The relationship of thymulin activity, immune parameters of HIV disease progression and substance use in a cohort of HIV seropositive alcohol and drug users

Zinc is essential for the activity of thymulin, a thymic hormone involved in T-lymphocyte differentiation and activation. Zinc deficiency is widespread in populations with HIV infection, and HIV+ drug users are particularly susceptible to zinc deficiency and immune suppression. This dissertation explored the relationship of zinc-bound active thymulin to plasma zinc, CD4+ and CD8+ cell count, the CD4+/CD8+ ratio, and drug use in HIV-infected drug users. Zinc-bound active thymulin was assessed in plasma of HIV+ drug users who were participating in a 30 month zinc supplementation trial. Plasma from 80 participants at the 12 month visit, and 40 of these same participants, randomly selected, at the baseline visit were assessed for zinc-bound active thymulin levels using a modification of the rosette inhibition assay. Thymulin activity was directly associated with CD4+ cell count (β = 0.127, p = 0.002) and inversely associated with cocaine use (β = −0.908, p = 0.026; R2 = 0.188, p = 0.019) independent of HIV viral load, age, gender and antiretroviral use. An increase in thymulin activity was 1.4 times more likely when CD4+ cell count increased (OR = 1.402, 95%CI: 1.006–1.956), independent of change in viral load, antiretroviral use, and age. Participants who used cocaine consistently, were 7.6 times less likely to have an increase in thymulin activity (OR = 0.133, 95%CI: 0.017–1.061). There was a direct correlation between change in plasma zinc and change in zinc-bound active thymulin (r = 0.243, p = 0.13). Analysis of CD4+ cell count decline in 222 participants in the zinc supplementation trial across the 30 months showed that both crack cocaine use and heavy alcohol use accelerated CD4+ cell count decline. Thymulin activity is directly associated with HIV disease progression, measured by CD4+ cell count, and is depressed with cocaine use independent of antiretroviral use and HIV viral load. Cocaine and heavy alcohol accelerate CD4+ cell count decline. The effect of cocaine on thymic output requires further evaluation as a mechanism for the association of cocaine use with faster HIV disease progression.

An investigation of the relationship between antemortem and postmortem drug concentrations in blood

In the field of postmortem toxicology, principles from pharmacology and toxicology are combined in order to determine if exogenous substances contributed to ones death. In order to make this determination postmortem and (whenever available) antemortem blood samples may be analyzed. This project focused on evaluating the relationship between postmortem and antemortem blood drug levels, in order to better define an interpretive framework for postmortem toxicology. To do this, it was imperative to evaluate the differences in antemortem and postmortem drug concentrations, determine the role microbial activity and evaluate drug stability. Microbial studies determined that the bacteria Escherichia coli and Pseudomonas aeruginosa could use the carbon structures of drugs as a source of food. This would suggest prior to sample collection, microbial activity could potentially affect drug levels. This process however would stop before toxicologic evaluation, as at autopsy blood samples are stored in tubes containing the antimicrobial agent sodium fluoride. Analysis of preserved blood determined that under the current storage conditions sodium fluoride effectively inhibited microbial growth. Nonetheless, in many instances inconsistent drug concentrations were identified. When comparing antemortem to postmortem results, diphenhydramine, morphine, codeine and methadone, all showed significantly increased postmortem drug levels. In many instances, increased postmortem concentrations correlated with extended postmortem intervals. Other drugs, such as alprazolam, were likely to have concentration discrepancies when short antemortem to death intervals were coupled with extended postmortem intervals. While still others, such as midazolam followed the expected pattern of metabolism and elimination, which often resulted in decreased postmortem concentrations. The importance of drug stability was displayed when reviewing the clonazepam/ 7-aminoclonazepam data, as the parent drug commonly converted to its metabolite even when stored in the presence of a preservative. In instances of decreasing postmortem drug concentrations the effect of refrigerated storage could not be ruled out. A stability experiment, which contained codeine, produced data that indicated concentrations could continue to decline under the current storage conditions. The cumulative data gathered for this experiment was used to identify concentration trends, which subsequently aided in the development of interpretive considerations for the specific analytes examined in the study.

Illicit interest groups: The political impact of the Medellin drug trafficking organizations in Colombia

Although drug trafficking organizations (DTOs) exist and have an effect on health, crime, economies, and politics, little research has explored these entities as political organizations. Legal interest groups and movements have been found to influence domestic and international politics because they operate within legal parameters. Illicit groups, such as DTOs, have rarely been accounted for—especially in the literature on interest groups—though they play a measurable role in affecting domestic and international politics in similar ways. Using an interest group model, this dissertation analyzed DTOs as illicit interest groups (IIGs) to explain their political influence. The analysis included a study of group formation, development, and demise that examined IIG motivation, organization, and policy impact. The data for the study drew from primary and secondary sources, which include interviews with former DTO members and government officials, government documents, journalistic accounts, memoirs, and academic research. To illustrate the interest group model, the study examined Medellin-based DTO leaders, popularly known as the "Medellin Cartel." In particular, the study focused on the external factors that gave rise to DTOs in Colombia and how Medellin DTOs reacted to the implementation of counternarcotics efforts. The discussion was framed by the implementation of the 1979 Extradition Treaty negotiated between Colombia and the United States. The treaty was significant because as drug trafficking became the principal bilateral issue in the 1980s; extradition became a major method of combating the illicit drug business. The study's findings suggested that Medellin DTO leaders had a one-issue agenda and used a variety of political strategies to influence public opinion and all three branches of government—the judicial, the legislative, and the executive—in an effort to invalidate the 1979 Extradition Treaty. The changes in the life cycle of the 1979 Extradition Treaty correlated with changes in the political power of Medellin-based DTOs vis-à-vis the Colombian government, and international forces such as the U.S. government's push for tougher counternarcotics efforts.

An investigation of the relationship between maltreatment and alcohol and other drug (AOD) problems in African -American and Hispanic adolescent girls

Maltreatment experienced in childhood or adolescence is a known risk factor for later problem alcohol and/or other drug (AOD) use (Bailey & McCloskey, 2005; Shin, Edwards, Heeren, 2009). A growing body of empirical work has found significant associations between adolescent girls’ AOD use and maltreatment experiences. However, questions remain as to how this relation unfolds with African-American and Hispanic adolescent girls. Guided by four relational models that have been proposed in the literature, this study examined the links between maltreatment, trauma symptoms, and alcohol and/or other drug (AOD) problems in a sample of 170 African-American and Hispanic adolescent girls who were participants in a school-based AOD use intervention. Results of this study revealed that maltreatment experiences (physical and emotional abuse) were positively related to trauma symptoms, which were positively related to AOD problem severity, alcohol abuse, alcohol dependency, drug abuse, and drug dependency. Perceived discrimination moderated this relation between sexual abuse and trauma symptoms, such that more perceived discrimination resulted in a stronger effect of sexual abuse on trauma symptoms. Ethnic identity moderated the relation between sexual abuse and AOD problem severity, such that ethnic identity demonstrated protective properties in the relation between sexual abuse and AOD problem severity. My research adds to extant knowledge on the relation between maltreatment and AOD use in adolescent girls and suggests the importance of developing interventions targeting maltreatment and AOD use concurrently.

Effect of the Supplemental Nutrition Assistance Program (SNAP) and nutrition education on nutrition and health outcomes of HIV+ individuals

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. ^ SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. ^ Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.^

Different Wars Require Different Strategies: Separating the “War on Drugs” from the “War on Drug [Traffickers]”

Using the securitization framework to highlight the arguments that facilitated the “War on Drugs”, this paper highlights a separate war against drug traffickers. Facilitated by ideology through the rhetoric promoted by the “War on Drugs,” the fear of communist expansion and democratic contraction, the “War on Drug Traffickers” was implemented, requiring its own strategy separate from the “War on Drugs.” This is an important distinction because the play on words changes the perception of the issue from one of drug addiction to one of weak institutions and insurgent/terrorist threat to those institutions. Furthermore, one cannot propose strategy to win, lose, or retreat in a war that one has been unable to identify properly. And while the all-encompassing “War on Drugs” has motivated tremendous discourse on its failure and possible solutions to remedy its failure, the generalizations made as a result of the inability to distinguish between the policies behind drug addiction and the militarized policies behind drug trafficking have discounted the effect of violence perpetrated by the state, the rationale for the state perpetrating that violence, and the dependence that the state has on foreign actors to perpetrate such violence. This makes it impossible to not only propose effective strategy but also to persuade states that participate in the “War on Drug Traffickers” to adopt the proposed strategy.

Does U.S counter-drug policy affect nationalism in the Anglophone Caribbean? A comparative study on the impact of counter-drug policy on nationalism in Jamaica and Trinidad and Tobago

This dissertation examined the effect of United States counter-drug policy on nationalism in small states, focusing on Jamaica and Trinidad and Tobago. The states were selected for their roles and geostrategic importance in the illegal drug trade; Jamaica being the largest drug producing country in the Anglophone Caribbean and having strong links to the trade of Colombian cocaine, and Trinidad being a mere seven miles from the South American coast. Since U.S. counterdrug policies have frequently been viewed in the region as imperialistic, this dovetails into ideas on the perceptions of smallness and powerlessness of Caribbean nations. Hence, U.S. drug policies affect every vulnerability faced by the Caribbean, individually and collectively. Thus, U.S. drug policy was deemed the most appropriate independent variable, with nationalism as the dependent variable. In both countries four Focus Groups and one Delphi Study were conducted resulting in a total of 60 participants. Focus Group participants, recruited from the general population, were asked about their perception of the illegal drug trade in the country and the policies their government had created. They were also asked their perception on how deeply involved the U.S. was in the creation of these policies and their opinions on whether this involvement was positive or negative. The Delphi Study participants were experts in the field of local drug policies and also gave their interpretations of the role the U.S. played in local policy creation. Coupled with this data, content analysis was conducted on various newspaper articles, press releases, and speeches made regarding the topic. In comparing both countries, it was found that there is a disconnect between government actions and the knowledge and perceptions of the general public. In Trinidad and Tobago this disconnect was more apparent given the lack of awareness of local drug policies and the utter lack of faith in government solutions. The emerging conclusion was that the impact of U.S. drug policy on nationalism was more visible in Trinidad and Tobago where there was a weaker civil society-government relationship, while the impact on nationalism was more obscure in Jamaica, which had a stronger civil-society government relationship.

An Investigation of the Relationship Between Maltreatment and Alcohol and Other Drug (AOD) Use Among African-American and Hispanic Adolescent Girls

Maltreatment experienced in childhood or adolescence is a known risk factor for later problem alcohol and/or other drug (AOD) use (Bailey & McCloskey, 2005; Shin, Edwards, Heeren, 2009). A growing body of empirical work has found significant associations between adolescent girls’ AOD use and maltreatment experiences. However, questions remain as to how this relation unfolds with African-American and Hispanic adolescent girls. Guided by four relational models that have been proposed in the literature, this study examined the links between maltreatment, trauma symptoms, and alcohol and/or other drug (AOD) problems in a sample of 170 African-American and Hispanic adolescent girls who were participants in a school-based AOD use intervention. Results of this study revealed that maltreatment experiences (physical and emotional abuse) were positively related to trauma symptoms, which were positively related to AOD problem severity, alcohol abuse, alcohol dependency, drug abuse, and drug dependency. Perceived discrimination moderated this relation between sexual abuse and trauma symptoms, such that more perceived discrimination resulted in a stronger effect of sexual abuse on trauma symptoms. Ethnic identity moderated the relation between sexual abuse and AOD problem severity, such that ethnic identity demonstrated protective properties in the relation between sexual abuse and AOD problem severity. My research adds to extant knowledge on the relation between maltreatment and AOD use in adolescent girls and suggests the importance of developing interventions targeting maltreatment and AOD use concurrently.

Effect of the Supplemental Nutrition Assistance Program (SNAP) and Nutrition Education on Nutrition and Health Outcomes of HIV+ Individuals

Factors associated with and barriers to participation in Supplemental Nutrition Assistance Program (SNAP) and the effect participation has on food security, nutrition status, disease status and quality of life was investigated in a cross-sectional study including 175 HIV infected individuals. In addition, the effect of a targeted nutrition education on nutrition knowledge, readiness to dietary behavior change, nutrition status, disease status and quality of life was also investigated among a subset of the population (N = 45) in a randomized clinical control trial. SNAP participation rate was 70.3%, similar to the State of Florida and national participation rates. SNAP participation was positively and independently associated with being born in the US (P < 0.001), having monthly income less than $1000 (P = 0.006), and receiving antiretroviral treatment (P < 0.001). Participation barriers include denial of participation by program, recent incarceration, living in a shelter where participation is not allowed and unawareness of eligibility status. In regression analyses, SNAP participation was not significantly associated with improved food security, nutrition status, disease status and health related quality of life (HRQOL). Over half (56%) of the population experienced food insecurity and had inadequate intakes of half of the nutrients assessed. Illicit drug, alcohol and cigarette use were high in this population (31%, 55% and 63% respectively), and affected food security, nutrients intake, disease status and HRQOL. The nutrition education intervention resulted in a trend towards improvements nutrition knowledge, self-efficacy, and readiness to change without impacting nutrition status, disease state and quality of life. Food insecurity and other nutrition related issues, with implications for treatment, management and cost of HIV disease, continue to plague infected individuals living in poverty. More resources, including food and nutrition programs, specifically targeted towards this population are needed to address these issues.