Predictors of needle-sharing behavior among IDUs entering treatment

Abstract

Public funded treatment intake data from 3905 injection drug users were analyzed to identify correlates of reported needle sharing. Respondents included all first admissions to treatment from July 1, 1988 to June 30, 1989 in the city and county of San Francisco. More previous experience in drug treatment predicted lower rates of needle sharing (OR = 0.85, 95% C.I.= 0.79 - 0.92). Young age, cocaine use and white or Hispanic ethnicity predicted higher rates of needle sharing. The finding that drug treatment reduces the frequency of needle sharing in this population has important policy implications; these data support the role of treatment availability in reducing the spread of HIV among injection drug users.     

A longitudinal evaluation of prevalent negative beliefs about residential placement for troubled adolescents

To investigate the validity of five prevalent negative beliefs about residential placement, we followed adolescents from a residential program and a comparison group at 3-month intervals for 4 to 8 years. This residential program in the Midwest uses the Teaching-Family Model in which six to eight adolescents live in a family-style environment. The interviews included five scales reflecting youths' views about important aspects of their lives in placement: (1) Delivery of Helpful Treatment, (2) Satisfaction with Supervising Adults, (3) Isolation from Family, (4) Isolation from Friends, and (5) Sense of Personal Control. Hierarchical linear modeling allowed us to estimate group differences while controlling for developmental trends, demographic factors, and prior differences between groups. The two groups were equivalent on all scales before the study. During the following placement, however, the treatment group's ratings were significantly more positive than the comparison group on four of the five scales and approached significance on the fifth. These findings suggest that negative beliefs about life in residential placement for adolescents may not apply to all programs.The authors acknowledge Gaylon Oswalt, Beth Chmelka, and Brian Noss for their assistance on this study and Richard Dangel, Thomas Dows, Robert Hawkins, Kathleen Lenerz, Kevin Moore, James Whittaker, and Montrose Wolf for helpful comments on this paper.     

ANALYSIS OF FREE-TIME CONTINGENCIES AS POSITIVE VERSUS NEGATIVE REINFORCEMENT

Providing a short break contingent on completed work may increase responding through positive reinforcement (e.g., access to preferred activities) or negative reinforcement (e.g., escape from work). In this investigation, three analyses conducted with a boy with profound mental retardation showed that (a) a 20-s break increased responding more than a positive reinforcer (cola) did, and (b) the reinforcing effects of a 20-s break were affected by the availability of positive reinforcers during the break.     

Evidence for an anaphoric mechanism within syntactic processing: Some reference relations defy semantic and pragmatic constraints

In three experiments, we examined an interaction between the pronounthey and syntactic analysis. Experiment 1 demonstrates thatthey can slow reading times tois when this verb is visually presented immediately after a sentence fragment ending with an ambiguous expression such asflying kites. This effect seems to involve a coreference assignment linkingthey and the ambiguous expression that influences the syntactic analysis of the latter. Experiments 2 and 3 show that this effect can operate even when coreference betweenthey and the ambiguous expression is implausible. These results support a modular theory of comprehension that includes structurally oriented reference processes with access to some, but not all, of the listener’s knowledge relevant to coreference.     

The patient in the family and the family in the patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.     

APPLYING BEHAVIOR ANALYSIS TO CLINICAL PROBLEMS: REVIEW AND ANALYSIS OF HABIT REVERSAL

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.     

The Effect of Racial and Ethnic Diversity on the Delivery of Mental Health Services in Pediatric Primary Care

The effects of racial and ethnic diversity on the detection and management of behavioral and emotional problems in pediatric primary care are addressed. Service access and utilization as a function of race and culture are initially examined. Important barriers within pediatric training including minimal emphases on behavioral training and the limited supply of minority physicians are underscored. The impact of ethnicity on the development and maintenance of the clinical relationship that is critical to accurately and sensitively identifying and managing behavioral and developmental problems is briefly addressed. Recommendations for further integration of racial/ethnic issues into mental health service provision within the pediatric primary care arena are presented.     

Causal Relations and Explanatory Strategies in Physics

Many philosophers now regard causal approaches to explanation as highly promising, even in physics. This is due in large part to James Woodward's influential argument that a wide variety of scientific explanations are causal, based on his interventionist approach to causation. This article argues that some derivations describing causal relations and satisfying Woodward's criteria for causal explanation fail to be explanatory. Further, causal relations are unnecessary for a range of explanations, widespread in physics, involving highly idealized models. These constitute significant limitations on the scope of causal explanation. We have good reason to doubt that causal explanation is as widespread or important in physics as Woodward and other proponents maintain.