Crack Cocaine Use Research Articles

Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

ObjectiveTo assess the association between lifetime crack cocaine use and psychiatric (post-traumatic stress disorder, current depression, current dysthymia, generalized anxiety disorder, panic disorder with agoraphobia, social phobia, as well as SRQ scores and suicide risk) and substance-use disorders (tobacco, alcohol, cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens and opioids) in youth in the general population of the city of Pelotas, RS. MethodThis was a cross-sectional population-based study, involving 1560 participants between 18 and 24years old. Lifetime substance use and abuse were investigated using the ASSIST inventory. Psychiatric comorbidities were assessed using the Mini-International Neuropsychiatric Interview and symptoms of common mental disorders were evaluated with the Self-Reported Questionnaire (SRQ). ResultsThe prevalence of lifetime crack cocaine use in the sample was 2.5%. Its use was associated with total SRW scores and the presence of post-traumatic stress disorder, antisocial personality disorder and suicide risk in the final regression model. Tobacco, alcohol, cannabis, cocaine, amphetamine and cocaine dependence were also associated with lifetime use of crack cocaine. DiscussionYouth with a history of crack cocaine use had a higher prevalence of psychiatric conditions such as post-traumatic stress disorder, as well as an increased risk of tobacco, alcohol, cannabis, cocaine, amphetamine and inhalant use and dependence.

Crack cocaine use impairs anterior cingulate and prefrontal cortex function in women with HIV infection.

Crack cocaine use is associated with impaired verbal memory in HIV-infected women more than uninfected women. To understand the neural basis for this impairment, this study examined the effects of crack cocaine use on activation of the prefrontal cortex (PFC) and strategic encoding during a verbal memory task in HIV-infected women. Three groups of HIV-infected women from the Chicago Consortium of the Women's Interagency HIV Study were compared: current users of crack cocaine (n = 10), former users of cocaine (n = 11), and women who had never used cocaine (n = 9). Participants underwent functional magnetic resonance imaging during a verbal memory task and completed a neuropsychological test of verbal memory. On the neuropsychological test, current crack users performed significantly worse than other groups on semantic clustering, a measure of strategic encoding, p < 0.05. During encoding, activation in left anterior cingulate cortex (ACC) was lower in current and former cocaine users compared to never users. During recognition, activation in bilateral PFC, specifically left dorsal medial PFC and bilateral dorsolateral PFC, was lower in current and former users compared to women who had never used cocaine. Lower activation in left dorsolateral PFC was correlated with worse performance on the recognition task, p < 0.05. The verbal learning and memory deficits associated with cocaine use in women with HIV may be partially accounted for by alterations in ACC and PFC function.

Oxidative stress and BDNF as possible markers for the severity of crack cocaine use in early withdrawal

An important goal of addiction research is to discover neurobiological markers that could predict the severity of addiction and help to determine appropriate treatment. Brain-derived neurotrophic factor (BDNF) and thiobarbituric acid reactive substances (TBARS) are being related to cerebral plasticity and impairment caused by substance abuse. This study aims to evaluate alteration of TBARS and BDNF levels among crack cocaine users during early drug withdrawal and its relationship to severity of drug use. Forty-nine adults crack cocaine users were recruited at a public psychiatric hospital with a specialized addiction treatment unit. Blood sample was collected at intake and discharge for the analysis of TBARS and BDNF measures. Information about drug use was assessed by the Addiction Severity Index 6th Version (ASI-6). Detailed information about crack cocaine use was obtained through the "Profile of the crack cocaine user." Severity of crack use was estimated using information from age of first crack use, years of crack use, and crack rocks used in the previous 30days. There is a positive correlation between TBARS levels and severity of crack cocaine use (R = 0.304, p = 0.04) and a negative correlation between BDNF and severity of crack cocaine use (R = -0.359, p = 0.01) at discharge. Also, we found an inverse correlation between TBARS and BDNF levels (R = -0.294, p = 0.004) at discharge. Our findings suggest that BDNF and TBARS could be possible markers for the severity of drug use. Further studies may show how those markers could be related to staging, prognosis, and treatment in crack cocaine dependence.

Perfil clínico e cognitivo de usuários de crack internados

Trata-se de estudo transversal que objetivou avaliar: consumo de crack (entrevista semi-estruturada), funcionamento adaptativo (relativo às amizades, trabalho e família), psicopatológico (Adult Self-Report) e funções cognitivas (Screening Cognitivo do WAIS-III) de usuários de crack internados. Dos 84 participantes (90,5% homens), 53,6% fez uso diário de crack no último ano, com consumo médio usual de 1,54 gramas (DP=0,53; Mín.=0,5; Máx.=2,5). Houve grande prevalência de classificação na faixa clínica nos problemas internalizantes (77,4%), externalizantes (77,4%), funcionamento adaptativo (variando de 84,6 a 97,6%) e de comportamentos transgressores (70,3% comportamentos de quebra de regras e 59,6% comportamentos anti-sociais). As funções cognitivas encontraram-se preservadas (médio inferior/médio/médio superior) na grande maioria (>75%) dos entrevistados, com pior desempenho no subteste Vocabulário (22,6% classificação inferior).

Violent and sexual behaviors and lifetime use of crack cocaine: a population-based study in Brazil

To estimate the prevalence of lifetime use of crack cocaine and to assess associations with violent and sexual behaviors in young adults selected from the general population of Pelotas, Southern Brazil. This cross-sectional population-based study included 1,560 participants aged 18-24 years. The use of alcohol and other substances, including crack cocaine, was assessed using the alcohol, smoking and substance involvement screening test. Other variables included violent behaviors, firearm possession, and sexual risk behaviors. The frequency of antisocial personality disorder was also investigated. Associations were analyzed using a crude model and models adjusted for sex, social class, and the use of snorted cocaine. Lifetime prevalence of crack cocaine use was 2.51 %, and it was higher among males and individuals coming from more vulnerable social classes (D or E). In the final multivariate models, lifetime use of crack cocaine was associated with episodes of aggression and firearm possession, as well as with a higher chance of not having used condom in the last sexual intercourse. In less conservative models, crack cocaine use was associated with other violent and sexual risk behaviors. The strong association observed between lifetime use of crack cocaine and different violent and sexual risk behaviors underscores relevant characteristics of people who use crack cocaine. Improving our understanding of possible causal chains leading to such associations should be a priority in future studies.

Pulmonary Function in HIV-Infected Recreational Drug Users in the Era of Anti-Retroviral Therapy.

Individuals with HIV infection commonly have pulmonary function abnormalities, including airflow obstruction and diffusion impairment, which may be more prevalent among recreational drug users. To date, the relationship between drug use and pulmonary function abnormalities among those with HIV remains unclear. To determine associations between recreational drug use and airflow obstruction, diffusion impairment, and radiographic emphysema in men and women with HIV. Cross-sectional analysis of pulmonary function and self-reported recreational drug use data from a cohort of 121 men and 63 women with HIV. Primary outcomes were the presence (yes/no) of: 1) airflow obstruction, (pre- or post-bronchodilator forced expiratory volume in 1 second/forced vital capacity<0.70); 2) moderate diffusion impairment (diffusing capacity for carbon monoxide <60% predicted); and 3) radiographic emphysema (>1% of lung voxels <-950 Hounsfield units). Exposures of interest were frequency of recreational drug use, recent (since last study visit) drug use, and any lifetime drug use. We used logistic regression to determine associations between recreational drug use and the primary outcomes. HIV-infected men and women reported recent recreational drug use at 56.0% and 31.0% of their study visits, respectively, and 48.8% of men and 39.7% of women reported drug use since their last study visit. Drug use was not associated with airway obstruction or radiographic emphysema in men or women. Recent crack cocaine use was independently associated with moderate diffusion impairment in women (odds ratio 17.6; 95% confidence interval 1.3-249.6, p=0.03). In this cross-sectional analysis, we found that recreational drug use was common among HIV-infected men and women and recent crack cocaine use was associated with moderate diffusion impairment in women. Given the increasing prevalence of HIV infection, any relationship between drug use and prevalence or severity of chronic pulmonary diseases could have a significant impact on HIV and chronic disease management.

On Liberation

A will to escape organizes the practice of Latin American Christian liberation while at the same time enacting a new genre of captivity. After a shift in US interdiction efforts, the vast majority of cocaine produced in the Andes for the United States now passes through Guatemala. With this drastic increase has come a spike in the use of crack cocaine, as well as the proliferation of drug rehabilitation centers. Run by Pentecostal Christians, these centers warehouse users (against their will) in the name of liberation. Locked up, tied up, and told to shape up, these users confess, at times plead, that they want out and they want it now. Pastors, in response, assure them that captivity is itself liberation—that slavery is salvation. This will to escape provokes a pair of guiding questions. They are, at their most philosophical: How do openings become enclosures? How do lines of flight become absolute dead ends?

The Perspective of Crack Users Regarding Their Social Reintegration after the End of Treatment in Therapeutic Communities

The use of crack cocaine has been gaining prominence in the media, because even though it’s a phenomenon that emerged little more than twenty years ago, it’s already an epidemic in Brazil. The large number of crack users represents a public health problem, affecting family, professional and social relations. This study investigated the perspectives of crack users regarding their social reintegration. The sample was composed of ten addicted men between the ages of 19 and 37, admitted to therapeutic communities for a social reintegration process. Semi-structured interviews were recorded, transcribed and analyzed through Content Analysis. The main results show that studying, working with addiction and meeting the expectations of family appear to be the main objectives of this period of rehabilitation. Other concerns that were quite emphasized referred to redeeming and gaining acceptance of the family, making new friends and keeping away from old ones (partners in use). As for their professional life, most respondents cited working with recovery as a possibility. Among the reintegration strategies, community work, the quest for God and church attendance, and attending healthy environments were mentioned. Calling and/or talking with friends was cited in relation to actions to be taken in case of a break down. These results indicate that there are several aspects that surround the social reintegration of crack addicts. They also indicate different paths that can help develop new interventions to assist dependents in the recovery phase.

Alcohol and Crack Cocaine Use in Women: A 14-Year Cross-Sectional Study

This article aims to describe the record type for first-time hospital admissions of 761 women at a single institution between 1997 and 2010 according to International Classification of Diseases, 10th revision, criteria, for mental and behavioral disorders due to psychoactive substance use (F10-F19). This cross-sectional study included a convenience sample of 4,736 patients in the Brazilian public health system, among whom 761 were women. Overall, the rate of alcohol-related hospitalizations decreased from 93.6% in 1997 to 50.9% in 2010. In contrast, the rate of crack cocaine-related hospitalizations increased in women from 2.8% in 1997 to 67.8% in 2010. The linear regression was R2 = 0.8472. These data indicate a new trend in the pattern of psychoactive substance use in women.

Rare Case of Acute Aortic Dissection in a Young Non-Hypertensive and Non-Pregnant Lady

Acute aortic dissection is a catastrophic episode that usually presents as a sudden, painful, ripping sensation in the chest or back. It has an estimated annual incidence of approximately 5 to 30 per million.The primary event in aortic dissection is a tear in the aortic intima. The most important predisposing factor for acute aortic dissection is systemic hypertension. Other predisposing factors include disorders of collagen (Marfan syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, aortic coarctation, Turner syndrome, coronary artery bypass graft surgery, previous aortic valve replacement, crack cocaine use, strenuous resistance training and trauma. Approximately half of the aortic dissection observed in women under 45 years old has been reported to be related to pregnancy. Herein, we present a case of type A aortic dissection diagnosed in a 37 year old non hypertensive, nonpregnant female. Aortic dissection is not uncommon or impossible in a young healthy and previously asymptomatic female. A high level of suspicion is required for prompt diagnosis and treatment.

Neighbourhood structural characteristics and crack cocaine use: Exploring the impact of perceived neighbourhood disorder on use among African Americans

BackgroundCrack cocaine use and associated negative social and health consequences remain a significant public health problem. Research that expands beyond the individual by considering the environmental context as a determinant of cocaine use is growing. The main objectives of this paper are to examine the effects of perceived neighbourhood disorder as an independent correlate of the frequency of recent crack cocaine use and whether its impact is mediated by use-related practices and social context of use among an African American adult sample in Atlanta (GA). MethodsCross-sectional data were collected from 461 respondents who were recruited through active and passive community outreach from 70 disadvantaged urban neighbourhoods across Atlanta. Multivariable negative binomial regression was performed to assess the independent association of perceived neighbourhood disorder with crack cocaine use frequency and to explore potential mediation by use-related practices and social context of use. ResultsPerceived neighbourhood disorder did not remain statistically significant after accounting for use-related practices and social context of use. Involvement in drug distribution and having traded sex were associated with increases in frequency of drug use, while using in safer places and using alone were associated with decreases in frequency of use. ConclusionThe results show that perceived neighbourhood disorder is associated with frequency of crack cocaine use independently of socio-demographics. However, its significance was eliminated when controlling for use-related practices and the social context of use. Such practices and the social context of use may mediate the relationship between neighbourhood disorder and crack cocaine use. Future research is needed to more fully elucidate the links between individual and neighbourhood characteristics that are related to crack cocaine use and strategies to reduce use must consider the salience of use-related practices and the social context of use.

Disorders of taste function in crack cocaine addicts

Cocaine can be smoked in the form of rocks (crack cocaine or crack) by means of pipes. The use of crack cocaine is a health problem in several countries. The aim of this study was to evaluate taste perception in chronic crack cocaine users compared with a drug-free control group. Sixty males (21–45 years-old) were divided into two groups (30 crack cocaine users and 30 nonusers) and taste function was assessed using the taste strips technique with the four basic tastes. The mean age of the experimental and control group was of 31 years (21–45). In the case group, the average consumption of crack cocaine was 4 g/day. These individuals were using this illicit drug for more than seven years. Seven (23.3%) patients concomitantly used crack cocaine and cocaine (3.8 g per day). Crack cocaine users had difficulty recognizing salty flavor, subsequently sweet and bitter. In general, crack cocaine users confused the salty taste as sour or bitter. All patients in case group (100%) and 23 (76.6%) control subjects were unable to identify the sweet solution less concentrated. Twenty (66.6%) crack cocaine users and 7 (23.3%) had hypogeusia. According to these results, it can be concluded that the chronic use of crack was able to change the taste perception leading to a high prevalence of hypogeusia in these individuals.

Adolescentes e crack: pelo caminho das pedras

Nos últimos anos, a sociedade tem observado uma rápida expansão no uso de crack, especialmente por adolescentes e jovens. É evidente a necessidade de ouvir esses sujeitos de para melhor compreender sua situação. Para atender a essa necessidade, desenvolvemos uma pesquisa qualitativa descritivo-exploratória cujo foco foi um grupo terapêutico para adolescentes usuários de crack que ocorreu no Centro de Atenção Psicossocial Infanto-Juvenil (CAPSi) em uma cidade do interior do Rio Grande do Sul, Brasil. Amparados na modalidade expost-facto, analisamos documentos produzidos nessa instituição. O resultado foi uma cartografia que acompanhou discursivamente os adolescentes pelo "caminho das pedras": os lugares, tratamentos, pessoas, ideias e momentos dos quais falam.

HIV Prevalence, Substance Use, and Sexual Risk Behaviors Among Transgender Women Recruited Through Outreach

Transgender women ("transwomen") face a disproportionate HIV disease burden; the odds of being HIV-positive are estimated to be 34.2 times higher for transwomen than the United States adult population. From January 1, 2005 through December 31, 2011, HIV prevention outreach encounters were conducted with 2,136 unique transwomen on the streets and at high-risk venues in Los Angeles County. The outreach encounters were comprised of a low-intensity health education and risk reduction intervention, which included referrals to needed services. The goal of the encounters was to assess the participant's level of substance use and sexual risk behaviors to provide appropriate risk reduction strategies and supplies. The sample evidenced high rates of recent alcohol (57.7 %), marijuana (25.6 %), and methamphetamine (21.5 %) use, lifetime injection drug or illegal hormone use (66.3 %), and recent engagement in sex work (73.3 %). Multivariate logistic regression analysis revealed that recent methamphetamine (AOR = 2.09; p ≤ 0.001) and/or crack cocaine (AOR = 2.19; p = 0.010) use, injection drug/hormone use (AOR = 1.65; p ≤ 0.001), unprotected anal intercourse during sex work (AOR = 2.24; p = 0.029), and any non-Hispanic minority racial status were all associated with increased odds of reporting a HIV-positive status. The transwomen encountered via outreach exhibited many risk co-factors for HIV infection and transmission.

Butyrylcholinesterase Genetic Variants: Association with Cocaine Dependence and Related Phenotypes

ObjectiveThe search for genetic vulnerability factors in cocaine dependence has focused on the role that neuroplasticity plays in addiction. However, like many other drugs, the ability of an individual to metabolize cocaine can also influence susceptibility to dependence. Butyrylcholinesterase (BChE) metabolizes cocaine, and genetic variants of the BChE gene (BCHE) alter its catalytic activity. Therefore, we hypothesize that cocaine users with polymorphisms in BCHE can show diverse addictive behaviors due to differences in effective plasma concentrations of cocaine. Those polymorphisms might also influence users to prefer one of the two main preparations (crack or powder cocaine), despite having equal access to both. The present work investigates polymorphisms in BCHE and if those genetic variants constitute risk factors for cocaine dependence and for crack cocaine use.MethodsA total of 1,436 individuals (698 cocaine-dependent patients and 738 controls) were genotyped for three single nucleotide polymorphisms (SNPs) in BCHE: rs1803274, rs4263329, and rs4680662.ResultsFor rs4263329, a nominal difference was found between cases and controls. For rs1803274 (the functional SNP), a statistically significant difference was found between patients who used crack cocaine exclusively and those who used only powder cocaine (P = 0.027; OR = 4.36; 95% CI = 1.18–16.04). Allele frequencies and genotypes related to other markers did not differ between cases and controls or between the two cocaine subgroups.ConclusionsOur findings suggest that the AA genotype of rs1803274 is a risk factor for crack cocaine use, which is more addictive than powder cocaine use. Further studies are needed in order to confirm this preliminary result and clarify the role of BCHE and its variants in cocaine dependence.

Continued low uptake of treatment for hepatitis C virus infection in a large community‐based cohort of inner city residents

Despite advances in HCV treatment, recent data on treatment uptake is sparse. HCV treatment uptake and associated factors were evaluated in a community-based cohort in Vancouver, Canada. The CHASE study is a cohort of inner city residents recruited from January 2003-June 2004. HCV status and treatment were retrospectively and prospectively determined through data linkages with provincial virology and pharmacy databases. Logistic regression analyses were used to identify factors associated with HCV treatment uptake. Among 2913, HCV antibody testing was performed in 2405, 64% were HCV antibody-positive (n = 1533). Individuals with spontaneous clearance (18%, n = 276) were excluded. Among the remaining 1257 HCV antibody-positive participants (mean age 42, 71% male), 29% were Aboriginal. At enrolment, the majority reported recent injecting (60%) and non-injecting drug use (87%). Between January 1998 and March 2010, 6% (77 of 1257) initiated HCV treatment. In adjusted analyses, Aboriginal ethnicity [adjusted odds ratio (AOR) 0.23; 95% CI 0.10, 0.51] and crack cocaine use (AOR 0.61; 95% CI 0.37, 0.99) were associated with a decreased odds of receiving HCV treatment, while methamphetamine injecting (AOR 0.16; 95% CI 0.02, 1.18) trended towards a lower odds of receiving treatment. HCV treatment uptake ranged from 0.2 (95% CI 0.0, 0.7) per 100 person-years (PYs) in 2003 to 1.6 (95% CI 0.9, 2.6) per 100 PYs in 2009. HCV treatment uptake remains low in this large community-based cohort of inner city residents with a high HCV prevalence and access to universal healthcare.

Crystal methamphetamine initiation among street-involved youth

Background: Although many settings have recently documented a substantial increase in the use of methamphetamine-type stimulants, recent reviews have underscored the dearth of prospective studies that have examined risk factors associated with the initiation of crystal methamphetamine use. Objectives: Our objectives were to examine rates and risk factors for the initiation of crystal methamphetamine use in a cohort of street-involved youth. Methods: Street-involved youth in Vancouver, Canada, were enrolled in a prospective cohort known as the At-Risk Youth Study (ARYS). A total of 205 crystal methamphetamine-naïve participants were assessed semi-annually and Cox regression analyses were used to identify factors independently associated with the initiation of crystal methamphetamine use. Results: Among 205 youth prospectively followed from 2005 to 2012, the incidence density of crystal methamphetamine initiation was 12.2 per 100 person years. In Cox regression analyses, initiation of crystal methamphetamine use was independently associated with previous crack cocaine use (adjusted relative hazard [ARH] = 2.24 [95% CI: 1.20–4.20]) and recent drug dealing (ARH = 1.98 [95% CI: 1.05–3.71]). Those initiating methamphetamine were also more likely to report a recent nonfatal overdose (ARH = 3.63 [95% CI: 1.65–7.98]) and to be male (ARH = 2.12 [95% CI: 1.06–4.25]). Conclusions: We identified high rates of crystal methamphetamine initiation among this population. Males those involved in the drug trade, and those who used crack cocaine were more likely to initiate crystal methamphetamine use. Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.

Drug use and HIV treatment outcomes among HIV-infected men who have sex with men accessing Ryan White services in New York: a cross-sectional study

BackgroundDrug use poses multiple challenges to maintenance of the physical health of HIV-infected individuals. Few studies have explored the association between drug use and HIV treatment outcomes among HIV-infected men who have sex with men (MSM). We aimed to examine the relation between drug use (defined here as use of crystal methamphetamine, crack cocaine or cocaine, heroin, or off-label prescription medications) and HIV treatment outcomes (unsuppressed viral load and a low CD4 count) among HIV-infected MSM. MethodsAnalyses were done on all HIV-infected MSM who received Ryan White part A funded services at provider agencies in the greater New York metropolitan area, and had: an enrolment in a Ryan White part A programme between November, 2010, and June, 2012; at least one substance use assessment; and a valid viral load measurement with or without CD4 count in the 6 months before the substance use assessment. The primary outcomes for this study were unsuppressed viral load (>200 copies per mL) and a low CD4 count (<350 cells per μL). Independent associations between substance use and HIV treatment outcomes were examined by multivariate logistic regression. The multivariate model adjusted for all other covariates associated with poor HIV outcomes with p values less than 0·05 in unadjusted analyses. Results are presented as adjusted odds ratios (aORs) with 95% CIs. This project was classified as a programme evaluation (not research) by legal counsel at the New York City Department of Health and Mental Hygiene. FindingsAmong 3287 HIV-infected MSM, 366 (11%) reported drug use. Most of the study population was aged 30–49 years (1798 [55%]; range 13–82 years), non-Hispanic black (1424 [43%]), and on antiretroviral therapy (2530 [79%]). In bivariate analyses, drug users were more likely than non-users to have unsuppressed viral load (234 of 340 [some missing values; 69%] vs 1044 of 2717 [38%]) and a low CD4 count (154 of 336 [46%] vs 924 of 2691 [34%]). In multivariate analyses controlling for sociodemographic and clinical characteristics, drug users were more likely to have unsuppressed viral load (aOR 2·74, 95% CI 2·09–3·59) and a low CD4 count (1·41, 1·10–1·80) than were non-users. InterpretationOur results show a significant relation between drug use and both low CD4 count and unsuppressed viral load. Future studies should examine biological and psychosocial predictors of drug use, to inform intervention development for MSM who are drug users in HIV care settings. Although the substance use data for this study were based on self-report, which could be limited by recall and social desirability bias, this study was strengthened by use of the New York City HIV Surveillance Registry, which is a comprehensive source of longitudinal HIV-related laboratory data for individuals diagnosed with HIV or receiving HIV care in New York City. FundingThis work was supported through a grant from the Health Resources and Services Administration(H89HA00015) to the New York City Department of Health and Mental Hygiene.

Ritual de consumo do crack: aspectos socioantropológicos e repercussões para a saúde dos usuários

The use of crack cocaine has given rise to an intense discussion in society. Research has contributed to the characterization of users and the negative consequences of its use. However, few studies have conducted in-depth study of the social and cultural contexts in which crack cocaine is used. Thus, this study seeks to discuss the ritual of crack cocaine use and its social and health consequences for the user. It is a qualitative study developed in the Psychosocial Care Centers for Alcohol and Drugs (Portuguese acronym: Caps-ad). The individuals were selected in two groups of key-informants: crack cocaine users undergoing treatment and health professionals. Data was obtained by means of semi-structured interviews. The results revealed that the use of crack cocaine is not dissociated with the current organizational structure of society. There is a link between the use of this substance and the social organization for its use. By using crack cocaine, the individuals try to be part of a consumer market, actively participating in what society perceives as new. The forms and locations of use are directly related to users' health, making it necessary for healthcare services to detect, approach and make health interventions in these locations of use.

Differences in Risk Behaviors, Care Utilization, and Comorbidities in Homeless Persons Based on HIV Status

This cross-sectional pilot project measured differences by HIV status in chronic health conditions, primary care and emergency department use, and high-risk behaviors of homeless persons through self-report. Using selective random sampling, 244 individuals were recruited from a homeless shelter. The reported HIV prevalence was 6.56% (n = 16), with the odds of HIV higher in persons reporting crack cocaine use. HIV-infected persons were more likely to report a source of regular medical care and less likely to use the emergency department than uninfected persons. Validation of findings through exploration of HIV and health care access in homeless persons is needed to confirm that HIV-infected homeless persons are more likely to have primary care. Distinctions between primary care and specialty HIV care also need to be explored in this context. If findings are consistent, providers who care for the homeless could learn more effective ways to engage homeless patients.