower HIV drug risk scores at follow-ups. CONCLUSIONS: Combined psychotherapy and pharmacotherapy did not produce a significant reduction in HIV drug risk beyond that seen in an assessment-only control group. The greatest declines in HIV drug risk were found in participants with high protocol adherence and those with depression remission.

Adult↗

PubMed2005

A model to provide comprehensive testing for HIV, viral hepatitis, and sexually transmitted infections at a short-term drug treatment center.

Substance users are at high risk for blood-borne infections as well as those that are transmitted sexually. Substance abuse treatment centers present an opportunity to offer comprehensive counseling and testing (CCT) for HIV, viral hepatitis, and sexually transmitted infections (STIs) to this high-risk population. We examined the feasibility and acceptability of one model of CCT among substance users. CCT was offered to 145 consecutive inpatients; study participants completed a risk factor questionnaire and selected from a menu of testing options. Thirty-six percent of those approached agreed to participate and accepted at least one biologic test. Sixty-two percent of participants accepted all tests that were offered. While beneficial to those who accept testing, the described model of CCT is feasible in a drug treatment center, but acceptable to only a minority of inpatients.

Adolescent↗

PubMed2005

Educational attainment but not literacy is associated with HIV risk behavior among incarcerated women.

PURPOSE: To identify the educational factors associated with HIV risk behaviors among incarcerated women. METHODS: We evaluated a cohort of female detainees at The Rhode Island Adult Correctional Institute between July and September 2004. Among the 423 women who participated in the study, 55% did not have a high school diploma, 29% had < or = 8th grade reading capacity, 32% had a learning disability, 37% had problem drinking, and 61% (257/423) reported HIV risk behavior. RESULTS: In multiple logistic regression, participants who had completed high school had the lowest likelihood of HIV risk behavior (adjusted odds ratio [OR] 0.35, 95% confidence interval [CI] 0.12-1.00). There was no association between participants? literacy level and HIV risk behavior (adjusted OR 2.02, 95% CI 0.83-4.92). CONCLUSIONS: Correctional education programs to reduce HIV risk behavior should focus on those with low educational attainment irrespective of literacy skills.

Adult↗

PubMed2005

Caregiver burden and depression among informal caregivers of HIV-infected individuals.

BACKGROUND: Few studies have examined the factors associated with depression in informal caregivers of HIV-infected persons. OBJECTIVE: To investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals. DESIGN: Cross-sectional study using baseline data from an ongoing randomized trial of a supportive telephone intervention. PARTICIPANTS: One hundred seventy-six dyads of HIV patients and their informal caregiver. MEASUREMENTS: Depression was defined as a Beck Depression Inventory >10. A Caregiver Strain Index >6 identified informal caregivers with a high caregiver burden. We used logistic regression to identify characteristics that were associated with depression in the informal caregiver. RESULTS: Informal caregivers were 42 years old (SD, 13), 53% female, 59% nonwhite, and 30% had education beyond high school. Forty-seven percent of informal caregivers were the patient's partner, 18% a friend, and 35% a family member. Twenty-seven percent of informal caregivers had a high caregiver burden, and 50% were depressed. We found significantly greater odds of informal caregiver depression with high caregiver burden (OR, 6.08; 95% CI, 2.40 to 15.4), informal caregiver medical comorbidity besides HIV (OR, 2.32; 95% CI, 1.09 to 4.92), spending all day together (OR, 3.92; 95% CI, 1.59 to 9.69), having to help others besides the HIV patient (OR, 2.55; 95% CI, 1.14 to 5.74), and duration of the HIV patient's diagnosis (OR, 1.01 per month; 95% CI, 1.00 to 1.01). CONCLUSIONS: High caregiver burden was strongly associated with depression among HIV-infected individuals' informal caregivers, who themselves had difficult life circumstances. Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving.

Adult↗

PubMed2005

Respiratory symptom relief related to reduction in cigarette use.

INTRODUCTION: Many smokers reduce their cigarette consumption during failed attempts to quit. We report the impact of changes in consumption on smoking-related respiratory symptom severity (SRRSS). METHODS: Between February 2002 and May 2004 we recruited 383 smokers from 5 methadone maintenance programs for a randomized trial of nicotine replacement plus behavioral treatment versus nicotine replacement alone for smoking cessation. Cigarette use in the 28 days prior to the interview, and severity of SRRSS using a 7-item respiratory index, were assessed at baseline and at 3-month follow-up. OUTCOME: Baseline minus 3-month assessment difference in SRRSS score. RESULTS: Follow-up of 319 participants (83.3%), mean age 40.4 years, 51.4% male, who smoked 26.4 cigarettes per day, demonstrated a mean reduction of 16.7 cigarettes per day. A reduction in cigarette use was positively and significantly (b=0.29, t=5.16, P<.001) associated with a reduction in smoking-related symptom severity after adjusting for age, gender, race, years of regular smoking, baseline nicotine dependence, and history of treatment for asthma or emphysema. A 1 standard deviation reduction in average daily smoking (about 14.1 cigarettes) was associated with a 0.28 standard deviation decrease in smoking-related symptom severity. CONCLUSION: Reduction in symptom severity increases as absolute reduction in daily smoking increases. This is the first study to demonstrate an association between subjective short-term health changes and reduction in smoking.

Adult↗