African American Crack Cocaine Users Research Articles

Integrating Motivational Interviewing, Motivational Incentives, and Harm Reduction as a Group Therapy Intervention with African American Crack Cocaine Users Living with HIV

This article describes the integration of three evidence-supported approaches as a group therapy intervention with African American crack cocaine users living with HIV: motivational interviewing, motivational incentives, and harm reduction. The group is held at Provident Hospital, Chicago, Illinois, the first African American–owned hospital in the United States. The goals of the group are to prevent relapse, decrease the risk of homelessness, and help to improve decision-making skills.

An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection

The purpose of this study was to assess the efficacy of brief group interventions, the positive choices intervention (PCI) and a standard intervention (SI), to increase condom use and intention to use condoms and to change condom use attitudes and beliefs. The design of the study was a randomized comparative trial. Participants were 347 heterosexual African American crack cocaine users living with HIV infection. Data were collected at intake and at three and nine months after intake. Behavioral and sociocognitive data were collected. Although both brief interventions achieved positive results, there were significant differences in outcomes between the interventions groups. The mean number of sex partners was significantly lower in the PCI group at three months. The proportion of those assigned to the PCI reporting sex with a paid partner significantly decreased, while the proportion disclosing their serostatus to their partners increased. There were no significant differences on these measures in the SI group. Significant time effects were found on measures of condom use, condom use attitudes, and self-efficacy beliefs. These measures significantly increased from intake to one month for both groups. One significant time-by-group effect was found. The measure of situational self-efficacy significantly increased in the PCI group, but not the SI group. Results also showed significant time-by-time effects. Mean condom use, intention to use condoms, attitudes, and condom use self-efficacy beliefs showed significant difference between three and nine months. However, there was no clear pattern of change. Findings suggest that brief group interventions designed to reduce HIV can help heterosexual drug users living with HIV infection increase condom use and intention to use condoms and change condom use attitudes and beliefs. A significant time-by-group effect was observed only for situational self-efficacy, suggesting limited additional efficacy of the PCI intervention. Given similar positive findings between groups, more research is needed to determine which components of brief interventions produce changes in motivations and risk behaviors.

A Psychosocial Comparison of New Orleans and Houston Crack Smokers in the Wake of Hurricane Katrina

The purpose of this study was to compare psychological distress in a sample of African American crack cocaine users who relocated to Houston from New Orleans after Hurricane Katrina to African American drug users resident in Houston. Fifty-four African Americans from New Orleans were compared to a sample of 162 people in Houston. Data were collected between June 2002 and December 2005. There were no significant differences between the two groups on either depression or anxiety, but the New Orleans sample scored higher on the self-esteem scale and scored slightly lower on the risk-taking scale.

Decisions to participate in research: views of underserved minority drug users with or at risk for HIV

Under-representation of minority populations, particularly African Americans, in HIV/AIDS research is problematic because African Americans bear a greater disease burden from HIV/AIDS. Studies of motivations for participating in research have emphasized factors affecting individuals’ willingness to participate and barriers to participation, especially in regard to HIV vaccine research. Little is known about how underserved minority drug users perceive research and their decisions to participate. This study describes African American drug users’ perceptions of research participation and their decisions to participate based on three kinds of hypothetical HIV/AIDS-related clinical studies. In-depth, qualitative interviews were conducted with 37 underserved, African American crack cocaine users, recruited from participants already enrolled in three different behavioral HIV prevention studies. Interviews were recorded, transcribed, coded for themes and sub-themes and analyzed using directed and conventional content analysis. Participants’ decisions to take part in research often involved multiple motivations for participating. In addition, decisions to participate were characterized by four themes: a desire for information; skepticism and mistrust of research and researchers; perceptions of medical care and monitoring within a study; and participant control in decisions to participate or decline participation. Lack of adequate information and/or medical care and monitoring within a study were related to mistrust, while the provision of information was viewed by some individuals as a right and acknowledgement of the participant's contribution to the study. Participants perceived, rightly or wrongly, that medical monitoring would control some of the risks of a study. Participants also described situations of exerting control over decisions to enter or withdraw from a research study. Preliminary findings suggest that continuous communication and provision of information may enhance enrollment and adherence. Further exploration of decisions to participate in research will add to the understanding of this complex phenomenon and enhance the ability of individuals with HIV/AIDS to benefit from research.

Stages of Consistent Condom Use, Partner Intimacy, Condom Use Attitude, and Self-Efficacy in African-American Crack Cocaine Users

This study examined how condom use attitude, self-efficacy, and partner intimacy related to five stages of consistent condom use. Interview data were collected from sexually active, heterosexual, African-American crack cocaine smokers (N = 366). Dependent measures assessed both the participants' own responses and their perceptions about their last sex partner's own personal condom use attitude and participants' condom use self-efficacy expectations. Partner intimacy was assessed both as a continuous attitudinal and as a discrete relationship measure. Less than 10% were classified as consistent condom users. Two thirds of inconsistent users were in the Precontemplation (PC) stage. The contemplation (C) and preparation (P) stages were equal among the remainder of the inconsistent condom users. Higher partner intimacy reduced modestly readiness for consistent condom use. The stage but not the intimacy group was related to the condom use attitudes and self-efficacy measures. Last partners' perceived own negative attitudes were significantly related to the stages of consistent condom use and was especially low in the action (A) and maintenance (M) stages. Participants' own negative attitudes were unrelated to the stages. Of the self-efficacy measures, both participants' performance and situational condom use self-efficacies increased significantly after the PC stage and were highest in the P, A, and M stages. However, situational self-efficacy accounted for most of performance self-efficacy variance. In sum, consistent condom use was rare. A partner's attitudes and the participants' own situational self-efficacy expectations, rather than intimacy, determined the readiness to adopt consistent condom use.

Perceived Neighborhood Safety and Depressive Symptoms Among African American Crack Users

This study examined the association between perceived neighborhood safety and depressive symptoms among 443 out-of-treatment African American crack cocaine users interviewed between 2000 and 2002 in North Carolina and tested the regression of depression on perceived neighborhood safety and common predictors of depression. Perceived neighborhood safety was an important predictor of depressive symptoms in models that adjusted for other correlates of depression. The findings are limited by the cross-sectional nature of the data and the complex etiology and course of depression. Additional research is needed to clarify the relationship between perceived neighborhood safety and depression. The study was supported by the National Institute on Drug Abuse.

Perceptions of Risk in Research Participation Among Underserved Minority Drug Users

Research with underserved minority drug users is essential to quality health care and prevention. Understanding how participants perceive risk in research is necessary to inform research regulators so that research protections are neither lax, exposing participants to harm, nor overly stringent, thereby denying access to beneficial research. Data from 37 semistructured interviews of underserved, African-American crack cocaine users, collected from February to May 2006 in a large, urban setting, were analyzed using content analysis. In three hypothetical studies, participants recognized risks as relative and articulated and evaluated specific risks. Research regulators may enhance the accuracy of risk assessment in research by incorporating the views of participants. Study implications and limitations are noted. Future research on risk perception in research participation is suggested.

Multiple Sexual Partnerships in a Sample of African-American Crack Smokers

The sample for this study consisted of 692 sexually active African-American crack cocaine users living in Houston, TX who reported more than one sexual partner in the previous 30 days. Participants were asked to describe each of their two most recent partners from a list of eight choices: spouse/like a spouse/lover; close friend/friend/acquaintance/customer you like/customer. Analyses were conducted on the 1,384 partners and 692 partnership combinations reported. Partnerships and partnership patterns were examined with respect to three risk behaviors-unprotected sex, alcohol use to accompany sex, and drug use to accompany sex-and with respect to three affective measures-partner intimacy, condom use responsibility, and condom use self-efficacy. Results indicate that while many partnerships were based on trading sex for money or drugs, many participants reported partners they considered a spouse or friend. Risk behaviors and affective measures were found to differ by partner type.

The impact of HIV-related interventions on HIV risk behavior in a community sample of African American crack cocaine users

While there are reports of the impact of specific interventions designed to reduce HIV drug and sexual risk behaviors, there are few reports of the impact of HIV interventions in a community-based sample. We report on baseline data from a sample of African American crack smokers who were about to participate in an intervention designed to reduce HIV-related risk behaviors. The majority were male (80%), single (70%) and homeless (52%). Data indicated that 29% of the sample had been in a previous HIV intervention in the past 12 months, the majority in a correctional setting or CBO program. There were few systematic demographic differences between the two groups. Those who had been in an intervention reported using male and female condoms significantly more frequently on all measures of condom use, had positive condom use outcome expectations for male condoms and higher affective and situational condom-related self-efficacy beliefs. These data suggest that, at a community level, the spectrum of HIV risk-reduction programs does produce a significant improvement in condom use and related cognitions, although there is a need to cover a greater proportion of the population. Previous exposure to interventions must be a critical covariate in assessing the impact of future interventions.

Codeine Cough Syrup Use Among African-American Crack Cocaine Users

While studies show evidence of a clear problem with the prevalence of crack cocaine and codeine cough syrup use separately, the relationship between these substances of abuse and concurrent polydrug use is unknown. In an attempt to ascertain beyond anecdotal evidence, the authors carried out a cross-sectional study among 482 Mrican-American crack users to investigate the differences between those who were concurrently codeine cough syrup users and those who were not codeine cough syrup users in Houston, Texas. Logistic regression indicated that codeine use was significantly associated with lower participant age and lower education; codeine cough syrup users were significantly more likely than nonusers to not have a main sexual partner. in addition, codeine users had significantly higher odds of ever trading sex for money, marijuana use, and fry use. These findings are important in determining the “cultural novelties” relative to crack and codeine use among younger Mrican Americans.

Correlates of sexual assault in a sample of male African American crack cocaine users

Although numerous studies have reported an association between substance use and sexual assault, little is known about the impact of sexual assault on male African American crack cocaine users. This study found that from a sample of 137 respondents from Houston, Texas, one-third reported having been sexually assaulted at least once during their lifetime. Respondents who reported sexual assault were using cocaine more often and were more likely to be physically dependent on drugs and to report greater numbers of physical health problems due to their drug use. However, no differences were identified in respect of reported mental health problems, or problems with family, friends or the workplace associated with drug use. The findings suggest further research as to the impact of sexual assault on male crack cocaine users is warranted and that clinical staff working with male substance users require some awareness of the impacts of sexual assault.

Psychological Correlates of Trading Sex for Money Among African American Crack Cocaine Smokers

This article compares demographic characteristics, sexual practices, and psychosocial status among 193 African American female crack cocaine users who currently, previously, or never traded sex for money. Current traders were less likely to have a main sexual partner, more likely to have a casual sexual partner, and more likely to smoke larger quantities of crack. There was a significant trend towards current traders reporting lower self-esteem, greater depression and anxiety, poorer decision-making confidence, more hostility, less social conformity, greater risk taking behaviors, and more problems growing up, compared to previous and never traders. These differences suggest that interventions should address self-esteem, risk-taking practices, depression and anxiety as well as other psychosocial factors.

Medication compliance and satisfaction with treatment for HIV disease in a sample of African-American crack cocaine smokers.

The development of treatment regimes for African-American HIV-infected crack cocaine users has often been based on assumptions about compliance with medication regimes rather than evidence. This study sought to obtain baseline information on the adherence to antiretroviral medications by members of this important risk population in Houston, Texas. It was found that for only 5 of a range of 16 antiviral medications was there a significant correlation between levels of compliance reported by respondents and their beliefs as to how effective these medications are. Medication compliance was also found not to be associated with frequency of crack cocaine use in the month prior to interview. Furthermore, irrespective of both gender and their reported extent of medication compliance, the respondents tended to report positive relationships with their treating physician, with higher levels of satisfaction reported by women. These results suggest that the majority of African-American crack cocaine users are able to comply with HIV treatment regimes, with more than half (53%) claiming full compliance for one or more medications, and a further one third (31%) claiming compliance more than half the time. Moreover, these findings suggest that they will continue to take antiretroviral medications even if they have doubts about the effectiveness of these medications.

Condom use behaviors in HIV‐infected African American crack cocaine users

The purpose of this study was to investigate sexual risk behaviors and factors associated with consistent condom use of HIV+ African Americans receiving HAART who smoke crack. Participants were African Americans in Houston, Texas and over 18, being treated for HIV, and reported currently using crack. Measures included demographic variables, sexual behaviors, drug use, and nine psychosocial scales and seven escape scales. One hundred thirty seven participated in the study. Condom use was low across all partner types. Regression analyses revealed two demographic variables, and two psychosocial and one escape scale were significantly associated with intention to use condoms. One of the more alarming findings of this study concerns the large number of individuals who know they are HIV positive yet continue to have unprotected sex. The inconsistent condom use by these HIV+ individuals threatens the progress that has been made to stem the epidemic.

Condom use behaviors in HIV-infected African American crack cocaine users.

The purpose of this study was to investigate sexual risk behaviors and factors associated with consistent condom use of HIV+ African Americans receiving HAART who smoke crack. Participants were African Americans in Houston, Texas and over 18, being treated for HIV, and reported currently using crack. Measures included demographic variables, sexual behaviors, drug use, and nine psychosocial scales and seven escape scales. One hundred thirty seven participated in the study. Condom use was low across all partner types. Regression analyses revealed two demographic variables, and two psychosocial and one escape scale were significantly associated with intention to use condoms. One of the more alarming findings of this study concerns the large number of individuals who know they are HIV positive yet continue to have unprotected sex. The inconsistent condom use by these HIV+ individuals threatens the progress that has been made to stem the epidemic.

Situational correlates of condom use in a sample of African-American drug users who are primarily crack cocaine users.

We studied the situational determinants of condom use for vaginal sex in 151 African-American crack cocaine users in Houston, Texas, using situational presentation (Sitpres) methodology, which uses hypothetical scenarios with randomly generated levels of eight variables across 10 scenarios that may impact the decision to use a condom. Multiple regression showed that variables associated with a high probability of using a condom were older age, how badly the partner wants to use a condom, and how badly the respondent wants vaginal sex. Crack craving or level of intoxication were not correlates. The Sitpres methodology was successfully used by these crack users and data indicated that it was sexual variables, rather than drug-associated variables, that were significantly associated with condom use.

Health Care Utilization in Female African-American Crack Cocaine Users

ABSTRACT This study examined utilization of health care services by urban female African-American crack cocaine users recruited for a larger study developing HIV risk reduction interventions. Structured interviews were conducted with 149 women at a community-based field site. Nearly all women regularly sought health care during the past year, although only forty percent had any type of health insurance. Two-thirds had no regular primary care provider, with the highest percentage among women who did not have health insurance. Typically, women received care at public hospital outpatient clinics or emergency rooms and the most common care issues were female-related health issues and substance use. Many women reported having had routine exams such as general medical, pelvic, or pap smear in the past two years. However, fewer had dental, eye, or mammogram exams during that same time period, with many never having had such exams. Twenty-three percent of the women reported a lifetime diagnosis of a mental illness. Analyses by amount of crack use indicated that those who used most were least likely to be insured, and most likely to seek care at hospital emergency rooms. Multivariate analyses revealed that self-rated health and having a minor child predicted amount of health care received in the past year. Many female African-American crack cocaine users are not receiving important health care exams and services. Steps must be taken to improve preventive and primary care to female African-American crack cocaine users prior to the necessity of care in a more expensive hospital setting.

Life histories of crack-using African-American homeless men: salient themes

In-depth life history interviews with 31 African-American male crack-cocaine users in Philadelphia were conducted as part of a demonstration project on homeless substance-abuse programs. Topics analyzed include the informants’ extensive experience of early life disruptions, childhood trauma and interpersonal violence; the importance of street gang life and violence while growing up; the transitory and unstable nature of the men's employment histories; the development of their careers of drug use and dealing; the involvement of drinking and drugs in the transition to homelessness; and their view of treatment as a resource for a respite from the streets.

African Self-Consciousness, Misorientation Behavior, and a Self-Destructive Disorder: African American Male Crack-Cocaine Users

Addiction to substances is among the self-destructive disordersfound in the Azibo nosology. It is theorized that underlying these disorders is psychological misorientation that results from a distortion in African Self-Consciousness (ASC). To explore ASC and the relationship between it and misorientation behavior for a population of 101 African American males suffering from crack-cocaine addiction, the ASC scale and a background questionnaire measuring misorientation behaviorwere administered, andfactorand chi-square analyses were conducted. The results ofafactor analysis of the ASC scale yielded twofactors and indicated that there may be some distortion inASCfor this population. Chi-square analyses revealed no significant difference in misorientation behavior between the first and fourth quartile groups created on the two factors. Chi square analyses conducted on the total sample classified into three ASC orientation groups (incorrect ASC orientation, ASC orientation unclear, ASC orientation correct); however, they did yield significant differences in misorientation behavior Results are discussed in terms of Kambon 's (1992) African personality theory, the Azibo nosology (Azibo, 1989, in press), and psychodynamics perhaps characteristic of this population.

Comparison of African-American adolescent crack cocaine users and nonusers: Background factors in drug use and HIV sexual risk behaviors.

Comparison of African-American adolescent crack cocaine users and nonusers: Background factors in drug use and HIV sexual risk behaviors.