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Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health 2021; 16:1167-1186. [PMID: 33843462 PMCID: PMC8338763 DOI: 10.1080/17441692.2021.1903528] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
Big Events are periods during which abnormal large-scale events like war, economic collapse, revolts, or pandemics disrupt daily life and expectations about the future. They can lead to rapid change in health-related norms, beliefs, social networks and behavioural practices. The world is undergoing such Big Events through the interaction of COVID-19, a large economic downturn, massive social unrest in many countries, and ever-worsening effects of global climate change. Previous research, mainly on HIV/AIDS, suggests that the health effects of Big Events can be profound, but are contingent: Sometimes Big Events led to enormous outbreaks of HIV and associated diseases and conditions such as injection drug use, sex trading, and tuberculosis, but in other circumstances, Big Events did not do so. This paper discusses and presents hypotheses about pathways through which the current Big Events might lead to better or worse short and long term outcomes for various health conditions and diseases; considers how pre-existing societal conditions and changing 'pathway' variables can influence the impact of Big Events; discusses how to measure these pathways; and suggests ways in which research and surveillance might be conducted to improve human capacity to prevent or mitigate the effects of Big Events on human health.
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Affiliation(s)
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | | | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | - Maria R Khan
- NYU Grossman School of Medicine, New York, NY, USA
| | - David C Perlman
- Mount Sinai Beth Israel and Center for Drug Use and HIV Research, New York, NY, USA
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2
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Crawford ND, Haardöerfer R, Cooper H, McKinnon I, Jones-Harrell C, Ballard A, von Hellens SS, Young A. Characterizing the Rural Opioid Use Environment in Kentucky Using Google Earth: Virtual Audit. J Med Internet Res 2019; 21:e14923. [PMID: 31588903 PMCID: PMC6800460 DOI: 10.2196/14923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background The opioid epidemic has ravaged rural communities in the United States. Despite extensive literature relating the physical environment to substance use in urban areas, little is known about the role of physical environment on the opioid epidemic in rural areas. Objective This study aimed to examine the reliability of Google Earth to collect data on the physical environment related to substance use in rural areas. Methods Systematic virtual audits were performed in 5 rural Kentucky counties using Google Earth between 2017 and 2018 to capture land use, health care facilities, entertainment venues, and businesses. In-person audits were performed for a subset of the census blocks. Results We captured 533 features, most of which were images taken before 2015 (71.8%, 383/533). Reliability between the virtual audits and the gold standard was high for health care facilities (>83%), entertainment venues (>95%), and businesses (>61%) but was poor for land use features (>18%). Reliability between the virtual audit and in-person audit was high for health care facilities (83%) and entertainment venues (62%) but was poor for land use (0%) and businesses (12.5%). Conclusions Poor reliability for land use features may reflect difficulty characterizing features that require judgment or natural changes in the environment that are not reflective of the Google Earth imagery because it was captured several years before the audit was performed. Virtual Google Earth audits were an efficient way to collect rich neighborhood data that are generally not available from other sources. However, these audits should use caution when the images in the observation area are dated.
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Affiliation(s)
- Natalie Danielle Crawford
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Regine Haardöerfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Hannah Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Izraelle McKinnon
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Carla Jones-Harrell
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - April Ballard
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | | - April Young
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Stahler GJ, Mennis J. Treatment outcome disparities for opioid users: Are there racial and ethnic differences in treatment completion across large US metropolitan areas? Drug Alcohol Depend 2018; 190:170-178. [PMID: 30041092 DOI: 10.1016/j.drugalcdep.2018.06.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND The present study examined racial/ethnic disparities in initial treatment episode completion for adult clients reporting opioids as their primary problem substance in large US metropolitan areas. METHODS Data were extracted from the 2013 TEDS-D dataset (Treatment Episode Dataset-Discharge) for the 42 largest US metropolitan statistical areas (MSAs). Fixed effects logistic regression controlling for MSA was used to estimate the effect of race/ethnicity on the likelihood of treatment completion. The model was repeated for each individual MSA in a stratified design to compare the geographic variation in racial/ethnic disparities, controlling for gender, age, education, employment, living arrangement, treatment setting, medication-assisted treatment, referral source, route of administration, and number of substances used at admission. RESULTS Only 28% of clients completed treatment, and the results from the fixed effects model indicate that blacks and Hispanics are less likely to complete treatment compared to whites. However, the stratified analysis of individual MSAs found only three of the 42 MSAs had racial/ethnic disparities in treatment completion, with the New York City (NYC) MSA largely responsible for the disparities in the combined sample. Supplementary analyses suggest that there are greater differences between whites and minority clients in the NYC MSA vs. other cities on characteristics associated with treatment completion (e.g., residential treatment setting). CONCLUSION This study underscores the need for improving treatment retention for all opioid using clients in large metropolitan areas in the US, particularly for minority clients in those localities where disparities exist, and for better understanding the geographic context for treatment outcomes.
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Affiliation(s)
- Gerald J Stahler
- Department of Geography and Urban Studies, Temple University, (025-27), 309 Gladfelter Hall, Philadelphia, PA 19122, United States.
| | - Jeremy Mennis
- Department of Geography and Urban Studies, Temple University, (025-27), 309 Gladfelter Hall, Philadelphia, PA 19122, United States.
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Pouget ER. Social determinants of adult sex ratios and racial/ethnic disparities in transmission of HIV and other sexually transmitted infections in the USA. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160323. [PMID: 28760764 PMCID: PMC5540863 DOI: 10.1098/rstb.2016.0323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 11/12/2022] Open
Abstract
In Black population centres in the USA, adult sex ratios (ASRs) are strongly female-biased primarily due to high male incarceration and early mortality rates. I explore the system of social determinants that shape these ASRs, and describe their apparent consequences. Evidence suggests that female-biased ASRs play a role, along with racial residential segregation, to increase mixing between core and peripheral members of sexual networks, facilitating transmission of human immunodeficiency virus and other sexually transmitted infections. Unique historical factors underlie Black male incarceration and mortality rates in the USA, making comparisons with other groups or other countries challenging.This article is part of the themed issue 'Adult sex ratios and reproductive decisions: a critical re-examination of sex differences in human and animal societies'.
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Affiliation(s)
- Enrique Rodriguez Pouget
- Center for Policing Equity at John Jay College of Criminal Justice, 524 West 59th Street, Room 6.63.14, New York, NY 10019, USA
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Sacks-Davis R, Daniel M, Roy É, Kestens Y, Zang G, Ramos Y, Hellard M, Jutras Aswad D, Bruneau J. The role of living context in prescription opioid injection and the associated risk of hepatitis C infection. Addiction 2016; 111:1985-1996. [PMID: 27238912 DOI: 10.1111/add.13470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/06/2016] [Accepted: 05/23/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Prescription opioid injection (POI) is a leading risk factor for hepatitis C virus (HCV). Residential context relates to high‐risk injection behaviour. This study assessed whether residence in the inner city (versus surrounding areas in Montréal Island) modified the effects of correlates of POI or the relationship between POI and HCV incidence. DESIGN Prospective cohort study. SETTING Montréal, Canada. PARTICIPANTS A total of 854 people who inject drugs (18% female, 25% age < 30 years), living on Montréal Island, were interviewed every 3–6 months from 2004 to 2012. MEASUREMENTS Study visits included HCV antibody testing and an interviewer‐administered questionnaire. Generalized estimating equations were used to test whether place of residence modified the effects of correlates of POI. Cox regression was used to test whether place of residence modified the relationship between POI and HCV incidence. FINDINGS At baseline, inner‐city participants were more likely to report POI in the past month (40 versus 25%, P < 0.001). The association between POI and heroin injection, syringe sharing and sharing of injecting equipment varied according to place of residence and was greater in the inner city. The hazard of HCV infection associated with POI was greater among inner‐city participants compared to those in the surrounding areas [adjusted hazard ratio (HR) = 3.38, 95% confidence interval (CI) = 1.88–6.07 versus HR = 1.26, 95% CI = 0.65–2.42, P = 0.025]. CONCLUSIONS Among people who inject prescription opioids in Montréal, Canada, those who live in inner‐city areas are more likely to engage in injecting‐related risk behaviours and have a higher risk of hepatitis C virus infection than those who live in the suburbs.
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Affiliation(s)
- Rachel Sacks-Davis
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Mark Daniel
- School of Population Health, University of South Australia, Adelaide, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Élise Roy
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Canada.,Institut National de Santé Publique, Montréal, Canada
| | - Yan Kestens
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Geng Zang
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Yuddy Ramos
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Didier Jutras Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada. .,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada.
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Cooper HLF, West B, Linton S, Hunter-Jones J, Zlotorzynska M, Stall R, Wolfe ME, Williams L, Hall HI, Cleland C, Tempalski B, Friedman SR. Contextual Predictors of Injection Drug Use Among Black Adolescents and Adults in US Metropolitan Areas, 1993-2007. Am J Public Health 2015; 106:517-26. [PMID: 26691126 DOI: 10.2105/ajph.2015.302911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine whether contextual factors shape injection drug use among Black adolescents and adults. METHODS For this longitudinal study of 95 US metropolitan statistical areas (MSAs), we drew annual MSA-specific estimates of the prevalence of injection drug use (IDU) among Black adolescents and adults in 1993 through 2007 from 3 surveillance databases. We used existing administrative data to measure MSA-level socioeconomic status; criminal justice activities; expenditures on social welfare, health, and policing; and histories of Black uprisings (1960-1969) and urban renewal funding (1949-1974). We regressed Black IDU prevalence on these predictors by using hierarchical linear models. RESULTS Black IDU prevalence was lower in MSAs with declining Black high-school dropout rates, a history of Black uprisings, higher percentages of Black residents, and, in MSAs where 1992 White income was high, higher 1992 Black income. Incarceration rates were unrelated. CONCLUSIONS Contextual factors shape patterns of drug use among Black individuals. Structural interventions, especially those that improve Black socioeconomic security and political strength, may help reduce IDU among Black adolescents and adults.
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Affiliation(s)
- Hannah L F Cooper
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Brooke West
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Sabriya Linton
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Josalin Hunter-Jones
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Maria Zlotorzynska
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Ron Stall
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Mary E Wolfe
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Leslie Williams
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - H Irene Hall
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Charles Cleland
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Barbara Tempalski
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
| | - Samuel R Friedman
- Hannah L. F. Cooper, Sabriya Linton, Josalin Hunter-Jones, Maria Zlotorzynska, and Mary E. Wolfe are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Brooke West is with the Division of Global Public Health, University of California at San Diego, La Jolla. Leslie Williams, Barbara Tempalski, and Samuel R. Friedman are with National Development and Research Institutes Inc, New York, NY. Ron Stall is with the Department of Behavioral and Community Health Sciences and Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. H. Irene Hall is with the HIV Incidence and Case Surveillance Branch, Centers for Disease Control and Prevention, Atlanta. Charles Cleland is at the School of Nursing, New York University, New York, NY
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The role of neighborhoods in shaping perceived norms: An exploration of neighborhood disorder and norms among injection drug users in Baltimore, MD. Health Place 2015; 33:181-6. [PMID: 25840353 DOI: 10.1016/j.healthplace.2015.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 11/22/2022]
Abstract
A large literature suggests that social norms contribute to HIV and substance use related behaviors. Less attention has been given to neighborhood factors that may contribute to the development of norms about risky behaviors. We examined the cross-sectional associations between perceptions of one's neighborhood and norms of perceived prevalence of, and peer support for sex exchange and risky injection behaviors. The sample consisted of 719 people who reported injecting heroin and cocaine and did not move in the past 6 months in Baltimore, MD. Living in a neighborhood with disorder was associated with believing that others exchanged sex, practiced risky injection behaviors (descriptive norms) and approved of risky injection behavior (injunctive norms).
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8
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Heavy drinking during periods of high unemployment: 15-year trend study of the role of race/ethnicity. Drug Alcohol Depend 2013; 133:383-90. [PMID: 23880246 DOI: 10.1016/j.drugalcdep.2013.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/22/2013] [Accepted: 06/23/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study conceptualized high unemployment rate as a stressor deriving from the social structure. It tracked American adults' heavy drinking rates 1997-2011, intending to examine (1) whether heavy drinking escalates with rising unemployment, and (2) whether racial minorities, who feel economic downturns more than the majority, engage in heavy drinking at a higher level than Whites in times of high unemployment. METHODS Research questions were answered using data from the Combined National Health Interview Survey. The present final sample included only respondents classified as heavy drinkers: those reporting that, on days (in the preceding year) on which they had consumed alcohol, they had regularly had at least 5 drinks. RESULTS The study, which considered individual-level social structural factors, overall found rising unemployment rate to be associated with high measures for heavy-drinking frequency but low measures for heavy-drinking quantity. It did not find race to moderate the unemployment-heavy-drinking relationship, although some empirical evidence has shown racial minorities to be relatively more responsive to fluctuating unemployment inherent in the economic cycle. CONCLUSIONS Our results in general call for further research on roles of gender and race in heavy drinking, especially where Black females are concerned. Blacks' greater heavy-drinking frequency and greater heavy-drinking quantity (versus Whites) observed in this study may shed light on persistent racial disparities in Americans' health.
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Abstract
Economic and political instability and related "big events" are widespread throughout the globe. Although they sometimes lead to epidemic HIV outbreaks, sometimes they do not-and we do not understand why. Current behavioural theories do not adequately address these processes, and thus cannot provide optimal guidance for effective intervention. Based in part on a critique of our prior "pathways" model of big events, we suggest that cultural-historical activity theory (CHAT) may provide a useful framework for HIV research in this area. Using CHAT concepts, we also suggest a number of areas in which new measures should be developed to make such research possible.
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10
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Abeldaño RA, Fernández AR, Ventura CAA, Estario JC. Consumo de sustancias psicoactivas en dos regiones argentinas y su relación con indicadores de pobreza. CAD SAUDE PUBLICA 2013. [DOI: 10.1590/s0102-311x2013000500007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Se realizó un análisis de base de datos recolectados en la Encuesta Nacional de Prevalencia de Consumo de Sustancias Psicoactivas (ENPreCoSP-2.008) tomando 6.122 casos, con los objetivos de describir las prevalencias de consumo de sustancias psicoactivas; y evaluar la asociación entre la existencia de necesidades básicas insatisfechas y el nivel de ingresos familiares, con el consumo de sustancias psicoactivas en personas entre las edades de 18 a 34 años, residentes en las regiones noroeste (NOA) y noreste (NEA) argentino. Se realizaron análisis descriptivos y regresión logística. Las prevalencias de consumo en la vida, el último año y el último mes fueron mayores en sustancias legales. Así también, el consumo fue mayor en el sexo masculino. Los indicadores de situación de pobreza operaron como factor de riesgo para el consumo de sustancias legales. Los resultados encontrados dan cuenta de situaciones diferenciales en el consumo de sustancias psicoactivas, en relación al género y a las condiciones de pobreza.
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11
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Metropolitan social environments and pre-HAART/HAART era changes in mortality rates (per 10,000 adult residents) among injection drug users living with AIDS. PLoS One 2013; 8:e57201. [PMID: 23437341 PMCID: PMC3578804 DOI: 10.1371/journal.pone.0057201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022] Open
Abstract
Background Among the largest US metropolitan areas, trends in mortality rates for injection drug users (IDUs) with AIDS vary substantially. Ecosocial, risk environment and dialectical theories suggest many metropolitan areas characteristics that might drive this variation. We assess metropolitan area characteristics associated with decline in mortality rates among IDUs living with AIDS (per 10,000 adult MSA residents) after highly active antiretroviral therapy (HAART) was developed. Methods This is an ecological cohort study of 86 large US metropolitan areas from 1993–2006. The proportional rate of decline in mortality among IDUs diagnosed with AIDS (as a proportion of adult residents) from 1993–1995 to 2004–2006 was the outcome of interest. This rate of decline was modeled as a function of MSA-level variables suggested by ecosocial, risk environment and dialectical theories. In multiple regression analyses, we used 1993–1995 mortality rates to (partially) control for pre-HAART epidemic history and study how other independent variables affected the outcomes. Results In multivariable models, pre-HAART to HAART era increases in ‘hard drug’ arrest rates and higher pre-HAART income inequality were associated with lower relative declines in mortality rates. Pre-HAART per capita health expenditure and drug abuse treatment rates, and pre- to HAART-era increases in HIV counseling and testing rates, were weakly associated with greater decline in AIDS mortality. Conclusions Mortality among IDUs living with AIDS might be decreased by reducing metropolitan income inequality, increasing public health expenditures, and perhaps increasing drug abuse treatment and HIV testing services. Given prior evidence that drug-related arrest rates are associated with higher HIV prevalence rates among IDUs and do not seem to decrease IDU population prevalence, changes in laws and policing practices to reduce such arrests while still protecting public order should be considered.
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Interdisciplinary mixed methods research with structurally vulnerable populations: case studies of injection drug users in San Francisco. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 24:101-9. [PMID: 23312109 DOI: 10.1016/j.drugpo.2012.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/27/2012] [Accepted: 12/09/2012] [Indexed: 02/07/2023]
Abstract
Research with injection drug users (IDUs) benefits from interdisciplinary theoretical and methodological innovation because drug use is illegal, socially sanctioned and often hidden. Despite the increasing visibility of interdisciplinary, mixed methods research projects with IDUs, qualitative components are often subordinated to quantitative approaches and page restrictions in top addiction journals limit detailed reports of complex data collection and analysis logistics, thus minimizing the fuller scientific potential of genuine mixed methods. We present the methodological logistics and conceptual approaches of four mixed-methods research projects that our interdisciplinary team conducted in San Francisco with IDUs over the past two decades. These projects include combinations of participant-observation ethnography, in-depth qualitative interviewing, epidemiological surveys, photo-documentation, and geographic mapping. We adapted Greene et al.'s framework for combining methods in a single research project through: data triangulation, methodological complementarity, methodological initiation, and methodological expansion. We argue that: (1) flexible and self-reflexive methodological procedures allowed us to seize strategic opportunities to document unexpected and sometimes contradictory findings as they emerged to generate new research questions, (2) iteratively mixing methods increased the scope, reliability, and generalizability of our data, and (3) interdisciplinary collaboration contributed to a scientific "value added" that allowed for more robust theoretical and practical findings about drug use and risk-taking.
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Green TC, Martin EG, Bowman SE, Mann MR, Beletsky L. Life after the ban: an assessment of US syringe exchange programs' attitudes about and early experiences with federal funding. Am J Public Health 2012; 102:e9-16. [PMID: 22420810 PMCID: PMC3484785 DOI: 10.2105/ajph.2011.300595] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to determine whether syringe exchange programs (SEPs) currently receive or anticipate pursuing federal funding and barriers to funding applications following the recent removal of the long-standing ban on using federal funds for SEPs. METHODS We conducted a telephone-administered cross-sectional survey of US SEPs. Descriptive statistics summarized responses; bivariate analyses examined differences in pursuing funding and experiencing barriers by program characteristics. RESULTS Of the 187 SEPs (92.1%) that responded, 90.9% were legally authorized. Three received federal funds and 116 intended to pursue federal funding. Perceived federal funding barriers were common and included availability and accessibility of funds, legal requirements such as written police support, resource capacity to apply and comply with funding regulations, local political and structural organization, and concern around altering program culture. Programs without legal authorization, health department affiliation, large distribution, or comprehensive planning reported more federal funding barriers. CONCLUSIONS Policy implementation gaps appear to render federal support primarily symbolic. In practice, funding opportunities may not be available to all SEPs. Increased technical assistance and legal reform could improve access to federal funds, especially for SEPs with smaller capacity and tenuous local support.
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Simmons J, Rajan S, McMahon JM. Retrospective accounts of injection initiation in intimate partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:303-11. [PMID: 22398215 DOI: 10.1016/j.drugpo.2012.01.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/24/2011] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The influence of family members, peers and sexual partners on initiation to injection drug use is well established. Furthermore, research on gender differences in injection initiation has recognized the increased vulnerability of women, in particular, to injection-related health risks, and the gendered nature of the injection initiation experience. Yet more research is needed on the interpersonal and structural dynamics that shape injection initiation within intimate partnerships. METHODS This paper draws on narrative data from semi-structured ethnographic interviews with 25, relatively stable, drug-using couples from two New York City neighbourhoods. The study was conducted between 2007 and 2009. Our analyses focus on retrospective accounts of injection initiation from IDUs who were initiated to injection (or initiated their partners) in current or former intimate partnerships. In particular we analyse narratives of injection initiation events where both partners participated as initiates or initiators. RESULTS Transition to injection within intimate partnerships was common, especially for women, and occurred in specific contexts. Structural and interpersonal dynamics, including the ubiquity of drugs in poor communities and the gendered nature of drug acquisition and use strategies, as well as the problem of increased drug tolerance, situational impediments to drug access, and the perceived cost-benefit of injecting, all influenced the process of initiation to injection drug use within couples. The data also suggest that, even when risks associated with injection initiation were understood, both pragmatic and emotional considerations within relationships tended to offset concerns about potential dangers. CONCLUSION The findings suggest the need for a broad range of interventions (including couples-focussed interventions) to minimize rates of injection initiation within intimate partnerships.
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Affiliation(s)
- Janie Simmons
- National Development and Research Institutes, New York, NY, USA.
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Abstract
This qualitative study examines the interpersonal and structural barriers to drug treatment program entry, retention, and outcomes experienced by injection drug-using couples, and the program policies regarding injection drug-using couples seeking treatment in New York, New York. Our findings reveal a mismatch between the substantial need for concurrent and coordinated treatment for partnered injection-drug users and programmatic policies that are antithetical to such treatment approaches. This discrepancy can be attributed to the lack of viable options for couple-focused treatment approaches that fit within the current drug treatment system. We provide a rationale and a roadmap for the development of innovative approaches for couple-based drug treatment.
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Affiliation(s)
- Janie Simmons
- National Development and Research Institutes, New York, New York 10010, USA.
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Walkup J, Akincigil A, Hoover DR, Siegel MJ, Amin S, Crystal S. Use of Medicaid data to explore community characteristics associated with HIV prevalence among beneficiaries with schizophrenia. Public Health Rep 2011; 126 Suppl 3:89-101. [PMID: 21836742 DOI: 10.1177/00333549111260s314] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES People with severe mental illness (SMI) may be at increased risk for several adverse health conditions, including HIV/AIDS. This disproportionate disease burden has been studied primarily at the individual rather than community level, in part due to the rarity of data sources linking individual information on medical and mental health characteristics with community-level data. We demonstrated the potential of Medicaid data to address this gap. METHODS We analyzed data on Medicaid beneficiaries with schizophrenia from eight states that account for 66% of cumulative AIDS cases nationally. RESULTS Across 44 metropolitan statistical areas (MSAs), the treated prevalence of HIV among adult Medicaid beneficiaries diagnosed with schizophrenia was 1.56% (standard deviation = 1.31%). To explore possible causes of variation, we linked claims files with a range of MSA social and contextual variables including local AIDS prevalence rates, area-based economic measures, crime rates, substance abuse treatment resources, and estimates of injection drug users (IDUs) and HIV infection among IDUs, which strongly predicted community infection rates among people with schizophrenia. CONCLUSIONS Effective strategies for HIV prevention among people with SMI may include targeting prevention efforts to areas where risk is greatest; examining social network links between IDU and SMI groups; and implementing harm reduction, drug treatment, and other interventions to reduce HIV spread among IDUs. Our findings also suggest the need for research on HIV among people with SMI that examines geographical variation and demonstrates the potential use of health-care claims data to provide epidemiologic insights into small-area variations and trends in physical health among those with SMI.
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Affiliation(s)
- James Walkup
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA.
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Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug Alcohol Depend 2011; 118:100-10. [PMID: 21515001 DOI: 10.1016/j.drugalcdep.2011.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States. METHOD We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs. RESULTS SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data. CONCLUSIONS SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.
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Ben Lakhdar C, Bastianic T. Economic constraint and modes of consumption of addictive goods. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:360-5. [DOI: 10.1016/j.drugpo.2011.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 03/04/2011] [Accepted: 03/14/2011] [Indexed: 11/25/2022]
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Zivin K, Paczkowski M, Galea S. Economic downturns and population mental health: research findings, gaps, challenges and priorities. Psychol Med 2011; 41:1343-1348. [PMID: 20836907 PMCID: PMC3846090 DOI: 10.1017/s003329171000173x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Prior research suggests that the current global economic crisis may be negatively affecting population mental health. In that context, this paper has several goals: (1) to discuss theoretical and conceptual explanations for how and why economic downturns might negatively affect population mental health; (2) present an overview of the literature on the relationship between economic recessions and population mental health; (3) discuss the limitations of existing empirical work; and (4) highlight opportunities for improvements in both research and practice designed to mitigate any negative impact of economic declines on the mental health of populations. Research has consistently demonstrated that economic crises are negatively associated with population mental health. How economic downturns influence mental health should be considered in policies such as social protection programs that aim to promote recovery.
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Affiliation(s)
- K Zivin
- Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA.
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