No abstract

The impact of crack cocaine use on number of sex partners was examined using bivariate analyses and a logistic model on a national treatment cohort of 4939 individuals. Number of sex partners over the last 12 months was dichotomized as none/one versus multiple partners for the logistic analyses. The model included 11 independent variables not including prostitution or use of crack cocaine. For both genders, the bivariate analyses showed significant positive associations between crack use and number of partners regardless of type of sexual activity; those who used crack had more partners for all sexual activities queried, compared to those who did not. Cocaine, whether in powder or crack form, was positively associated with prostitution for both genders. For men the odds ratio for crack cocaine use ranged from 1.6 (heterosexual anal) to 5.5 (homosexual anal) and for women from 2.9 (heterosexual oral) to 4.1 (homosexual oral). If prostitution is added to the model the odds ratios are reduced for homosexual activities for men and reduced dramatically for all types of sexual activity for women.

Patient activation describes an individual's readiness to participate in their health care. Lower levels of activation that may contribute to poor health outcomes have been documented in Latino patients. We administered a brief activating intervention directed at Spanish-speakers that sought to improve and encourage question-asking during a medical visit. We used quantitative measures of patient attitudes supplemented with open-ended questions to evaluate the effectiveness of the intervention at a community health center. Post-intervention changes in the Patient Activation Measure (PAM) and Decision Self-Efficacy (DSE) were measured. Both control and intervention group PAM scores changed significantly, but for those at lower levels of activation, only the intervention group showed significant gains. For the DSE the intervention group showed significant changes in scores. These findings, which are supported by the qualitative data, suggest that the intervention helped patients who may have difficulty asking questions during medical visits.

No abstract

U.S. state governments have the responsibility to regulate and license behavioral health care interventions, such as for addiction and mental illness, with increasing emphasis on implementing evidence-based programs (EBPs). A serious obstacle to this is lack of clarity or agreement about what constitutes “evidence-based.” The study’s purpose was to determine the extent to which and in what contexts web-based Evidence-based Program Registries (EBPRs) are referenced in state government statutes and regulations (“mandates”) concerning behavioral health care. Examples are What Works Clearinghouse, National Register of Evidence-based Programs and Practices, and Cochrane Database of Systematic Reviews. The study employed the Westlaw Legal Research Database to search for 30 known EBPR websites relevant to behavioral health care within the statutes and regulations of all 50 states. There was low prevalence of EBPR references in state statutes and regulations pertaining to behavioral health care; 20 states had a total of 33 mandates that referenced an EBPR. These mandates usually do not rely on an EBPR as the sole acceptable source for classifying a program or practice as “evidence-based.” Instead, EBPRs were named in conjunction with internal state or external sources of information about putative program effectiveness, which may be less valid than EBPRs, to determine what is “evidence-based.” Greater awareness of scientifically based EBPRs and greater understanding of their advantages need to be fostered among state legislators and regulators charged with making policy to increase or improve the use of evidence-based programs and practices in behavioral health care in the United States.