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Tuberculosis Knowledge, Perceived Risk and Risk Behaviors Among Homeless Adults: Effect of Ethnicity and Injection Drug Use

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Abstract

The objectives of this study were to investigate Tuberculosis (TB) knowledge, perceived risk, and risk behaviors in a sample of homeless persons with latent TB in the Skid Row district of Los Angeles. Particular emphasis was given to comparing these variables among homeless persons of varying ethnic backgrounds and among those who did and did not report a history of injection drug use (IDU). Baseline data were collected from 415 homeless individuals recruited to participate in a Tuberculosis chemoprophylaxis intervention. Areas of interest relative to TB knowledge and perceived risk for infection were behavioral factors surrounding substance use and abuse; personal factors measured in terms of current depression; and sociodemographic and situational factors, such as age, ethnicity, history of incarceration, and duration of homelessness. Findings revealed differences in substance abuse. IDUs were more likely to have histories of daily drug use and alcohol dependency, but were less apt to report recent use of crack cocaine. TB knowledge deficits centered on ignorance with respect to modes of transmission and risk factors for TB infection. IDU was also associated with depression. Latinos and IDUs were most likely to lack TB knowledge. There is a pressing need for accessible, available, culturally acceptable and sustained TB screening and intervention programs designed to address multiple risk factors and knowledge deficits with respect to TB infection in homeless populations.

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REFERENCES

  1. CA DHS (2001). California Department of Health Services: Report on Tuberculosis in California, 2000. Available: http://www.applications.dhs.ca.gov/pressreleases/store/pressreleases/02–09.html.

  2. D'Amore J, Hung O, Chiang W, Goldfrank L. The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med 2001; 8:1051–5.

    Google Scholar 

  3. Gelberg L, Panarites C, Morgenstern H, Leake B, Andersen R, Koegel P. Tuberculosis skin testing among homeless adults. J Gen Intern Med 1997; 12:25–33.

    Google Scholar 

  4. Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet 2001; 1:77–84.

    Google Scholar 

  5. Bock NN, McGowan JE Jr, Blumberg HM. Few opportunities found for tuberculosis prevention among the urban poor. Int J Tuberc Lung Dis 1998; 2:124–9.

    Google Scholar 

  6. Hernández-Garduno E, Kunimoto D, Wang L, Rodrı´gues M, Elwood RK, Black W, Mak S, FitzGerald JM. Predictors of clustering of tuberculosis in Greater Vancouver: a molecular epidemiologic study. CMAJ 2002; 167:349–52.

    Google Scholar 

  7. Zolopa AR, Hahn JA, Gorter R, Miranda J, Wlodarczyk D, Peterson J, Pilote L, Moss AR. HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. JAMA 1994; 272:455–61.

    Google Scholar 

  8. Howard AA, Klein RS, Schoenbaum EE, Gourevitch MN. Crack cocaine use and other risk factors for tuberculin positivity in drug users. Clin Infect Dis 2002; 35:1183–90.

    Google Scholar 

  9. Nyamathi A, Bayley L, Anderson N, Keenan C, Leake B. Perceived factors influencing the initiation of drug and alcohol use among homeless women and reported consequences of use. Women Health 1999; 29:99–114.

    Google Scholar 

  10. Nyamathi A, Leake B, Gelberg L. Sheltered versus nonsheltered homeless women differences in health, behavior, victimization, and utilization of care. J Gen Intern Med 2000; 15:565–72.

    Google Scholar 

  11. Robertson MJ, Zlotnick C, Westerfelt A. Drug use disorders and treatment contact among homeless adults in Alameda County, California. Am J Public Health 1997; 87:221–8.

    Google Scholar 

  12. Wenzel S. Unpublished data. Drug abuse, violence, and HIV/AIDS in Impoverished women project, RAND Corporation, 2002.

  13. Tessler R. Comparison of homeless veterans with other homeless men in a large clinical outreach program. Psychiatr Q 2002; 73:109–19.

    Google Scholar 

  14. Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med 2003; 18:248–57.

    Google Scholar 

  15. Brudney K, Dobkin J. Resurgent tuberculosis in New York City: human immunodeficiency virus, homelessness, and the decline of tuberculosis control programs. Am Rev Respir Dis 1991; 144:745–9.

    Google Scholar 

  16. Pablos-Méndez A, Knirsch CA, Barr RG, Lerner BH, Frieden TR. Nonadherence in tuberculosis treatment: predictors and consequences in New York City. Am J Med 1997; 102:164–70.

    Google Scholar 

  17. Marinac JS, Willsie SK, McBride D, Hamburger SC. Knowledge of tuberculosis in high-risk populations: survey of inner city minorities. Int J Tuberc Lung Dis 1998; 2:804–10.

    Google Scholar 

  18. Ailinger R, Dear M. Adherence to tuberculosis preventive therapy among Latino immigrants. Public Health Nurs 1998; 15:19–24.

    Google Scholar 

  19. Carey JW, Oxtoby M, Nguyen L, Huynh V, Morgan M, Jeffrey M. Tuberculosis beliefs among recent Vietnamese refugees in New York State. Public Health Rep 1997; 112:66–72.

    Google Scholar 

  20. Grossman DC, Krieger JW, Sugarman JR, Forquera RA. Health status of urban American Indians and Alaska Natives. A population-based study. JAMA 1994; 271:845–50.

    Google Scholar 

  21. Hu DJ, Fleming PL, Castro KG, Jones JL, Bush TJ, Hanson D, Chu SY, Kaplan J, Ward JW. How important is race/ethnicity as an indicator of risk for specific AIDS-defining conditions? J Acquir Immune Defic Syndr Hum Retrovirol 1995; 10:374–80.

    Google Scholar 

  22. Pablos-Méndez A, Blustein J, Knirsch CA. The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics. Am J Public Health 1997; 87:574–9.

    Google Scholar 

  23. Borgdorff MW, Behr MA, Nagelkerke NJ, Hopewell PC, Small PM. Transmission of tuberculosis in San Francisco and its association with immigration and ethnicity. Int J Tuberc Lung Dis 2000; 4:287–94.

    Google Scholar 

  24. Moss AR, Hahn JA, Tulsky JP, Daley CL, Small PM, Hopewell PC. Tuberculosis in the homeless. A prospective study. Am J Respir Crit Care Med 2000; 162(2 Pt 1):460–4.

    Google Scholar 

  25. Frieden TR, Woodley CL, Crawford JT, Lew D, Dooley SM. The molecular epidemiology of tuberculosis in New York City: the importance of nosocomial transmission and laboratory error. Tuber Lung Dis 1996; 77:407–413.

    Google Scholar 

  26. Kelly P. Isolation and stigma: the experience of patients with active tuberculosis. J Community Health Nurs 1999; 16:233–41.

    Google Scholar 

  27. Poss J. The meanings of tuberculosis for Mexican migrant farm workers in the United States. Soc Sci Med 1998; 47:105–202.

    Google Scholar 

  28. Rubel A, Garro L. Social and cultural factors in the successful control of tuberculosis. Public Health Rep 1992; 107:626–36.

    Google Scholar 

  29. Yamada S, Caballero J, Matsunaga D, Agustin G, Magana M. Attitudes regarding tuberculosis in immigrants from the Philippines to the United States. Fam Med 1999; 31:477–82.

    Google Scholar 

  30. Morisky DE, Malotte CK, Choi P, Davidson P, Rigler S, Sugland B, Langer M. A patient education program to improve adherence rate with anti-tuberculosis drug regimens. Health Educ Q 1990, 17:253–68.

    Google Scholar 

  31. Simpson D, Chatham L. TCU/DATAR Forms Manual. Ft. Worth, TX: Institute of Behavioral Research, Texas Christian University, 1995.

    Google Scholar 

  32. Nyamathi A, Leake B, Longshore D, Gelberg L. Reliability of homeless women's reports: Concordance between hair assay and self-report of cocaine use. Nursing Res 2001; 50:165–71.

    Google Scholar 

  33. Radloff S. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1977; 1:385–401.

    Google Scholar 

  34. Centers for Disease Control and Prevention (CDC). Tuberculosis morbidity among U.S.-born and foreign-born populations—United States, 2000. MMWR 2002; 51:101–4.

    Google Scholar 

  35. Ailinger RL, Lasus H, Dear M. Americans' knowledge and perceived risk of tuberculosis. Public Health Nurs 2003; 20:211–5.

    Google Scholar 

  36. Sebastian M, Bothamley G. Tuberculosis preventive therapy: Perspective from a multi-ethnic community. Respir Med 2000; 94:648–53.

    Google Scholar 

  37. Tulsky JP, Pilote L, Hahn JA, Zolopa AJ, Burke M, Chesney M, Moss AR. Adherence to isoniazid prophylaxis in the homeless. A randomized controlled trial. Arch Intern Med 2000; 160:697–702.

    Google Scholar 

  38. Janz N, Becker M. The health belief model: A decade later. Health Educ Q 1984; 11:1–47.

    Google Scholar 

  39. Kitazawa S. Tuberculosis health education needs in homeless shelters. Public Health Nurs 1995; 12:409–16.

    Google Scholar 

  40. Poss J. Developing an instrument to study the tuberculosis screening behaviors of Mexican migrant farm workers. J Transcult Nurs 1999; 10:306–19.

    Google Scholar 

  41. Salomon N, Perlman DC, Friedmann P, Perkins MP, Ziluck V, Jarlais DC, Paone D. Knowledge of tuberculosis among drug users. Relationship to return rates for tuberculosis screening at a syringe exchange. J Subst Abuse Treat 1999; 16:229–35.

    Google Scholar 

  42. Durante A, Selwyn P, O'Connor P. Risk factors for and knowledge of mycobacterium tuberculosis infection among drug users in substance abuse treatment. Addiction 1998; 93:1393–401.

    Google Scholar 

  43. Ngamvithayapong J, Winkvist A, Diwan V. High AIDS awareness may cause tuberculosis patient delay: Results from an HIV epidemic area, Thailand. AIDS 2000; 14:1413–9.

    Google Scholar 

  44. Torres L, Arazo P, Blas Pérez J, del Pilar Amador M, Antonia Lezcano M, José Revillo M, Bautista García-Moya J. Resistance of Mycobacterium tuberculosis in Zaragoza, Spain (1993–1997) and related factors. Med Clin (Barc) 2000; 115:605–9.

    Google Scholar 

  45. El-Serag HB, Anand B, Richardson P, Rabeneck L. Association between hepatitis C infection and other infectious diseases: A case for targeted screening? Am J Gastroenterol, 2003; 98:167–74.

    Google Scholar 

  46. Portilla J, Esteban J, Llinares R, Belda J, Sa´nchez-Paya J, Isabel Manso M. Prevalence of chronic hidden infections in a cohort of patients in substitutive treatment with methadone. Med Clin (Barc) 2001; 116:330–2.

    Google Scholar 

  47. Bock NN, Metzger BS, Tapia JR, Blumberg HM. A tuberculin screening and isoniazid preventive therapy program in an inner-city population. Am J Respir Crit Care Med 1999; 159:295–300.

    Google Scholar 

  48. Batki SL, Gruber VA, Bradley JM, Bradley M, Delucchi K. A controlled trial of methadone treatment combined with directly observed isoniazid for tuberculosis prevention in injection drug users. Drug Alcohol Depend 2002; 66:283–93.

    Google Scholar 

  49. Chaisson RE, Barnes GL, Hackman J, Watkinson L, Kimbrough L, Metha S, Cavalcante S, Moore RD. A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users. Am J Med 2001; 110:610–5.

    Google Scholar 

  50. Centers for Disease Control and Prevention (CDC). Prevention and control of tuberculosis in U.S. communities with at-risk minority populations. Recommendations of the Advisory Council for the Elimination of Tuberculosis (ACET). MMWR 41(RR-5), 1–11.

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Authors and Affiliations

  1. University of California, Los Angeles, CA, USA

    Adeline Nyamathi & Heather Sands

  2. University of Puerto Rico, CA, USA

    Angela Pattatucci-Aragón

  3. University of California, Los Angeles, CA, USA

    Jill Berg & Barbara Leake

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  1. Adeline Nyamathi
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  4. Jill Berg
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Nyamathi, A., Sands, H., Pattatucci-Aragón, A. et al. Tuberculosis Knowledge, Perceived Risk and Risk Behaviors Among Homeless Adults: Effect of Ethnicity and Injection Drug Use. Journal of Community Health 29, 483–497 (2004). https://doi.org/10.1007/s10900-004-3396-2

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