Predicting protected sexual behaviour using the Information-Motivation-Behaviour skills model among adolescent substance abusers in court-ordered treatment

The Information-Motivation-Behavioural skills model (Fisher & Fisher, 1992) was used to predict condom use among adolescents residing in a court-ordered inpatient substance abuse treatment programme (N = 271; 181 male and 90 female, primarily of minority ethnicity). In a predictive structural equation model, demographic variables, HIV transmission knowledge, and motivational variables of pro-condom norms and attitudes, and perceived susceptibility predicted condom use skills and condom use self-efficacy. Along with the other variables in the model, condom skills and condom self-efficacy were hypothesized to predict condom use over a three-month period. It was found that condom skills were predicted by greater age, pro-condom attitudes and greater perceived susceptibility. Condom self-efficacy was predicted by gender, pro-condom norms and condom attitudes. Condom use was significantly predicted by pro-condom norms and stronger condom self-efficacy. Both condom skills and knowledge did not significantly predict condom use. Significant demographic predictors of condom use included greater age and gender. Results suggest that changing personal attitudes about condoms and reinforcing the power of pro-condom beliefs among significant others will encourage condom use among adolescents who are at high risk for HIV and other STDs.

Symbolic method in invariant theory

A symbolic method based on an extension of the straightening algorithm is developed for the representation of joint invariants of symmetric and skew-symmetric tensors. For skew-symmetric tensors, the method holds over infinite fields of arbitrary characteristic.

Laparoscopic liver surgery: parenchymal transection using saline-enhanced electrosurgery

Minimally invasive liver resection (MILR) has evolved considerably in the past decade. Safe hepatic parenchymal transection, has been one of the technical hurdles that has become evident during the growth of MILR. Advances in technology have now made safe liver transection a reality allowing resections of greater magnitude. In this review, the precoagulation approach is described in both methodology and technique. Using this method of liver transection, we have been able to perform MILR of all varieties and magnitudes, with favorable patient outcomes. A detailed description of one particular device will be highlighted to disseminate our experience and thus broaden the technical options for hepatobiliary surgeons wishing to offer their patients a minimally invasive therapy.

The projected distributions of Mastacomys fuscus and Rattus lutreolus in south-eastern Australia under a scenario of climate change: potential for increased competition?

Animal distribution is strongly controlled by climate, especially at higher altitudes where harsher conditions favour fewer vertebrate species. A predicted consequence of climate change is increased pressure on these higher-altitude faunal communities by invasion of lower-altitude species more suited to warmer conditions. The distribution of two such species, the broad-toothed rat (Mastacomys fuscus) and swamp rat (Rattus lutreolus) (with the former generally occurring at higher altitude except in Tasmania), were examined using BIOCLIM. Modelled climate change with a 20% reduction in precipitation and a warming of 2.9°C at latitude 36°S (Snowy Mountains) and 3.4°C at 42°S (central Tasmania) suggests that M. fuscus will retreat to higher altitudes. The core areas of R. lutreolus will also contract, but significantly they will also move so that they overlap current core areas of M. fuscus on the mainland. Barrington Tops is the northernmost known location for M. fuscus and is climatically marginal. The recent invasion of Barrington Tops by R. lutreolus and decline of M. fuscus raises the question as to whether the modelled broader range changes will result in greater competition between the invading R. lutreolus and the cool-climate specialist M. fuscus, resulting in the further loss of the latter.

Predictors of sexual transmission risk behaviors among HIV-positive young men

Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15-24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, white ethnicity and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals.

Impact of parent death and an intervention on the adjustment of adolescents whose parents have HIV/AIDS

The impact of parental death and the efficacy of a coping-skills intervention were examined on the adjustment of 211 adolescent children of parents with HIV/AIDS (PWH) over a 2-year period. During the follow-up period, 35% of the PWH died. Using longitudinal structural equation model, controlling for prior measures of adjustment at baseline, the authors found that children of deceased PWH reported significantly more emotional distress and problem behaviors 2 years later. Youth randomized with their parent to a coping-skills intervention reported significantly fewer problem behaviors and sexual partners 2 years later. Also, adolescents were better-adjusted 2 years later when their parents had reported less emotional distress and less severe physical health symptoms at baseline. Female adolescents reported more emotional distress at baseline and at 2 years than males; male adolescents reported more problem behaviors at baseline than the females.

Gender differences in the prediction of problem alcohol use in adulthood: exploring the influence of family factors and childhood maltreatment

OBJECTIVE

The purpose of this study was to contrast men and women in prospective relationships among family-oriented and alcohol-related variables obtained during adolescence, childhood physical, emotional and sexual abuse collected retrospectively, and later adult problem alcohol use.

METHOD

In structural equation models, early family processes (support/bonding, parent drug-use problems, parental divorce and childhood maltreatment) and prior alcohol use simultaneously predicted adult problem alcohol use at two later time points in a longitudinal community sample of 426 (305 female) adults.

RESULTS

Significant relationships were found among family processes, childhood maltreatment, and problem alcohol use within time and longitudinally for both men and women. Greater family support/bonding during adolescence predicted less problem alcohol use in adulthood. Men and women who experienced sexual abuse as a child reported more problem alcohol use in adulthood. Problem alcohol use was stable across time. Men reported more problem alcohol use in adolescence and adulthood, and women reported more early sexual abuse. These results contradict those that find no significant relationships between childhood abuse and subsequent alcohol-related problems. Parental drug use problems during the participant's adolescence did not directly predict problem alcohol use in adulthood. The relationship was more indirect in that parental drug use was associated with family-related concomitants that in turn were significant predictors of more problem alcohol use in adulthood.

CONCLUSIONS

The strong stability for problem alcohol use across the three time periods is a signal that alcohol use in adolescence should not be ignored; furthermore, family dynamics need attention in addressing problem alcohol use.

Conceptualizing the multidimensional nature of self-efficacy: assessment of situational context and level of behavioral challenge to maintain safer sex. National Institute of Mental Health Multisite HIV Prevention Trial Group

A. Bandura (1991) argued that self-efficacy measurement should be specific both to the situation in which the behavior occurs and level of challenge in that situation. Measures consistent with the 2 dimensions were developed with graded challenge levels and differing gender-appropriate situations. Participants were 1,496 controls in the National Institute of Mental Health Multisite HIV Prevention Trial recruited from STD clinics and health service centers (925 women and 571 men). The authors tested 4 separate-sex confirmatory factor analysis models as follows: (a) Condom negotiation efficacy as a unitary construct across situations and gradation of difficulty; (b) situation as preeminent, which transfers across skills whatever the gradation of difficulty; (c) skill as predominant, irrespective of situation; and (d) a multidimensional design that simultaneously accounts for both situation and graded difficulty. Consistent with Bandura's theory, the multidimensional model provided the best fit for both samples.

Targeted mailed materials and the Medicare beneficiary: increasing mammogram screening among the elderly

OBJECTIVES

Older women have the highest breast cancer rates but are underscreened relative to their risk. Racial/ethnic minority women especially have low screening rates, often because of financial constraints. In response, Medicare introduced subsidized biennial mammogram benefits in 1991. This study examined the effect on mammography rates of an intervention that informed women about the Medicare benefit.

METHODS

A list frame method of subject selection was used to select random samples of eligible women from the Health Care Financing Administration's master beneficiary file. Women were interviewed by telephone in 1991 (N = 917) before the targeted mailing and in 1993 (N = 922). One control and 2 treatment communities participated.

RESULTS

Mammogram use increased significantly among minorities in the treatment groups. Among minorities who received the intervention, Black women were twice as likely (odds ratio = 1.97) and Hispanic women were more than twice as likely (odds ratio = 2.33) to undergo screening relative to their untreated cohorts.

CONCLUSIONS

A targeted low-cost mailed intervention can help increase screening rates among elderly minority women. The Health Care Financing Administration should promote its benefits aggressively if it expects to reach its target--elderly beneficiaries.

Severity of homelessness and adverse birth outcomes

Predictors and the prevalence of adverse birth outcomes among 237 homeless women interviewed at 78 shelters and meal programs in Los Angeles in 1997 were assessed. It was hypothesized that they would report worse outcomes than national norms, that African Americans would report the worst outcomes because of their greater risk in the general population, and that homelessness severity would independently predict poorer outcomes beyond its association with other adverse conditions. Other predictors included reproductive history, behavioral and health-related variables, psychological trauma and distress, ethnicity, and income. African Americans and Hispanics reported worse outcomes than are found nationally, and African Americans reported the worst outcomes. In a predictive structural equation model, severity of homelessness significantly predicted low birth weight and preterm births beyond its relationship with prenatal care and other risk factors.

Burnout in substance abuse counselors. Impact of environment, attitudes, and clients with HIV

Due to associations between acquired immunodeficiency sydnrome (AIDS) and substance abuse, many substance abuse treatment counselors have clients with human immunodeficiency virus (HIV)/AIDS. We assess the contribution of various hypothesized predictors of burnout among 134 substance abuse counselors working with clients with HIV/AIDS. Counselors reported practice-related variables, including support from coworkers and supervisors, caseload, percentage of HIV-positive clients, and whether they worked at a methadone clinic, and personal characteristics of job efficacy and education. The three burnout dimensions were emotional exhaustion, depersonalization, and personal accomplishment. Emotional exhaustion was significantly predicted by less support, less efficacy, and working in a methadone clinic. Depersonalization was predicted by less efficacy, less support, and working in a methadone clinic. Personal accomplishment was predicted by having a lower percentage of clients with HIV/AIDS, and more efficacy, support, and education. We present empirically based suggestions for interventions that can prevent or limit burnout.

Correlates of HIV risk-taking behaviors among African-American college students: the effect of HIV knowledge, motivation, and behavioral skills

This study identifies theoretically based predictors of condom use in a sample of 253 sexually active African-American college students recruited from two historically African-American colleges. The Information-Motivation-Behavioral (IMB) skills model of AIDS-preventive behavior was employed to delineate the roles of HIV/AIDS knowledge, experiences with and attitudes toward condom use, peer influences, perceived vulnerability, monogamy, and behavioral skills. A predictive structural equation model revealed significant predictors of more condom use including: male gender, more sexual HIV knowledge, positive experiences and attitudes about condom use, nonmonogamy, and greater behavioral skills. Results imply that attention to behavioral skills for negotiating safer sex and training in the proper use of condoms are key elements in reducing high risk behaviors. Increasing the specific knowledge level of college students regarding the subtleties of sexual transmission of HIV is important and should be addressed. Heightening students' awareness of the limited protection of serial monogamy, and the need to address gender-specific training regarding required behavior change to reduce transmission of HIV should be an additional goal of college health professionals.

Gender differences in behavioural and psychosocial predictors of HIV testing and return for test results in a high-risk population

We assessed gender differences in psychosocial and behavioural predictors of HIV testing and returning for results in a high-risk sample of 1,049 predominately minority, impoverished, homeless and/or drug-abusing women (n = 621) and men (n = 428). Predictors included latent variables representing injection drug use, self-esteem, social support, AIDS knowledge, poor access to health services, perceived risk for AIDS, sexual risk behaviour and the mediators of positive and negative coping styles. Significant predictors of test and return for women included injection drug use, greater social support, more AIDS knowledge, a higher perceived risk for AIDS and a positive coping style. Significant predictors for the men included injection drug use, greater AIDS knowledge, a higher perceived risk for AIDS and a positive coping style. Although greater social support was not significant for the men, the significant predictors of HIV testing and return were generally similar for the men and women. However, the men evaluated their risk of AIDS significantly lower than the women, although they reported more sexual risk behaviours and equally risky injection drug use behaviours. Results suggest that interventions designed to increase AIDS knowledge, to raise the perception of risk and to promote a positive coping style would be effective in encouraging more HIV testing for both men and women, but raising perceptions of what constitutes personal risk behaviours may need special emphasis when delivering prevention programmes to men.

Mercaptoacetate induces feeding through central opioid-mediated mechanisms in rats

The endogenous opioid system has been implicated in the mediation of food intake elicited by such regulatory challenges as glucoprivation induced by 2-deoxy-D-glucose (2DG) or food deprivation in rodents. Administration of the free fatty acid oxidation inhibitor, mercaptoacetate (MA), produces a potent short-term increase in feeding in rats, the mechanisms of which have been dissociated from that elicited by 2DG. The present study evaluated whether MA-induced feeding in rats was mediated by the endogenous opioid system through systemic administration of the general opioid antagonist, naltrexone, through central administration of either general, mu, mu(1), kappa(1) or delta opioid antagonists, and through central administration of antisense oligodeoxynucleotide (AS ODN) probes directed against specific exons of either the mu (MOR-1), kappa (KOR-1), kappa(3) (KOR-3/ORL-1) or delta (DOR-1) opioid receptor clones. MA-induced feeding was significantly and dose-dependently reduced by systemic naltrexone (0.005-5 mg/kg); these ingestive effects were quite selective since neither total, ambulatory nor stereotypic activity was affected by either MA itself or MA paired with naltrexone. MA-induced feeding was significantly reduced by central pretreatment with either naltrexone (0.1-20 microgram) or mu-selective (beta-funaltrexamine, 0.1-20 microgram), mu(1)-selective (naloxonazine, 1-20 microgram), kappa(1)-selective (nor-binaltorphamine, 0.1-20 microgram), or delta-selective (naltrindole, 1-20 microgram) opioid receptor antagonists. MA-induced feeding was significantly reduced by AS ODN probes directed against either exons 1, 2 or 3, but not exon 4 of the MOR-1 clone, exon 3, but not exons 1 or 2 of the KOR-1 clone, exons 1 or 2, but not exon 3 of the KOR-3/ORL-1 clone, and exon 1, but not exons 2 or 3 of the DOR-1 clone. These data are discussed in terms of opioid mediation of ingestive responses related to fat, and in terms of potential central sites of action at which lipoprivic ingestive responses might act.

Predicting health services utilization among homeless adults: a prospective analysis

This study expands on the Andersen-Newman health services utilization (HSU) model. In a community-based homeless sample (n = 363) baseline predisposing, enabling, and needs-based variables predicted hospitalization and ambulatory outpatient service utilization within 1 year after baseline. Standard predisposing and enabling variables were supplemented with latent constructs representing substance use, mental illness, poor housing status, social support, community support, and barriers to health care. Need is represented by baseline health status. Poor physical health, more barriers, drug use, African American ethnicity, less community support, and less education predicted hospitalization, the least desirable form of HSU. Poor health, female gender, a regular source of care, community support, drug use, and fewer alcohol problems predicted an office visit. Because outpatient visits for acute conditions provide an opportunity for generally neglected preventive services and health screenings, this study suggests convenient multiservice health-related programs for the homeless that include drug and alcohol treatment.

A latent variable analysis of coexisting emotional deficits in substance abusers: alexithymia, hostility, and PTSD

The emotional disturbance of substance abusers is often described as an inability to identify and express feelings coupled with an excess vulnerability to experience negative affect. However, there is only limited empirical support for this perspective. To validate this description, we first defined components of alexithymia, hostility, and posttraumatic stress disorder (PTSD) derived from established measures of each by conducting confirmatory factor analyses based on a self-report data set from a clinical sample of 253 alcoholics and drug addicts. We then fashioned and tested overarching latent variables representing the three aspects of emotional dysfunction (i.e., alexithymia, hostility, and PTSD) and finally tested the correlations among these overarching variables. We found a strong association between a factor labeled Bottled-Up Emotions and another labeled Neurotic Hostility (r = .62) as well as an association between PTSD and Bottled-Up Emotions (r = .66). The structure, magnitude, and intercorrelation of the latent variables did not depend on the type of psychoactive substance abused. These results support the view that features of alexithymia and hostility coexist in substance abusers and that this joint deficit is part of a broad disturbance across multiple psychological domains including pathological response to traumatic stress.

Personal, cognitive, behavioral, and demographic predictors of HIV testing and STDs in homeless women

Using a multiracial sample of 621 homeless women, we tested a latent variable causal model of personal, cognitive, behavioral, and demographic predictors of two coping mediators and the outcome variables of HIV testing and return for test results and a recent STD infection. HIV testing and return were predicted by more social support, greater AIDS knowledge, greater perceived risk for AIDS, and more problem-focused coping strategies. Recent STDs were predicted by more AIDS knowledge, emotion-focused coping strategies, and risky sexual behavior and one measured variable, crack cocaine use. Emotion-focused coping strategies were predicted by drug use, less self-esteem, more social support, and greater perceived risk for AIDS. Hispanics reported less emotion-focused coping strategies than African-Americans. Predictors of problem-focused coping strategies included less drug use, more self-esteem, more social support, more AIDS knowledge, and less risky sexual behavior. African-Americans reported less problem-focused coping strategies than Latinas. Indirect effects on the outcomes mediated through coping styles are also reported. Theoretical and practical implications of results for community outreach are discussed.

"Reactive filtration": use of functionalized porous polymer monoliths as scavengers in solution-phase synthesis

[reaction: see text] Solid functionalized porous monolithic disks with reactive polymer chains grafted to their inner pore surface have been developed for scavenging excess reagents from reaction mixtures. A poly(chloromethylstyrene-co-divinylbenzene) monolith was cut into disks and activated by graft polymerizing 4-vinyl-2,2-dimethylazlactone to its pore surface. In contrast to the direct copolymerization of reactive monomers, grafting increases the accessibility of the reactive groups. Application of the reactive disks is demonstrated in the scavenging of excess amines from reaction mixtures in different solvents.

Psychosocial predictors of current drug use, drug problems, and physical drug dependence in homeless women

We examined risk and protective factors associated with three qualitatively different drug use constructs describing a continuum of drug use among a sample of 1,179 homeless women. Relationships among positive and negative sources of social support, positive and negative coping strategies, depression, and the drug constructs of current drug use, drug problems, and physical drug dependence were assessed using structural equation models with latent variables. Current drug use was predicted by more negative social support (from drug-using family/friends), depression, and less positive coping. Drug Problems were predicted by more negative coping, depression, and less positive coping. Physical Drug Dependence was predicted by more negative social support and depression, and less positive social support. Results highlighted the importance of investigating both the positive and negative dimensions of psychosocial functioning, while suggesting that empowering homeless women and offering tangible resources for coping with the stress of being homeless may be beneficial to them.

Associations between drug abuse treatment and cigarette use: evidence of substance replacement

The influence of risk-behavior bias, drug use, prior cigarette use, and prior and current participation in drug treatment on cigarette use was analyzed using a 3-wave survey of 346 drug abusers. Participation in drug treatment and a risk-behavior bias were hypothesized to predict greater cigarette use. After controlling for prior levels of cigarette use with a longitudinal path model, it was found that participation in drug treatment at Wave 2 significantly predicted increased cigarette use at Wave 2. There were similar results at Wave 3. Additional analyses indicated that reduced heroin use was especially associated with more smoking. Risk-behavior bias predicted more drug and cigarette use and predicted less participation in drug treatment at Wave 3. These results suggest that drug treatment, reduced heroin use, and a tendency toward risky behavior may lead to increased cigarette use, which may represent a form of substance replacement.

Problem behavior of adolescents whose parents are living with AIDS

Substance use, acts of sexual risk, conduct problems, and internalizing, externalizing, and somaticizing mental health symptoms were examined among 239 adolescent children and their parents living with AIDS in New York City. Consistent with theories regarding imitative behavior, stress, and anticipatory loss, adolescents' externalizing behavior problems and somatic symptoms were related to their parents' status.

Parentification and its impact on adolescent children of parents with AIDS

Parentification refers to children or adolescents assuming adult roles before they are emotionally or developmentally ready to manage those roles successfully. We assess predictors and outcomes of parentification among adolescent children of Parents with AIDS (PWAs) in two phases. In Phase 1, relationships among parental AIDS-related illness, parent drug use, parent and adolescent demographics, and parentification indicators (parental, spousal, or adult role-taking) were assessed among 183 adolescent-parent pairs (adolescents: 11 to 18 years, M = 14.8 years, 54% female; parents: 80% female). Adult role-taking was associated with maternal PWAs, female adolescents, and greater parent drug use. Greater parental AIDS-related illness predicted more spousal and parental role-taking. Parent drug use predicted more parental role-taking. In Phase 2, we examined the impact of parentification on later adolescent psychological adjustment (N = 152 adolescents). Adult role-taking predicted more internalized emotional distress; parental role-taking predicted externalized problem behaviors: sexual behavior, alcohol and marijuana use, and conduct problems. Given these dysfunctional outcomes, we discuss interventions to mitigate parentification among children of PWAs.

Predicting personality pathology among adult patients with substance use disorders: effects of childhood maltreatment

The purpose of this study was to examine predictive relationships between types of childhood maltreatment and personality disorders in a substance-abusing population. Three hundred thirty-nine drug- or alcohol-dependent patients completed a reliable and valid retrospective measure of childhood trauma, the CTQ, and a self-report inventory that assesses the entire range of DSM-III-R personality disorders, the PDQ-R. As a preliminary step, factor analyses were used to group personality disorders into the three DSM-III-R Axis II clusters (Clusters A, B, and C), although some diagnostic subclusters were also found. Structural equation modeling analyses revealed several significant paths between types of maltreatment and personality disorder clusters (and subclusters). Physical abuse and physical neglect were related to a subcluster of "psychopathic" personality disorders consisting of childhood and adult antisocial personality traits and sadistic traits. Emotional abuse emerged as a broad risk factor for personality disorders in Clusters A, B, and C. Emotional neglect was related to the traits of schizoid personality disorder, which formed its own subcluster. Finally, sexual abuse, which had been expected to predict borderline personality disorder traits, was unrelated to any personality disorder cluster. These findings support the view that child maltreatment contributes to the high prevalence of co-morbid personality disorders in addicted populations.

A trial to increase mammography utilization among Los Angeles Hispanic women

The objective of this program was to increase mammography screening rates among Hispanic women through a series of targeted community-wide interventions. A diverse array of outreach efforts was offered by the program to increase awareness and use of screening mammography. Before the program, 12 percent of the Hispanic women surveyed in the intervention community had been screened, compared with 27 percent after the program. There was no change in screening among Hispanic women in the control community (23 percent before and 24 percent after the program). The program demonstrated that the awareness and behavior of "hard-to-reach" underscreened Hispanic women can be changed through intensive targeted outreach and that a church-based cancer control program can play an effective role in the process. This finding has national health policy implications.

The effects of establishment practices, knowledge and attitudes on condom use among Filipina sex workers

The findings for a baseline assessment for a community-based HIV/STD prevention intervention for commercial sex workers (CSWs) and managers of the establishments that employ them in the Philippines is presented in this study. CSW knowledge, attitudes, behaviours and establishment policies concerning HIV prevention were assessed. Baseline assessments are part of an iterative process that will be used to modify the planned intervention. The preliminary findings point to the importance of an intervention that stresses changes in establishment policies and expectations as a means of reducing risk behaviours associated with HIV/STD transmission.

Psychosocial antecedents of needle/syringe disinfection by drug users: a theory-based prospective analysis

Working from the AIDS risk reduction model and other theories of behavior change, we tested psychosocial antecedents of needle/syringe disinfection by 136 injection drug users. High perceived self-efficacy for risk reduction exerted a positive effect on needles/syringe disinfection attempts 1 year later. Self-efficacy was, in turn, related to lower perceived infection risk, peer norms more favorable to risk reduction, and greater knowledge of AIDS. Behavioral intention had no significant effect on subsequent disinfection attempts. These results suggest that disinfecting needles/syringes is partly non-volitional; that high perceived infection risk may be counterproductive to injection risk reduction; and that perceive self-efficacy, but not intention to change behavior, may be a useful leverage point for AIDS preventive intervention.

Long-term impact of Drug Abuse Resistance Education (D.A.R.E.). Results of a 6-year follow-up

The long-term effectiveness of Drug Abuse Resistance Education (D.A.R.E.) was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 twelfth-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although the authors found no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th grade, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample but not in a validation sample. Findings from the two studies suggest a possible sleeper effect for D.A.R.E. in reference to the use of harder drugs, especially among teenage males.

Assessing the impact of HIV risk reduction counseling in impoverished African American women: a structural equations approach

We assessed changes in cognitive, psychological, and risky behavior latent variables after traditional or specialized AIDS education after 2 years using structural equation modeling (SEM) in a sample of impoverished at-risk African American women (N = 300). Both groups reported significant improvement at 2 years in their self-esteem and social resources. They also reported less threat perception, avoidant coping, emotional disturbance, HIV risk behavior, and drug use behavior. There was an advantage to specialized group membership. When compared with the traditional group at 2 years, women in the specialized group reported enhanced social resources, reduced emotional distress, less use of an avoidant coping style, and less drug use. We discuss advantages of culturally sensitive HIV risk reduction programs and the importance of connecting women with social services in their communities.

Comparability and representativeness of clinical homeless, community homeless, and domiciled clinic samples: physical and mental health, substance use, and health services utilization

Evaluating the representativeness of homeless samples is important for generalizing research findings on the homeless and designing interventions targeting their health needs. The present study contrasts homeless and domiciled free-clinic users (216 homeless [132 men, 84 women], 212 domiciled [102 men, 110 women]) and 531 community homeless persons (388 men, 143 women) on latent variables representing substance use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients equalled the community sample in substance abuse and psychological problems but exceeded the sample in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. Relationships among the variables are reported, and implications concerning health needs among the homeless are discussed.

Comparability and representativeness of clinical homeless, community homeless, and domiciled clinic samples: physical and mental health, substance use, and health services utilization

Evaluating the representativeness of homeless samples is important for generalizing research findings on the homeless and designing interventions targeting their health needs. The present study contrasts homeless and domiciled free-clinic users (216 homeless [132 men, 84 women], 212 domiciled [102 men, 110 women]) and 531 community homeless persons (388 men, 143 women) on latent variables representing substance use, mental and physical health, appearance, life satisfaction, and health services utilization (HSU). Homeless clinic patients equalled the community sample in substance abuse and psychological problems but exceeded the sample in HSU and cleanliness. Homeless clinic users reported more substance abuse, poorer health, greater mental illness and mental HSU, less cleanliness, and lower life satisfaction than domiciled patients. Relationships among the variables are reported, and implications concerning health needs among the homeless are discussed.

Ethnic differences in the psychosocial antecedents of needle/syringe disinfection

This study examined psychosocial antecedents of needle/syringe disinfection by 209 injection drug users in three ethnic groups. Among Whites, high perceived self-efficacy for risk reduction had a positive effect on subsequent disinfection attempts. Among African Americans and Mexican Americans, peer norms favorable to risk reduction had a positive effect on subsequent disinfection attempts, while self-efficacy had no effect. These results suggest that risk-reduction capabilities may be rooted in individualistic perceptions of the self among White drug users, while 'collective self' perceptions are more relevant to these capabilities among African American and Mexican American drug users. HIV risk intervention may have more impact in specific ethnic groups if these distinctions are taken into account. Results also demonstrate the importance of comparing models of behavior change across ethnic groups.

Three-year follow-up of Drug Abuse Resistance Education (D.A.R.E.)

The long-term effectiveness of D.A.R.E. was assessed by contrasting 9th-grade students who received the program in the 6th grade with others who did not receive the program. Of 38 elementary schools eligible for D.A.R.E. programs, 21 received the program and 17 did not. A follow-up survey assessed central D.A.R.E. concepts such as self-esteem, resistance to peer pressure, delay of experimentation with drugs, and drug use. Employing latent variables to represent the concepts, no significant differences were found between D.A.R.E. participants and controls. The authors discuss attenuation of effects and the generally antidrug context of schools.

Psychosocial predictors of AIDS risk behavior and drug use behavior in homeless and drug addicted women of color

The present study examined a causal model consisting of personal and social resources, threat appraisal processes, coping styles, and barriers to risk reduction as predictors of general AIDS risk and specific drug use behaviors among homeless African American (N = 714) and Latina (N = 691) women. The model, which was based on a stress and coping framework, supported many of the hypothesized relationships. Active coping was associated with fewer general AIDS risk behaviors for both groups and less specific drug use behavior among African American women. Specific drug use behavior was predicted by high threat appraisal and avoidant coping for both groups. Ethnic differences and implications for intervention are discussed.

Psychosocial predictors of AIDS risk behavior and drug use behavior in homeless and drug addicted women of color

The present study examined a causal model consisting of personal and social resources, threat appraisal processes, coping styles, and barriers to risk reduction as predictors of general AIDS risk and specific drug use behaviors among homeless African American (N = 714) and Latina (N = 691) women. The model, which was based on a stress and coping framework, supported many of the hypothesized relationships. Active coping was associated with fewer general AIDS risk behaviors for both groups and less specific drug use behavior among African American women. Specific drug use behavior was predicted by high threat appraisal and avoidant coping for both groups. Ethnic differences and implications for intervention are discussed.

Determinants of undernutrition among homeless adults

Factors associated with undernutrition were investigated in a broad community-based sample of 457 homeless adults (344 men and 113 women) who were interviewed and examined in a variety of settings during the summer of 1985. Latent variables representing drug use, alcohol use, a stereotyped homeless appearance, mental illness, poor physical health status, and measured variables of age, sex, income, and number of free food sources were used as predictors of undernutrition. Undernutrition was indicated with three anthropometric measures (weight, triceps skinfold, and upper arm muscle area in the lowest 15th percentile) and one observational measure. Thirty-three percent of the sample was undernourished as defined by at least one of the anthropometric measures. Undernutrition was significantly associated with more drug use, fewer free food sources, less income, and male sex. The findings identify persons at risk for undernutrition and suggest programs to alleviate their hunger, including increased funding for food stamps and other income supports, more free food sources such as shelters and souplines, and drug treatment programs.

Plethystic algebras and vector symmetric functions

An isomorphism is established between the plethystic Hopf algebra Pleth(Super[L]) and the algebra of vector symmetric functions. The Hall inner product of symmetric function theory is extended to the Hopf algebra Pleth(Super[L]).

Plethystic Hopf algebras

The notion of a plethystic algebra associated with a Hopf algebra endowed with a suitable bilinear form is defined. A special case is the Hopf algebra of symmetric functions.

Children's internalizing and externalizing behaviors and maternal health problems

Examined the impact of a range of health related constructs reflecting maternal physical symptomatology, health services utilization, subjective health status, depressed mood, medical-psychological complaints, and marital adjustment on children's internalizing and externalizing behavior problems in a community sample (N = 145). Physical symptomatology predicted a general second-order latent factor of children's behavior problems. Depressed mood predicted a primary latent factor of internalizing child behavior problems. Seizure symptoms, and more health problems in the last 4 years specifically predicted child psychosomatic complaints/anxiety. Thus, general physical symptoms predicted a broad spectrum of problem behaviors, whereas specific mental or physical health problems predicted similar distinct problem behavior syndromes. Implications of these results for identifying children at risk for psychopathology, and the relevance of social learning theory and a broader based family systems approach are discussed.

The importance of physician communication on breast cancer screening of older women

BACKGROUND

Breast cancer screening rates, especially for mammography, continue to lag for older women, particularly for women older than 65 years.

METHODS

We investigated the associations of key variables with reported rates of mammography and clinical breast examination in a sample of 972 women older than 50 years; 724 of them were older than 65 years. They were surveyed in late 1990 through 30-minute bilingual telephone interviews.

RESULTS

Although it was hypothesized that race, age, health status, and physician-patient communication variables would influence utilization rates, only the communication variables (and two access variables) significantly predicted a recent mammogram or clinical breast examination. In particular, the style of the communication--the patient's report of the physician's enthusiasm for mammography when it was discussed with women at the office visit--influenced the women's screening behavior significantly. Women who perceived that their physicians had some enthusiasm for mammography were more than four and a half times more likely than women whose physicians had no or little enthusiasm for mammography to have had one within the previous year. Other findings were that about half of the Los Angeles, Calif, women in this study reported a recent mammogram, an increase from the one third who reported one in the previous survey of 1988; a decline in screening was not reported until after age 75 years. About a quarter of the study women, on the other hand, had never been screened despite the long-standing recommendation for regular screening of women older than 50 years and the risk of breast cancer increasing with age. Surprisingly, women at higher risk of breast cancer were not being screened any more systematically than women at lower risk.

CONCLUSION

We conclude that improved physician-patient communication skills could be a highly effective and easy-to-learn strategy to increase overall screening rates.

Structural equation analyses of clinical subpopulation differences and comparative treatment outcomes: characterizing the daily lives of drug addicts

The use of structural equation modeling (SEM) is illustrated for comparative treatment outcome research conducted with heterogeneous clinical subpopulations within large multimodality treatment settings. All analyses are accomplished with SEM analogs of more familiar classical multivariate techniques. The effect of the early period of treatment on the daily lives of 486 clients in two drug abuse treatment modalities (methadone maintenance and outpatient counseling) is evaluated. Structured means analysis is used to assess initial differences between modalities on the latent means of 6 latent constructs reflecting daily life. The effect of treatment modality and attrition from the program on daily life latent constructs is evaluated while initial selection differences are statistically controlled. Effect sizes are computed on the basis of SEM parameter estimates. The advantage of SEM over classic multivariate approaches for correcting for selection bias when assessing comparative outcomes is explained.

Psychosocial correlates and predictors of AIDS risk behaviors, abortion, and drug use among a community sample, of young adult women

Relations among latent constructs of Social Conformity, Sensation Seeking, Polydrug Use, Sexual Experience, Abortion, and Risky AIDS Behaviors were examined among a community sample of women (N = 438, mean age = 25.5 years) using confirmatory factor analysis (CFA) and predictive structural equation models (SEM). In the CFA, Risky AIDS Behavior was strongly related to more Polydrug Use and less Social Conformity and modestly related to Sexual Experience and Abortions. In SEMs, Social Conformity significantly predicted less Risky AIDS Behavior and less Polydrug Use but did not predict Abortions. Prior Sexual Experience predicted more Polydrug Use and Abortions. We conclude that the same psychological processes and predispositions that relate low social conformity to drug use and other unhealthy behaviors also influence AIDS-risk behaviors, even among a community sample of women.

Structural equation analyses of clinical subpopulation differences and comparative treatment outcomes: characterizing the daily lives of drug addicts

The use of structural equation modeling (SEM) is illustrated for comparative treatment outcome research conducted with heterogeneous clinical subpopulations within large multimodality treatment settings. All analyses are accomplished with SEM analogs of more familiar classical multivariate techniques. The effect of the early period of treatment on the daily lives of 486 clients in two drug abuse treatment modalities (methadone maintenance and outpatient counseling) is evaluated. Structured means analysis is used to assess initial differences between modalities on the latent means of 6 latent constructs reflecting daily life. The effect of treatment modality and attrition from the program on daily life latent constructs is evaluated while initial selection differences are statistically controlled. Effect sizes are computed on the basis of SEM parameter estimates. The advantage of SEM over classic multivariate approaches for correcting for selection bias when assessing comparative outcomes is explained.

Consequences of adolescent drug use on young adult job behavior and job satisfaction

Longitudinal data (N = 785) collected during Ss high school years (1971-1973) and in 1981 were used to assess the influence of adolescent drug use on adult job behaviors, job satisfaction, and adverse terminations while accounting for concurrent adult drug use, years of drug use, and adolescent achievement motivation. Relationships were minimal between adolescent drug use and adult work-related indicators in confirmatory factor analyses (CFAs) and predictive path models. Although significantly related in the CFAs, higher adolescent achievement motivation did not predict less adult drug use when adolescent drug use was included as a control. Less achievement motivation in adolescence significantly predicted more negative job behaviors and less job satisfaction, but not terminations. Correlations were significant between more adolescent drug use and less adolescent achievement motivation and between adult job problems and adult drug use.

Evidence for urothelial cell activation in interstitial cystitis

Bladder biopsy samples from 17 interstitial cystitis patients and 20 controls were evaluated for urothelial cell activation using a panel of monoclonal antibodies to HLA-DR, intercellular adhesion molecule 1, interleukin 1 alpha and tumor necrosis factor alpha. Urothelial cells in the majority (13 of 16, 81%) of the biopsies from patients with interstitial cystitis showed increased expression of HLA-DR, while fewer samples were positive for intercellular adhesion molecule 1 (3 of 16, 19%), interleukin 1 alpha (2 of 17, 12%) or tumor necrosis factor alpha (1 of 15, 7%). No urothelial cell expression of intercellular adhesion molecule 1, interleukin 1 alpha or tumor necrosis factor alpha was detected in the controls, and only 1 of 20 control samples contained HLA-DR positive urothelial cells. These results suggest that an unusual type of cellular activation is present in interstitial cystitis. In vitro studies with cultured normal urothelial cells indicated that cells activated with gamma interferon and tumor necrosis factor alpha expressed intercellular adhesion molecule 1 and HLA-DR, although increases in intercellular adhesion molecule 1 expression occurred earlier. Urothelial cells in interstitial cystitis patients may be defective in ability to express intercellular adhesion molecule 1. Alternatively, the differential expression of HLA-DR and intercellular adhesion molecule 1 in interstitial cystitis specimens may represent a functional subset of interstitial cystitis or reflect different stages of the disease. Urothelial cell activation in interstitial cystitis may result in aberrant immune responses and immune activation within the bladder. Because HLA-DR can be detected in paraffin-embedded tissues, evaluation of urothelial cell HLA-DR expression, although not specific for interstitial cystitis, may become a useful tool in the pathological evaluation of biopsy tissues from patients with this disease.

The monoclonal antibody BQ16 identifies the alpha 6 beta 4 integrin on bladder cancer

Monoclonal antibody BQ16, raised against UM-UC-9, a human bladder cancer cell line, exhibited strong reactivity with most bladder carcinoma tissue samples and cell lines. In normal urothelium, BQ16 stained only the basal surface of urothelial cells at the junction with the lamina propria. BQ16 immunoprecipitated two protein bands of approximately 140 and 180 kDa (under non-reducing conditions), while on Western blots, BQ16 identified only the 140 kDa protein indicating that BQ16 binds to one chain of a dimeric protein complex. The dimeric structure, molecular size, and basal orientation of the BQ16 antigen prompted a comparison with the alpha 6 beta 4 integrin identified by monoclonal antibody UM-A9. In most tissues BQ16 and UM-A9 produced identical staining patterns. However, normal lymphocytes and certain bladder cancer cell lines were BQ16 positive but failed to react with UM-A9, indicating that the BQ16 and UM-A9 epitopes can be expressed independently. Pulse-chase immunoprecipitation experiments showed that the alpha 6 subunit was more prominent in early BQ16 precipitates and the beta 4 subunit was more prominent in early UM-A9 precipitates. Furthermore, preclearing cell extracts with the anti-alpha 6 antibody GoH3 removed all BQ16 reactivity and in UM-A9-negative, BQ16-positive cells, BQ16 precipitated the alpha 6 beta 1 complex. We conclude that BQ16 identifies the alpha 6 integrin subunit and that alpha 6 beta 4 integrin is strongly expressed in most bladder cancers.

On the span of supersymmetric Young tableaux

De Concini et al. [De Concini, C., Eisenbud, D. & Procesi, C. (1980) Invent. Math. 56, 129-165] have established for classical Young bitableaux the fact that the span of all bitableaux of shape lambda over the rationals includes all bitableaux of all shapes mu > lambda. We extend their result to the more general setting of supersymmetric Young tableaux. Our proof, even in the classical case, has the advantage of providing an explicit combinatorial algorithm for the computation of the coefficients.