During the past two decades there has been much research conducted on the relationship between the risky sexual behavior practices and substance use among U.S. adolescents. This body of research has documented the fact that substance use and not using condoms are the most important indicators associated with the risk of becoming infected with sexually transmitted diseases (STD) both among adolescents and adults (Florida Department of Public Health, 2004; Malow, Devieux, Jennings, & Lucenko, 2001; McCoy & Inciardi, 1995). Data from those reports and studies indicate that adolescents and adults who use a condom regularly and appropriately are 20 times less likely to contract an STD than those who do not (Pinkerton & Abramson, 1997). However, less empirical evidence exists about the factors that influence adolescent use of condoms, particularly among adolescents who are detained due to their criminal lifestyle. Researchers have found both a high prevalence of STD in addition to early onset of sexual activity without protection among some adolescent groups such as the detainees (D'angelo & DiClemente, 1996) and that adolescents tend to underestimate their risks of acquiring the human immunodeficiency virus (HIV) (Magura, Shapiro, & Kang, 1994). Many adolescents will experiment with alcohol and other drugs. This behavior may compromise their judgment and increase their chances of engaging in risky sex (Rotheram-Borus, 2000). Hence the need for research that investigates the influence that substance use, risky sexual attitudes, knowledge about the transmission of HIV, and both peer and parental approval of condom use have on the use of condoms among both female and male adolescent detainees. Lastly, it is important for additional research to be conducted because adolescent detainees have been identified as being at high risk of becoming infected with an STD (Malow, Rosemberg, & Devieux, 2006). The purpose of this study was to examine the relationship among adolescent substance use, gender, sexual risk attitude, attitude about personal use of condoms, knowledge associated with the transmission of HIV, peer and family approval of condom use, history of sexually transmitted diseases (STD) and the level of condom use in a sample of adolescents housed in a correctional institution. Further details of the explanatory variables, the control variables and their expected relationships can be found in the review of the Literature in Chapter 2. Also, more information about the separate analysis of the research questions is detailed in the Methods section in Chapter 3. Based on the literature detailed in Chapter 2 (e.g., Malow et al., 2006), the current study’s researcher anticipated that adolescents’ higher levels of illicit drug use would be related to higher levels of sexual risk behaviors, as measured by lower levels of condom use, than their counterparts who used no drugs. Similarly, it was hypothesized that positive attitudes toward condom use and higher levels of HIV risk knowledge would be associated with a lower level of risky sexual behaviors along with a higher level of condom use skill. It was further hypothesized that the level of approval perceived from parents and peers regarding condom use was going to be related to adolescents’ safe sex behavior (i.e., condom use). Therefore, it was expected that participants’ perception of a high level of approval to use condoms from peers and parents would be a statistically significant variable in helping explain the condom use within this sample of adolescent detainees.

Research targeting the chemically dependent woman has received little attention, even though the research indicates a convergence of male and female drinking norms. Research centered on the special issues of the chemically dependent woman also needs to be extended beyond the scope of actual alcohol and drug abuse and resulting treatment to include information on what issues women face in their recovery process. The findings would help treatment providers design more successful interventions for this population. This study used qualitative methods to investigate issues that 12 chemically dependent women, ranging in actual time in recovery from first to third year post inpatient treatment, discussed as part of a 16 week therapy group. Their recorded responses were transcribed and analyzed, using Glaser and Strauss' methods of comparative analysis, comparing the women between three groups desiginated by the divisions of first, second, and third year post inpatient treatment. The findings indicate that all share many of the same issues, however there are marked differences between the groups. All the women had difficulties with intra- and interrelationships, finding it difficult to maintain a healthy recovery in spite of the problems they confronted in experiencing reality without mind-altering substances. Many issues were influenced by the subjects' family of origin history and sex-role orientation. Conflicts in role obligations resulting in work, family, parenting, and relationship problems surfaced. All the women were aware of additional substance and compulsive dependencies that they would like to eliminate; however, avoiding relapse of their alcohol/drug addiction was the major concern for most. The findings reveal that the longer women spent time actively undertaking a concerted program of recovery, the more they experienced integration into the rest of society, and that the acquisition of life skills and resolution of the past were important factors to the success of this integration. The categories and theme issues that emerged from the analysis have implications for social work practice, policy, and further research. / Arts, Faculty of / Social Work, School of / Graduate

archives@tulane.edu / Background: Although engagement and retention in HIV care and treatment is a critical issue across populations, it is of particular importance among female sex workers (FSWs) as they are disproportionately affected by HIV due to high rates of sexual risk behaviors and large sexual networks. Drug use is one of the most consistent and salient barriers to successful engagement in HIV care and treatment. For many FSWs, drug use is a common part of their daily lives. While individual-level factors likely explain a substantial portion of variability in drug use behavior, evidence demonstrates that differences in health behaviors and outcomes cannot be fully explained by individual-level factors alone. Previous explorations of drug-related harms have found that neighborhoods and social networks are two important environments that impact substance use behavior and associated health outcomes; yet, there has been little research on the interacting effects of networks and neighborhoods on drug use among FSWs living with HIV. Objective: Using innovative geospatial and social network methods, the purpose of this pilot study was 1) to characterize the physical and social risk environments of a small cohort of FSWs living with HIV in the Dominican Republic (DR), and 2) to examine the association between their daily activity patterns and social relationships on illicit drug use. Methods: A micro-longitudinal observational study design was employed. Data collection activities included: (1) semi-structured questionnaire, (2) daily activity space mapping, (3) daily behavior diary, (4) social network survey; and (5) secondary data. Statistical analysis included spatial mapping, social network analysis, univariate and bivariate means analysis, generalized estimating equations (GEE) with repeated measures, interaction and effect modification. Results: Findings suggest that social networks, specifically drug networks and sex and drug networks, and daily activity path and location-based risk exposures are independently associated with risk of daily drug use, and that network risk profile modifies the association between location-based risk exposure and daily drug use. Results from Paper 1 show that participants exposed to a higher number of risk outlets within 200 meters of their weekly activity paths weighted by time exposed had an increased risk of daily drug use (RRadj: 2.83, 95%CI: 1.14, 7.03). Similarly, per unit increase in risk outlet exposure within 200 meters of sex work locations was associated with an increased risk of daily drug use (RRadj: 1.03, 95%CI: 1.00, 1.05). Paper 2 results indicate that participants with more drug using members and sexual partners who were also drug users in their social networks were 8.89 (95%CI: 2.62, 30.33) and 6.08 (95 CI%: 1.20, 30.92) times more likely to use drugs compared to those with fewer drug using members and sexual partners who used drugs. Finally, paper 3 results suggest that the joint effects of networks and activity space are greater than individual effects alone and that drug network and sex and drug network modify the association between sex work location risk environment exposure and daily drug use. No differences were detected among individuals with large drug and sex and drug networks, but among individuals with small drug and sex and drug networks, per unit increase in risk outlet exposure within 200-meters of sex work locations was associated with an increased risk of daily drug use. Conclusions: This research provides significant information on the overlapping and diverging characteristics of the social factors and physical spaces that shape drug use in the broader context of sex work, HIV, and vulnerability in a low-and middle-income country (LMIC) setting. Findings may be used to inform integrated care interventions that are geographically targeted and address the social processes and structures that influence drug harms and HIV treatment in a highly stigmatized and vulnerable population. / 1 / Erica Ann Felker-Kantor

In this paper we will discuss our unsuccessful attempt to conduct a self-report study of delinquent behavior in an urban multi-racial high school in Portland, Oregon. Much of this report reflects our preparation in conducting a self-report study and our analysis of why if failed. The contention of this study is that delinquent behavior, and not juvenile delinquency is the major problem facing youth serving agencies and the public. The purpose of this study is an attempt to refine an often used method of measuring delinquent behavior – the self–report. Favoring a self–report technique of data collection rather than an analysis of rate variations, a comparison of matched samples or a study of subcultures, tends to ground this study in a “radical non-intervention” approach to the field of delinquent behavior. This particular approach views delinquent behavior as widespread throughout society rather than concentrated among the economically disadvantaged or in a certain subculture of the adolescent population.

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Marijuana has been found to be the sole substance used by 57.3 percent of illicit drug users in the United States (NSDUH 2008). Taking this statistic into mind, it makes sense that individuals currently wed, divorced, cohabitating, or in some form of committed, romantic relationship would also be affected by the use of marijuana. While in today’s society the process of mate selection and relationship formation is considered to be a rather private and personal affair, some aspects of relationships still have consequences for the greater society. The effects of failed pairings on the individuals involved can have numerous repercussions; such ramifications are only multiplied when children are present within the relationship. The purpose of this project was to gain an understanding of the interplay between marijuana use and relationships and to better understand the means and methods by which relationships and marijuana use change over time. The influence of one’s personal, committed relationships on the increase, decrease, initiation, or cessation of marijuana use is examined in this study. Through the use of qualitative, in-depth interviews with 19-seven current and former users of marijuana, the underlying processes and events associated with the use of marijuana within relationships are better understood. According to the current research, marijuana can have both positive and negative repercussion on the romantic relationships of users. However, the most negative impacts on relationships tend to be seen when partners are unequally matched on their usage of the substance.

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This study investigated the personal medication management practices of some Medicare eligible university retirees and their dependents. This is important since older adults often take multiple medications and are more susceptible to adverse reactions and interactions. The general hypothesis regarding where retirees medications are obtained and their understanding of their use was not supported. Responses to the research questions revealed a higher level of understanding and compliance than previously reported by others. Also, they are unlikely to participate in an employer sponsored educational intervention. This may be related to the educational level of the sample. Suggestions for future research including sample selection, questionnaire wording and scaling are discussed. / Fisher Institute for Wellness and Gerontology

OBJECTIVE: Most drug use screening measures rely on and are validated against self-report. Fear of negative consequences often promotes denial of drug use. For pregnant women, social stigma and fear of legal consequences make underreporting of drug use even more likely. An indirect screener that could effectively identify pregnant women at risk for illicit drug use without reliance on disclosure would be clinically significant. The purpose of the current study was to develop and validate an indirect measure of prenatal drug use by comparing correlates of prenatal drug use to urinalysis results. METHOD: Pregnant women attending an OB appointment at the VCUHS Women’s Health Clinic were recruited and consented to participate in an anonymous, two-phase study. In Phase 1, women completed a 20-minute computerized assessment which included a true/false index of items known to tap behavioral, medical, psychological, experiential and demographic correlates of drug abuse and dependence. In Phase 2, participants were asked to provide a urine sample for drug testing. Women received a $20 gift card after they participated in each phase. RESULTS: Two hundred and thirty-one women completed both Phase 1 and 2 (94% completion rate). Participants were primarily African-American (66%), single (75%) and receiving public assistance (70%). Urinalysis revealed that 16% of the sample tested positive for recent drug use, while only 5% of women self-reported past month drug use. After examining the univariate and multivariate relationships between each indirect item and drug status (i.e., positive or negative urinalysis), six indirect items were chosen to comprise the Wayne Indirect Drug Use Screener-Pregnancy (WIDUS-P). Cross-validation analyses resulted in a sensitivity of .90, specificity of .75, and AUC of .85. In comparison to direct screening approaches, the WIDUS-P was superior in identifying pregnant women who had used drugs recently. CONCLUSIONS: Findings support the use of an indirect screening tool to identify prenatal drug use, especially over currently-used direct methods. Such a measure could easily be implemented into regular clinic practice and result in more cost-effective and better identification of prenatal drug use.