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Biomedical subjects

R S Falck

Publications and source records attributed to R S Falck.

At least 19 recordsLinked to original sources
PubMed2001

Constructing a consensus-based prevention outcome measurement instrument.

This article describes Ohio's Prevention Evaluation Project (PEP). The purpose of the project was to develop a process and instrument to assess behavioral and attitudinal outcomes in primary drug abuse prevention programs targeting young people aged twelve to seventeen. One of PEP's principal achievements was the inclusion of community prevention program providers from throughout the state in the evaluation instrument development. The effort produced a self-administered questionnaire to capture data on young peoples' drug use practices, attitudes toward drugs, and problematic behaviors. Most significantly, the product produced was the acceptance and endorsement of community-based programs. The forty-one-item questionnaire has good to excellent reliability for virtually all measures, as assessed by the test-retest method. The instrument is a product of a process that brought together a university-based research team, state alcohol and drug abuse prevention administrators, and representatives of public programs. PEP demonstrates how to productively link service providers, administrators, and evaluators to develop a process for assessing the effectiveness of prevention programs. The process and tools described serve as a model for other communities wanting to evaluate their prevention programming.

Adolescent↗
PubMed2001

The epidemiology of physical attack and rape among crack-using women.

This prospective study examines the epidemiology of physical attack and rape among a sample of 171 not-in-treatment, crack-cocaine using women. Since initiating crack use, 62% of the women reported suffering a physical attack. The annual rate of victimization by physical attack was 45%. Overall, more than half of the victims sought medical care subsequent to an attack. The prevalence of rape since crack use was initiated was 32%, and the annual rate was 11%. Among those women having been raped since they initiated crack use, 83% reported they were high on crack when the crime occurred as were an estimated 57% of the perpetrators. Logistic regression analyses showed that duration of crack use, arrest for prostitution, and some college education were predictors of having experienced a physical attack. Duration of crack use and a history of prostitution were predictors of suffering a rape. Drug abuse treatment programs must be sensitive to high levels of violence victimization experienced by crack-cocaine using women. Screening women for victimization, and treating the problems that emanate from it, may help make drug abuse treatment more effective.

Adolescent↗
PubMed2000

Longitudinal application of the medical outcomes study 36-item short-form health survey with not-in-treatment crack-cocaine users.

BACKGROUND: The Medical Outcomes Study SF-36 has been used infrequently with substance abusers. OBJECTIVES: The objectives of this study were to use the SF-36 to assess changes in the health status of crack-cocaine users over time, to determine the characteristics of users who change, to assess the influence of frequency of crack use on SF-36 health status, and to determine the utility of the SF-36 with crack users. DESIGN: A multilevel model was used to analyze data that were collected every 6 months over a 2-year period. SUBJECTS: The sample consisted of 439 not-in-treatment crack-cocaine users. MEASURES: The SF-36 was administered at baseline and follow-up interviews. Data on the frequency of crack-cocaine use were also collected. RESULTS: On average, SF-36 health status remained fairly static during the study although statistically significant increases in scores occurred on the social functioning and role-emotional subscales. Variation in subjects' health trajectories occurred but was not, for the most part, explained by individual characteristics. Frequency of crack use was negatively related to scores on the physical functioning, social functioning, and mental health subscales. Most subscales did not reflect what are commonly recognized to be the health-compromising effects of cocaine use, raising questions about the use of the SF-36 with illicit drug users. CONCLUSIONS: Changes in crack users' SF-36 health status were uncommon. Frequency of crack use was negatively associated with health status. Several SF-36 subscales may be helpful in studies involving illicit drug users in which limited assessments of health status are needed.

Activities of Daily Living↗
PubMed2000

Crack-cocaine users as victims of physical attack.

This study evaluates the correlates of physical attack among people who use crack cocaine in Dayton, Ohio. Using a retrospective and prospective natural history design, data from baseline and 1-year follow-up interviews were used to calculate the prevalence of physical attack and the annual rate of physical attack suffered by 440 not-in-treatment crack-cocaine users. Logistic regression was used to determine the correlates of physical attack. The lifetime prevalence of physical attack was 63.0%; the annual rate was 36.8%. At baseline, daily crack users were more likely to report a previous attack since they began using crack (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.18-2.77). Longer duration of crack use was also associated with experiencing an attack (OR, 1.09; 95% CI, 1.04-1.14). Between baseline and 12-month follow-up, the odds of men being attacked were significantly less than those for women (OR, 0.48; 95% CI, 0.23-0.99). Physical attack is widespread among crack-cocaine users, and does not vary by ethnicity. Injuries often result in the need for medical care. Over the short term, women are at increased risk. Accessible and effective drug abuse treatment is needed to diminish the harm this population suffers.

Adult↗
PubMed1999

Understanding HIV risks of chronic drug-using men who have sex with men.

Focus groups and individual structured interviews were conducted in six cities with 98 predominantly street-recruited men who had a recent history of smoking crack or injecting drugs and who reported having had sex with other men (MSM) in the past year. Twenty-six focus groups explored the cultural and social context of participant's drug use and sexual activity and addressed outreach and HIV prevention issues pertinent to this population. Narrative summaries developed from verbatim focus group transcripts identified seven themes: (a) sexual orientation and gender identity; (b) interactions within and between MSM networks; (c) drug use, sexual activity and personal relationships; (d) HIV transmission bridges; (e) preferred HIV information sources; (f) HIV knowledge, prevention practices and risk behaviours; and (g) availability of HIV and drug-related services. Of the 98 MSM drug users, 42% identified publicly as gay or homosexual; 35% identified publicly, but only 21% privately, as heterosexual. A total of 51% had one or more female sex partners in the past year. There was a high frequency of unprotected sex in conjunction with drug use and a distinct preference for having sex when high. For most participants, drug use rather than sexual orientation formed the core of personal identity. Participants reported associating primarily with other drug users, usually MSM, and had limited contact with people who did not use drugs and the mainstream gay community. Participants' sexual and drug-injecting activities were judged to be a bridge for transmission of HIV to both people who used drugs and those who did not.

Adolescent↗
PubMed1999

Evaluation of HIV risk reduction intervention programs via latent growth model.

The latent growth model (LGM) has drawn increasing attention in behavioral studies using longitudinal data. The LGM captures the level and trajectory of behavior change, variation in both the initial status and the trend of behavior change, as well as the time-ordered covariation between the initial status and change. This study demonstrates how the LGM can be applied in the evaluation of intervention programs targeting HIV risk behavior among drug users. Multi-group piecewise latent growth models were fit to longitudinal data with three repeated response measures.

Female↗
PubMed1998

Needle transfer among injection drug users: a multilevel analysis.

OBJECTIVE: The purpose of the study described here is to extend our understanding of needle transfer behaviors among injection drug users (IDUs) by combining both micro and macro variables in a multilevel model. METHODS: A sample of 8,404 IDUs interviewed at 18 sites of the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Program (COOP) was used for the study. A multilevel model was employed to deal with intraclass correlation in the sample and to evaluate the impact of micro and macro variables on needle transfer among IDUs. RESULTS: A significant intraclass correlation was detected in the sample. Needle transfer was associated with both the individual characteristics and the features of the social setting in which they were embedded. Some of the micro slopes were fixed, while some varied from site to site, depending on the values of macro variables. The micro intercept and the micro slope of ethnicity vary randomly across social settings, while they are partially determined by macro variables. CONCLUSION: Considering the intraclass correlation in the data and the effects of contextual features on individual behaviors, multilevel analysis of HIV risk behaviors should be considered when combining data from micro and macro levels (e.g., individual and project site levels).

Acquired Immunodeficiency Syndrome↗
PubMed1998

A preliminary evaluation of a modified needle-cleaning intervention using bleach among injection drug users.

This study examines an intervention designed to improve needle-cleaning practices among injection drug users (IDUs) in Dayton and Columbus, Ohio, to meet the recommended bleach exposure time of at least 30 seconds. Simulated needle-cleaning practices were observed in offices at baseline and after an intervention at 2 to 4 week and 6-month follow-ups. Descriptive statistics, t-tests, logistic, and multiple regressions were used to examine behavior change and the correlates of safer cleaning practices. At baseline (n = 541), the mean bleach exposure time was 13.8 seconds. At first follow-up (n = 410), the mean bleach contact time (23.4 s) increased significantly (t = 8.59; p < .05). At 6-month follow-up (n = 83), the mean bleach exposure time (21.1 s) also increased significantly (t = 2.98; p < .05). Longer bleach contact time was associated with higher injection frequency and needle transfer at 6-month follow-up. Although mean bleach exposure time increased significantly at both follow-ups, only 30.3% of the IDUs kept bleach in the syringe for at least 30 seconds at 6-month follow-up. Improved interventions are needed.

Adult↗
PubMed1997

Factors influencing condom use among heterosexual users of injection drugs and crack cocaine.

OBJECTIVES: To study factors that influence the self-reported use of condoms among injection drug users and crack smokers. STUDY DESIGN: A cross-sectional design was used to collect data from drug-using heterosexual men (n = 247) and women (n = 107). RESULTS: Participants were largely African American (79.4%), male (69.8%), and unmarried (90.1%). The mean age for men was 39.9 years, 35.5 years for women. Drug user groups consisted of individuals who used both crack cocaine and injection drugs (40.1%), noninjecting crack smokers (33.1%), and non-crack-smoking injection drug users (26.8%). Daily injection drug or crack use was reported by 62.9% of the sample. One third of the sample reported recent vaginal sex with more than one partner. More than 70% of the participants frequently used drugs when having sex. Logistic regression showed that individuals who were high when having vaginal sex were less likely to use condoms than people who were not high (odds ratio [OR] 0.82; 95% confidence interval [CI], 0.68-0.99); individuals whose partners got high when having sex were more likely to report condom use (OR 1.20; 95% CI, 1.01-1.42); individuals were less likely to use condoms when having sex with a main partner (OR 0.40; 95% CI, 0.20-0.80); individuals who believed it was important to use condoms were more likely to use condoms (beta = 0.57, P < 0.00); and people who believed condoms reduced sexual pleasure were less likely to use condoms (beta = -0.53, P < 0.00). CONCLUSIONS: In addition to being sensitive to partner characteristics, sex risk-reduction interventions targeting users of injection drugs or crack must address the widespread use of psychoactive drugs that occurs immediately before and during sex because such use presents a significant impediment to the employment of safer-sex techniques that rely on condoms. Until such interventions are in place, access to drug abuse treatment is a critical dimension of human immunodeficiency virus and other sexually transmitted disease prevention.

Adult↗
PubMed1995

Drug abuse treatment experience and HIV risk behaviors among active drug injectors in Ohio.

This study compares the sociodemographic characteristics and human immunodeficiency virus (HIV) risk behaviors of injection drug users who had received drug abuse treatment in the previous 5 years and those who had not received treatment. The National AIDS Demonstration Research Program database provided 2001 structured interviews, representing Cleveland, Columbus, Cincinnati, and Dayton, Ohio. About 43% of the subjects reported having received treatment in the previous 5 years. Length of involvement with drugs, more frequent injection, more legal problems, and higher levels of HIV risk behaviors were associated with a history of treatment. Incorporating HIV risk reduction education in drug abuse treatment is an urgent priority.

Adult↗
PubMed1995

Reducing HIV needle risk behaviors among injection-drug users in the Midwest: an evaluation of the efficacy of standard and enhanced interventions.

This study compares the impact of a standard and an enhanced intervention on the needle-use behaviors reported by injection-drug users (IDUs) living in a low-seroprevalence area in the Midwest. Data on the drug- and needle-use practices of 381 IDUs completing a standard (n = 232) or an enhanced (n = 149) intervention who were followed-up five to nine months after a baseline interview were analyzed using bivariate and multivariate techniques. The results indicate that IDUs who participated in the enhanced intervention reported safer needle practices than standard intervention IDUs at follow-up. In addition, less frequent injectors were much more likely to adopt safer needle-use practices than were daily drug injectors, regardless of intervention track. The results suggest that more intensive interventions have advantages over minimalist efforts--in specific contexts. This finding has important implications for the HIV needle risk-reduction efforts targeting IDUs.

Adult↗
PubMed1995

Injection drug users, crack-cocaine users, and human services utilization: an exploratory study.

Estimates of the number of people addicted to heroin and cocaine run into the millions. How these drug abusers interact with the social services system is not well understood. To gain insight into the nature and extent of such interactions, an exploratory study was conducted to gather information on the perceptions and utilization of human services by 44 drug abusers not in treatment. Twenty-nine injection drug users and 15 crack-cocaine users participated in focus group sessions and structured interviews. Participants were recruited by indigenous outreach workers in Dayton and Columbus, Ohio. Findings revealed a very high rate of service use by the drug users. The results raise questions about the role and efficacy of the social services system in identifying drug users and addressing their needs. In addition, the findings raise perplexing questions regarding the effectiveness of acquired immune deficiency syndrome risk-reduction efforts among injection drug users and crack-cocaine users.

Adult↗
PubMed1995

Usefulness of the health belief model in predicting HIV needle risk practices among injection drug users.

A health belief model (HBM) that included the dimensions of perceived susceptibility, seriousness, benefits, barriers, and self-efficacy was employed to predict which injection drug users (IDUs) were engaged in needle-use practices that reduced their risk for contracting the human immunodeficiency virus (HIV). A sample of 118 active IDUs, many of whom also used crack cocaine, responded to interviewer-administered questionnaires that gathered information on their drug-use practices in the last thirty days, as well as their health beliefs. Logistic regression analysis revealed that two health beliefs--perceived self-efficacy (OR = 1.27, 95% CI = 1.04, 1.55) and perceived susceptibility (OR = .82, 95% CI = .71, .94)--were significantly related to safer injection practices. Other predictors of safer injection were black ethnicity (OR = 3.18, 95% CI = 1.19, 8.47) and injection frequency (OR = .99, 95% CI = .98, .99). The results of this study suggest that the HBM has a role to play in risk-reduction programs targeting IDUs.

Adult↗
PubMed1992

Case management to enhance AIDS risk reduction for injection drug users and crack cocaine users: practical and philosophical considerations.

The AIDS intervention model described herein represents a new "mixed" model of case management, one that combines AIDS risk-reduction education with a modified version of the traditional broker of services model. The case management component of the model is designed to heed and address those immediate needs that may distract a person from attending to the AIDS risk-reduction messages. The educational component of the model can help a person develop interest in the case management services. The result is a model that, theoretically, can have a greater impact than either component alone would have. The advantages of the model are its flexibility, its ability to quickly assess and address clients' concerns, and its short duration that enhances the likelihood that drug users will complete the process.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Popping and snorting volatile nitrites: a current fad for getting high.

In certain social circles a variety of volatile nitrites are being used extensively to expand creativity, stimulate music appreciation, promote a sense of abandon in dancing, and intensify sexual experience. Soon after amyl nitrite (the prototype of this group) became a prescription drug, legally produced substitutes appeared and were sold as room odorizers. Analyses of eight of these substitutes showed them to contain isomers of butyl or amyl alcohol and a corresponding nitrite. The authors describe the context of use of these products and their desired and adverse effects.

Amyl Nitrite↗