Risk Environments, Race/Ethnicity, and HIV Status in a Large Sample of People Who Inject Drugs in the United States

INTRODUCTION:

We analyzed relationships between place characteristics and being HIV-negative among black, Latino, and white people who inject drugs (PWID) in the US.

METHODS:

Data on PWID (N = 9077) were from the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance. Administrative data were analyzed to describe the 968 ZIP codes, 51 counties, and 19 metropolitan statistical areas (MSAs) where they lived. Multilevel multivariable models examined relationships between place characteristics and HIV status. Exploratory population attributable risk percents (e-PAR%s) were estimated.

RESULTS:

Black and Latino PWID were more likely to be HIV-negative if they lived in less economically disadvantaged counties, or in MSAs with less criminal-justice activity (i.e., lower drug-related arrest rates, lower policing/corrections expenditures). Latino PWID were more likely to be HIV-negative in MSAs with more Latino isolation, less black isolation, and less violent crime. E-PAR%s attributed 8-19% of HIV cases among black PWID and 1-15% of cases among Latino PWID to place characteristics.

DISCUSSION:

Evaluations of structural interventions to improve economic conditions and reduce drug-related criminal justice activity may show evidence that they protect black and Latino PWID from HIV infection.

Below: Characteristics of the sample of people who inject drugs (PWID), drawn from the 2009 CDC Survey

Full article at:   http://goo.gl/guvTRj

By:  Cooper HL1, Linton S1, Kelley ME1, Ross Z2, Wolfe ME1, Chen YT1, Zlotorzynska M1, Hunter-Jones J1, Friedman SR3, Des Jarlais DC4, Tempalski B3,DiNenno E5, Broz D5, Wejnert C5, Paz-Bailey G5; National HIV Behavioral Surveillance Study Group.

• 1Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, United States of America.
• 2ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY 14850, United States of America.
• 3Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, United States of America.
• 4The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 39 Broadway, 5th floor, New York, NY 10006, United States of America.
• 5Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS-E46), Atlanta, GA 30333, United States of America. 
• PLoS One. 2016 Mar 14;11(3):e0150410. doi: 10.1371/journal.pone.0150410. eCollection 2016.

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Patient Characteristics & Predictors of Completion in Residential Treatment for Substance Use Disorders

Aims and method 

To identify the patient characteristics and rates of retention in a residential rehabilitation drug and alcohol service (Springhill) based on an eclectic model of care. Patients were assessed using the Alcohol and Drug Outcome Measure (ADOM), a brief tool designed for the New Zealand setting. We looked at correlations between demographic, social and drug use parameters. Logistic regression assessed the relative impact of each variable on completion. 

Results 

The 183 patients who completed the data collection did not differ from 47 non-completers by demographic data; 62.2% of patients completed the programme, with equal number of men and women. One in five participants was Maori, the indigenous minority. Alcohol (51.9%) was the commonest drug of misuse, with methamphetamine (16.4%) and cannabis (14.2%) also significant. Completers were more likely to be Maori, have conflict with family and housing problems, although the last became non-significant in logistic regression. 

Clinical implications 

Retention rates are higher in Springhill than in comparable programmes. Ethnicity and family conflict predict completion, although the reasons for this are unclear. ADOM is an effective tool that can be used in a clinical setting to enable analysis of service provision.

...Significant morbidity is reported in physical, psychological and social domains by the patients in this study. These problems are directly related to drug use and small changes in use are likely to be associated with significant benefits to health, relationships and well-being. Previous economic analysis indicates major benefits associated with effective addictions intervention also.³⁶ The relative failure of community intervention for this cohort argues in favour of residential intervention, particularly if retention is high, and implies improved prognosis. This is the case for Springhill and may relate to positive longer-term outcomes.^37,38 Follow-up studies will enable further examination of longer-term benefits and overcome the limitation of using completion as a proxy marker for improved prognosis.

Identifying who is likely to benefit most from residential treatment allows for a more targeted approach to management. Prior research has recommended a ‘non-discriminatory approach to referral’ and no clear indicators are apparent in the current literature base. Using regression analyses to consider the impact of several factors likely to alter treatment completion, we are able to show that Maori, the indigenous minority in New Zealand, and those with conflict in the home are more likely to complete the programme. The programme includes the capacity for patients to engage with a cultural assessment but does not include individual or group activities that are specifically culturally oriented. Previous research identifies greater social morbidity in Maori in an out-patient addictions setting³⁹ and greater satisfaction with a culturally specific service. Cultural factors have been a point of focus in policy debate about the provision of services,²⁹ with some advocating for a culturally appropriate approach research methodology frame, although support (and the application) of this is very limited. The current findings suggest Maori manage well in a generic eclectic setting. This does not indicate a generic service is likely to outperform a culturally specific service; rather, Maori are more likely than clients of other ethnicities to complete this programme. Ethnicity is not a proxy marker for social disadvantage as measured by social role difficulties, employment, housing problems and crime in this study as the linear regression of model D elucidates. Understanding the impact of homelessness in dependence is complex,⁴⁰ although the parsimonious explanation of having basic needs met does not preclude the potential for recovery and may be an important component of successful recovery...

Full article at:   http://goo.gl/Z2pxRJ

By:  Giles Newton-Howes1 and James Stanley1

1Otago University, Wellington, New Zealand

Correspondence to Giles Newton-Howes (Email: zn.ca.ogato@sewoh-notwen.selig)

Dr Giles Newton-Howes BA, BSc, MBChB, MRCPsych, FRANZCP is senior lecturer at the Department of Psychological Medicine, Wellington School of Medicine, Otago University, Wellington, New Zealand, and honorary senior lecturer at Imperial College London, UK. Dr James Stanley PhD is a research fellow at Wellington School of Medicine, Otago University.

BJPsych Bull. 2015 Oct;39(5):221-7. doi: 10.1192/pb.bp.114.047639.

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Ethnic Differences in the Links Between Benefit Finding & Psychological Adjustment in People Living with HIV

Experiencing growth after the diagnosis of a life threatening illness is commonly reported among people living with HIV (PLWH). 

The links between benefit finding and better adjustment in PLWH have been identified, but it is less clear whether these links vary by ethnicity. Minority stress theory suggests that individuals from minority populations may have unique stress experiences, which can have negative health implications but may also provide opportunity for growth. 

We hypothesized that the association between benefit finding and psychological adjustment would be stronger for Black (n = 80) than White (n = 87) PLWH. Contrary to predictions, the relationship between benefit finding and better adjustment was significant for White but not Black PLWH. Post-hoc analyses suggested that sexual orientation played role in this relationship. 

The relationship between benefit finding and psychological adjustment may be complex for Black PLWH, or they may achieve adjustment using other resources.

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By:  Fekete EM1, Chatterton M2, Skinta MD3, Williams SL4.

• 1School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN, 46227, USA. feketee@uindy.edu.
• 2School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, Indianapolis, IN, 46227, USA.
• 3Pacific Graduate School of Psychology, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA.
• 4Department of Psychology, East Tennessee State University, P.O. Box 70649, Johnson City, TN, 37614, USA.
• J Behav Med. 2016 Jan 19. 

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Race, Ethnicity, and Adolescent Violent Victimization

The risk of adolescent violent victimization in the United States varies considerably across racial and ethnic populations; it is unknown whether the sources of risk also vary by race and ethnicity. 

This study examined the correlates of violent victimization for White, Black, and Hispanic youth. Data collected from 11,070 adolescents (51 % female, mean age = 15.04 years) during the first two waves of the National Longitudinal Study of Adolescent to Adult Health were used to estimate group-specific multilevel logistic regression models. 

The results indicate that male, violent offending, peer deviance, gang membership, and low self-control were significantly associated with increased odds of violent victimization for all groups. Some activities-including getting drunk, sneaking out, and unstructured socializing with peers-were risk factors for Black adolescents only; skipping school was a risk factor only for Hispanic adolescents. 

Although there are many similarities across groups, the findings suggest that minority adolescents are particularly vulnerable to violent victimization when they engage in some activities and minor forms of delinquency.

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By:  Tillyer MS1, Tillyer R2.

• 1Department of Criminal Justice, University of Texas at San Antonio (http://copp.utsa.edu/department/category/criminal-justice/), 501 W. Cesar E. Chavez Blvd., San Antonio, TX, 78207, USA. Marie.Tillyer@utsa.edu.
• 2Department of Criminal Justice, University of Texas at San Antonio, 501 W. Cesar E. Chavez Blvd., San Antonio, TX, 78207, USA. Rob.Tillyer@utsa.edu. 
• J Youth Adolesc. 2016 Jan 14.

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Masculinities & Ethnicities: Ethnic Differences in Drive for Muscularity in British Men & the Negotiation of Masculinity Hierarchies

Although relatively little is known about ethnic differences in men's drive for muscularity, recent theoretical developments suggest that ethnic minority men may desire greater muscularity to contest their positions of relative subordinate masculinity. 

This study tested this hypothesis in a sample of 185 White, 180 Black British, and 182 South Asian British men. Participants completed self-report measures of drive for muscularity, need for power, adherence to traditional cultural values, and ethnic group affiliation. 

Taking into account between-group differences in body mass index, results indicated that White men had significantly lower drive for muscularity than Black and South Asian men, who were not significantly different from each other. 

In addition, greater need for power was significantly associated with higher drive for muscularity in ethnic minority, but not White, men. Greater adherence to traditional cultural values, but not ethnic group affiliation, was associated with lower drive for muscularity in all ethnic groups. 

These results suggest that ethnic minority men may desire greater muscularity as a means of negotiating masculinity and attendant ideals of appearance.

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By:  Swami V1,2.

• 1Department of Psychology, University of Westminster, London, UK.
• 2Department of Psychology, HELP University College, Kuala Lumpur, Malaysia. 

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Ethnicity & Neighbourhood Deprivation Determines the Response Rate in Sexual Dysfunction Surveys

Background

Self-administered questionnaires provide a better alternative to disclose sensitive information in sexual health research. We describe the factors that determine the positive response (initial recruitment) to an initial invitation and subsequent completion of study to a postal questionnaire on sexual dysfunction.

Methods

South Asians (SA) and Europids with and without diabetes (DM) were recruited from GP clinics in UK. Men who returned the properly filled consent form (‘recruited-group’) were sent the questionnaire and those who returned it were considered as the ‘completed-group’. Index of Multiple Deprivation Scores (IMDs) were generated using UK postcodes. We calculated the recruitment rate and completion rate of the recruited and the study-completed groups respectively.

Results

Total approached sample was 9100 [DM: 2914 (32 %), SA: 4563 (50.1 %)]. Recruitment rate was 8.8 % and was higher in Europids and in patients with DM. Mean IMDs for the recruited group was 20.9 ± 11.9, and it was higher among recruited SA compared to Europids (p < 0.001). Mean IMDs was higher in the recruited group compared to non-recruited (p < 0.01). All four recruited groups (SA/Europid and DM/non-DM) had lower IMDs compared to non-recruited. Completion rate was 71.5 % (n 544) (SA: 62.3 %, Europids: 77.4 %; p < 0.05).

Conclusion

Recruitment for postal sexual health surveys is positively influenced by presence of investigated disease, older age, being from lesser deprived areas and Europid ethnicity. Furthermore, Europids were more likely to complete survey than South Asians irrespective of disease status.

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