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1.  Low-Frequency Heroin Injection among Out-of-Treatment, Street-Recruited Injection Drug Users 
In this paper, we explore the understudied phenomenon of “low-frequency” heroin injection in a sample of street-recruited heroin injectors not in drug treatment. We conducted a cross-sectional study of 2,410 active injection drug users (IDUs) recruited in San Francisco, California from 2000 to 2005. We compare the sociodemographic characteristics and injection risk behaviors of low-frequency heroin injectors (low-FHI; one to 10 self-reported heroin injections in the past 30 days) to high-frequency heroin injectors (high-FHI; 30 or more self-reported heroin injections in the past 30 days). Fifteen percent of the sample met criteria for low-FHI. African American race, men who have sex with men (MSM) behavior, and injection and noninjection methamphetamine use were independently associated with low-FHI. Compared to high-FHI, low-FHI were less likely to report syringe sharing and nonfatal heroin overdose. A small but significant proportion of heroin injectors inject heroin 10 or less times per month. Additional research is needed to qualitatively examine low-frequency heroin injection and its relationship to drug use trajectories.
doi:10.1007/s11524-012-9720-8
PMCID: PMC3675722  PMID: 22689300
Low-frequency heroin injection; Heroin; Drug injection; Out-of-treatment drug users
2.  Intercepting Binge Drinkers in Medical Settings: A View from California 
Journal of psychoactive drugs  2012;44(4):334-341.
The argument for universal alcohol screening in primary care is based on the assumption that most heavy drinkers routinely visit a doctor. This study examines whether drinking status is associated with higher or lower odds of visiting a doctor in the past year among California adults. As a point of comparison, the study also examines whether drinking status is associated with the odds of visiting an emergency room. Data came from the 2007 California Health Interview Survey. Multivariate logistic regression was used to examine the odds of visiting a doctor and an emergency room for abstainers, moderate drinkers, monthly binge drinkers, and weekly binge drinkers. After controlling for demographics, health coverage, and health status, binge drinkers had the same odds of visiting a doctor and the emergency room as moderate drinkers. Among binge drinkers, female gender, health coverage, and high blood pressure were associated with visiting a primary care doctor.
PMCID: PMC3518858  PMID: 23210382
access to health care; alcohol abuse; early intervention; screening; secondary prevention
3.  Shaping Smoking Cessation In Hard-To-Treat Smokers 
Objective
Contingency management (CM) can effectively treat addictions by providing abstinence incentives. However, CM fails for many who do not readily meet the abstinence criterion and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals, as shaping sets intermediate criteria for incentive delivery between the present behavior and total abstinence. This should result in HTT having improving rather than poor outcomes throughout treatment. We examined if shaping improved outcomes in HTT smokers (those never abstinent during a 10-visit baseline).
Method
Smokers were stratified into HTT (n=96) and easier-to-treat (n=50; ETT – those abstinent at least once during baseline), and randomly assigned to either standard CM or shaping (CMS). CM provided incentives for breath carbon monoxide (CO) levels < 4 ppm (approximately 1-day of abstinence). CMS shaped abstinence by providing incentives for CO levels lower than the 7th lowest of the participant’s last 9 samples or < 4 ppm. Interventions lasted for 60 successive weekdays visits.
Results
Cluster analysis identified four groups of participants: stable successes; improving; deteriorating; and poor outcomes. In comparison to ETT, HTT were more likely to belong to one of the two unsuccessful clusters (odds ratio (OR)=8.1, 95% CI [3.1, 21]). This difference between the HTT and the ETT was greater with CM (OR=42 [5.9, 307]) than with CMS where the difference between HTT and ETT was not significant. Assignment to CMS predicted membership in the improving (P=0.002) as compared to the poor outcomes cluster.
Conclusion
Shaping can increase the effectiveness of CM for HTT smokers.
doi:10.1037/a0018323
PMCID: PMC3623283  PMID: 20099951
Smoking Cessation; Contingency Management; Shaping; Percentile Schedules
4.  "Risk homeostasis"or "teachable moment"? the interaction between smoking behavior and lung cancer screening in the Mayo Lung Project 
The chest X-ray lung cancer screening program of Mayo Lung Project (MLP) yielded mixed results of improved lung case survival but no improvement in lung cancer mortality. This paper analyzes the smoking patterns of study participants in order to examine possible behavioral ramifications of periodic lung cancer screening. Using a longitudinal difference-of-difference model, we compared the smoking behavior, in terms of current smoker status among all subjects and the intensity of smoking among those continuing smokers, between those who received periodic lung cancer screening and those who received usual-care. In both arms of this lung cancer screening trial, there was a sizable decline in cigarette smoking one year after participants received baseline prevalence screening. There was no significant difference in current smoker status between the intervention group receiving periodic X-ray screening and the control group receiving usual care. While we detect that the continuing smokers in the intervention group smoked more than their counterparts in the control group, the magnitude of the difference is not sufficient to explain a substantial difference in lung cancer incidence between the two groups. Our study shows that periodic lung screening in MLP did not decrease smoking behavior beyond the observed decline following the initial prevalence screening conducted at baseline for both the intervention and control groups. Our results also indicate, paradoxically, that participants assigned to the intervention group smoked more cigarettes per day on average than those in the control group. Lung cancer screening programs need additional cessation components to sustain the abstinence effect typically observed following initial lung screening.
doi:10.1186/1617-9625-9-2
PMCID: PMC3033237  PMID: 21255463
5.  The Relative Role of Perceived Partner Risks in Promoting Condom Use in a Three-City Sample of High-Risk, Low-Income Women 
AIDS and Behavior  2010;15(7):1347-1358.
We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
doi:10.1007/s10461-010-9840-7
PMCID: PMC3180610  PMID: 20976538
Perceptions of partner HIV risk behaviors; Condom use; HIV transmission to women; Crack; Alcohol
6.  Simultaneous Recruitment of Drug Users and Men Who Have Sex with Men in the United States and Russia Using Respondent-Driven Sampling: Sampling Methods and Implications 
The Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) examined the role of drug use in the sexual transmission of the human immunodeficiency virus (HIV) from traditional high-risk groups, such as men who have sex with men (MSM) and drug users (DU), to lower risk groups in three US cities and in St. Petersburg, Russia. SATHCAP employed respondent-driven sampling (RDS) and a dual high-risk group sampling approach that relied on peer recruitment for a combined, overlapping sample of MSM and DU. The goal of the sampling approach was to recruit an RDS sample of MSM, DU, and individuals who were both MSM and DU (MSM/DU), as well as a sample of sex partners of MSM, DU, and MSM/DU and sex partners of sex partners. The approach efficiently yielded a sample of 8,355 participants, including sex partners, across all four sites. At the US sites—Los Angeles, Chicago, and Raleigh–Durham—the sample consisted of older (mean age = 41 years), primarily black MSM and DU (both injecting and non-injecting); in St. Petersburg, the sample consisted of primarily younger (mean age = 28 years) MSM and DU (injecting). The US sites recruited a large proportion of men who have sex with men and with women, an important group with high potential for establishing a generalized HIV epidemic involving women. The advantage of using the dual high-risk group approach and RDS was, for the most part, the large, efficiently recruited samples of MSM, DU, and MSM/DU. The disadvantages were a recruitment bias by race/ethnicity and income status (at the US sites) and under-enrollment of MSM samples because of short recruitment chains (at the Russian site).
doi:10.1007/s11524-009-9365-4
PMCID: PMC2705484  PMID: 19472058
Respondent-driven sampling; HIV; MSM; MSMW; DU; IDU; SATHCAP
7.  Recruiting drug-using men who have sex with men into behavioral interventions: A two-stage approach 
Drug-using men who have sex with men (MSM) are at high risk of acquiring or transmitting HIV infection. Efforts to change behaviors in this population have been hampered by difficulties in recruiting drug-using MSM into behavioral interventions. This study sought to develop an effective strategy for recruiting drug-using MSM into behavioral interventions that consist of motivational interviewing alone or motivational interviewing plus contingency management. MSM were recruited through advertising and community outreach into groups to discuss party drugs, party burnout, and sexual behavior, with the intervention subsequently described and enrollment offered in the group setting. Many more eligible MSM responded to advertisements for the discussion groups than advertisements for the interventions, and 58% of those who participated in the discussion groups volunteered for counseling. Men who entered counseling reported high levels of drug use and sexual activity and were racially and ethnically diverse; only 35% were willing to accept drug treatment. Results demonstrate that a two-stage strategy in which drug-using MSM are first recruited into discussion groups before they are offered a behavioral intervention can be an effective way to induce voluntary acceptance of an intervention employing a behavioral risk-reduction approach.
doi:10.1093/jurban/jti030
PMCID: PMC3456171  PMID: 15738314
Contingency management; Gay and bisexual men; Health services marketing; Illicit drugs; Motivational interviewing; Sexual risk behaviors
8.  Elements of well-being affected by criminalizing the drug user. 
Public Health Reports  2002;117(Suppl 1):S146-S150.
OBJECTIVE: The authors examine the possible adverse consequences of incarceration on drug offenders, their families, and their communities. OBSERVATIONS: State and federal policies on drug felons may affect eight elements of personal and community well-being: children and families, access to health benefits, access to housing benefits, access to assistance for higher education, immigration status, employment, eligibility to vote, and drug use or recidivism. CONCLUSIONS: Minorities have a high chance of felony conviction and an increasing lack of access to resources, suggesting that patterns of drug conviction and health disparities may be mutually reinforcing. Large numbers of people sent to prison for drug offenses are now completing their terms and reentering communities. Their reentry will disproportionately affect minority communities. Without resources (education, job opportunities, insurance, health care, housing, and the right to vote) drug abusers face a higher risk of recidivism and increase the burden on their communities.
PMCID: PMC1913697  PMID: 12435838

Results 1-8 (8)