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Kristensen K, Williams LD, Kaplan C, Pineros J, Lee E, Kaufmann M, Mackesy-Amiti ME, Boodram B. A Novel Index Measure of Housing-related Risk as a Predictor of Overdose among Young People Who Inject Drugs and Injection Networks. RESEARCH SQUARE 2023:rs.3.rs-3083889. [PMID: 37461549 PMCID: PMC10350242 DOI: 10.21203/rs.3.rs-3083889/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Background For people who inject drugs (PWID), housing instability due to decreasing housing affordability and other factors (e.g., loss of housing due to severed relational ties, evictions due to drug use) results in added pressure on an already vulnerable population. Research has shown that housing instability is associated with overdose risk among PWID. However, the construct of housing instability has often been operationalized as a single dimension (e.g., housing type, homelessness, transience). We propose a multi-dimensional measure of housing instability risk and examine its association with drug overdose to promote a more holistic examination of housing status as a predictor of overdose. Methods The baseline data from a network-based, longitudinal study of young PWID and their networks living in metropolitan Chicago, Illinois was analyzed to examine the relationship between a housing instability risk index-consisting of five dichotomous variables assessing housing instability-and lifetime overdose count using negative binomial regression. Results We found a significant positive association between the housing instability risk score and lifetime overdose count after adjusting for 12 variables. Conclusions Our results support the practical utility of a multi-dimensional measure of housing instability risk in predicting overdose and highlight the importance of taking a holistic approach to addressing housing instability when designing interventions.
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Affiliation(s)
| | | | | | | | - Eunhye Lee
- University of Illinois Chicago School of Public Health
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Zakimi N, Greer A, Bouchard M, Dhillon A, Ritter A. Sociometric network analysis in illicit drugs research: A scoping review. PLoS One 2023; 18:e0282340. [PMID: 36848370 PMCID: PMC9970099 DOI: 10.1371/journal.pone.0282340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Sociometric or whole network analysis, a method used to analyze relational patterns among social actors, emphasizes the role of social structure in shaping behaviour. Such method has been applied to many aspects of illicit drug research, including in the areas of public health, epidemiology, and criminology. Previous reviews about social networks and drugs have lacked a focus on the use of sociometric network analysis for illicit drugs research across disciplines. The current scoping review aimed to provide an overview of the sociometric network analysis methods used in illicit drugs research and to assess how such methods could be used for future research. METHODS A systematic search of six databases (Web of Science, ProQuest Sociology Collection, Political Science Complete, PubMed, Criminal Justice Abstracts, and PsycINFO) returned 72 relevant studies that met the inclusion criteria. To be included, studies had to mention illicit drugs and use whole social network analysis as one of their methods. Studies were summarized quantitatively and qualitatively using a data-charting form and a description of the studies' main topics. RESULTS Sociometric network analysis in illicit drugs research has grown in popularity in the last decade, using mostly descriptive network metrics, such as degree centrality (72.2%) and density (44.4%). Studies were found to belong to three study domains. The first, drug crimes investigated network resilience and collaboration patterns in drug trafficking networks. The second domain, public health, focused on the social networks and social support of people who use drugs. Finally, the third domain focused on the collaboration networks of policy, law enforcement, and service providers. CONCLUSION Future illicit drugs research using whole network SNA should include more diverse data sources and samples, incorporate mixed and qualitative methods, and apply social network analysis to study drug policy.
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Affiliation(s)
- Naomi Zakimi
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
| | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Martin Bouchard
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Arshpreet Dhillon
- School of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Barnes DM, Xu S, Cleland CM, McKnight C, Des Jarlais D. Recurrent Injecting Drug Use as a Mediator between Psychiatric Disorder and Non-Fatal Overdose. Subst Use Misuse 2022; 57:1248-1256. [PMID: 35611936 DOI: 10.1080/10826084.2022.2076877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Unintentional drug overdose has increased markedly in the United States. Studies document an association between psychiatric disorder and unintentional overdose; we extend this research through a preliminary test of a causal model of recurrent injection drug use mediating this relationship. METHODS In a cross-sectional study of 241 adults in New York City with a possible current substance use disorder, we conducted conventional and Imai's mediation analyses to examine if psychiatric disorder is associated with increased prevalence of ever overdosing and if recurrent injection drug use mediates this association. Our cross-sectional data permit the first step of assessing causal models: testing if statistical associations are consistent with the model. RESULTS Fifty-eight percent of the sample endorsed previous psychiatric disorder diagnosis and 35.7% reported ever overdosing. Imai's mediation analysis showed that, adjusting for covariates, the total association between psychiatric diagnosis and ever overdosing (adjusted prevalence difference [aPD] = 0.16, 95% CI 0.04-0.28) was composed of a direct effect (aPD = 0.09, 95% CI -0.03 - 0.21, p = 0.136) and an indirect effect (aPD = 0.07, 95% CI 0.02-0.13). Recurrent injecting drug use contributed to 42% (ratio of indirect effect to total effect; 95% CI 12 - 100%, p = 0.02) of the association between psychiatric diagnosis and ever overdosing. Conventional mediation analysis produced similar results. CONCLUSIONS Our results provide a warrant for taking the necessary next step for assessing a causal model using longitudinal data, potentially providing a strong rationale for intervening on psychiatric disorders to stem overdose.
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Affiliation(s)
- David M Barnes
- School of Global Public Health, New York University, New York, NY, USA
| | - Shu Xu
- School of Global Public Health, New York University, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Courtney McKnight
- School of Global Public Health, New York University, New York, NY, USA
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
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Rudolph AE, Young AM. Privacy and Confidentiality Considerations for Collecting HIV Risk Network Data among Men who Have Sex with Men and Implications for Constructing Valid Risk Networks. SOCIAL NETWORKS 2021; 67:47-54. [PMID: 34712004 PMCID: PMC8547314 DOI: 10.1016/j.socnet.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Studies aiming to construct risk networks have historically collected network members' names, demographic characteristics and relational data (i.e., type, strength, duration, frequency of interaction, and HIV-related risk behaviors between the pair). Due to difficulties in constructing risk networks stemming from partner anonymity and the use of nicknames, some studies also collect network members' screen names, phone numbers, physical attributes, and scars/tattoos to assist with entity resolution. In-depth interviews with 20 men who have sex with men and transgender women in Kentucky assessed privacy/confidentiality concerns as well as accuracy/recall issues associated with providing these details. Most preferred providing alters' nicknames/first names only or a first name with the first letter of the last name. Many perceived screen names, phone numbers, and scars/tattoos to be too personal/identifying. Willingness to provide more detailed information varied by relationship type/strength, which could influence the validity of the resulting network.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston MA
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia PA
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington KY
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington KY
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Ibragimov U, Cooper KE, Batty E, Ballard AM, Fadanelli M, Gross SB, Klein EM, Lockard S, Young AM, Cooper HLF. Factors that influence enrollment in syringe services programs in rural areas: a qualitative study among program clients in Appalachian Kentucky. Harm Reduct J 2021; 18:68. [PMID: 34193165 PMCID: PMC8244225 DOI: 10.1186/s12954-021-00518-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky. METHODS We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process of becoming aware of SSPs, and barriers and facilitators to SSP enrollment. Applying constructivist grounded theory methods and guided by the Intersectional Risk Environment Framework (IREF), we applied open, axial and selective coding to develop the grounded theory. RESULTS Stigma, a feature of IREF's meso-level social domain, is the main factor hampering SSP enrollment. PWID hesitated to visit SSPs because of internalized stigma and because of anticipated stigma from police, friends, family and healthcare providers. Fear of stigma was often mitigated or amplified by a constellation of meso-level environmental factors related to healthcare (e.g., SSPs) and social (PWID networks) domains and by PWID's individual characteristics. SSPs mitigated stigma as a barrier to enrollment by providing low threshold services in a friendly atmosphere, and by offering their clients program IDs to protect them from paraphernalia charges. SSP clients spread positive information about the program within PWID networks and helped their hesitant peers to enroll by accompanying them to SSPs. Individual characteristics, including child custody, employment or high social status, made certain PWID more susceptible to drug-related stigma and hence more likely to delay SSP enrollment. CONCLUSIONS Features of the social and healthcare environments operating at the meso-level, as well as PWID's individual characteristics, appear to enhance or mitigate the effect of stigma as a barrier to SSP enrollment. SSPs opening in locations with high stigma against PWID need to ensure low threshold and friendly services, protect their clients from police and mobilize PWID networks to promote enrollment.
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Affiliation(s)
| | | | - Evan Batty
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - April M Ballard
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Monica Fadanelli
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Skylar B Gross
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Emma M Klein
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Scott Lockard
- Kentucky River District Health Department, Hazard, KY, USA
| | - April M Young
- University of Kentucky College of Public Health, Lexington, KY, USA
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E Rudolph A, Fernau DJ, Tobin KE, Latkin C. Individual and social network correlates of recent treatment for substance use disorders among persons who use drugs in Baltimore, MD (2014 - 2017). Drug Alcohol Depend 2020; 217:108278. [PMID: 32949885 PMCID: PMC7736566 DOI: 10.1016/j.drugalcdep.2020.108278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND This analysis examined individual and network correlates of treatment enrollment for substance use disorders (SUDs) in the past 6 months and whether these factors varied by type(s) of drug(s) used and type of SUD treatment received. METHODS Between 2014 and 2017, 330 Baltimore residents who reported using heroin, crack, and/or cocaine in the past 6 months completed a survey to assess demographics, substance use, recent SUD treatment enrollment, and information about their network members. The primary outcome was recent enrollment in any type of SUD treatment (i.e., methadone maintenance, detox, residential, outpatient, and meetings/self-help) vs. none. Using logistic regression, recent SUD treatment enrollment was regressed on individual and network characteristics. RESULTS Overall, 214 were enrolled in some form of SUD treatment in the past 6 months (56.6% Methadone Maintenance, 29.8% Detox, 25.9% Residential, 47.8% Outpatient, and 90.7% Meetings/Self-Help). The median number of network members listed was 4.0 (interquartile range: 4-6). In the adjusted model, the odds of SUD treatment enrollment increased with each additional network member who was currently enrolled in SUD treatment (Adjusted Odds Ratio [AOR]:2.22; 95%CI:1.47-3.33). The odds of SUD treatment enrollment decreased by 35% for each additional network member who used heroin, crack, and/or cocaine and could provide them with social support (AOR:0.65; 95%CI:0.48-1.88). CONCLUSIONS Our findings suggest a complex link between the intersecting roles of network members and SUD treatment outcomes among persons who use drugs and the importance of collecting detailed social network information on the different domains of social support provided.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Philadelphia PA 19122, USA.
| | - Deborah J Fernau
- Department of Epidemiology, Boston University School of Public Health, Talbot Building 715 Albany St., Boston University, Boston, MA 02118, USA
| | - Karin E Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA
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Fadanelli M, Cloud DH, Ibragimov U, Ballard AM, Prood N, Young AM, Cooper HLF. People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 85:102588. [PMID: 31753603 DOI: 10.1016/j.drugpo.2019.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/20/2019] [Accepted: 11/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Though overdose rates have been increasing in US rural areas for two decades, little is known about the rural risk environment for overdoses. This qualitative study explored the risk environment for overdoses among young adults in Eastern Kentucky, a rural epicenter of the US opioid epidemic. METHODS Participants were recruited via community-based outreach. Eligibility criteria included living in one of five rural Eastern Kentucky counties; being aged 18-35; and using opioids to get high in the past 30 days. Semi-structured interviews explored the rural risk environment, and strategies to prevent overdose and dying from an overdose. Interviews were transcribed verbatim and analyzed using constructivist grounded-theory methods. RESULTS In this sample (N = 19), participants reported using in a range of locations, including homes and outdoor settings; concerns about community stigma and law enforcement shaped the settings where participants used opioids and the strategies they deployed in these settings to prevent an overdose, and to survive an overdose. Almost half of participants reported using opioids in a "trap house" or other dealing locations, often to evade police after buying drugs, and reported that others present pressed them to use more than usual. If an overdose occurred in this setting, however, these same people might refuse to call EMS to protect themselves from arrest. Outdoor settings presented particular vulnerabilities to overdose and dying from an overdose. Most participants reported using opioids outdoors, where they skipped overdose prevention steps to reduce their risk of arrest; they worried that no one would find them if they overdosed, and that cell phone coverage would be too weak to summon EMS. CONCLUSION Findings suggest that initiatives to reduce overdoses in Eastern Kentucky would be strengthened by de-escalating the War on Drugs and engaging law enforcement in initiatives to protect the health of people who use opioids.
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Affiliation(s)
- Monica Fadanelli
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA.
| | - David H Cloud
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - April M Ballard
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Nadya Prood
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - April M Young
- College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
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Rudolph AE, Upton E, McDonald MJ, Young AM, Havens JR. Peer influence of injection drug use cessation among dyads in rural eastern Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 85:102604. [PMID: 31740176 DOI: 10.1016/j.drugpo.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/30/2019] [Accepted: 11/10/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND This analysis aims to assess whether injection drug use cessation among peers predicts injection drug use cessation among individuals and explores whether this association varies by relationship type and strength. METHODS Data were collected through baseline and 6-month assessments for the Social Networks among Appalachian People study (2008-2011). Interviewer-administered surveys collected sociodemographic and drug use behaviors (past 6 months and lifetime). Participants also listed sex, drug use, and social support partners (past 6 months). Listed names were cross-referenced with survey participants to identify relationships between study participants. The analytic sample was further restricted to include only those relationship pairs where both individuals reported a history of injection drug use at baseline (n = 244 unique individuals and 746 dyads). We fit a generalized estimating equations logistic regression model to (1) assess the relationship between peer injection cessation and individual injection cessation and (2) determine whether the strength of this association differs by relationship-level variables (i.e., relationship role, relationship type, relationship duration, frequency of interaction, residential proximity). RESULTS Overall, those with a network member who ceased injection drug use were more likely to stop injecting over the following 6-month period (AOR=1.65). The magnitude of this association was greater for social support partners (AOR=2.95), family members (AOR=3.56), those with whom the participant interacted at least daily (AOR=2.17), and those who the participant knew longer (AOR=2.09). Further, among family members, the effect size was greater when relationships were further restricted to immediate family members (AOR=5.35). CONCLUSION Our findings suggest that in this rural community, closer, more supportive relationships, may be more influential for modeling injection cessation; however, relationship-types were not mutually exclusive so differences in effect size across strata may not be statistically significant. In this setting, social support through the recovery process (including cessation attempts with peers) may increase likelihood of injection cessation.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, United States.
| | - Elizabeth Upton
- Department of Mathematics and Statistics, Boston University, Boston, MA, United States; Department of Mathematics and Statistics, Williams College, Williamstown, MA, United States
| | - Madelyn J McDonald
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, United States; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States; Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, United States
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