Showing papers by "Karen L. Dugosh published in 2012"

Restoring balance: a consensus statement on the protection of vulnerable research participants

Abstract: A diverse panel convened in June 2011 to explore a dilemma in human research: some traits may make individuals or communities particularly vulnerable to a variety of harms in research; however, well-intended efforts to protect these vulnerable individuals and communities from harm may actually generate a series of new harms.We have presented a consensus statement forged by the panel through discussion during a 2-day meeting and the article-writing process.We have identified practical problems that sometimes arise in connection with providing additional safeguards for groups labeled as vulnerable and offered recommendations on how we might better balance concerns for protection with concerns for justice and participant autonomy.

Adaptive Programming Improves Outcomes in Drug Court: An Experimental Trial.

Abstract: Prior studies in Drug Courts reported improved outcomes when participants were matched to schedules of judicial status hearings based on their criminological risk level. The current experiment determined whether incremental efficacy could be gained by periodically adjusting the schedule of status hearings and clinical case-management sessions in response to participants' ensuing performance in the program. The adjustments were made pursuant to a priori criteria specified in an adaptive algorithm. Results confirmed that participants in the full adaptive condition (n = 62) were more than twice as likely as those assigned to baseline-matching only (n = 63) to be drug-abstinent during the first 18 weeks of the program; however, graduation rates and the average time to case resolution were not significantly different. The positive effects of the adaptive program appear to have stemmed from holding noncompliant participants more accountable for meeting their attendance obligations in the program. Directions for future research and practice implications are discussed.

Paying Substance Abusers in Research Studies: Where Does the Money Go?

Abstract: Background: Research involving substance-abusing participants is often hindered by low rates of recruitment and retention. Research suggests that monetary payment or remuneration can be an effective strategy to overcome these obstacles. Objectives: This article provides a brief overview of these issues and provides data reflecting how substance-abusing participants in several of our studies used their baseline and follow-up payments. We also present research findings related to how the mode of payment (i.e., cash, check, gift card) may affect how payments are used. Conclusions and Significance: Overall, our findings suggest that participants use their research payments in a responsible and safe manner. Limitations and recommendations for future research are discussed.

The Prevalence of HIV Risk Behaviors among Felony Drug Court Participants.

Abstract: ACCORDING TO RECENT ESTIMATES from the Centers for Disease Control and Prevention (CDC; Hall et al., 2008), approximately 1.2 million adults and adolescents in the United States are HIV positive, representing approximately 0.4% of the total population. An estimated 56,300 adolescents and adults were newly infected with the HIV virus in 2006. Seventy-three percent of these new infections occurred among males, 45% among African–Americans, and 17% among Hispanics. Over half of the new infections occurred among males who have sex with males (MSM). The relationship between drug use and HIV risk is well documented. According to CDC estimates, injection drug use (22%) was the third most common high-risk behavior among individuals living with HIV [after male-to-male sexual contact (45%) and high-risk heterosexual contact (27%)]. In addition to risks of direct and indirect transmission associated with injection drug use, noninjection substance users are also disproportionately at risk for contracting HIV through sexual transmission. Substance use has been frequently linked to sexual risk behaviors and viral transmission among both heterosexuals and MSM. Clearly, drug and alcohol use can affect economic status, social network membership, and decision making with respect to partner selection and condom use. These factors often lead to unsafe sexual practices (e.g., Brewer et al., 2007; Celentano, Latimore, & Mehta, 2008; Cheng et al., 2010; Kwiatkowski & Booth, 2000; Molitor, Bautista, & Choi; Royce et al., 1997). Finally, research has demonstrated that the biological effects of drug abuse can affect a person's susceptibility to HIV infection and the progression of AIDS (e.g., Bagby et al., 2006; Samet et al., 2003, 2004). The high rates of drug use put substance-abusing offenders at a high risk for contracting HIV infection and for transmitting the virus to others. It is estimated that approximately 80% of prison and jail inmates were under the influence of drugs or alcohol at the time of their arrest (Belenko & Peugh, 2005; James, 1988; Teplin, 1994). Of those in jail who are HIV positive, intravenous drug use is among the most predominant methods of transmission (Dean, Lansky, & Fleming, 2002; Hammett et al., 1994, as cited in Swartz, Lurigio, & Weiner, 2004). In fact, early estimates (Vlahov et al., 1989) indicated that 85% of these infections were linked to intravenous drug use. More recent estimates identify this rate to be closer to one-half (Dean et al., 2002). In addition, other factors are likely to contribute to the elevated HIV risk in incarcerated individuals including poverty, unemployment, lack of health care access (Hammet, Harmon, & Maruschak, 1999), and social networks that include high-risk associates (Friedman et al., 1999). Individuals in the criminal justice system have been found to be at a particularly high risk for HIV/AIDS infection and transmission. The relatively high prevalence rate for HIV infection has been well established in incarcerated populations. Nationwide, an estimated 22,144 HIV positive inmates were in state and federal prisons at the end of December 2008, accounting for 1.5% of the total prison population (Maruschak, 2009), almost four times higher than in the total U.S. population. Among them were 5,113 confirmed AIDS cases accounting for 0.4% of the total prison population. Furthermore, it has been estimated that 17%–25% of HIV-infected individuals pass through the prison system annually (Braithwaite & Arriola, 2003; Spalding et al., 2009). Although the primary focus of HIV prevention efforts for the criminal justice system has been on incarcerated populations (e.g., Braithwaite & Arriola, 2003; Hammet et al., 1999), the majority of offenders are actually not incarcerated but rather are under community supervision, with over five million offenders on probation or parole (Glaze & Bonczar, 2009). Rates of drug involvement are particularly high in this population, putting them at higher risk for HIV infection. At the end of 2008, 30% of probationers had been charged with drug offenses and another 17% had been charged with driving while impaired (DWI). Approximately 37% of parolees had served a sentence for a drug offense. Belenko et al. (2004) examined the prevalence of HIV and risk behaviors in a sample of offenders who were under community supervision. They reported HIV/AIDS prevalence rates that mirrored those observed in inmates, rates of injection drug use that were slightly higher, and a high prevalence of risky sex behaviors. Little research has focused on the rates of engagement in HIV risk behaviors in other types of community corrections settings. For instance, Drug Courts are one of the most empirically supported approaches for successfully diverting drug using offenders from incarceration to drug treatment and case management in the community (e.g., Aos et al., 2001; Latimer, Morton-Bourgon, & Chretien, 2006; Lowenkamp, Holsinger, & Latessa, 2005; Marlowe, DeMatteo, & Festinger, 2003; Marlowe, Festinger, & Lee, 2004; Wilson, Mitchell, & MacKenzie; Schaffer, 2006). Drug Courts are special criminal court dockets that provide a judicially supervised regimen of substance abuse treatment and other needed services for nonviolent, substance-abusing offenders in lieu of criminal prosecution or incarceration (Marlowe et al., 2008). The first Drug Court was established in 1989, and there are now more than 2,500 Drug Courts in the United States and its territories (National Association of Drug Court Professionals, 2011). Given the rapid expansion of Drug Courts to serve the needs of drug-involved offenders and the high prevalence of HIV risk behaviors that have been identified among other substance-abusing criminal justice populations, it is important to understand the prevalence of HIV risk behaviors among this growing population. The purpose of this descriptive paper is to examine the prevalence of HIV drug and sex risk behaviors in a sample of participants from one felony Drug Court located in Philadelphia, Pennsylvania. Nearly two-thirds of all people living with HIV/AIDS in the city of Philadelphia are African–American, 75% are males, and almost two-thirds are under the age of 40 (Philadelphia Department of Public Health, 2009). Given these demographic disparities in HIV/AIDS rates in the city of Philadelphia, we also examined the relationship between race, gender, and age and engagement in high-risk behaviors. Findings from the study may provide an important first step in establishing the need for evidence-based HIV risk reduction interventions as a standard part of the Drug Court curriculum.

Psychometric assessment of a self-administered version of the Significant Other Survey.

Abstract: While there are a number of general measures that assess interpersonal and psychological distress experienced by individuals who are in a close relationship with a substance abusing adult, until recently the field has lacked a psychometrically sound, self-administered multidimensional measure explicitly designed to measure the problems of non-substance abusing adults who are concerned about a substance using loved one. This study examined the psychometric properties of a 54-item, self-administered (SA) version of the Significant Other Survey (SOS), a measure designed to address this gap. The SOS-SA assesses problems across seven problem domains (emotional, relationship, family, financial, physical violence, legal, health). Coefficient alpha estimates (N=168) were good to excellent for five of the domains, the test-retest reliability (N=83) across a 7-day time frame was fair to excellent for all seven domains. Similar reliability coefficients were identified regardless of whether the item queried about the problem frequency or perceived severity. There was preliminary support for the construct and discriminant validity of the SOS-SA. The SOS-SA appears to be a promising instrument given that it is brief, requires no specialized training to administer, and has good psychometric properties.