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Garpenhag L, Dahlman D. Screening for breast and cervical cancer among OST patients: a qualitative study of barriers and suggested interventions to increase participation. Int J Qual Stud Health Well-being 2023; 18:2175767. [PMID: 36756664 PMCID: PMC9930823 DOI: 10.1080/17482631.2023.2175767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
PURPOSE Women with current or previous drug use are at risk of poor breast and cervical cancer outcomes. While screening is known to decrease cancer mortality, screening participation is sparsely investigated among drug dependent women. The aim of this study was to explore experiences of breast and cervical cancer screening-including barriers and suggested interventions to promote increased participation-among women in opioid substitution treatment (OST). METHODS Three focus group interviews were conducted at one OST clinic in Malmö, Sweden. The interviews were moderated by OST staff, assisted by a researcher. A descriptive qualitative analysis was carried out using a template analysis approach, employing a model of healthcare access to organize the description of barriers. RESULTS The 11 participants reported several barriers to screening access, affecting the perceived need of screening and the opportunities to seek and reach screening services. Some barriers appear to be specific to women with previous or current drug use. Suggested interventions were moral and practical support, integrated/specialized delivery of screening services, and enhanced screening invitation procedures. CONCLUSIONS The study findings provide insight to difficulties with screening compliance among women with current or previous drug use, and provide a knowledge base for quantitative and intervention studies.
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Affiliation(s)
- Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden,CONTACT Lars Garpenhag Clinical Research Center, Centrum för primärvårdsforskning, Box 50322, 202 13, Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University/Region Skåne, Malmö, Sweden,Faculty of Medicine, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
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Heidari O, Tormohlen K, Dangerfield DT, Tobin KE, Farley J, Aronowitz SV. Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review. J Nurs Scholarsh 2023; 55:605-622. [PMID: 36480158 PMCID: PMC10635283 DOI: 10.1111/jnu.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION People who inject drugs (PWID) have a greater burden of multimorbid chronic diseases than the general population. However, little attention has been paid to the engagement in primary care for services related specifically to injection drug use and management of underlying chronic comorbid diseases for this population. This systematic review identified facilitators and barriers to healthcare engagement in the primary care setting among PWID. DESIGN AND METHODS Studies were identified by a literature search of PubMed, CINAHL, and EMBASE, and by searching the references of retrieved articles. Studies were included if they measured active injection drug use, and outcomes related to primary care engagement characterized by: diagnosis of a health condition, linkage or retention in care, health condition-related outcomes, and reported patient-provider relationship. RESULTS Twenty-three articles were included. Using the behavioral model, factors within predisposing, enabling, need, and health behavior domains were identified. Having co-located services and a positive patient-provider relationship were among the strongest factors associated with healthcare utilization and engagement while active injection drug use was associated with decreased engagement. CONCLUSIONS To our knowledge, this is the only review of evidence that has examined factors related to primary care engagement for people who inject drugs. Most articles were observational studies utilizing descriptive designs. Although the assessment of the evidence was primarily rated 'Good', this review identifies a significant need to improve our understanding of primary care engagement for PWID. Future research and intervention strategies should consider these findings to better integrate the holistic care needs of PWID into primary care to reduce morbidity and mortality associated with injection drug use and chronic disease. CLINICAL RELEVANCE Primary care engagement is important for preventative care, early diagnosis of disease, and management of chronic diseases, including addressing problems of substance use. This review highlights factors nurses can utilize to facilitate primary care engagement of PWID.
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Affiliation(s)
- Omeid Heidari
- University of Washington, School of Nursing, Department of Child, Family, and Population Health Nursing, 1959 NE Pacific Street, Seattle, WA 98195
| | - Kayla Tormohlen
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, 615 N. Wolfe St, Baltimore, MD 21205
| | - Derek T. Dangerfield
- George Washington University, Milken Institute School of Public Health, Department of Prevention and Community Health, 950 New Hampshire Ave NW #2, Washington, DC 20052
- Us Helping Us, Inc. Georgia Ave. NW. Washington, DC 20010
| | - Karin E. Tobin
- Johns Hopkins University, School of Nursing, 525 N. Wolfe St, Baltimore, MD 21205
| | - Jason Farley
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health, Behavior, and Society, 615 N. Wolfe St, Baltimore, MD 21205
| | - Shoshana V. Aronowitz
- University of Pennsylvania, School of Nursing, Department of Family and Community Health, 418 Curie Blvd, Pennsylvania, PA, 19104
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Pauly B, Sullivan G, Inglis D, Cameron F, Phillips J, Rosen C, Bullock B, Cartwright J, Hainstock T, Trytten C, Urbanoski K. Applicability of a national strategy for patient-oriented research to people who use(d) substances: a Canadian experience. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:22. [PMID: 35610726 PMCID: PMC9127478 DOI: 10.1186/s40900-022-00351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Europe and North America are in the grips of a devastating overdose crisis. People who use substances often feel unsafe to access healthcare due to fears of stigma, blame, judgement, poor treatment, or other repercussions. As a result, they often avoid, delay, or leave care, resulting in premature death and missed opportunities for care. Internationally, there have been concerted efforts to move towards patient-engaged research to enhance the quality of health care systems and services. In Canada, the Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research (SPOR) initiative promotes engagement of patients as active partners in health care research. As part of a community based patient oriented research project, we critically analyze the SPOR framework to provide insights into what constitutes safer research with people who use(d) substances. METHODS We undertook a two-stage process that began with a review of community based research principles and the SPOR framework. At the second stage, we undertook a qualitative descriptive study employing focus groups to generate description of the adequacy and appropriateness of the SPOR framework for guiding research with people who use(d) substances on four key dimensions (patient engagement, guiding principles, core areas of engagement and benefits). The data were analyzed using qualitative content analysis to identify key issues and insights. RESULTS While the SPOR framework includes a range of patient roles, principles and areas for engagement, there are issues and gaps related to essential elements of safe patient-oriented research for people who use substances. These include an individualized focus on patients as partners, lack of recognition of community benefits, power imbalances and distrust due to systemic stigma, engagement as one way capacity building and learning, and lack of accountability for taking action on research findings. CONCLUSIONS Given the extent of stigma in health care and the ongoing illicit drug policy crisis, strategies for enhancing equitable Patient-Oriented Research (POR) include shifting language from patient partners to community researchers, recognizing power inequities and adding trust and equity as core POR principles including pay equity. Employing community based participatory research as a POR methodology allows the lead researchers to fully engage community throughout the research process, enhances community benefits and accountability for action.
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Affiliation(s)
- Bernadette Pauly
- University of Victoria School of Nursing, Canadian Institute for Substance Use Research, Victoria, Canada.
| | - Ginger Sullivan
- University of Victoria School of Nursing, Canadian Institute for Substance Use Research, Victoria, Canada
| | - Dakota Inglis
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
| | | | | | - Conor Rosen
- Umbrella Society for Addictions and Mental Health, Victoria, Canada
| | - Bill Bullock
- Victoria Division of Family Practice, Victoria, Canada
| | - Jennifer Cartwright
- BC Support Unit, Advancing Patient Oriented Research, Vancouver Island Regional Centre, Victoria, Canada
| | - Taylor Hainstock
- BC Support Unit, Advancing Patient Oriented Research, Vancouver Island Regional Centre, Victoria, Canada
| | | | - Karen Urbanoski
- University of Victoria, Canadian Institute for Substance Use Research, Victoria, Canada
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Gehring ND, Speed KA, Launier K, O'Brien D, Campbell S, Hyshka E. The state of science on including inhalation within supervised consumption services: A scoping review of academic and grey literature. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 102:103589. [DOI: 10.1016/j.drugpo.2022.103589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 01/09/2023]
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Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study. Cancer Causes Control 2021; 33:213-222. [PMID: 34743253 PMCID: PMC8776671 DOI: 10.1007/s10552-021-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
Purpose Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01513-2.
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Bäckström E, Troberg K, Håkansson A, Dahlman D. Healthcare Contacts Regarding Circulatory Conditions among Swedish Patients in Opioid Substitution Treatment, with and without On-Site Primary Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4614. [PMID: 33925318 PMCID: PMC8123605 DOI: 10.3390/ijerph18094614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/10/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
Patients in Opioid Substitution Treatment (OST) have increased mortality and morbidity, with circulatory conditions suggested to be a contributing factor. Since OST patients tend to have unmet physical healthcare needs, a small-scale intervention providing on-site primary healthcare (PHC) in OST clinics was implemented in Malmö, Sweden in 2016. In this study, we assessed registered circulatory conditions and healthcare utilization in OST patients with and without use of on-site PHC. Patients from four OST clinics in Malmö, Sweden, were recruited to a survey study in 2017-2018. Medical records for the participants were retrieved for one year prior to study participation (n = 192), and examined for circulatory diagnoses, examinations and follow-ups. Patients with and without on-site PHC were compared through descriptive statistics and univariate analyses. Eighteen percent (n = 34) of the sample had 1≤ registered circulatory condition, and 6% (n = 12) attended any clinical physiology examination or follow-up, respectively. Among patients utilizing on-site PHC (n = 26), the numbers were 27% (n = 7) for circulatory diagnosis, 15% (n = 4) for examinations, and 12% (n = 3) for follow-up. OST patients seem underdiagnosed in regard to their circulatory health. On-site PHC might be a way to diagnose and treat circulatory conditions among OST patients, although further research is needed.
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Affiliation(s)
- Eric Bäckström
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Region Skåne, 205 02 Malmö, Sweden;
| | - Katja Troberg
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; (K.T.); (A.H.)
- Malmö Addiction Centre, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Anders Håkansson
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; (K.T.); (A.H.)
- Malmö Addiction Centre, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Region Skåne, 205 02 Malmö, Sweden;
- Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, 221 85 Lund, Sweden; (K.T.); (A.H.)
- Malmö Addiction Centre, Skåne University Hospital, 205 02 Malmö, Sweden
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Dahlman D, Magnusson H, Li X, Sundquist J, Sundquist K. Drug use disorder and risk of incident and fatal breast cancer: a nationwide epidemiological study. Breast Cancer Res Treat 2020; 186:199-207. [PMID: 33156489 PMCID: PMC7940313 DOI: 10.1007/s10549-020-05998-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
Purpose Breast cancer is one of the most common cancer forms in women and it is often detected by screening. However, women with drug use disorders (DUD) are less likely to be reached by screening programs. In this study, we aimed to investigate breast cancer incidence, mortality and stage at time of diagnosis among women with DUD compared to the general female population in Sweden. Methods We performed a follow-up study based on Swedish national register data for the period January 1997–December 2015. The study was based on 3,838,248 women aged 15–75 years, of whom 50,858 were registered with DUD. Adjusted hazard ratios (HRs) for incident and fatal breast cancer, and cancer stage at time of diagnosis, were calculated for women with and without DUD using Cox regression analysis. Results DUD was associated with incident breast cancer (HR 1.08, 95% confidence interval [CI] 1.02–1.14, p = 0.0069), fatal breast cancer (HR 1.60, 95% CI 1.42–1.82, p < 0.001), and stage IV breast cancer, i.e. metastasis at diagnosis (HR 2.06, 95% CI 1.44–2.95, p < 0.001). Conclusions Women with DUD were identified as a risk group for incident, fatal and metastasized breast cancer, which calls for attention from clinicians and policy makers. Cancer screening attendance and other healthcare seeking barriers are likely to affect the risk increase among women who use drugs; however, more research is needed on the underlying mechanisms. Electronic supplementary material The online version of this article (10.1007/s10549-020-05998-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.
| | - Hedvig Magnusson
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Box 503 22, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine At Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Box 503 22, Malmö, Sweden.,Department of Family Medicine and Community Health, Icahn School of Medicine At Mount Sinai, New York, USA.,Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
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8
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Dahlman D, Ekefäll M, Garpenhag L. Health Literacy among Swedish Patients in Opioid Substitution Treatment: A Mixed-Methods Study. Drug Alcohol Depend 2020; 214:108186. [PMID: 32721789 DOI: 10.1016/j.drugalcdep.2020.108186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Poor health and unmet healthcare needs is common among people with substance use disorder (SUD) including patients in opioid substitution treatment (OST). Low health literacy (HL) is associated with poverty, low education and physical limitations, but is unexplored in an OST context. METHODS Mixed-methods were used. Participants were consecutively recruited by clinic staff or researcher, from five OST clinics in Malmö, Sweden, during September - November 2019. HL level was measured through HLS-EU-Q16 (n?=?286). Self-reported socioeconomic correlates of HL were analyzed through logistic regression. Patients' experiences of HL-related problems were assessed through six focus group interviews (n?=?23) moderated by an OST employee. RESULTS While 46% had sufficient HL (13-16 points of maximum 16), 32% did not receive a HL score due to too many missing answers. No correlates of sufficient HL level were found. Missing HL level was associated with low educational attainment (Ajusted odds ratio [AOR] 1.94; 95% Confidence interval [CI] 1.13-3.32) and negatively associated with employment (AOR 0.28; 95% CI 0.11-0.71). Qualitative data revealed a diversity in participants' self-assessed capabilities, and problems associated with access, comprehension, trust and dependency on addiction-specific services. CONCLUSIONS This study highlights that HL level is low, and identifies a number of concrete problems related to HL in the studied population. The results implicate a need for tailored interventions regarding health information among OST patients.
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Affiliation(s)
- Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden.
| | - Malin Ekefäll
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Lars Garpenhag
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
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Semenza DC, Isom Scott DA, Grosholz JM, Jackson DB. Disentangling the health-crime relationship among adults: The role of healthcare access and health behaviors. Soc Sci Med 2020; 247:112800. [PMID: 32006755 DOI: 10.1016/j.socscimed.2020.112800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/19/2019] [Accepted: 01/11/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, USA.
| | - Deena A Isom Scott
- Department of Criminology and Criminal Justice and African American Studies Program, University of South Carolina, USA
| | - Jessica M Grosholz
- Department of Liberal Arts and Social Sciences, University of South Florida, Sarasota-Manatee, USA
| | - Dylan B Jackson
- Department of Criminal Justice, University of Texas, San Antonio, USA
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Moravac CC. Reflections of Homeless Women and Women with Mental Health Challenges on Breast and Cervical Cancer Screening Decisions: Power, Trust, and Communication with Care Providers. Front Public Health 2018; 6:30. [PMID: 29600243 PMCID: PMC5863503 DOI: 10.3389/fpubh.2018.00030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
This study conducted in Toronto, Canada, explored the perceptions of women living in homeless shelters and women with severe mental health challenges about the factors influencing their decision-making processes regarding breast and cervical cancer screening. Twenty-six in-depth qualitative interviews were conducted. The objectives of this research were (i) to provide new insights about women's decision-making processes, (ii) to describe the barriers to and facilitators for breast and cervical cancer screening, and (iii) to offer recommendations for future outreach, education, and screening initiatives developed specifically for under/never-screened marginalized women living in urban centers. This exploratory study utilized thematic analysis to broaden our understanding about women's decision-making processes. A constructed ontology was used in an attempt to understand and describe participants' constructed realities. The epistemological framework was subjective and reflected co-created knowledge. The approach was hegemonic, values-based, and context-specific. The aim of the analysis was to focus on meanings and actions with a broader view to identify the interplay between participants' narratives and social structures, medical praxis, and policy implications. Results from 26 qualitative interviews conducted in 2013-2014 provided insights on both positive and negative prior cancer screening experiences, the role of power and trust in women's decision-making, and areas for improvement in health care provider/patient interactions. Outcomes of this investigation contribute to the future development of appropriately designed intervention programs for marginalized women, as well as for sensitivity training for health care providers. Tailored and effective health promotion strategies leading to life-long cancer screening behaviors among marginalized women may improve clinical outcomes, decrease treatment costs, and save lives.
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Rojas P, Li T, Ravelo GJ, Dawson C, Sanchez M, Sneij A, Wang W, Kanamori M, Cyrus E, De La Rosa MR. Correlates of Cervical Cancer Screening Among Adult Latino Women: A 5-Year Follow-Up. WORLD MEDICAL & HEALTH POLICY 2017; 9:239-254. [PMID: 29034117 DOI: 10.1002/wmh3.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Latinas have the highest incidence rates of cervical cancer in the United States, and Latinas in the United States are less likely to utilize cervical cancer screening. METHOD We used secondary data analysis of a non-clinical convenience sample (n=316 women at baseline; n=285 at five-year follow-up) to examine correlates of cervical cancer screening among adult Latina women. Univariate and multiple logistic regression models using Generalized Estimated Equations (GEE) algorithm were utilized to assess the influence of the independent variables. RESULTS Women who reported their main healthcare source as community health clinics, women who were sexually active, and women who reported that a healthcare provider discussed HIV prevention with them were more likely to report having a cervical cancer screening (aOR=2.06; CI=1.20, 3.52). CONCLUSION The results suggest a need for continued efforts to ensure that medically underserved women (e.g., Latina women) receive counseling and education about the importance of preventive cancer screening.
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Affiliation(s)
- Patria Rojas
- associate research professor at Florida International University
| | - Tan Li
- assistant professor in the Department of Biostatistics at Florida International University
| | | | | | - Mariana Sanchez
- post-doctoral fellow at the Center for Research on US Latinos HIV/AIDS and Drug Abuse at Florida International University
| | - Alicia Sneij
- PhD student in the Robert Stempel School of Social Work and Public Health at Florida International University
| | - Weize Wang
- graduate student the Robert Stempel School of Social Work and Public Health at Florida International University
| | - Mariano Kanamori
- post-doctoral fellow the Robert Stempel School of Social Work and Public Health at Florida International University
| | - Elena Cyrus
- post-doctoral fellow in the Center for Research on US Latinos HIV/AIDS and Drug Abuse at Florida International University
| | - Mario R De La Rosa
- professor and director of the Center for Research on US Latinos HIV/AIDS and Drug Abuse at Florida International University
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Paul P, Hakobyan M, Valtonen H. The association between self-perceived health status and satisfaction with healthcare services: Evidence from Armenia. BMC Health Serv Res 2016; 16:67. [PMID: 26892950 PMCID: PMC4759944 DOI: 10.1186/s12913-016-1309-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 02/11/2016] [Indexed: 12/05/2022] Open
Abstract
Background Armenians very rarely seek healthcare services and, consequently experience more serious health conditions. With its ongoing reforms, Armenia is focusing on linking health system financing to the quality and volume of care provided. We examine the relationship between the perceived health status of the population and the satisfaction with healthcare services. Methods A pooled probit model is applied to analyse three datasets (2010, 2011 and 2012) from the Integrated Living Conditions Survey (ILCS). Results We find a strong association between self-perceived health and satisfaction with healthcare services but this association is not consistent across regions. Conclusions The socioeconomic position of the household alone does not explain the perception of individual health status. The perceived dwelling condition and geography of residence emerged as important stressors on associations between the perceived health status of the population and the satisfaction with healthcare services. We have modelled the perceived health status and satisfaction with the healthcare services using demand side datasets. This study establishes the need to re-examine this association in a multidimensional construct.
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Affiliation(s)
- Pavitra Paul
- Department of Health and Social Management, University of Eastern Finland (Kuopio Campus), P.O. Box 1627, 70211, Kuopio, Finland.
| | | | - Hannu Valtonen
- Faculty of Social Sciences and Business Studies, University of Eastern Finland, 70211, Kuopio, Finland
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Abstract
This article uses the behavioral model for vulnerable populations to evaluate the use of substance abuse treatment services among a sample of 926 substance abusers with one or more vulnerable health designations. A two-stage hierarchical logistic regression was completed to determine the influence of vulnerable and traditional need factors on the probability of receiving substance abuse treatment. Among traditional covariates, increased odds of receiving substance abuse treatment are associated with being either non-Hispanic White, Hispanic, having an income > US$5,000, and having a regular source of care. Among vulnerable covariates, injection drug use (odds ratio [OR] = 2.19, confidence interval [CI] = [1.46, 3.27]) and the receipt of public benefits (OR = 1.98, CI = [135, 2.92]) remain independent risk factors for the receipt of substance abuse treatment. Many who experience substance abuse disorders can also experience a multitude of other vulnerable health classifications, suggesting the need for a comprehensive, multidisciplinary approach to the treatment of substance use disorders.
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Cucciare MA, Coleman EA, Saitz R, Timko C. Enhancing Transitions from Addiction Treatment to Primary Care. J Addict Dis 2014; 33:340-53. [PMID: 25299380 DOI: 10.1080/10550887.2014.969602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Al-Tayyib AA, Thiede H, Burt RD, Koester S. Unmet Health Care Needs and Hepatitis C Infection Among Persons Who Inject Drugs in Denver and Seattle, 2009. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 16:330-40. [DOI: 10.1007/s11121-014-0500-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Turner AK, Harripersaud K, Crawford ND, Rivera AV, Fuller CM. Differences in HIV risk behavior of injection drug users in New York City by health care setting. AIDS Care 2013; 25:1321-9. [PMID: 23451991 DOI: 10.1080/09540121.2013.772275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the "Pharmacist As Resources Making Links to Community Services" (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, health-care utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, nondaily injectors, insured, and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting, suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high-risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings.
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Affiliation(s)
- A K Turner
- a Department of Epidemiology , Columbia University , New York , NY , USA
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Injection drug users' perspectives on placing HIV prevention and other clinical services in pharmacy settings. J Urban Health 2012; 89:354-64. [PMID: 22231488 PMCID: PMC3324615 DOI: 10.1007/s11524-011-9651-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In their role as a source of sterile syringes, pharmacies are ideally situated to provide additional services to injection drug users (IDUs). Expanding pharmacy services to IDUs may address the low utilization rates of healthcare services among this population. This qualitative study of active IDUs in San Francisco explored perspectives on proposed health services and interventions offered in pharmacy settings, as well as facilitators and barriers to service delivery. Eleven active IDUs participated in one-on-one semistructured interviews at a community field site and at a local syringe exchange site between February and May 2010. Results revealed that most had reservations about expanding services to pharmacy settings, with reasons ranging from concerns about anonymity to feeling that San Francisco already offers the proposed services in other venues. Of the proposed health services, this group of IDUs prioritized syringe access and disposal, clinical testing and vaccinations, and provision of methadone. Pharmacists' and pharmacy staff's attitudes were identified as a major barrier to IDUs' comfort with accessing services. The findings suggest that although IDUs would like to see some additional services offered within pharmacy settings, this is contingent upon pharmacists and their staff receiving professional development trainings that cultivate sensitivity towards the needs and experiences of IDUs.
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Villanti A, German D, Sifakis F, Flynn C, Holtgrave D. Smoking, HIV status, and HIV risk behaviors in a respondent-driven sample of injection drug users in Baltimore, Maryland: The BeSure Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:132-147. [PMID: 22468974 DOI: 10.1521/aeap.2012.24.2.132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Tobacco use is the largest preventable cause of death in the United States. Associations between cigarette smoking and HIV risk behaviors were examined among 669 injection drug users (IDU) in the 2006 wave of the National HIV Behavioral Surveillance System in Baltimore, Maryland, using respondent-driven sampling. The adjusted prevalence of smoking among IDU was 92.1%, with 32.7% smoking < 1 pack of cigarettes per day (light smoking) and 59.3% smoking ≥ 1 packs per day (heavy smoking). Self-reported HIV prevalence decreased as smoking frequency increased (p = 0.001). In multivariate analysis, heavy smokers were more likely to report painkiller use and binge drinking and less likely to report anal sex or health care use in the past year than light smokers. Results suggest that health care use mediates the relationship between heavy smoking and self-reported HIV. Integrating smoking cessation with HIV prevention services could address unmet health needs in IDU.
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Affiliation(s)
- Andrea Villanti
- Department of Health, Behavior and Society, JohnsHopkins Bloomberg School of Public Health, 624 N. Broadway, Room 259, Baltimore, MD 21205,
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19
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Small LFF. Determinants of physician utilization, emergency room use, and hospitalizations among populations with multiple health vulnerabilities. Health (London) 2010; 15:491-516. [PMID: 21169208 DOI: 10.1177/1363459310383597] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Understanding the factors that influence differing types of health care utilization within vulnerable groups can serve as a basis for projecting future health care needs, forecasting future health care expenditures, and influencing social policy. In this article the Behavioral Model for Vulnerable Populations is used to evaluate discretionary (physician visits) and non-discretionary (emergency room visits, and hospitalizations) health utilization patterns of a sample of 1466 respondents with one or more vulnerable health classification. Reported vulnerabilities include: (1) persons with substance disorders; (2) homeless persons; (3) persons with mental health problems; (4) victims of violent crime; (5) persons diagnosed with HIV/AIDS; (6) and persons in receipt of public benefits. Hierarchical logistic regression is used on three nested models to model factors that influence physician visits, emergency room visits, and hospitalizations. Additionally, bivariate logistic regression analyses are completed using a vulnerability index to evaluate the impact of increased numbers of vulnerability on all three forms of health care utilization. Findings from this study suggest the Behavioral Model of Vulnerable Populations be employed in future research regarding health care utilization patterns among vulnerable populations. This article encourages further research investigating the cumulative effect of health vulnerabilities on the use of non-discretionary services so that this behavior could be better understood and appropriate social policies and behavioral interventions implemented.
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Robbins JL, Wenger L, Lorvick J, Shiboski C, Kral AH. Health and oral health care needs and health care-seeking behavior among homeless injection drug users in San Francisco. J Urban Health 2010; 87:920-30. [PMID: 20945108 PMCID: PMC3005094 DOI: 10.1007/s11524-010-9498-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California's state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal's adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics.
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Affiliation(s)
- Jonathan Leserman Robbins
- Joint Medical Program, University of California, Berkeley and University of California, San Francisco, 570 University Hall, Berkeley, CA, 94720-1190, USA.
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Rundle-Thiele S, Russell-Bennett R. Patient influences on satisfaction and loyalty for GP services. Health Mark Q 2010; 27:195-214. [PMID: 20446141 DOI: 10.1080/07359681003745162] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Little is known about the influence that patients themselves have on their loyalty to a general practitioner (GP). Consequently, a theoretical framework that draws on diverse literature is proposed to suggest that along with satisfaction, patient loyalty is an important outcome for GPs. Comprising 174 Australian patients, this study identified that knowledgeable patients reported lower levels of loyalty while older patients and patients visiting a GP more frequently reported higher levels of loyalty. The results suggest that extending patient-centered care practices to encompass all patients may be warranted in order to improve patient satisfaction and loyalty. Further, future research opportunities abound, with intervention and dyadic research methodologies recommended.
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Small LFF. Use of Mental Health Services among People with Co-Occurring Disorders and other Mental Health co-morbidities: Employing the Behavioral Model of Vulnerable Populations. ACTA ACUST UNITED AC 2010; 3:81-93. [PMID: 20559416 DOI: 10.1080/17523281003717871] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND: Persons with mental disorders frequently have other co-occurring problems such as substance related disorders and HIV/AIDS. Individuals with co-occurring medical and mental disorders encounter great obstacles to receiving mental health services. AIMS: This paper uses the Behavioral Model of Vulnerable Populations to evaluate use of mental health services among groups with co-occurring disorders (CODs) and other co-morbid relationships. The association between receipt of mental health treatment and traditional/vulnerable predisposing, enabling, and need factors are examined. METHODS: Bivariate analysis and two-stage hierarchical logistic regression were completed. RESUTLS: A sample of 553 persons who reported mental health problems within the past year had one or more of the following vulnerabilities: (1) substance disorders; (2) homelessness; (3) victims of violent crime; (4) diagnosed with HIV/AIDS; (5) recipient of public benefits; and 31.3% reported having received some form of mental health treatment. Both traditional and vulnerable characteristics are significant predictors of receipt of mental health treatment. Vulnerable predictors indicated decreased odds of receiving mental health treatment were associated with injection and chronic drug use, (OR = .42, CI: .22 - .77) and (OR = .38, CI: .22 - .64) respectively. CONCLUSION: The Behavioral Model of Vulnerable Populations could be employed in future research of CODs and other co-morbid group's utilization of mental health treatment.
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Affiliation(s)
- La Fleur F Small
- Department of Sociology & Department of Geriatrics, Wright State University, Dayton, Ohio, USA
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Malinowska-Sempruch K, Bonnell R, Hoover J. Civil society-a leader in HIV prevention and tobacco control. Drug Alcohol Rev 2009; 25:625-32. [PMID: 17132578 DOI: 10.1080/09595230600944578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many civil society organisations (CSOs) have been at the forefront of identifying new ideas and implementing innovative models regarding health and health systems around the world. Their activities become highly charged, however, when they engage in advocacy efforts designed to influence change in policies and systems linked with more controversial or complicated public health issues. Policies, laws and regulations regarding illicit drugs and tobacco fall directly into that category. There is no doubt that the use of both kinds of substances can have the same health consequences-including ill health and death-yet they are approached in widely different ways. Smoking is legal to some extent in every country in the world, and is generally considered a matter of personal choice. Many people believe that efforts to limit tobacco use are coercive and impede on individual rights. Those who use illicit drugs such as heroin, meanwhile, are with few exceptions considered social deviants, misfits and lawbreakers. Many CSOs support comprehensive, government-funded prevention strategies coupled with non-punitive, non-judgmental programmes designed to help users change behaviour. Such strategies are designed to reflect and respond to the medically addictive nature of both tobacco and many illegal drugs. Proponents argue that not only are the public health benefits of expansive, well-conceived interventions potentially vast, but so too are the social and economic benefits accruing from lower rates of debilitating disease and premature death. To that end, many international, national and local CSOs are identifying the direct and indirect health consequences of tobacco and illegal drug use; proposing and advocating for strategies to limit their impact; and sharing information and resources with like-minded organisations elsewhere. This leadership role has helped influence and shape policy, especially in recent years. This paper examines civil society's involvement in efforts to change drug and tobacco policy in selected countries in Central and Eastern Europe and the former Soviet Union (CEE/FSU). It concludes that in Poland and Kazakhstan, in terms of tobacco control, and increasingly in Ukraine and parts of Central Asia in terms of harm reduction, multi-sectoral approaches are the most effective way to engage citizens and to implement comprehensive strategies to change behaviour by supportive measures, not punitive ones.
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Affiliation(s)
- Kasia Malinowska-Sempruch
- International Harm Reduction Development Program (IHRD), Open Society Institute, New York 10019, USA.
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Xiao H, Barber JP. The effect of perceived health status on patient satisfaction. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2008; 11:719-725. [PMID: 18179667 DOI: 10.1111/j.1524-4733.2007.00294.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine the effect of perceived health status on three components of patient satisfaction. METHODS The Household Component of the 1999 Medical Expenditure Panel Survey for people 35-64 years of age was used to examine the effect of perceived health status on patient satisfaction measured in terms of access to care, provider quality and quality of care. Descriptive statistics and multivariate regression were used to describe the subjects and to examine the relationship between patient satisfaction and perceived health status controlling for patient demographic factors, health factors and provider characteristics. All analyses used STATA 8.0 which is designed to analyze weighted data. RESULTS A total of 4,417 patients (71% women) met the inclusion criteria for the study. Patients who rated their health excellent or good scored higher on the three dimensions of patient satisfaction. Higher scores on one or more components of patient satisfaction were associated with being older, married, better educated and having higher income, health insurance and good mental health. Seeing the health-care provider for an old problem resulted in lower levels of patient satisfaction. Provider characteristics significantly related to patient satisfaction were listening to the patient, being a specialist, seeing patients in an office setting and being located in the South. CONCLUSIONS This study has shown that patient satisfaction is influenced by a person's self-perceived health status and other personal characteristics that are external to the delivery of health care. These findings suggest that patient satisfaction data should be used judiciously because a significant portion of the variation may be attributed to factors endogenous to the patient and therefore are not amenable to provider intervention.
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Affiliation(s)
- Hong Xiao
- College of Pharmacy and Pharmaceutical Science, Florida A&M University, Tallahassee, FL 32307, USA.
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Campbell JV, Garfein RS, Thiede H, Hagan H, Ouellet LJ, Golub ET, Hudson SM, Ompad DC, Weinbaum C. Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users. Drug Alcohol Depend 2007; 91 Suppl 1:S64-72. [PMID: 17276018 DOI: 10.1016/j.drugalcdep.2006.09.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 09/16/2006] [Accepted: 09/17/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite CDC recommendations to vaccinate injection drug users (IDUs) against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections, coverage remains low. Vaccination programs convenient to IDUs have not been widely implemented or evaluated. We assessed whether convenience and monetary incentives influenced uptake of free vaccine by 18-30-year-old IDUs in five U.S. cities. METHODS IDUs recruited from community settings completed risk behavior self-interviews and testing for antibodies to HAV (anti-HAV) and hepatitis B core antigen (anti-HBc). Vaccine was offered presumptively at pre-test (except in Chicago); on-site availability and incentives for vaccination differed by site, creating a quasi-experimental design. RESULTS Of 3181 participants, anti-HAV and anti-HBc seroprevalence was 19% and 23%, respectively. Although 83% of participants were willing to be vaccinated, only 36% received > or =1 dose, which varied by site: Baltimore (83%), Seattle (33%), Los Angeles (18%), New York (17%), and Chicago (2%). Participation was highest when vaccine was available immediately on-site and lowest when offered only after receiving results. Monetary incentives may have increased participation when on-site vaccination was not available. CONCLUSION IDUs were willing to be vaccinated but immediate, on-site availability was critical for uptake. Convenience should be a key consideration in designing strategies to increase vaccine coverage among IDUs.
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Affiliation(s)
- Jennifer V Campbell
- HIV/AIDS Epidemiology Program, Public Health-Seattle & King County, 400 Yesler Way 3rd Floor, c/o Hanne Thiede, Seattle, WA 98104, USA.
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Mark KE, Murray PJ, Callahan DB, Gunn RA. Medical care and alcohol use after testing hepatitis C antibody positive at STD clinic and HIV test site screening programs. Public Health Rep 2007; 122:37-43. [PMID: 17236606 PMCID: PMC1802122 DOI: 10.1177/003335490712200105] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The Centers for Disease Control and Prevention recommend screening individuals at risk for hepatitis C virus (HCV) infection. However, few published data describe outcomes of individuals with antibody to HCV (anti-HCV) identified through screening programs. The purpose of this study was to assess rates of medical evaluation and HCV treatment, change in alcohol consumption, and barriers to medical care after testing anti-HCV positive through a public screening program. METHODS Anti-HCV positive individuals identified through San Diego sexually transmitted disease (STD) clinics and an HIV test site screening program were informed of positive test results, provided education and referral, and contacted by telephone three, six, and > or =12 months later. RESULTS From September 1, 1999, to December 31, 2001, 411 anti-HCV positive individuals were newly identified, of whom 286 (70%) could be contacted > or = three months after receipt of test results (median length [range] of follow-up 14 [3-35] months). Of these 286, 156 (55%) reported having received a medical evaluation, of whom 19 (12%) began HCV treatment. Of 132 who reported drinking alcohol before diagnosis, 100 (76%) reported drinking less after diagnosis. Individuals with medical insurance at diagnosis were more likely than those without insurance to obtain a medical evaluation during follow-up (75 [68%] of 111 vs. 70 [45%] of 155; p < 0.001). Among those who did not obtain an evaluation, the most commonly reported reason was lack of insurance. CONCLUSIONS Only about half of newly identified anti-HCV positive individuals received a medical evaluation, although 76% reported drinking less alcohol. Identifying ways to improve medical access for those who are anti-HCV positive could improve the effectiveness of screening programs.
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Affiliation(s)
- Karen E Mark
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Braitstein P, Li K, Kerr T, Montaner JSG, Hogg RS, Wood E. Differences in access to care among injection drug users infected either with HIV and hepatitis C or hepatitis C alone. AIDS Care 2007; 18:690-3. [PMID: 16971276 DOI: 10.1080/09540120500359330] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Access to HCV (Hepatitis C virus) care for HIV/HCV-co-infected patients is an urgent public health concern. The objective of the present study was to describe the self-reported health status of HIV/HCV-co-infected and HCV-mono-infected injection drug users and to describe their access to HCV-related care. Beginning in May 1996, persons who had injected illicit drugs in the previous month were recruited into the Vancouver Injection Drug User Study (VIDUS). At baseline and then semi-annually, participants complete an interviewer-administered questionnaire. Blood is drawn at each semi-annual interview and tested for HIV and Hepatitis C infection. Data for this descriptive, cross-sectional study were drawn from the most recent of either the July 2003 or December 2003 nurse-administered questionnaire. Statistics used were the chi-square, Wilcoxon Rank Sum and Student's t-test. Logistic regression was used to examine factors independently associated with accessing HCV care. There were 707 individuals eligible for this analysis, including 240 HIV/HCV-co-infected and 467 HCV-mono-infected persons. Co-infected individuals were more likely to be female, younger, of Aboriginal ethnicity and less likely to use heroin daily. The HCV-mono-infected group tended to report higher rates of HCV-related symptoms, including fatigue, liver pain, nausea, night-sweats and stomach pain. However, it was the HIV/HCV-co-infected group who were more likely to report that they believed their hepatitis C was affecting them. The HIV/HCV-co-infected group were also more likely to report having received any hepatitis-related follow-up care, including blood work, liver biopsies and referrals to specialists. In logistic regression analysis, factors independently associated with ever receiving any hepatitis C related follow-up were HIV/HCV-co-infection (AOR 3.1; 95% CI: 2-4.7), being older (AOR 1.04; 95% CI: 1.02-1.06 per year older), using heroin daily (AOR 0.54; 95% CI: 0.36-0.82) and believing that hepatitis C was affecting one's health (AOR 1.4; 95% CI: 1.0-2.1). In conclusion, our data indicate more HCV healthcare utilization among those HIV/HCV-co-infected.
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Affiliation(s)
- P Braitstein
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
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Larson MJ, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH. Emergency department and hospital utilization among alcohol and drug-dependent detoxification patients without primary medical care. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2006; 32:435-52. [PMID: 16864472 DOI: 10.1080/00952990600753958] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Utilization of emergency department (ED) services and hospitalization among a cohort of substance abusers are described based on structured research interviews with 470 adults without primary care admitted to an urban residential detoxification program. Cross-sectional analysis of baseline data of subjects found nearly 19% of subjects went to an ED on 2 or more occasions in the 6 months prior to detoxification and 14% were admitted for an overnight hospitalization. Upon further analysis of past 6-month ED utilization, the following factors were independently associated with increased odds of ED use: White race; at least one month homeless in the past 5 years chronic health condition; injury in past 6 months; and subject perception that their substance abuse interfered with seeking care from a regular doctor. Subjects with cocaine as a primary problem had lower odds of ED utilization than a reference group with alcohol as a primary problem.
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Affiliation(s)
- Mary Jo Larson
- New England Research Institutes, Watertown, Massachusetts 02472, USA.
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Heinzerling KG, Kral AH, Flynn NM, Anderson RL, Scott A, Gilbert ML, Asch SM, Bluthenthal RN. Unmet need for recommended preventive health services among clients of California syringe exchange programs: implications for quality improvement. Drug Alcohol Depend 2006; 81:167-78. [PMID: 16043308 DOI: 10.1016/j.drugalcdep.2005.06.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 06/24/2005] [Accepted: 06/28/2005] [Indexed: 11/22/2022]
Abstract
BACKGROUND Comprehensive preventive services are recommended for injection drug users (IDU), including screening tests, vaccinations, risk reduction counseling, and sterile syringes. Syringe exchange programs (SEP) may facilitate receipt of preventive services by IDUs, but whether SEP clients receive recommended preventive care is not known. We examined use of recommended preventive services by clients of 23 SEPs throughout California. METHODS Five hundred and sixty SEP clients were recruited from 23 SEPs throughout California between March and September 2003. Receipt of 10 recommended preventive services and source of care (SEP versus non-SEP providers) was ascertained from client interviews. RESULTS On average, SEP clients received only 13% of recommended preventive services and 49% of clients received none of the recommended services. Of services that were received, 76% were received from SEPs. In multivariate analysis, use of drug treatment and more frequent SEP visits were associated with receipt of recommended preventive services by clients. CONCLUSIONS SEPs are often the only source of preventive care for their IDU clients. Still, SEP clients fail to receive most recommended preventive services. Interventions to increase use of preventive services and improve the quality of preventive care received by IDUs, such as increased access to drug treatment and SEPs, are needed.
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Affiliation(s)
- K G Heinzerling
- UCLA Robert Wood Johnson Clinical Scholars Program, 911 Broxton Avenue, Third Floor, Los Angeles, CA 90024, USA.
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Lally MA, MacNevin R, Sergie Z, Hitt R, DiSpigno M, Cenedella C, Stein MD. A model to provide comprehensive testing for HIV, viral hepatitis, and sexually transmitted infections at a short-term drug treatment center. AIDS Patient Care STDS 2005; 19:298-305. [PMID: 15916492 PMCID: PMC1852463 DOI: 10.1089/apc.2005.19.298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Substance users are at high risk for blood-borne infections as well as those that are transmitted sexually. Substance abuse treatment centers present an opportunity to offer comprehensive counseling and testing (CCT) for HIV, viral hepatitis, and sexually transmitted infections (STIs) to this high-risk population. We examined the feasibility and acceptability of one model of CCT among substance users. CCT was offered to 145 consecutive inpatients; study participants completed a risk factor questionnaire and selected from a menu of testing options. Thirty-six percent of those approached agreed to participate and accepted at least one biologic test. Sixty-two percent of participants accepted all tests that were offered. While beneficial to those who accept testing, the described model of CCT is feasible in a drug treatment center, but acceptable to only a minority of inpatients.
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Affiliation(s)
- Michelle A Lally
- Miriam Hospital, Providence, Rhode Island., Brown Medical School, Providence, Rhode Island 02906, USA.
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Lieb S, Friedman SR, Zeni MB, Chitwood DD, Liberti TM, Gates GJ, Metsch LR, Maddox LM, Kuper T. An HIV prevalence-based model for estimating urban risk populations of injection drug users and men who have sex with men. J Urban Health 2004; 81:401-15. [PMID: 15273264 PMCID: PMC3455939 DOI: 10.1093/jurban/jth126] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Issues of cost and complexity have limited the study of the population sizes of men who have sex with men (MSM) and injection drug users (IDUs), two groups at clearly increased risk for human immunodeficiency virus (HIV) and other acute and chronic diseases. We developed a prototypical, easily applied estimation model for these populations and applied it to Miami, Florida. This model combined HIV prevalence estimates, HIV seroprevalence rates, and census data to make plausible estimates of the number and proportion of MSM and IDUs under a number of assumptions. Sensitivity analyses were conducted to test the robustness of the model. The model suggests that approximately 9.5% (plausible range 7.7%-11.3%) of Miami males aged 18 years or older are MSM (point estimate, N = 76,500), and 1.4% (plausible range 0.9%-1.9%) of the total population aged 18 years or older are IDUs (point estimate, N = 23,700). Males may be about 2.5 times more likely than females to be IDUs. The estimates were reasonably robust to biases. The model was used to develop MSM and IDU population estimates in selected urban areas across Florida and should be replicable in other medium-to-large urban areas. Such estimates could be useful for behavioral surveillance and resource allocation, including enhanced targeting of community-based interventions for primary and secondary HIV prevention.
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Drumm RD, McBride DC, Metsch L, Page JB, Dickerson K, Jones B. "The rock always comes first": drug users' accounts about using formal health care. J Psychoactive Drugs 2004; 35:461-9. [PMID: 14986875 DOI: 10.1080/02791072.2003.10400493] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Illicit drug use remains a significant public health threat. The issues surrounding drug use are recognized by public health professionals as important for several reasons. The incidence and prevalence of drug use persists in spite of the extensive societal, interpersonal, and individual consequences. In addition, the chronic health issues and health care costs associated with drug use continue to spiral. A wide variety of quantitative studies have examined the extent of health care problems, access, cost, and health care satisfaction among illicit drug users. While these studies offer important information through survey formats, fewer studies focus on subjective constructions of health care management from the users' perspective. This article examines the elements of the decision-making process involved in accessing formal health care among chronic and injecting street drug users. Twenty-eight in-depth interviews provide the data for this analysis, which is part of a large quantitative study of 1,479 injecting and chronic drug users and nondrug users in Miami, Florida. By exploring the elements of health care access through the eyes of the drug users, researchers and treatment professionals may gain insights into new ways to improve health care access for this at-risk population.
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Affiliation(s)
- René D Drumm
- Department of Social Work, Andrews University, Berrien Springs, Michigan 49104-0030, USA.
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