Having Multiple Sexual Partners among Iranian Intra-Venous Drug Users

Background: Transmission of HIV from intra-venous drug users (IDUs) to the community occurs predominantly through high-risk sexual behaviors. Limited information exists regarding the high-risk sexual behaviors of IDUs in Iran. Aim. The aim of this study was to determine the prevalence and factors associated with having multiple sexual partners among Iranian IDUs. Methods. This is a national survey on drug-dependent adults. Participants were sampled from medical centers, prisons, and streets of capitals of 29 provinces in Iran, between May 2007 and February 2008. We analyzed data of 1,416 current IDUs. Socio-demographics and drug use characteristics were entered into a binary logistic regression model to determine predictors of having multiple sexual partners. Results. Having multiple sexual partners in the past or at the time of survey was reported by 56.4% of Iranian IDUs. Multivariate analysis showed that the likelihood of having multiple sexual partners in IDUs decreased by being married (odds ratio [OR], 0.38; P < .001) and increased by female gender (OR, 13.44; P = .02), having illegal income (OR, 1.72; P = .003), higher monthly family income (OR, 1.01; P = .003), pleasure, curiosity, and recreation as cause of first drug use (OR, 1.37; P = .04), ruins as usual place for injection (OR, 1.89; P = .001), and history of syringe sharing (OR, 1.50; P = .02). Conclusions. Having multiple sexual partners was reported by majority of Iranian IDUs, and this was linked to socio-demographics, initiation data, and other risk behaviors. This information should be considered in prevention efforts to reduce sexual transmission of HIV infection in Iran

Drug Use among Street Children in Tehran, Iran: A Qualitative Study

Introduction and objective: Globally, children who work and live on the streets are at higher risk of undesired behavioral health outcomes, including increased drug use and abuse. Considering the rapid growth of this population in Iran and the lack of program planning that is partly due to a scarcity of research-based information, this study was conducted in 2013 to investigate drug use among street children in Tehran. Method: With a qualitative design, we conducted a Rapid Assessment and Response (RAS) Survey of street children in Tehran, 2012-2013. Data were also obtained from ten focus group discussions with street children using semi-structured questionnaires and 27 in-depth interviews with key informants in governmental, non-governmental, and international organizations. Results: The variation in age at first use, type of drugs, and pattern of drug use were found based on ethnicity. Gypsy boys and girls reported consuming more alcohol than other groups. Drug use problems were commonly described among families of street children. Children whose parents had drug-use problems described using drugs earlier than other children. Informants reported that families with drug-related problems used children for procurement of drugs. Children themselves described using drugs to cope with stress, reduce physical and psychological stressors and problems such as fatigue, sadness, and pressure resulting from frequent failures in life. Conclusion: These results suggest that intervention and prevention programs dealing with drug use of street children in Iran should include family and peers when addressing drug use by street children

Stressful Life Events and Risk of Depression 25 Years Later; Race and Gender Differences

BACKGROUND: Although stressful life events (SLE) predict subsequent risk of developing a major depressive episode (MDE), limited information exists on whether or not race and gender alters the predictive role of SLE on risk of MDE over a long-term period. The current study explored race and gender differences in the long-term predictive role of SLE at baseline (1986) on subsequent risk of MDE 25 years later (2011) in a nationally representative cohort in the United States.METHODS: Using a life course epidemiological approach, this longitudinal study borrowed data from the Americans’ Changing Lives Study (ACL) 1986- 2011. Main predictor of interest was baseline SLE over the last three years measured at 1986. Main outcome was risk of MDE [Composite International Diagnostic Interview (CIDI)] 25 years later (2011). Covariates included demographics, socioeconomics, depressive symptoms (Center for Epidemiological Studies-Depression Scale [CES-D]), chronic medical conditions, and health behaviors measured at baseline (1986). Gender and race were the focal moderators. We employed logistic regressions in the pooled sample, and specific to race and gender, to test whether or not SLE × race and SLE × gender interactions are significant. RESULTS: In the pooled sample, baseline SLE (1986) predicted risk of MDE 25 years later (2011). We also found a gender by SLE interaction, suggesting a stronger predictive role of SLE for subsequent clinical depression for men compared to women. Race did not modify the predictive role of SLE on subsequent risk of MDE 25 year later. CONCLUSIONS: How SLE predicts MDE 25 years later differs for men and women, with a stronger predictive role for men, compared to women. More research is needed to better understand the complex links between gender, sex, stress, and depression

Socioeconomic Status - Mortality Link; Do Race and Place Matter?

Abstract:Background: Despite the well-established literature on the protective effects of socioeconomic status (SES) against mortality, these effects may vary based on contextual factors such as race and place. Using 25-year follow up data of a nationally representative sample of adults in the U.S., this study had two aims: 1) to explore separate, additive, and multiplicative effects of race and place (urbanity) on mortality, and 2) to test the effects of education and income against all-cause mortality based on race and place.Methods: The Americans’ Changing Lives (ACL) Study followed Whites and Blacks 25 years and older adults from 1986 until 2011. The focal predictors were baseline SES (education and income) collected in 1986. The main outcome was time to death due to all causes from 1986 until 2011. Age, gender, and behaviors (smoking and exercise) and health (chronic medical conditions, self-rated health and depressive symptoms) were potential confounders. A series of survey Cox proportional hazard models were used to test protective effects of education and income on mortality based on race and urbanity. Results: While race and place had separate effects on mortality, the additive and multiplicative effects of race and place were not significant. Higher education and income were protective against all-cause mortality in the pooled sample. While the protective effects of education was explained by baseline health, the effect of income remained significant beyond health. Race and urbanity significantly interacted with baseline education but not income on all-cause mortality, suggesting that protective effects of education but not income depend on race and place. Conclusion: The survival gain associated with education in the United States depends on race and place. These findings suggest that populations differently benefit from SES resources, particularly education. Differential effect of education on employment and health care may explain differential protective effect of education based on race and place. Findings support the diminishing returns hypothesis for Blacks

Black- White Differences in Predictive Validity of Depressive Symptoms for Subsequent Major Depression

BackgroundBlack- White differences are shown in psychosocial and medical correlates of depressive symptoms and major depressive disorder (MDD). The current longitudinal study compared Blacks and Whites for the association between baseline depressive symptoms and subsequent risk of MDD 15 years later. MethodsData came from the Americans’ Changing Lives (ACL) Study that followed 3,361 individuals (2,205 Whites and 1,156 Blacks) from 1986 to 2001. Predictor was baseline depressive symptoms measured using an 11-item Center for Epidemiological Studies-Depression (CES-D) in 1986. Outcome was 12 month MDD measured using the Composite International Diagnostic Interview (CIDI) at 2001. Covariates included baseline socio-demographics, financial difficulty, chronic medical conditions, and self-rated health (SRH) measured at 1986. We used logistic regression to evaluate the association between baseline CES-D score and CIDI-based MDD 15 years later net of demographics, SES, CMCs and SRH. The models were applied in the pooled sample, as well as Blacks and Whites. We also reported data on reliability and factor structure of CES-D based on ethnicity. ResultsAccording to the logistic regression models, baseline CES-D scores were predictive of subsequent CIDI- based 12 month MDD 15 years later among Whites but not Blacks. Ethnic differences in predictive validity of CES-D scores on MDD could not be attributed to the ethnic differences in reliability of the CES-D which was even higher for Blacks than Whites. ConclusionBlack–White differences exist in the association between baseline depressive symptoms and subsequent risk of MDD over 15 years. Ethnic differences in the longitudinal link between baseline CES-D and subsequent risk of MDD among Blacks may explain some of the Black - White differences in social, psychological, and medical correlates of depressive symptoms and depression. Future research is still needed to compare Blacks and Whites for confirmatory factor analysis of the CES-D

Whites’ Depression More Hopeless than Blacks’ Depression; a National Study of Older Adults

AbstractBACKGROUND: Hopelessness is a core component of depression. Our information is, however, very limited on ethnic variations in the magnitude of the link between depression and hopelessness. Using a national sample of older adults in United States, we compared Blacks and Whites for the magnitude of the association between depressive symptoms and hopelessness. METHODS: With a cross-sectional design, we used baseline data of the Religion, Aging, and Health Survey, 2001. Linear regression models were used for data analysis. Depressive symptoms (CES-D) and hopelessness were conceptualized as independent and dependent variables in different models. Demographic factors (age and gender), socio-economic status (education and marital status), and health (self-rated health) were covariates. Ethnicity was the moderator.RESULTS: In the pooled sample, higher depressive symptoms were predictive of hopelessness, above and beyond all covariates. We also found significant interactions suggesting that the association between depressive symptoms and hopelessness is weaker among Blacks compared to Whites. In ethnic- specific models, there were significant associations between depressive symptoms and hopelessness among Whites but not Blacks. CONCLUSIONS: Depressive symptoms accompany more hopelessness among Whites than Blacks. This finding may explain why Blacks with depression have a lower tendency to commit suicide. Future research should test whether or not Whites with depression better respond to psychotherapies and cognitive behavioral therapies that focus on hope enhancement. This finding may explain differential correlates of depression based on race and ethnicity

Education and Alcohol Consumption among Older Americans; Black-White Differences

Abstract:Purpose: Although the link between education and alcohol consumption is known, limited information exists on racial differences in this link. We conducted the current study to test Black- White differences in the association between education and alcohol consumption among older adults in the United States. Methods: This cross-sectional survey enrolled 1,493 Black (n=734) and White (n=759) older adults (age 66 or more) in United States. Data came from the Religion, Aging, and Health Survey, 2001. Race, demographics, socio-economics, and alcohol consumption were measured. Independent variable was education level. Outcome was alcohol consumption. Race was the focal moderator. Logistic regression was used for data analysis. Results: Education was positively associated with ever drinking in the pooled sample. Race, however, interacted with education level on drinking, suggesting a smaller effect of education on drinking for Blacks compared to Whites. Among Whites, high school graduation and college graduation were associated with increased odds of ever drinking, net of covariates. Among Blacks, high school graduation but not college graduation was associated with ever drinking. Conclusion: Blacks and Whites differ in how socio-economic status (i.e. education) shapes behaviors health behaviors (i.e. drinking). How race modifies consequences and correlates of social determinants of health is not yet clear. College graduation may result in the same level of change to the social network and income of race group members. Lower effect of education on health of Blacks may be due to the structural role of race and racism that has resulted in lower job availability and pay for Blacks

Socio-economic status and receptive needle and syringe sharing behaviors among Iranian Drug Injectors; a national study

Background: Although needle and syringe sharing is one of the main routs of transmission of HIV in several countries in the middle east, very little is known about how socioeconomic status of injecting drug users (IDUs) is linked to the receptive syringe sharing behaviors in these countries. Aim: To study socioeconomic correlates of receptive needle and syringe sharing among IDUs in Iran.Methods: The study used data from the Unhide Risk Study, a national survey of IDUs. This study sampled 636 IDUs (91% male) via snowball sampling from eight provinces in Iran in 2009. Socio-demographic and drug use characteristics were collected. We used a logistic regression to determine factors associated with receptive needle and syringe sharing during the past six months.Results: From 636 IDUs enrolled in this study, 68% (n=434) reported receptive needle and syringe sharing behaviors in the past six months. Odds of receptive needle and syringe sharing in the past six months was lower among IDUs who were male (OR=0.29, 95% CI= 0.12 to 0.70), had higher education (OR=0.74, 95% CI=0.64 to 0.86) but higher among those who were unemployed (OR=4.05, 95% CI=1.50 to 10.94), and were single (OR=1.47, 95% CI=1.02 to 2.11).Conclusion: This study presented factors associated with risk of receptive needle and syringe sharing among Iranian IDUs. This information may be used for HIV prevention and harm reduction purposes. Socioeconomic status of Iranian IDUs may be closely linked to high risk injecting behaviors among them

Race, depressive symptoms, and all-cause mortality in the United States

Purpose: Despite the well-established association between baseline depressive symptoms and risk of all cause-mortality, limited information exists on racial differences in the residual effects of baseline depressive symptoms above and beyond socio-economic status (SES) and physical health on this link. The current study compared Blacks and Whites for the residual effects of depressive symptoms over SES and health on risk of long-term all-cause mortality in the United States. Methods: Data came from the Americans’ Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults with up to 25 years of follow up. The study followed 3,361 Blacks or Whites for all-cause mortality between 1986 and 2011. The main predictor of interest was baseline depressive symptoms measured at 1986 using an 11- item Center for Epidemiological Studies-Depression scale (CES-D). Covariates included baseline demographics (age and gender), SES (education and income), and health [chronic medical conditions (CMC), self-rated health, and body mass index (BMI)] measured at 1986. Race (Black versus White) was the focal moderator. We ran a series of Cox proportional hazard models, in the pooled sample and also stratified by race. Results: In the pooled sample, higher depressive symptoms at baseline were associated with higher risk of all-cause mortality except when the CMC, SRH, and BMI were added to the model. In this later model, race interacted with baseline depressive symptoms, suggesting a larger effect of depressive symptoms on mortality among Whites compared to Blacks. Among Whites, depressive symptoms were associated with increased risk of mortality, after controlling for SES, but not after controlling for health (CMC, SRH and BMI) as well. Among Blacks, depressive symptoms were not associated with mortality before that health was introduced to the model. After controlling for health, baseline depressive symptoms showed an inverse association with all-cause mortality among Blacks. While the effect of baseline depressive symptoms on mortality disappeared after controlling for health among Whites, SRH did not interfere (confound) with the effect of depressive symptoms on mortality among Blacks.Conclusion: The effect of depressive symptoms on increased risk of all –cause mortality which existed among Whites could not be found for Blacks