Online Program

Effects of cognitive flexibility on the relationship between needle sharing and hepatitis c infection

Monday, November 4, 2013 : 10:56 a.m. - 11:14 a.m.

Eugene Dunne, MA, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
Joy Scheidell, MPH, Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL
Maria Khan, PhD, School of Public Health, Department of Epidemiology and Biostatistics, University of Florida, Gainesville, FL
William Latimer, PhD, MPH, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
AIMS: To assess whether cognitive flexibility mediates the relationship between needle sharing and Hepatitis C (HCV) infection among injection drug users in Baltimore, Maryland. METHOD: A secondary data analysis of injection drug users (N = 628; 55.7% African American; 56.1% male, mean age = 32.9) enrolled in a NIDA-funded NEURO-HIV Epidemiologic study. Biological samples were obtained to test for HCV. Participants completed a battery of neuropsychological measures and a structured psychosocial interview to assess drug use and high-risk behaviors. Trails Making Test (Part B) completion time was used to measure cognitive flexibility. RESULTS: 303 (48.2%) participants tested positive for HCV. Needle sharing was a significant predictor of HCV infection (Z=9.14, p<.001). Those reporting lifetime needle sharing performed significantly worse on the cognitive flexibility task than those who reported no needle sharing (t=2.29, p=.022). Impaired cognitive flexibility was also a significant predictor of HCV status (Z=4.31, p<.001). Using the Preacher and Hayes (2008) INDIRECT macro for SPSS to test for mediation with 1000 bootstrapped samples, the positive relationship between needle sharing and HCV was mediated by cognitive flexibility (Z=8.95, p<.001). The indirect effects of the mediator are considered significant as zero is not included in the 95% biased-corrected and accelerated confidence interval. Race and intelligence were entered as covariates. Overall, the model accounted for 27.3% of the variance in HCV status. CONCLUSIONS: When injection drug users are confronted with the decision of whether or not to share needles, they may struggle with weighing the risks and rewards as a result of their diminished cognitive flexibility.

Learning Areas:

Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Program planning
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify executive dysfunction as a barrier to Hepatitis C prevention efforts. Demonstrate that deficits in cognitive flexibility mediate the positive relationship between needle sharing and HCV infection among injection drug users.

Keyword(s): Hepatitis C, Injection Drug Users

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in the data collection and data analysis on this study for three years. I received a masters degree in Clinical Psychology at Towson University (Maryland). I am currently a doctoral student in Clinical and Health Psychology at the University of Florida, Gainesville. My interests include substance use and infection disease prevention.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.