title: Substance abuse and the transmission of hepatitis C among persons with severe mental illness.
abstract: OBJECTIVE
  The authors sought to better understand the relationship of substance abuse to higher rates of transmission of hepatitis C among persons with severe mental illness.
  
  
  METHODS
  S: The authors assessed 668 persons with severe mental illness for HIV, hepatitis B, and hepatitis C infection through venipuncture. Demographic characteristics, substance abuse, and risk behaviors for blood-borne infections were assessed through interviews and collection of clinical data.
  
  
  RESULTS
  Eighty-two percent of the assessed persons were not infected, and 18 percent had hepatitis C. Among those with hepatitis C infection, 546 (82 percent) tested negative for all viruses. Of the 122 (18 percent) who had hepatitis C, 53 (8 percent) had only hepatitis C, 56 (8 percent) had both hepatitis C and hepatitis B, three (1 percent) had hepatitis C and HIV, and ten (2 percent) had all three infections. More than 20 percent of the sample reported lifetime intravenous drug use, and 14 percent reported lifetime needle sharing. Fifty-seven percent had sniffed of snorted cocaine, and 39 percent had smoked crack. A stepwise regression model was used to identify interaction effects of these behaviors and risk of hepatitis C infection among persons with severe mental illness. Use of needles and of crack cocaine were associated with a large increase in the likelihood of hepatitis C infection.
  
  
  CONCLUSIONS
  S: The high rates of co-occurring substance use disorders among persons with severe mental illness, coupled with the role of substance abuse as the primary vector for hepatitis C transmission, warrants special consideration.
authors.affiliation: Center of Behavioral Health, Justice, and Public Policy at the University of Maryland School of Medicine, 3700 Koppers Street, Suite 402, Baltimore, Maryland 21227, USA. fosher@psych.umaryland.edu
authors.forename: Fred C
authors.initials: FC
authors.lastname: Osher
authors.forename: Richard W
authors.initials: RW
authors.lastname: Goldberg
authors.forename: Scot W
authors.initials: SW
authors.lastname: McNary
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
authors.forename: Susan M
authors.initials: SM
authors.lastname: Essock
authors.forename: Marian I
authors.initials: MI
authors.lastname: Butterfield
authors.forename: Stanley D
authors.initials: SD
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D017848:Blood-Borne Pathogens; D015897:Comorbidity; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D016485:Needle Sharing / Q000009:adverse effects; D012307:Risk Factors; D012309:Risk-Taking; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D014481:United States / Q000453:epidemiology