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1.  Consequences of a restrictive syringe exchange policy on utilization patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk 
Drug and alcohol review  2015;34(6):637-644.
Syringe distribution policies continue to be debated in many jurisdictions throughout the U.S. The Baltimore Needle and Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000–2004) that dictated less than 1-for-1 exchange for non-program syringes.
Data were derived from the Baltimore NSP, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program-level output measures (i.e., distributed:returned syringe ratio, client volume) before, during, and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1-for-1 exchange ratios at the client-level before and during the restrictive exchange policy periods.
During the restrictive policy period, the average annual program-level ratio of total syringes distributed:returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients, and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33,508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1-for-1 exchange ratio were being white, female, and less than 30 years old.
With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to HIV among IDUs and the broader community. The study provides evidence to the potentially harmful effects of such policies.
PMCID: PMC4881850  PMID: 25919590
Needle-exchange programs; public policy; Baltimore; drug users; HIV
2.  Sexually Transmitted Infection Prevalence and Behavioral Risk Factors among Latino and Non-Latino Patients Attending the Baltimore City STD Clinics 
Sexually transmitted diseases  2010;37(3):191-196.
Many studies have evaluated factors influencing STD/HIV disparities between African-American and white populations, but fewer have explicitly included Latinos for comparison.
We analyzed demographic and behavioral data captured in electronic medical records of patients first seen by a clinician in one of two Baltimore City public STD clinics between 2004 and 2007. Records from white, African-American, and Latino patients were included in the analysis.
There were significant differences between Latinos and other racial/ethnic groups for several behavioral risk factors studied, with Latino patients reporting fewer behavioral risk factors than other patients. Latinos were more likely to have syphilis, but less likely to have gonorrhea than other racial/ethnic groups. English-proficient Latina (female) patients reported higher rates of infection and behavioral risk factors than Spanish-speaking Latina patients. After adjustment for gender and behavioral risk factors, Spanish-speaking Latinas also had significantly less risk of sexually transmitted infections than did English-speaking Latinas.
These results are consistent with other studies showing that acculturation (as measured by language proficiency) is associated with increases in reported sexual risk behaviors among Latinos. Future studies on sexual risk behavior among specific Latino populations characterized by country of origin, level of acculturation, and years in the U.S. may identify further risk factors and protective factors to guide development of culturally appropriate STD/HIV interventions.
PMCID: PMC2828531  PMID: 19910863
Hispanic/Latino; sexually transmitted disease clinic; racial/ethnic disparities; acculturation; gonorrhea; chlamydia; syphilis; HIV
3.  Utilization patterns and correlates of retention among clients of the needle exchange program in Baltimore, Maryland 
Drug and alcohol dependence  2009;103(3):93-98.
NEP effectiveness at a population level depends on several factors, including the number of IDUs retained, or consistently accessing services. Patterns of retention in the Baltimore Needle Exchange Program (BNEP) from 1994 to 2006 were calculated using enrollment surveys and client records. We used Andersen’s Behavioral Model of Health Services Use to frame our examination of factors associated with retention. Client retention was measured in two ways: whether a client returned to the exchange within twelve months of enrollment and how many times a client returned within these twelve months. BNEP clients (N=12,388) were predominantly male (69%), African-American (73%), and ≥ age 30 (86%). Nearly two-thirds (64%) of clients returned within twelve months of their first BNEP visit. The median number of return visits per client within twelve months was one (IQR 0–5). Young age (<30), being married, having an injection drug use history of less than twenty years, and living farther from the BNEP site were characteristics independently associated with both measures of low retention in multivariate analysis. Among younger injectors, geographical proximity was a particularly important predictor of retention. Further insight into the influence of these factors may help in developing programmatic changes that will be effective in increasing retention.
PMCID: PMC2744092  PMID: 19464827
needle exchange; syringe exchange; injection drug user; retention; behavioral model of health services use; african-american; youth; neighborhood
4.  Increases in Oral and Anal Sexual Exposure among Youth Attending STD Clinics in Baltimore, Maryland. 
We examined reports of receptive oral or anal sex among clinic patients age 12−25 over time. Odds of reporting oral sex were approximately three times higher in 2004 than in 1994; odds of anal sex were twice as high. Providers should be aware of increased risk behavior among young people.
PMCID: PMC2350224  PMID: 18295140
5.  Use of Low-dose Aspirin as Secondary Prevention of Atherosclerotic Cardiovascular Disease Among US Adults (From the National Health Interview Survey, 2012) 
The American journal of cardiology  2015;115(7):895-900.
Current guidelines recommend that adults with atherosclerotic cardiovascular disease take low-dose aspirin or other antiplatelet medications as secondary prevention of recurrent cardiovascular events. Yet, no national level assessment of low-dose aspirin use for secondary prevention of cardiovascular disease has been reported among a community-based population. Using data from the 2012 National Health Interview Survey, we assessed low-dose aspirin use among those with atherosclerotic cardiovascular disease. We estimated the prevalence ratios of low-dose aspirin use, adjusting for sociodemographic status, health insurance, and cardiovascular risk factors. Among those with atherosclerotic cardiovascular disease (n=3,068), 76% had been instructed to take aspirin, and 88% of those were following this advice. Of those not advised, 11% took aspirin on this own. Overall, 70% were taking aspirin (including those who followed their health care provider's advice and those who were not advised but took aspirin on their own). Logistic regression models showed that women, non-Hispanic blacks and Hispanics, those aged 40–64 years, with a high school education or with some college, or with fewer cardiovascular disease risk factors were less likely to take aspirin than men, non-Hispanic whites, those aged ≥65 years, with a college education or higher, or with all four selected cardiovascular disease risk factors, respectively. Additional analyses conducted among those with coronary heart disease only (n=2,007) showed similar patterns. In conclusion, use of low-dose aspirin for secondary prevention was 70%, with high reported adherence to health care providers' advice to take low-dose aspirin (88%), and significant variability within subgroups.
PMCID: PMC4365416  PMID: 25670639
atherosclerotic cardiovascular disease; low-dose-aspirin; cardiovascular prevention; surveillance

Results 1-5 (5)