Faculty Bibliography

OBJECTIVES/OBJECTIVE:This study conducted a randomized controlled trial with 600 recently released homeless men exiting California jails and prisons. METHODS:The purpose of this study was to primarily ascertain how different levels of intensity in peer coaching and nurse-partnered intervention programs may impact reentry outcomes; specifically: (a) an intensive peer coach and nurse case managed (PC-NCM) program; (b) an intermediate peer coaching (PC) program with brief nurse counseling; and (c) the usual care (UC) program involving limited peer coaching and brief nurse counseling. Secondary outcomes evaluated the operational cost of each program. RESULTS:When compared to baseline, all three groups made progress on key health-related outcomes during the 12-month intervention period; further, 84.5 % of all participants eligible for hepatitis A/B vaccination completed their vaccine series. The results of the detailed operational cost analysis suggest the least costly approach (i.e., UC), which accounted for only 2.11 % of the total project expenditure, was as effective in achieving comparable outcomes for this parolee population as the PC-NCM and PC approaches, which accounted for 53.98 % and 43.91 %, respectively, of the project budget. CONCLUSIONS:In this study, all three intervention strategies were found to be comparable in achieving a high rate of vaccine completion, which over time will likely produce tremendous savings to the public health system.

BACKGROUND:High attrition among research participants undermines the validity and generalizability of field research. This study contrasted two incentivizing methods--money orders (MOs) or rechargeable incentive cards (RICs)--with regard to rates of participants' study engagement and follow-up contact over a 6-month period. METHODS:Substance abusers (N = 303) in Los Angeles, California were recruited and randomized to either an MO (control) or RIC (experimental) condition. All participants were asked to call the researchers at the beginning of each calendar month for the ensuing 5 months to update their locator information, even if nothing had changed. Each call resulted in a $10 payment, issued immediately via the RIC system or by MO by mail. Research staff located and interviewed all participants at Month 6. Contact logs assessed level of effort required to locate participants and conduct follow-up interviews. RESULTS:Relative to controls, RIC participants, especially those with low ability to defer gratification, initiated more monthly calls. Six-month follow-up rates did not differ between RIC (75%) and controls (79%), though the RIC condition was associated with an average staff time savings of 39.8 minutes per study participant. DISCUSSION/CONCLUSIONS:For longitudinal public health research involving itinerant study participants, the RIC method produces a modest benefit in study engagement and reduced staff time devoted to participant tracking and payments. However, the overall cost-effectiveness of this approach will depend on the pricing model of the card-issuing vendor (which in turns depends on the scale of the project, with per-unit costs falling for larger projects).

BACKGROUND/PURPOSE/OBJECTIVE:This study sought to examine the prevalence and correlates of psychological distress among incarcerated youth in Taiwan using the 5-item Brief Symptom Rating Scale (BSRS-5). METHODS:This cross-sectional census survey study was conducted in 2007 among all the juveniles incarcerated in 23 correctional institutions (n = 1505) in Taiwan using a self-administered anonymous questionnaire. Of the total 1505 participants, 1363 completed the questionnaire (91% response rate). We excluded 494 participants as they were aged either over 17 years or under 12 years. Psychological distress was measured among the final 869 participants using the BSRS-5. Psychological distress was defined as a total score of at least 6 out of 20. Those identified as having psychological distress were then pooled into a case group and compared with control participants without psychological distress. RESULTS:The prevalence of psychological distress was 44.1%. Among the case group, sleep disturbance (36.8%) had the highest prevalence of severe or very severe symptoms, followed by depression (34.7%), and hostility (27.9%). Multivariate logistic regression analysis revealed that correlates of psychological distress included the following: being female; having a poor self-rated health status; having joined a gang; having experienced life disturbances prior to the current imprisonment; and having ever had a smoking habit. CONCLUSION/CONCLUSIONS:Significant sex differences were found for both the overall BSRS-5, as well as for each individual item of the BSRS-5. Treatment programs and interventions should be carefully tailored to address the mental health needs of juvenile inmates in a sex-specific manner using a multifaceted approach.

BACKGROUND:Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. OBJECTIVES/OBJECTIVE:The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. METHODS:A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. RESULTS:Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. DISCUSSION/CONCLUSIONS:Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

Homeless men exiting California State jails and prisons are a heterogeneous community with varied childhood, incarceration and drug use histories. This cross-sectional study assessed whether homeless men who were discharged from either jail or prison into a residential substance abuse treatment program, differed in terms of methamphetamine and heroin use. This study utilized baseline data collected on 540 recently paroled men randomized to one of three programs that assessed the impact of a peer coaching intervention on subsequent drug use and re-incarceration. We found that younger ex-offenders exiting prisons and jails were more likely to have used methamphetamine alone, whereas African American ex-offenders were less likely to have used methamphetamine alone when compared to other ethnic groups. Further, ex-offenders exiting jails and self-reporting use of heroin only at baseline were significantly more likely than their counterparts to have been removed from home before age 18. For men exiting jails, there was an association between lower self-esteem and having used methamphetamine but not heroin. However, having used both heroin and methamphetamine was associated with both violent crime and cognitive problems in both jail and prison samples. Our findings showcase the need to understand unique correlates of both heroin and methamphetamine as they relate to jail and prison populations.

High levels of hostility present a formidable challenge among homeless ex-offenders. This cross-sectional study assessed correlates of high levels of hostility using baseline data collected on recently-released male parolees (N=472; age 18-60) participating in a randomized trial focused on prevention of illicit drug use and recidivism. Predictors of high levels of hostility included greater depressive symptomatology, lower self-esteem, having a mother who was treated for alcohol/drugs, belonging to a gang, more tangible support, having used methamphetamine and having a history of cognitive difficulties. These findings highlight the need to understand predictors of hostility among recently released homeless men and how these predictors may relate to recidivism. Research implications are discussed as these findings will shape future nurse-led harm reduction and community-based interventions.