universally useful markers of medical underservedness. The purpose of this study was to determine how well race/ethnicity and income identify women who do not receive screening mammography in the City of Philadelphia. METHODS: Telephone survey of adult residents of the City of Philadelphia. Households were sampled using random digit dialing stratified by service area. Interviews were conducted in English or Spanish between June and September 1998. Women ! 50 yo were asked``About how long has it been since you last had a mammogram?'' and women who had not had a mammogram in past year were asked the most important reason they had not had a mammogram. RESULTS: Of 6,329 eligible households, 4,114 individuals (65%) agreed to participate. 828 respondents were women between 50 and 75 years of age. Mean age was 61.9 yrs; 46% were Caucasian, 48% African-American and 4% Hispanic; 26% had not completed high school. Mean annual household income was $19,000 (range < $8,000 to > $100,000). 75% had undergone screening mammography in the prior year, 9% one to two years previously, 11% more than two years ago and 5% had never had a mammogram. In the overall sample, mammography in the prior year was associated with African-American ethnicity (RR 1.19, 95% 1.1 ± 1.3), but not with age, income or education. However, there were significant interactions between ethnicity and income and ethnicity and age. Income was associated with mammography among Caucasian women only (RR 1.28, 95% CI 1.0 ± 1.7 for above vs. below federal poverty level) and age was associated with mammography among African-American women only (RR 1.34, 95% CI 1.0 ± 1.8 for over 60 vs. 60 and under). Among women who had not had a mammogram in the prior year, African-American women were less likely to cite lack of motivation as their reason for not undergoing screening (RR 0.70, 95% CI 0.48 ± 0.99) and more likely to cite system barriers (e.g. insurance, transportation) than Caucasian women. CONCLUSION: In the city of Philadelphia, low income, minority women no longer represent the underserved for screening mammography. Furthermore, the characteristics of women underusing screening mammography differ between African-American and Caucasian women. These data suggest that the sociodemographic characteristics of the medically underserved may depend upon type of medical care, geographic location and even ethnic group. Generalist efforts to reduce medical underservedness should be based on accurate assessments of the communities they serve. Our purpose was to describe the relationship between both selfreported (SR) and electronically monitored (MEMS) adherence (ADH) and HIV viral load (VL), and to characterize drug resistance patterns in subjects who failed to sustain virologic suppression on potent HAART regimens. METHODS: Subjects on HAART were recruited from a longitudinal study of HIV-infected drug users. During a median of 166 days, VL and ADH with all antiretrovirals were assessed by SR and MEMS at each of 6 monthly visits. ADH (% doses taken/doses prescribed) was assessed for both 1 day and 1 week preceding each visit, and mean ADH was calculated for the entire study period. We also studied drug resistance in 11 patients with viral rebound (VL > 1000 copies/ml for > 2 consecutive mos. after previously maintaining VL < 400 copies/ml for > 2 consecutive mos.). RESULTS: 501 SR estimates and 417 MEMS estimates were obtained from 85 subjects. Mean 1 week SR ADH correlated with mean 1 day SR ADH (76% v. 77%; r=0.84, p=0.0001), as did mean 1 week and 1 day MEMS ADH (55% v. 57%; r=0.86, p=0.0001). Though SR ADH was greater than MEMS ADH, both were correlated with VL (r=0.6 for 1 week MEMS, r=0.5 for 1 day MEMS, r=0.5 for 1 week SR, r=0.4 for 1 day SR). The following factors were associated with poor ADH: active heroin use (64% for active v. 80% for former use, p=.02), active cocaine use (38% for active v. 60% for former use, p=.009), active alcohol use (60% for subjects who drank several days/week v. 80% for subjects who drank less, p=.002), side effects (73% for subjects with > 2 side effects v. 83% for subjects with < 2, p=.08), and female gender (44% for women v. 60% for men, p=.04). Among the 11 patients in whom we analyzed ADH, resistance and rebound, we found that median ADH during viral suppression was 54% (range 0 ± 83%), and median ADH after rebound was 8% (range 0 ± 36%). Only 2/11 developed high-level phenotypic resistance, and 4/11 developed significant mutations in either RT or protease; M184 in 3/11 on 3TC, K103N in 2/2 on NNRTIs, and various IDV mutations in 1/11 on PIs. In 2/4 patients, M184 mutations were present without corresponding phenotypic resistance. CONCLUSION: High correlation between 1 day and 1 week estimates suggest that ADH does not change in the day before a visit. While SR overestimates true ADH, repeated quantitative SR estimates correlate with VL. Our data further show that SR ADH > 90% is necessary to maintain virologic suppression, and that active drug/alcohol use and medication side effects lower adherence. Our analysis of drug resistance suggests that significant RT or protease mutations may be present as early indicators of phenotypic resistance. However, due to lack of sufficient selective pressure, high level phenotypic resistance is uncommon after viral rebound when ADH is poor. PURPOSE: Pulmonary infections, including bacterial pneumonia, cause significant morbidity and mortality for patients infected with HIV. The purpose of this project was to determine the predictors of inpatient mortality among HIV patients with community-acquired pneumonia admitted in the early highly active antiretroviral therapy era, between 1995 ± 1997. METHODS: Trained abstractors performed retrospective chart reviews of hospitalized HIV patients diagnosed or suspected of having community-acquired pneumonia, who were admitted between 1995 ± 1997 at 86 hospitals in 7 geographic areas. We used hierarchically optimal classification tree analysis to develop a pre-admission severity of illness staging system for predicting inpatient mortality. RESULTS: Among HIV patients with confirmed or suspected community-acquired pneumonia (n=1112), the inpatient mortality rate was 9.5%. Multivariate modeling indicated a 5-category staging based on four predictors (Table 1) . Bootstrap validity analysis (50% resample) supported the stability of this model. CONCLUSION: Our staging system identifies HIV patients with low, moderate, and high risk of inpatient mortality from community-acquired pneumonia and may be useful for case-mix adjustment while exploring variations in community-acquired pneumonia mortality rates among hospitals and across cities caring for HIV patients. The potential risks of herbal supplement use is of growing concern. Reports of serious side effects and drug interactions have prompted many physicians to incorporate questions of supplement use into their medical history. Despite these efforts, clinicians are often faced with inadequate information due to the recent boom of combination herbal products known only by their trade names. Supplements marketed to consumers as weight loss remedies are one such group of products that frequently contain a multitude of``natural'' ingredients. This study was designed to characterize the ingredients found in a number of popular weight loss products in order to assist physicians in preventing potential adverse effects. METHODS: A systematic search of the World Wide Web was conducted to identify twenty herbal weight loss products for sale on the internet. Three search engines were used (HotBot, Google and Excite) and the search term``herbal weight loss.'' A site abstraction form was developed to collect data on the ingredients contained within each product. Descriptive statistics were used to characterize the most common ingredients found among the twenty combination products. RESULTS: Nine ingredients were identified in six or more of the products. These included: MaHuang, Ginger, Guarana, Siberian Ginseng, White Willow Bark, Chromium, Garcinia Cambogia, Gotu Kola, and Zinc. The number and frequency of each of these ingredients among the herbal weight loss products characterized are included in the table below. CONCLUSION: Despite little evidence of efficacy and the potential for significant toxicity, ingredients such as Mahuang, Guarana, and Chromium are found in a majority of weight loss products. Physicians need to take this into consideration when faced with a patient who discloses the use of an unfamiliar over-the-counter weight loss supplement. HIV prevention education is a part of substance abuse treatment at many correctional facilities, but the effectiveness of these programs has not been evaluated. The goals of our study were to evaluate who receives HIV prevention services in correctional substance abuse treatment programs, and to determine the impact of these services on short term risk behaviors. METHODS: This study was a secondary analysis of data from the National Treatment Improvement Evaluation Study (NTIES), conducted during 1993 ± 1995. A total of 1,223 HIVfree adult inmates, enrolled in nine correctional substance abuse treatment programs were evaluated. A composite index modeled after the validated Risk Assessment Battery (RAB) measured HIV risk behavior at treatment entry and at twelve-month follow-up. We employed multivariable analysis of covariance to assess the influence of receiving HIV prevention services, controlling for potential confounders, on HIV risk behavior at twelve-month follow-up. Because of assumed differences between those who were in and those who were out of custody during the follow-up period, all analyses were stratified by this variable. RESULTS: Overall, 77.1% of the sample received HIV prevention services while in treatment.