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R Hingson

Publications and source records attributed to R Hingson.

At least 19 recordsLinked to original sources
PubMed2001

Age of drinking onset and involvement in physical fights after drinking.

OBJECTIVE: To explore whether people who start drinking at an early age are more likely to have been in physical fights after drinking, independent of respondent history of alcohol dependence and frequency of heavy drinking. DESIGN: In 1992, the US Census Bureau interviewed, in person, 42 862 randomly selected adults age 18 or older, mean age 44, household response rate 91.9%, and in-person response rate 97.4%. The survey included questions regarding the age respondents started drinking, frequency of heavy drinking, and whether respondents were ever or in the past year in a physical fight after drinking alcohol. RESULTS: Relative to respondents who did not begin drinking until age 21 or older, those who started drinking before age 17 were 2.9 to 4.1 times more likely ever in their lives, and at least 3 times more likely in the past year, to have been in a fight after drinking. These relationships were found even after controlling for personal history of alcohol dependence, years of drinking, frequency of heavy drinking, smoking, drug use, and other personal characteristics associated with the age respondents started drinking. CONCLUSIONS: An early age of drinking onset was associated with alcohol-related violence not only among persons under age 21 but among adults as well. Physicians need to query adolescent patients about the age they began drinking and counsel them about the increased risks associated with early drinking onset, such as an increased risk of being involved in alcohol-related violence.

Adolescent↗
PubMed2001

Where children sit in cars: the impact of Rhode Island's new legislation.

OBJECTIVES: This study evaluated the impact of Rhode Island's legislation requiring children younger than 6 years to sit in the rear of motor vehicles. METHODS: Roadside observations were conducted in Rhode Island and Massachusetts in 1997 and 1998. Multivariate regression was used to evaluate the proportion of vehicles carrying a child in the front seat. RESULTS: Data were collected on 3226 vehicles carrying at least 1 child. In 1998, Rhode Island vehicles were less likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant changes in child passenger seating behavior occurred in Massachusetts during that period. CONCLUSIONS: Rhode Island's legislation seems to have promoted safer child passenger seating behavior.

Age Factors↗
PubMed2000

Effects of recent 0.08% legal blood alcohol limits on fatal crash involvement.

OBJECTIVES: This study assessed whether states that lowered legal blood alcohol limits from 0.10% to 0.08% in 1993 and 1994 experienced post-law reductions in alcohol related fatal crashes. METHODS: Six states that adopted 0.08% as the legal blood alcohol limit in 1993 and 1994 were paired with six nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre-law and post-law years. RESULTS: States adopting 0.08% laws experienced a 6% greater post-law decline in the proportion of drivers in fatal crashes with blood alcohol levels at 0.10% or higher and a 5% greater decline in the proportion of fatal crashes that were alcohol related at 0.10% or higher. CONCLUSIONS: If all states adopted the 0.08% legal blood alcohol level, 400-500 fewer traffic fatalities would occur annually.

Accidents, Traffic↗
PubMed1998

Trillion virion delay: time from testing positive for HIV to presentation for primary care.

BACKGROUND: Human immunodeficiency virus (HIV)-infected individuals' initial presentation to medical care frequently occurs at a point of advanced immunosuppression. OBJECTIVES: To investigate the time between HIV testing and presentation to primary care. Also to examine factors associated with delayed presentation. METHODS: One hundred eighty-nine consecutive outpatients without prior primary care for HIV infection were assessed at 2 urban hospitals: Boston City Hospital, Boston, Mass, and Rhode Island Hospital, Providence. Sociodemographics, alcohol and drug use, social support, sexual beliefs and practices, and HIV testing issues were examined in bivariate and multivariate analyses for association with delay in presentation to primary care after positive test results for HIV. RESULTS: Of 189 patients, 74 (39%) delayed seeking primary care for more than 1 year, 61 (32%) delayed for more than 2 years, and 35 (18%) for more than 5 years after an initial positive HIV serologic evaluation. The median CD4+ cell count of subjects was 0.28 x 10(9)/L (range, 0.001-1.71 x 10(9)/L). In multiple linear regression analysis the following characteristics were found to be associated with delayed presentation to primary care after HIV testing: history of injection drug use (P<.001); not having a living mother (P=.01); not having a spouse or partner (P=.08); not being aware of HIV risk before testing (P<.001); and being notified of HIV status by mail or telephone (P=.002). An interaction effect between sex and screening for alcohol abuse was significant (P=.03) and suggested longer delays for men with positive screening test results (CAGE [an alcoholism screening questionnaire containing 4 structured questions], 2+) compared with men without positive screening test results or women. CONCLUSIONS: Patients with positive HIV test results often delay for more than a year before establishing primary medical care. Information readily available at the time of HIV testing concerning substance abuse, social support, and awareness of personal HIV risk status is useful in identifying patients who are at high risk of not linking with primary care. Patients who were notified of their HIV status by mail or telephone delayed considerably longer than those notified in person. Efforts to ensure primary care linkage at the time of notification of positive HIV serostatus are necessary to maximize benefits for both individual and public health and should be an explicit task of posttest counseling.

Alcohol Drinking↗
PubMed1998

The social context of drinking, drug use, and unsafe sex in the Boston Young Men Study.

The objective of this study was to evaluate the relation between drinking, drug use, and unprotected anal intercourse in young men who have sex with men. A cross-sectional analysis of first-visit data from a prospective cohort of 508 young gay men recruited from 1993 through 1994 from bars, college campuses, and the Fenway Community Health Center in Boston was performed. The major outcome measures were any unprotected anal intercourse, after drinking and when sober, stratified by type of sexual partner (steady or nonsteady) during the previous 6 months and during the most recent sexual encounter. The average age of the cohort was 23.3 years; 77.6% were white, and 76.4% were in college. These young men had a median of 10.5 male sexual partners in their lifetimes, and 3 sexual partners in the previous 6 months before enrollment. One hundred and thirty-four (26%) reported unprotected anal intercourse during the previous 6 months. Individuals who had unprotected anal intercourse were more likely to have a drinking problem (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.26-3.01) and drank more (20.4 ml/day versus 13.9 ml/day; p < or = 0.01), compared with individuals who did not engage in unprotected anal intercourse. Overall, men were significantly less likely to have unprotected anal intercourse after alcohol or drug use, based on a series of paired analysis (OR = 0.27; 95% CI = 0.15-0.48). However, when we stratified by type of sexual partner, men were significantly more likely to have unprotected anal intercourse with their nonsteady sexual partners after drinking than when sober (OR = 4.33; 95% CI = 1.37-13.7), but were significantly less likely to have unprotected anal intercourse with steady partners (OR = 0.27; 95% CI = 0.15-0.48). The patterns observed as already mentioned for drinking were also found for substance use in general. Men who were more likely to have unprotected anal intercourse after substance use were significantly more likely to have a drinking problem (OR = 7.65; 95% CI = 2.34-24.59). These results suggest that the role of alcohol and unsafe sex in young gay men is complex, with the role of situational factors of paramount importance. Alcohol and substance use interventions designed to reduce HIV risk need to specify the role of substance use in the sexual context to be successful.

Adult↗
PubMed1998

Sexual ethics. Disclosure of HIV-positive status to partners.

OBJECTIVE: To determine factors associated with disclosure of human immunodeficiency virus (HIV)-positive status to sexual partners. METHODS: We interviewed 203 consecutive patients presenting for primary care for HIV at 2 urban hospitals. One hundred twenty-nine reported having sexual partners during the previous 6 months. The primary outcome of interest was whether patients had told all the sexual partners they had been with over the past 6 months that they were HIV positive. We analyzed the relationships between sociodemographic, alcohol and drug use, social support, sexual practice, and clinical variables; and whether patients had told their partners that they were HIV positive was analyzed by using multiple logistic regression. RESULTS: Study patients were black (46%), Latino (23%), white (27%), and the majority were men (69%). Regarding risk of transmission, 41% were injection drug users, 20% were homosexual or bisexual men, and 39% were heterosexually infected. Sixty percent had disclosed their HIV status to all sexual partners. Of the 40% who had not disclosed, half had not disclosed to their one and only partner. Among patients who did not disclose, 57% used condoms less than all the time. In multiple logistic regression analysis, the odds that an individual with 1 sexual partner disclosed was 3.2 times the odds that a person with multiple sexual partners disclosed. The odds that an individual with high spousal support disclosed was 2.8 times the odds of individuals without high support, and the odds that whites or Latinos disclosed was 3.1 times the odds that blacks disclosed. CONCLUSIONS: Many HIV-infected individuals do not disclose their status to sexual partners. Nondisclosers are not more likely to regularly use condoms than disclosers. Sexual partners of HIV-infected persons continue to be at risk for HIV transmission.

Disclosure↗
PubMed1998

Strategies to reduce driving under the influence of alcohol.

The purpose of this review is to update research on the prevention of alcohol-related traffic deaths since the 1988 Surgeon General's Workshop on Drunk Driving. Four primary areas of research are reviewed here: (a) general deterrence policies, (b) alcohol control policies, (c) mass communications campaigns, including advertising restrictions, and (d) community traffic safety programs. Modern efforts to combat drunk driving in the United States began with specific deterrence strategies to punish convicted drunk drivers, and then evolved to include general deterrence strategies that were targeted to the population as a whole. Efforts next expanded to include the alcohol side of the problem, with measures installed to decrease underage drinking and excessive alcohol consumption. In the next several years, greater efforts are needed on all these fronts. Also needed, however, are programs that integrate drunk driving prevention with other traffic safety initiatives.

Accidents, Traffic↗
PubMed1997

Factors associated with HIV testing among sexually active adolescents: a Massachusetts survey.

OBJECTIVE: To assess sexually active adolescents' knowledge, attitudes, and behaviors associated with human immunodeficiency virus (HIV) testing and to determine the factors important in their decision to obtain voluntary HIV testing. DESIGN: Anonymous, random, digit-dial telephone survey undertaken in 1993. SETTING: Massachusetts households. PARTICIPANTS: Adolescents, 16 to 19 years of age. RESULTS: Of the 567 adolescents surveyed who had sexual intercourse within the past year, 127 (22%) had received HIV testing, with 54 (10%) stating that this testing was for personal reasons. A "great deal" or "some" worry about getting HIV/acquired immunodeficiency syndrome (AIDS) was expressed by 51%, and 56% felt that it was at least a little likely that they will get AIDS. Misconceptions were common about aspects of HIV testing: 35% did not believe or did not know that the HIV test results were kept in confidence, 19% thought that AIDS testers informed partners if the results were positive, and 30% did not think that the HIV test was very accurate. Although 92% (452/490) had seen a physician in the past year, only 30% (136/452) had ever discussed AIDS with a doctor. Multivariable analysis identified five factors as independently associated with voluntary adolescent HIV testing: 1) having had more than one sexual partner within the past year [odds ratio (OR): 2.9; 95% confidence interval (CI): 1.5, 5.5]; 2) believing that condoms are only somewhat effective at preventing the spread of AIDS (OR: 2. 6; 95% CI: 1.4, 4.8); 3) having discussed AIDS with a doctor (OR: 2. 6; 95% CI: 1.4, 4.8); 4) not having had a teacher discuss AIDS (OR: 2.2; 95% CI: 1.2, 4.2); and 5) believing that a positive test result means one has AIDS as opposed to carrying the virus (OR: 2.0; 95% CI: 1.1, 3.7). High-risk behavior of infrequent condom use and a history of a sexually transmitted disease were not significantly associated with voluntary HIV testing. CONCLUSION: Among sexually active Massachusetts adolescents, voluntary HIV testing is uncommon. Teens who have had multiple sexual partners and who do not believe condoms are effective in preventing transmission were most likely to have been tested. Issues requiring clearer communication to patients include the testing process, its availability, and confidentiality. Physicians can play an influential role in the promotion of HIV testing by discussing HIV risk behaviors with patients and offering those at risk voluntary HIV counseling and testing.

AIDS Serodiagnosis↗
PubMed1996

Why are most drowning victims men? Sex differences in aquatic skills and behaviors.

Men have higher drowning rates than women for most age groups. Data from a 1991 national household survey (n = 3042) on aquatic activities were used to examine hypotheses about differential drowning rates by sex. Men and women were compared by (1) exposure to aquatic environments; (2) frequency of aquatic activities involving or potentially involving, submersion; (3) swimming training and ability; (4) aquatic risk-taking behaviors; and (5) alcohol use on or near the water. Men had elevated risks for exposure, risk taking, and alcohol use. It was concluded that several factors contribute to their relatively high drowning rates, including a possible interaction between overestimation of abilities and heavy alcohol use.

Adolescent↗
PubMed1996

Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program.

OBJECTIVES: The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related driving risks, and traffic deaths and injuries. METHODS: Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed. Four statewide telephone surveys (n = 15188) monitored self-reported driving after drinking. RESULTS: In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half. CONCLUSIONS: Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries.

Accidents, Traffic↗
PubMed1996

Lowering state legal blood alcohol limits to 0.08%: the effect on fatal motor vehicle crashes.

OBJECTIVES: This study was undertaken to determine whether reductions in alcohol-related fatal crashes following adoption of 0.08% legal blood alcohol limits were independent of general regional trends. METHODS: The first five states that lowered legal blood alcohol limits to 0.08% were paired with five nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre- and postlaw years. RESULTS: States adopting 0.08% laws experienced 16% and 18% relative postlaw declines in the proportions of fatal crashes involving fatally injured drivers whose blood alcohol levels were 0.08% or higher and 0.15% or higher. CONCLUSIONS: It all states adopted 0.08% legal blood alcohol limits, at least 500 to 600 fewer fatal crashes would occur annually.

Accidents, Traffic↗
PubMed1995

Methods used in studies of drink-drive control efforts: a meta-analysis of the literature from 1960 to 1991.

We searched the drink-drive control literature over the past three decades, finding over six thousand documents. After detailed review of the abstracts and papers, 125 studies contained separate empirical evaluations of the effects of 12 DWI control policies and enforcement efforts (administrative license suspension, illegal per se, implied consent, preliminary breath test, mandatory jail sentence, mandatory community service, mandatory license suspension, limits on plea bargaining, mandatory fines, selective enforcement patrols, regular police patrols, and sobriety checkpoints). The 125 studies contained 664 distinct analyses that formed the basis for meta-analysis. All of the DWI control efforts were associated with reductions in drink-driving and traffic crashes. The DWI control literature is limited by the preponderance of weak study designs and reports that often fail to include basic data required for meta-analysis. Because of the poor quality of much extant research, we were limited to simple gain scores or percent change estimates in the current study. Further research that does not include appropriate research designs and analytic methods will be of limited utility. We recommend that all future reports include effect estimates and standard error estimates, minimum data required for effective meta-analysis.

Accidents, Traffic↗
PubMed1993

A survey of attitudes, knowledge, and behavior related to HIV testing of adolescents and young adults enrolled in alcohol and drug treatment.

The objectives of this study were to assess attitudes, knowledge, and behavior related to human immunodeficiency virus (HIV) antibody testing of adolescents and young adults undergoing treatment for alcohol and drug problems. Setting and subjects were 101 adolescents and young adults enrolled in a New England substance abuse rehabilitation program. All subjects had heard about acquired immunodeficiency syndrome (AIDS) and 84% desired an HIV antibody test if it were anonymous and confidential. If found to be HIV positive, 83% stated that they would be less likely to continue substance-abuse treatment, 64% would be more likely to continue drug use, and 62% would be more likely to continue alcohol use. The likelihood of continuing school would decrease for 60%. Sixty percent would be more likely to increase use of condoms. Males were more likely than females to want to leave treatment and school, return to alcohol and drug use, and increase risk-taking behavior (p < 0.02). These findings suggest that teenagers undergoing treatment for substance-abuse problems require careful and comprehensive pre- and post-test counseling and follow-up when undergoing HIV antibody testing. Deciding when to test for HIV may impact on the success of substance-abuse treatment, as well as ability to control spread of HIV infection.

Adolescent↗
PubMed1993

Alcohol and non-traffic unintended injuries.

In a review of the English language literature on alcohol and unintentional injury we identified 21 studies on falls, 36 on drownings and 32 on burns from 1947-1986. The proportion of fatal and non-fatal fall victims who had been drinking ranged from 21-77%, and 18-53% respectively. In three more recent studies, 35-63% of persons fatally injured in falls had been drinking. In five other studies 13-37% of persons injured in non fatal falls had been drinking. In our earlier review of drowning studies with complete ascertainment and duration of submergence specified, 27-47% of those who drowned had positive BAC's. In eight subsequent studies, alcohol was identified in 21-47% of drowning deaths. In our earlier review alcohol was involved in 9-86% of burn deaths. In five more recent US studies, alcohol was found in 12-61% of fatally injured burn victims. Case control studies are needed to establish whether alcohol increases the risk of trauma. Studies are also needed of interventions to reduce the proportion of these injuries where alcohol is involved.

Accidental Falls↗
PubMed1992

Alcohol, drugs, and adolescent sexual behavior.

In a 1990 Massachusetts-wide random digit-dial telephone survey of 16-19 year olds, 66% reported sexual intercourse of whom 64% had sex after drinking and 15% after other drug use. Thirty-seven percent always used condoms. Forty-nine percent were more likely to have sex if they and their partner had been drinking, and 17% used condoms less often after drinking. Fewer, 32%, said they would be more likely to have sex if they and their partner had used drugs, with 10% less likely to use condoms after drug use. Since so few adolescents consistently use condoms, the greatest risk for HIV, sexually transmitted diseases, and unwanted pregnancy is the increased likelihood of having sex after drinking or drug use, not the decreased likelihood of condom use after drinking and drug use.

Adolescent↗
PubMed1990

Acquired immunodeficiency syndrome transmission: changes in knowledge and behaviors among teenagers, Massachusetts statewide surveys, 1986 to 1988.

Despite substantial progress, adolescents remain at high risk for human immunodeficiency virus (HIV) infection. Two independent random digit dial statewide Massachusetts surveys of 16- to 19-year-old persons conducted August through September 1986 and 1988 revealed that the proportion of teenagers who had discussed acquired immunodeficiency syndrome (AIDS) in schools increased from 52% to 82%. Knowledge about how AIDS is transmitted was also significantly higher in 1988. The proportion of teenagers using drugs other than alcohol and marijuana declined from 13% to 9%, and intravenous drug use declined from 1% to 0.1%. At the same time, among sexually active teenagers, the proportion who reported changes in sexual behavior to avoid AIDS increased from 16% to 34%. The proportion who adopted condom use to avoid AIDS increased from 2% to 19%. However, the overall proportion of teenagers who reported sexual intercourse in the past year increased significantly from 55% to 61%. In 1988, among sexually active teenagers, 37% never used condoms and 33% used them only some of the time. Of all respondents, 18% reported unprotected sex with more than one partner in the previous year, and 3% reported unprotected sex with intravenous drug users. Although mass media and school education may increase knowledge and stimulate some teenagers to change behavior, for others more personal forms of counseling may be needed. The effects of increasing physician counseling warrant special study. Teenagers who had spoken to physicians about AIDS were much more likely to have adopted condom use to avoid HIV exposure. However, although 80% of adolescents saw a physician in the past year, only 13% were counseled about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Effects of maternal marijuana and cocaine use on fetal growth.

To investigate the effects on infants of the use of marijuana and cocaine during pregnancy and to compare the importance of urine assays with that of interviews in ascertaining drug use, we prospectively studied 1226 mothers, recruited from a general prenatal clinic, and their infants. On the basis of either interviews or urine assays conducted prenatally or post partum, 27 percent of the subjects had used marijuana during pregnancy and 18 percent had used cocaine. When only positive urine assays were considered, the corresponding values were 16 percent and 9 percent, respectively. When potentially confounding variables were controlled for in the analysis, the infants whose mothers had positive urine assays for marijuana, as compared with the infants whose mothers were negative according to both interviews and urine assays, had a 79-g decrease in birth weight (P = 0.04) and a 0.5-cm decrement in length (P = 0.02). Women who had positive assays for cocaine, as compared with nonusers, had infants with a 93-g decrease in birth weight (P = 0.07), a 0.7-cm decrement in length (P = 0.01), and a 0.43-cm-smaller head circumference (P = 0.01). To compare our findings with those of other investigators who did not use urine assays, we repeated the analyses, considering only self-reported use of marijuana (23 percent) and cocaine (13 percent). There were no significant associations between such use as determined by interviews alone and any of the measures of outcome. We conclude that the use of marijuana or cocaine during pregnancy is associated with impaired fetal growth and that measuring a biologic marker of such use is important to demonstrate the association.

Adolescent↗