Investigating heterogeneity in violent offending liability among injection drug users from a developmental perspective

INTRODUCTION:

Violence is a major burden of harm among injecting drug users (IDU), however, the liability to violent offending is not well understood. The current study aimed to better understand differences in the liability to violence by determining whether IDU could be disaggregated into distinct violent offending classes, and determining the correlates of class membership.

METHODS:

A total of 300 IDU from Sydney, Australia were administered a structured interview examining the prevalence and severity of drug use and violent offending histories, as well as early life risk factors (maltreatment, childhood mental disorder, trait personality).

RESULTS:

IDU were disaggregated into four distinct latent classes, comprising a non-violent class (24%), an adolescent-onset persistent class (33%), an adult-onset transient class (24%) and an early-onset, chronic class (19%). Pairwise and group comparisons of classes on predispositional and substance use risks showed that the EARLY class had the poorest psychosocial risk profile, while the NON class had the most favourable. Multinomial logistic regression revealed that higher trait impulsivity and aggression scores, having a history of conduct disorder, frequent childhood abuse, and more problematic alcohol use, were independently associated with more temporally stable and severe violent offending. The model explained 67% of variance in class membership (χ²=207.7, df=51, p<0.001).

CONCLUSIONS:

IDU can be meaningfully disaggregated into distinct violent offending classes using developmental criteria. The age of onset of violence was indicative of class membership insomuch as that the extent of early life risk exposure was differentially associated with greater long-term liability to violence and drug use.

Purchase full article at:  http://goo.gl/Mlb7zp

By:  Torok M¹, Darke S², Shand F³, Kaye S².

¹National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. Electronic address: m.torok@unsw.edu.au.

²National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.

³Black Dog Institute, University of New South Wales, Sydney, Australia.

Addict Behav. 2016 Apr 22;60:165-170. doi: 10.1016/j.addbeh.2016.04.013. [Epub ahead of print] 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Impulsivity, Sensation Seeking, and Risk-Taking Behaviors among HIV-Positive and HIV-Negative Heroin Dependent Persons

Objective.

The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons.

Methods.

We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS).

Results.

In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups.

Conclusion.

Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people.

Comparison of subscale scores in each test between HIV-positive group and HIV-negative group.

Item∗	HIV-positive group	HIV-negative group	P value♦
Zuckerman Sensation Seeking Scale (SSS)
Thrill and adventure seeking	6.70 ± 2.80	6.33 ± 2.55	0.45
Experience seeking	4.28 ± 1.90	3.30 ± 2.03	0.007
Disinhibition	3.52 ± 1.65	2.95 ± 1.89	0.083
Boredom susceptibility	2.70 ± 1.65	2.48 ± 1.44	0.44
SSS total score	17.20 ± 5.75	15.07 ± 5.13	0.03
Balloon Analogue Risk Task (BART)
Average Number of puffs in Successful Balloons	34.58 ± 17.11	25.15 ± 13.35	0.002
Number of Successful Balloons	17.52 ± 4.02	22.63 ± 4.00	<0.001
Average Number of puffs in Each Balloon	30.40 ± 12.40	23.64 ± 11.58	0.004
Barratt Impulsiveness Scale (BIS)
Nonplanning impulsivity	28.38 ± 4.10	26.75 ± 4.99	0.053
Motor impulsivity	24.43 ± 5.04	24.57 ± 6.51	0.9
Cognitive impulsivity	19.47 ± 4.27	17.67 ± 4.94	0.035
BIS total score	72.25 ± 10.67	69.08 ± 14.02	0.16
Iowa Gambling Task (IGT)
Total duration of IGT (seconds)	286.54 ± 168.38	314.54 ± 144.77	0.38
Net amount of win (win − loss)	−12667.50  ±  −11223.32	−14242.93 ± 14446.33	0.55
IGT total score [(C + D)−(A + B)]	−2.56 ± 21.54	−5.65 ± 29.38	0.55

∗Data are represented as mean ± SD.

♦Independent sample t-test.

Full article at:   http://goo.gl/SKfpj0

By:  Koosha Paydary, ^{1 , 2 , 3} Somayeh Mahin Torabi, ² SeyedAhmad SeyedAlinaghi, ¹ Mehri Noori, ² Alireza Noroozi, ^{4 , 5}Sara Ameri, ^{1 , 2 , 3} and Hamed Ekhtiari ^{2 , 6 , *}

¹Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences (TUMS), Tehran, Iran

²Neurocognitive Laboratory, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences (TUMS), Tehran, Iran

³Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran

⁴School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Tehran, Iran

⁵Head of Substance Abuse Prevention and Treatment Office (SAPTO), Mental Health, Social Health and Addiction Department (MeHSHAD), Ministry of Health and Medical Education (MoHME), Tehran, Iran

⁶Translational Neuroscience Program, Institute for Cognitive Science Studies (ICSS), Tehran University of Medical Sciences (TUMS), Tehran, Iran

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Early Life Risks, Antisocial Tendencies & Preteen Delinquency

Early age-of-onset delinquency and substance use confer a major risk for continued criminality, alcohol and drug abuse, and other serious difficulties throughout the life course. Our objective is to examine the developmental roots of preteen delinquency and substance use. 

Using nationally representative longitudinal data from the UK Millennium Cohort Study (n = 13,221), we examine the influence of early childhood developmental and family risks on latent pathways of antisocial tendencies from ages 3 to 7, and the influence of those pathways on property crime and substance use by age 11. We identified a normative, non-antisocial pathway; a pathway marked by oppositional behavior and fighting; a pathway marked by impulsivity and inattention; and a rare pathway characterized by a wide range of antisocial tendencies. 

Children with developmental and family risks that emerged by age 3-specifically difficult infant temperament, low cognitive ability, weak parental closeness, and disadvantaged family background-face increased odds of antisocial tendencies. There is minimal overlap between the risk factors for early antisocial tendencies and those for preteen delinquency. Children on an antisocial pathway are more likely to engage in preteen delinquency and substance use by age 11, even after accounting for early life risk factors.

Purchase full article at:   http://goo.gl/A7otXL

By:  Staff J1, Whichard C1, Siennick S2, Maggs J1.

• 1Pennsylvania State University.
• 2Florida State University. 
• Criminology. 2015 Nov;53(4):677-701. Epub 2015 Oct 20.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Neurocognitive & Psychiatric Dimensions of Hot, But Not Cool, Impulsivity Predict HIV Sexual Risk Behaviors among Drug Users in Protracted Abstinence

BACKGROUND:

Impulsivity is an important risk factor for HIV risky drug and sexual behaviors. Research identifies hot (i.e. affectively-mediated, reward-based) and cool (motoric, attentional, independent of context) neurocognitive and psychiatric dimensions of impulsivity, though the impact of specific drugs of abuse on these varieties of impulsivity remains an open question.

OBJECTIVES:

The present study examined the associations of neurocognitive and psychiatric varieties of hot and cool impulsivity with measures of lifetime and recent sexual risk behaviors among users of different classes of drugs.

METHODS:

The study sample was comprised of drug users in protracted (> 1 year) abstinence: heroin mono-dependent (n = 61), amphetamine mono-dependent (n = 44), and polysubstance dependent (n = 73). Hot impulsivity was operationalized via neurocognitive tasks of reward-based decision-making and symptoms of psychopathy. Cool impulsivity was operationalized via neurocognitive tasks of response inhibition and symptoms of attention deficit/hyperactivity disorder (ADHD).

RESULTS:

Hot impulsivity was associated with sexual risk behaviors among heroin and amphetamine users in protracted abstinence, whereas cool impulsivity was not associated with sexual risk behaviors among any drug-using group. Neurocognitive hot impulsivity was associated with recent (past 30-day) sexual risk behaviors, whereas psychopathy was associated with sexual risk behaviors during more remote time-periods (past 6 month and lifetime) and mediated the association between heroin dependence and past 6-month sexual risk behaviors.

CONCLUSION:

Assessments and interventions aimed at reducing sexual risk behaviors among drug users should focus on hot neurocognitive and psychiatric dimensions of impulsivity, such as decision-making and psychopathy. Cool dimensions of impulsivity such as response inhibition and ADHD were not related to sexual risk behaviors among drug users in protracted abstinence.

Purchase full article at:   http://goo.gl/YW0wKz

By:  Wilson MJ1, Vassileva J2.

• 1 Department of Psychology , University of Illinois at Chicago , Chicago , IL , USA.
• 2 Department of Psychiatry , Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine , Richmond , VA , USA.
• Am J Drug Alcohol Abuse. 2016 Feb 2:1-11.  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Individual Differences in Men's Misperception of Women's Sexual Intent: Application and Extension of the Confluence Model

Men are more likely than women to misperceive a cross-sex companion's degree of sexual interest. The current study extends previous research by using the confluence model (Malamuth et al., 1991) to examine how narcissism and impulsive sensation-seeking are directly and indirectly associated with men's misperception of women's sexual interest. 

A community sample of young, single men (N = 470) completed audio computer-assisted self-interviews. Using path analyses, hostile masculinity and impersonal sexual orientation were proximal predictors of men's misperception of women's sexual intent. 

Additionally, narcissism was indirectly related to men's misperception through hostile masculinity. Impulsive sensation-seeking was directly and indirectly related to men's misperceptions through impersonal sexual orientation. Although there was a bivariate relationship between alcohol consumption and misperception, this relationship was not significant in the path model. 

Overall, these findings demonstrate the importance of considering how personality traits increase the risk for misperception.

Purchase full article at:   http://goo.gl/ATrWgx

By:  Wegner R1, Abbey A1.

• 1Wayne State University. 
• Pers Individ Dif. 2016 May 1;94:16-20.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Two Decades of Adolescent Suicides Assessed at Milan University's Medicolegal Unit

Highlights

• Seventy-eight autopsy cases of adolescents suicide in 20 years were analyzed.
• Epidemiology, forensic pathology and psychopathological data were discussed.
• Adolescents were involved in 2.23% of all suicides committed in the Milan area.
• In the majority of cases there were no premonitory signs or particular motives.

Aim

to analyze the cases of suicide committed by adolescents in and around the city of Milan over a 20-year period (1993–2012).

Materials and methods

cases of suicide involving individuals between 10 and 19 years of age were drawn from 20,757 autopsies performed by the Medico-legal Unit at Milan University. Seventy-eight cases were considered (20 females and 58 males, with the ratio of 1:2.9), and their clinical and circumstantial histories, epidemiology, forensic pathology and psychopathological issues were analyzed.

Result

Adolescents were involved in 2.23% of all suicides committed in Milan during the period examined. The “mean” victim is a male without psychiatric disease, aged between 16 and 19, that commits suicide outdoors.

Conclusions

In the majority of cases, there were no premonitory signs, nor any particular contingent or remote reason that might explain these violent deaths, which therefore remain “impulsive”.

Below:  Graphical representation of the annual distribution of the suicides

Below:  Graphical representation of the monthly distribution of the suicides

Below:  Distribution of the sample of adolescents by method chosen to commit suicide

Full article at:  http://goo.gl/F6rnkQ 

By:  Clerici CA1, Gentile G2, Marchesi M3, Muccino E2, Veneroni L1, Zoja R4.

• 1Sezione di Psicologia, Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Via Fratelli Cervi 93, 20090 Segrate MI, Italy.
• 2Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano, Italy.
• 3Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy.
• 4Sezione di Medicina Legale e delle Assicurazioni, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, 20133 Milano, Italy. Electronic address: riccardo.zoia@unimi.it.
• J Forensic Leg Med. 2016 Jan;37:15-21. doi: 10.1016/j.jflm.2015.09.016. Epub 2015 Oct 3. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Bidirectional Associations between Externalizing Behavior Problems and Maladaptive Parenting within Parent-Son Dyads Across Childhood

Coercive parent-child interaction models posit that an escalating cycle of negative, bidirectional interchanges influences the development of boys' externalizing problems and caregivers' maladaptive parenting over time. However, longitudinal studies examining this hypothesis have been unable to rule out the possibility that between-individual factors account for bidirectional associations between child externalizing problems and maladaptive parenting. 

Using a longitudinal sample of boys (N = 503) repeatedly assessed eight times across 6-month intervals in childhood (in a range between 6 and 13 years), the current study is the first to use novel within-individual change (fixed effects) models to examine whether parents tend to increase their use of maladaptive parenting strategies following an increase in their son's externalizing problems, or vice versa. These bidirectional associations were examined using multiple facets of externalizing problems (i.e., interpersonal callousness, conduct and oppositional defiant problems, hyperactivity/impulsivity) and parenting behaviors (i.e., physical punishment, involvement, parent-child communication). 

Analyses failed to support the notion that when boys increase their typical level of problem behaviors, their parents show an increase in their typical level of maladaptive parenting across the subsequent 6 month period, and vice versa. Instead, across 6-month intervals, within parent-son dyads, changes in maladaptive parenting and child externalizing problems waxed and waned in concert. Fixed effects models to address the topic of bidirectional relations between parent and child behavior are severely underrepresented. 

We recommend that other researchers who have found significant bidirectional parent-child associations using rank-order change models reexamine their data to determine whether these findings hold when examining changes within parent-child dyads.

Purchase full article at:   http://goo.gl/DVqrJ3

By:  Besemer S1, Loeber R2, Hinshaw SP3, Pardini DA4.

• 1University of California, Berkeley, Institute of Human Development (http://ihd.berkeley.edu/), 1205 Tolman Hall, Berkeley, CA, 94720, USA. besemer@berkeley.edu.
• 2Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
• 3Department of Psychology, University of California Berkeley, Berkeley, CA, USA.
• 4School of Criminology & Criminal Justice, Arizona State University, Phoenix, AZ, USA.
• J Abnorm Child Psychol. 2016 Jan 18. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Trajectories of Binge Drinking and Personality Change Across Emerging Adulthood

College students binge drink more frequently than the broader population, yet most individuals “mature out” of binge drinking. Impulsivity and sensation seeking traits are important for understanding who is at risk for maintaining binge drinking across college and the transition to adult roles. 

We use latent class growth analysis (LCGA) to examine longitudinal binge-drinking trajectories spanning from the end of high school through two years after college (mean ages 18.4 to 23.8). Data were gathered over 10 waves from students at a large Southwestern university (N = 2,245). We use latent factor models to estimate changes in self-reported impulsive (IMP) and sensation-seeking (SS) personality traits across two time periods – (1) the end of high school to the end of college, and (2) across the two-year transition out of college. 

LCGA suggested seven binge drinking trajectories: Frequent, Moderate, Increasing, Occasional, Low Increasing, Decreasing, and Rare. Models of personality showed that from high school through college, change in SS and IMP generally paralleled drinking trajectories, with Increasing and Decreasing individuals showing corresponding changes in SS. Across the transition out of college, only the Increasing group demonstrated a developmentally deviant increase in IMP, whereas all other groups showed normative stability or decreases in both IMP and SS. These data indicate that “late bloomers,” who begin binge drinking only in the later years of college, are a unique at-risk group for drinking associated with abnormal patterns of personality maturation during emerging adulthood. 

Our results indicate that personality targeted interventions may benefit college students.

Below:  Latent Difference Scores by Latent Trajectory Class

Full article at:   http://goo.gl/GcbTA2

By:  James R. Ashenhurst, Kathryn P. Harden, William R. Corbin, and Kim Fromme

James R. Ashenhurst, Psychology Department, University of Texas at Austin.

Contributor Information.

Correspondence concerning this article should be addressed to: James R. Ashenhurst, Ph.D. Department of Psychology, The University of Texas at Austin, 1 University Station A8000, Austin, TX 78712. Email: ude.saxetu@tsruhnehsa.semaj

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Pathways to HIV-Related Behavior among Heterosexual, Rural Black Men: A Person-Centered Analysis

We investigated the psychosocial mechanisms linking personal and contextual risk factors to HIV-related behavior among 498 rural Black men. We characterized HIV-related behavior in terms of profile groups and hypothesized that contextual and personal risk factors (childhood adversity, community disadvantage, incarceration, and racial discrimination) would predict HIV-related behavior indirectly via two psychosocial mechanisms: impulsivity and negative relational schemas. 

Study results documented three HIV-related behavior profile groups. 

• The Safer group reported low levels of risky behavior. 
• The Risk-Taking group reported inconsistent condom use and elevated substance use. 
• The Multiple Partners group reported the highest numbers of partners and relatively consistent condom use. 

Risk factors predicted profile groups directly and indirectly through psychosocial mechanisms. Impulsivity mediated the association between community disadvantage and membership in the risk-taking group. Negative relational schemas mediated the associations of childhood experiences and community disadvantage with membership in the multiple partners group. 

Specificity in pathways suggests the need for targeted interventions based on multidimensional characterizations of risk behavior.

Purchase full article at:   http://goo.gl/mEa3c0

  

By:   Steven M. Kogan,, Junhan Cho, Stacey Barnum, Allen Barton, Megan R. Hicks, Geoffrey L. Brown

Department of Human Development and Family Science, University of Georgia 

  

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Reducing Adverse Polypharmacy in Patients with Borderline Personality Disorder: An Empirical Case Study

Objective:

Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personality disorder. This case aims to demonstrate that potential.

Method:

This case report presents outcomes data for an individual with borderline personality disorder during the course of an extended psychiatric hospitalization. Symptomatic change is based on the Patient Health Questionnaire Somatic, Anxiety, and Depression Symptoms scales and World Health Organization 5-Item Well-Being Index. Change in polypharmacy is presented both in terms of absolute number and complexity of the medication regimen. Clinical outcomes data are provided at 2, 12, and 24 weeks postdischarge.

Results:

During a 56-day hospitalization, the patient demonstrated clinical improvement across clinical domains—all occurred within the context of reduced number (43%) and complexity (40%) of her medication regimen. Symptomatic improvement was sustained up to 6 months postdischarge.

Conclusions:

Despite good intentions, polypharmacy can be associated with iatrogenic harm and contribute to functional impairment, especially in the context of borderline personality disorder, in which symptomatic fluctuations are part of the illness itself. A reduction in the patient’s high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself. Additional measures of medication risk and liability have the potential to become markers of clinical effectiveness.

Clinical Points

• Despite good intentions, polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden.
• A reduction in patients’ high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself and might be conceptualized as a marker of clinical effectiveness.

Table 1.

Ms A’s Medications at Admission and Discharge

Admission	Indication	Discharge	Indication
Venlafaxine 75 mg: 3 by mouth in the morning and 2 by mouth at bedtime	Antidepressant
Lamotrigine 200 mg by mouth in the morning	Mood stabilizer	Lamotrigine 200 mg at bedtime	Mood stabilizer
Mirtazapine 30 mg by mouth at bedtime	Antidepressant	Mirtazapine 30 mg at bedtime	Antidepressant
Clonazepam 1 mg by mouth in the morning and at bedtime	Antianxiety	Hydroxyzine 25 mg every 8 h as needed	Antianxiety
Ziprasidone 80 mg by mouth in the morning and at bedtime	Antipsychotic	Ziprasidone 80 mg twice daily	Antipsychotic
Zolpidem 10 mg by mouth daily as needed for anxiety	Hypnotic
Metformin hydrochloride 1,000 mg by mouth twice daily	Diabetes	Metformin hydrochloride 1,000 mg in the morning and 500 mg at bedtime	Diabetes
Atorvastatin 40 mg by mouth at bedtime	High cholesterol
Esomeprazole 40 mg by mouth at bedtime	Gastroesophageal reflux disease	Esomeprazole 40 mg daily	Gastroesophageal reflux disease
Lithium carbonate 600 mg by mouth twice daily	Mood stabilizer	Lithium carbonate 600 mg twice daily	Mood stabilizer
Buspirone 7.5 mg by mouth twice daily	Antianxiety	Buspirone 7.5 mg twice daily	Antianxiety
Levothyroxine 50 mcg by mouth in the morning	Hypothyroid	Levothyroxine 100 mcg daily	Hypothyroid
Amphetamine/dextroamphetamine 25 mg by mouth in the morning and 20 mg at noon	Stimulant
Multivitamin: 1 by mouth daily	General health
Baby aspirin: 1 by mouth daily	Cardiovasular
Quinine sulfate: 2 tablets by mouth at bedtime	Leg cramps
Cetirizine 10 mg by mouth in the morning	Antihistamine
Atropine/diphenoxylate: 1 by mouth twice daily	Irritable bowel syndrome
Bismuth subsalicylate over-the-counter by mouth twice daily	Irritable bowel syndrome
Insulin glargine 45 IU subcutaneous twice daily	Diabetes	Insulin glargine 47 units subcutaneous in the morning and at bedtime	Diabetes
Insulin lispro sliding scale	Diabetes	Insulin lispro sliding scale	Diabetes
		Ferrous sulfate 324 mg daily	Anemia
		Pregabalin 50 mg twice daily	Paresthesia

Full article at: http://goo.gl/ubG1uX

By:   Alok Madan, PhD, MPH, John M. Oldham, MD, Sylvia Gonzalez, MD, and J. Christopher Fowler, PhD

The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.

Corresponding author.

Corresponding author: Alok Madan, PhD, MPH, The Menninger Clinic, 12301 S Main St, Houston, TX 77035 (Email: ude.regninnem@nadama).

 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health