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Biomedical subjects

R C Stephens

Publications and source records attributed to R C Stephens.

At least 19 recordsLinked to original sources
PubMed2000

Drugs and prisoners: treatment needs on entering prison.

An interview study was conducted among a group of incoming prisoners in a county jail in Ohio during the summers of 1997 and 1998 to assess their current drug treatment needs. "Incoming prisoners" refers to individuals who were being transferred from this county jail to the state prison system. Marijuana and cocaine were the most commonly tried illegal drugs among the subjects as well as the drugs of choice during the month prior to imprisonment. The Diagnostic Interview Schedule, combined with questions employed in the Drug Use Forecasting (DUF) project, was used to construct the questionnaire for this study. Based on the criteria of DSM-IV diagnoses, 57.5% of those interviewed had exhibited drug dependency at some point in their lives, and 51% were currently dependent on some substance. Thus, more than half of the incoming prisoners were in need of treatment for use of at least one substance. Cocaine dependence was the greatest problem facing this group of inmates, with an especially notable problem among the older females. Younger males were more likely to have current marijuana dependence. The study found that individuals currently dependent on cocaine or opiates perceived that they had a need for drug treatment, while those currently dependent on marijuana did not share this perception.

Adolescent↗
PubMed1996

Computer services for patients. Description of systems and summary of findings.

This article (1) describes a number of computer services provided to patients' homes, (2) summarizes four evaluation studies reported in this supplement, and (3) suggests direction for future research. The studies reviewed in this article suggest that computer services have little impact on patients' health status but a significant impact on use of services. Some computer services (eg, reminders) increase client visits and other services (eg, voice bulletin board) reduce clinic visits. The article suggests that a paradigm for conducting research on impact of home computer services on care of patients is missing and should be developed.

Cocaine↗
PubMed1996

A randomized trial of a telecommunications network for pregnant women who use cocaine.

OBJECTIVES: The authors describe computer services designed to make patients better informed and more motivated to participate in treatment. Patients use these services through their touch-tone telephone; access to a home computer or a modem is not needed. METHODS: The authors tested the impact of these computer services on the management of 179 pregnant women who had used cocaine during pregnancy or 1 month before pregnancy (as reported by the woman). Patients were randomly assigned to control and experimental groups; only the experimental group had access to the computer services. Patients were enrolled during the prenatal period and followed for 6 months after the birth of a live child. Self-reported data on the subjects' participation in drug treatment programs, health status (using the SF-36), and addiction severity (using the addiction severity index) were collected. The computer collected data on the frequency of the use of the service. The dependent variables were participation in formal treatment during the course of the project, and drug and alcohol use at exit interview. Multiple and logistic regressions were used to identify the effects of the intervention after controlling for demographic and baseline variables. RESULTS: Data showed that poor, pregnant, undereducated clients who use drugs and lived in multiple residences could use the services; about one-third of clients used the services more than three times a week. Access to the service did not lead to significant change in patients' health status, drug use, or utilization of services. Use of the services did lead to significant changes in participation in drug treatment: subjects who used the service more than three times a week were 1.5 times more likely to participate in formal drug treatment than subjects who used the service less often. Participation in formal drug treatment, however, was not effective in reducing the drug or the alcohol use. CONCLUSIONS: Almost all patients used the computer services to some extent, but there seems to be a threshold after which the use of the services had a more positive impact.

Adolescent↗
PubMed1996

Educating patients at home. Community Health Rap.

OBJECTIVES: The authors analyzed the impact of home health education by studying the impact of a computer service called Community Health Rap. When patients call this service, the computer records their questions and alerts an expert who records a response. Subsequently, the computer alerts the patient that the question has been addressed. METHODS: Subjects included a group of 82 pregnant women who had used cocaine during or 1 month before pregnancy (as reported by the woman) and a group of residents of zip code areas with the lowest income in Cleveland. From the drug-using pregnant women, we collected data regarding satisfaction with Community Health Rap, usage of Community Health Rap per month, self-reported health status (using the General Health Survey), and the extent of drug use (using the Addiction Severity Index). Trained coders also classified the nature of questions posed to the Community Health Rap by either the pregnant women who abuse drugs or the members of target households. Among the pregnant women who abuse drugs, we compared the differences between those who used the service and those who did not. To control for baseline differences between the two groups, analysis of co-variance was used with exit values as the dependent variables, the baseline values as the co-variates, and participation in the Community Health Rap as the independent variable. RESULTS: Almost half (45%) of poor, undereducated subjects who lived in inner urban areas used the computer service. Content analysis of Community Health Rap messages revealed that subjects had many questions that were of a social nature (regarding sex, relationships, etc), in addition to medical questions. Analysis showed that poor health status, more frequent drug use, lower education, and age did not affect regular use of Community Health Rap service. No health outcomes or utilization of treatment were associated with regular use of Community Health Rap. One exception, however, was that regular users of Community Health Rap reported slower improvement of their pain than those who did not use Community Health Rap. CONCLUSIONS: These data suggest that expansion of information services to households will not leave the poor and the undereducated population groups "behind." They will use computer services, though such services may not have an impact on their health status or cost of care.

Adult↗
PubMed1996

Electronic self-help and support groups.

OBJECTIVES: The authors examined the impact of a voice bulletin board on the following: (1) participation in self-help efforts, (2) expression of emotional support, (3) development of solidarity within the group, (4) utilization of health-care services, and (5) health status of subjects. METHODS: Subjects were 53 pregnant women who abused drugs. A quasi-experimental design with matched control group and observations before and after intervention were carried out. Clients in the control group were asked to participate in biweekly face-to-face meetings. Clients in the experimental group participated in the voice bulletin board. Experimental subjects had previous experience with computer services. Subjects reported their level of drug use, health status, and utilization of health services. They also reported on their symptoms, attitudes toward use of physician services, loneliness, willingness to disclose information in groups, and sense of solidarity with their group. The content of the communication among the experimental group was recorded and the utterances were classified as to the type of communication. Exit interviews were done 4 months after baseline interviews were conducted. Clients were paid to complete the baseline and the exit questionnaires, and 94% completed the exit questionnaires. The dependent variables were utilization or health status at exit; the co-variate was utilization or health status at baseline; and the independent variable was the group in which the subject participated. RESULTS: Clients were eight times more likely to participate in the voice bulletin board than in the face-to-face meeting (alpha < 0.01). The majority of the comments left on the bulletin board (54.6%) were for emotional support of each other; no "flaming" or overt disagreements occurred. The more clients participated in the voice bulletin board, the more they felt a sense of solidarity with each other (alpha < 0.001). Members of the experimental group reported significantly lower rates of visiting outpatient clinics than members of the control group (alpha < 0.05). Lower utilization did not lead to poor health status or more drug use: There were no statistically significant differences in the health status and drug use between the experimental and the control groups. CONCLUSIONS: Voice bulletin boards may be an effective method of providing support to mothers who have a history of drug use. Use of these services may lead to lower cost without worsening patients' health.

Adult↗
PubMed1996

Assessing substance abuse treatment needs among the homeless: a telephone-based interactive voice response system.

OBJECTIVES: We report on a pilot project that used a telephone-based interactive voice response system accessed by cellular phones at diverse sites, to interview homeless persons on their need for alcohol and other drug treatment. METHODS: Using this technique we surveyed 207 homeless adults at eight shelters in Cleveland, Ohio. RESULTS: The cellular approach was comparable to human-administered interviews in reliability and validity and yielded higher self-reported levels of drug use. CONCLUSIONS: Cellular telephones and interactive voice response interviewing systems can be useful tools in assessing for the health-service needs of difficult-to-reach populations.

Adult↗
PubMed1995

A review of factors affecting treatment outcomes: Expected Treatment Outcome Scale.

The Expected Treatment Outcome Scales was developed to gather information on clients who abuse drugs or alcohol, to assess their severity of illness, and to evaluate the effectiveness of drug treatment in nonrandomized clinical studies. The scale is based upon a multiattribute value model reflecting the opinions of an expert panel. The experts identified 25 variables, or predictors of relapse, from which 48 questions were constructed. Answers to the questions are individually scored. These scores are summed to produce an overall Expected Treatment Outcome score. This paper focuses on the development and preliminary validation of the Expected Treatment Outcome Scale. Results of our analysis show a correlation of .89 between the experts' average ratings of hypothetical clients and scores based on our scale. This finding suggests that the Expected Treatment Outcome Scale has face validity and accurately simulates the experts' judgments regarding treatment outcome. Further research is necessary to assess the reliability as well as the concurrent and predictive validity of our instrument.

Adult↗
PubMed1991

Effects of an intervention program on AIDS-related drug and needle behavior among intravenous drug users.

BACKGROUND: Behaviors which entail high risk for human immunodeficiency virus (HIV) infection among intravenous drug users can be significantly reduced through educational intervention. METHODS: The educational intervention was conducted by a health educator in a one-on-one format and provided information about acquired immunodeficiency syndrome (AIDS) and strategies for reducing the risk of infection. Risk was assessed prior to the intervention and was compared to a follow-up assessment obtained approximately three months later (n = 322). RESULTS: The percentage who reported using drugs intravenously decreased from 92.2 to 70.5, and the percentage who reported sharing syringes dropped from 67.4 to 24.3. Reductions of these and other high-risk behaviors were detected across various demographic subgroups, and analyses show that the impact of the intervention endured for several months. CONCLUSIONS: The findings suggest that intravenous drug users conform to a model of rational choice when confronted with accurate information about the devastating consequences of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Knowledge about AIDS among intravenous drug users: an evaluation of an education program.

Increasing intravenous drug users' (IVDUs) knowledge about the etiology and symptoms of the human immunodeficiency virus is a first step in controlling the spread of the virus to the general population. A comparison of pretest and posttest measures of knowledge of acquired immune deficiency syndrome among IVDUs participating in an AIDS education program reveals significant increases in knowledge after a basic one-hour education session. Additional analyses indicate that IVDUs are more ignorant of certain aspects of AIDS than others, and frequently less amenable to education efforts related to these aspects. Finally, the analyses show that the knowledge among IVDUs about AIDS is independent of the IVDU's demographic characteristics and risk-profile.

Acquired Immunodeficiency Syndrome↗
PubMed1979

A survey of students' awareness of and attitudes toward drug abuse prevention programs in New York State, winter 1974/75.

The present paper reports some results from a winter 1974-1975, New York State survey of junior and senior public high school youths' awareness of and attitudes toward the drug prevention efforts their schools had undertaken. The findings indicate that most youths are not aware of community resources available for assistance with a drug problem. Substantial discrepancies were found between student ratings of the effectiveness of prevention programs and the programs which they were most frequently exposed. Finally, the data highlight the peer context and drug culture aspect of the youths' substance taking, emphasizing that the sociocultural backgrounds of students need to be taken into account in prevention program development.

Adolescent↗
PubMed1977

A survey of substances use among junior and senior high school students in New York state, Winter 1974-75.

A survey designed to assess drug and alcohol use among the 1,600,000 students in Grades 7 through 12 who attend New York State public schools was administered in 10i schools during the winter of 1974-75. Findings indicate that over 80% of the students have used alcohol and that almost one-third of the students have used marijuana at least once. In addition, 60% of the marijuana users have used no other substance, with the possible exception of alcohol. Also, if a student has used a substance, he is likely to have used it within the last 6 months. Finally, multiple substance use is not predominant among marijuana users, but is predominant among users of other substances.

Adolescent↗
PubMed1977

The addict odyssey: from experimentation to addiction.

This study explores the "honeymoon" period in the addict's life, extending from his first use of narcotics to the point of his addiction. Retrospective interviews with 30 addicts in treatment programs suggest that the process of becoming an addict can be characterized as consisting of at least three elements: (1) increasing physical, psychological, and social rewards from involvement in the street addict life-sytle; (2) increasing commitment to one reference group; and (3) devaluation of any possible negative rewards in the drug life.

Adolescent↗