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The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder. J Addict Med 2024; 18:1-56. [PMID: 38669101 PMCID: PMC11105801 DOI: 10.1097/adm.0000000000001299] [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] [Indexed: 04/28/2024]
Abstract
The American Society of Addiction Medicine/American Academy of Addiction Psychiatry (ASAM/AAAP) Clinical Practice Guideline on the Management of Stimulant Use Disorder provides guidance on evidence-based strategies for the treatment of stimulant use disorders (StUDs), stimulant intoxication, and stimulant withdrawal, as well as secondary and tertiary prevention of harms associated with stimulant use. The Clinical Guideline Committee (CGC) comprised experts from ASAM and AAAP representing a range of clinical settings and patient populations. The guideline was developed following modified GRADE methodology. The process included a systematic literature review as well as several targeted supplemental searches. The CGC utilized Evidence to Decision tables to review available evidence and rate the strength of each recommendation. The clinical practice guideline was revised based on external stakeholder review. Key takeaways included: Contingency management represents the current standard of care for treatment of StUDs; Pharmacotherapies may be utilized off-label to treat StUDs; Acute stimulant intoxication can result in life-threatening complications that should be addressed in an appropriate level of care; Secondary and tertiary prevention strategies should be used to reduce harms related to risky stimulant use.
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Frank ND, Banta-Green CJ, Guthrie BL, Kingston S, Tinsley J, Whiteside L, Glick SN. Emergency Room Utilization and Methamphetamine Overdose Symptoms Among Syringe Services Program Participants in Washington State. Subst Use Misuse 2024; 59:1012-1019. [PMID: 38369494 DOI: 10.1080/10826084.2024.2317148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Methamphetamine overdose can cause severe psychological and physical health issues including psychosis, heart attack, and death. People who use methamphetamine (PWUM) who experience methamphetamine overdose symptoms (MOS) are advised to seek emergency healthcare; however, factors related to seeking care are not well characterized. METHODS This study used data from the 2021 Washington State Syringe Services Program (SSP) Health Survey, a cross-sectional survey administered to participants at 21 SSPs in Washington (N = 955). Participants answered questions related to substance use including emergency department/room (ER) utilization for methamphetamine use and whether they experienced psychological and physical MOS. Using Poisson regression, we assessed the association between ER utilization for methamphetamine use, non-fatal opioid overdose, and other key covariates among PWUM who experienced MOS. RESULTS Methamphetamine use in the last three months was reported by 86% of participants. Among PWUM, 31% reported psychological MOS, 19% reported physical MOS, and 37% reported ≥1 MOS in the prior three months. Non-fatal opioid overdose (adjusted prevalence ratio [APR] = 2.04, 95% CI = 1.38-3.03), main drug of goofball (heroin and methamphetamine combined) (APR = 1.98, 95% CI = 1.34-2.92) and recent blood infection/sepsis (APR = 2.07, 95% CI = 1.24-3.46) were associated with ER utilization for MOS. CONCLUSION Among people who use SSPs in Washington State, methamphetamine use remains high, and MOS are common. Recent non-fatal opioid overdose was positively associated with ER utilization for methamphetamine use among PWUM who experienced MOS. Patients in the ER for MOS should be screened for opioid use disorder and linked with harm reduction supplies like naloxone and medications for opioid use disorder.
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Affiliation(s)
- Noah D Frank
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Caleb J Banta-Green
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Susan Kingston
- Addictions, Drug & Alcohol Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Joe Tinsley
- HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, Washington, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Sara N Glick
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- HIV/STI/HCV Program, Public Health-Seattle & King County, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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Mehtani NJ, Chuku CC, Meacham MC, Vittinghoff E, Dilworth SE, Riley ED. Housing Instability Associated with Return to Stimulant Use among Previously Abstaining Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6830. [PMID: 37835100 PMCID: PMC10572661 DOI: 10.3390/ijerph20196830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
Stimulant use among unstably housed individuals is associated with increased risks of psychiatric co-morbidity, violence, HIV transmission, and overdose. Due to a lack of highly effective treatments, evidence-based policies targeting the prevention of stimulant use disorder are of critical importance. However, little empirical evidence exists on risks associated with initiating or returning to stimulant use among at-risk populations. In a longitudinal cohort of unstably housed women in San Francisco (2016-2019), self-reported data on stimulant use, housing status, and mental health were collected monthly for up to 6 months, and factors associated with initiating stimulants after a period of non-use were identified through logistic regression. Among 245 participants, 42 (17.1%) started using cocaine and 46 (18.8%) started using methamphetamine. In analyses adjusting for demographics and socio-structural exposures over the preceding month, experiencing street homelessness was associated with initiating cocaine use (AOR: 2.10; 95% CI: 1.04, 4.25) and sheltered homelessness with initiating methamphetamine use (AOR: 2.57; 95% CI: 1.37, 4.79). Other factors-including race, income, unmet subsistence needs, mental health, and treatment adherence-did not reach levels of significance, suggesting the paramount importance of policies directed toward improving access to permanent supportive housing to prevent stimulant use among unstably housed women.
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Affiliation(s)
- Nicky J. Mehtani
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA;
- Whole Person Integrated Care, San Francisco Department of Public Health, San Francisco, CA 94103, USA
| | - Chika C. Chuku
- Department of Public Health Sciences, University of Miami, Coral Gables, FL 33136, USA;
| | - Meredith C. Meacham
- Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA;
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA;
| | - Samantha E. Dilworth
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (S.E.D.)
| | - Elise D. Riley
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (S.E.D.)
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Breland H, Larkins S, Antonini V, Freese T, McGovern M, Dunn J, Rawson R. Stimulant use among patients in opioid treatment settings: Provider perspectives. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:209012. [PMID: 36931604 DOI: 10.1016/j.josat.2023.209012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/20/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Methadone maintenance therapy (MMT) has been a pillar of opioid addiction treatment. Opioid treatment programs (OTPs) have been faced with an escalating threat of stimulant use and related overdose deaths among patients. We know little about how providers currently address stimulant use while maintaining treatment for opioid use disorder. METHODS We conducted 5 focus groups with 36 providers (n = 11 prescribers; 25 behavioral health staff), and collected an additional 46 surveys (n = 7 prescribers; 12 administrators; 27 behavioral health staff). Questions focused on perceptions of patient stimulant use and interventions. We applied inductive analysis to identify themes relevant to identification of stimulant use, use trends, intervention approaches, and perceived needs to improve care. RESULTS Providers indicated a trend of rising stimulant use among patients, especially those experiencing homelessness or comorbid health conditions. They reported a range of approaches to patient screening and intervention, including medication and harm reduction, improving treatment engagement, increasing level of care, and providing incentives. Providers expressed less agreement as to which of these interventions were effective, and though providers saw stimulant use as a common and severe problem, they reported little problem recognition and interest in treatment from their patients. A particular concern of providers was the prevalence and danger of synthetic opioids, such as fentanyl. They sought more research and resources to identify effective interventions and medications to address these issues. Also notable was an interest in contingency management (CM) and use of reinforcements/rewards to encourage stimulant use reduction. CONCLUSION Providers face challenges in treating patients who use both opioids and stimulants. Although methadone is available to treat opioid use, no such "silver bullet" exists for stimulant use disorder. The rise in stimulant and synthetic opioid (e.g., fentanyl) combination products is presenting an extraordinary challenge for providers whose patients are at unprecedented risk for overdose. Providing OTPs with more resources to address polysubstance use is critical. Existing research indicates strong support for CM in OTPs, but providers reported regulatory and financial barriers to implementation. Further research should develop effective interventions that are accessible to providers in OTPs.
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Affiliation(s)
- Haley Breland
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sherry Larkins
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Valerie Antonini
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Thomas Freese
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Mark McGovern
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Julia Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Richard Rawson
- Integrated Substance Abuse Programs, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Presnall L, Suchting R, Hicks G, Hamilton J. Predictors of self-reported general health status in people experiencing homelessness with serious mental illness. Qual Life Res 2023:10.1007/s11136-023-03370-9. [PMID: 36808283 PMCID: PMC9939866 DOI: 10.1007/s11136-023-03370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The growing homeless population in the U.S.A. is disproportionately impacted by poor mental and physical health status, including a higher incidence of acute and chronic health problems, increased hospitalizations, and premature mortality compared to the general population. This study examined the association between demographic, social, and clinical factors and perceptions of general health status among the homeless population during admission to an integrated behavioral health treatment program. METHODS The study sample included 331 adults experiencing homelessness with a serious mental illness or co-occurring disorder. Participants were enrolled in services at a day program for unsheltered homeless adults, a residential substance use treatment program for males experiencing homelessness, a psychiatric step-down respite program for those experiencing homelessness following psychiatric hospitalization, permanent supportive housing for formerly chronically homeless adults, a faith-based food distribution program, and homeless encampment sites in a large urban area. Participants were interviewed using The Substance Abuse and Mental Health Services Administration's National Outcome Measures tool and a validated health-related quality of life measurement tool, SF-36. Data were examined using in elastic net regression. RESULTS The study found seven factors to be particularly strong predictors of SF-36 general health scores. Male gender, "other" sexual identity, stimulant use, and Asian race were all associated with better perceptions of health status, while transgender status, inhalant use, and number of times arrested were associated with poorer perceptions. CONCLUSION This study suggests targeted areas for health screening within the homeless population; however, more studies are necessary to demonstrate generalizability of the results.
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Affiliation(s)
- Landon Presnall
- Icahn School of Medicine at Mount Sinai (Morningside/West), New York, USA. .,Baylor College of Medicine, Houston, TX, USA. .,Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX, USA.
| | - Robert Suchting
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX USA
| | - Gaybrielle Hicks
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX USA
| | - Jane Hamilton
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX USA
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Schmidt CN, Wingo EE, Newmann SJ, Borne DE, Shapiro BJ, Seidman DL. Patient and provider perspectives on barriers and facilitators to reproductive healthcare access for women experiencing homelessness with substance use disorders in San Francisco. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231152374. [PMID: 36939096 PMCID: PMC9947686 DOI: 10.1177/17455057231152374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Women experiencing homelessness with substance use disorders face unique and intersecting barriers to realizing their reproductive goals. OBJECTIVE This study explored the reproductive aspirations of this population, as well as the barriers to accessing reproductive services from the perspectives of affected individuals, and the healthcare providers who serve them. DESIGN This mixed-methods study included surveys and interviews with women experiencing homelessness with substance use disorders and healthcare providers. METHODS We conducted surveys and semi-structured interviews with women recruited from opiate treatment programs and homeless encampments in San Francisco, California in 2018. We also conducted interviews and focus groups with healthcare providers in reproductive health and substance use treatment settings. Interviews were recorded, transcribed, and coded. Descriptive statistics of survey results were performed. RESULTS Twenty-eight women completed surveys, 96% of whom reported current substance use. Ten women participated in interviews. One-third (9/28) reported desiring pregnancy in the next year; over half (16/28) reported they would be somewhat or very happy to learn they were pregnant. A majority used no contraception at last intercourse (14/28). Twenty-six healthcare providers participated in interviews (n = 15) and focus groups (n = 2). Patients and providers identified similar barriers to care access, including discrimination, logistical and financial challenges, and delayed pregnancy awareness. While providers proposed solutions focused on overcoming logistical challenges, patients emphasized the importance of transforming the healthcare environment to treat patients affected by substance use and homelessness with dignity and respect. CONCLUSION Women experiencing homelessness with substance use disorders face intersecting and compounding barriers to accessing reproductive health services. For patients, the impact of stigma and bias on treatment experiences are particularly salient, in contrast to logistical barriers emphasized by providers. Improving access will require structural and individual-level solutions to address stigma and create person-centered, trauma-informed, and respectful care environments.
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Affiliation(s)
- Christina N Schmidt
- School of Medicine, University of
California San Francisco, San Francisco, CA, USA
| | - Erin E Wingo
- Department of Obstetrics, Gynecology
& Reproductive Services, University of California San Francisco and San
Francisco General Hospital, San Francisco, CA, USA
| | - Sara J Newmann
- Department of Obstetrics, Gynecology
& Reproductive Services, University of California San Francisco and San
Francisco General Hospital, San Francisco, CA, USA
| | - Deborah E Borne
- San Francisco Department of Public
Health, San Francisco, CA, USA
| | - Brad J Shapiro
- Department of Psychiatry, University of
California San Francisco, San Francisco, CA, USA
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology
& Reproductive Services, University of California San Francisco and San
Francisco General Hospital, San Francisco, CA, USA
- Dominika L Seidman, Department of
Obstetrics, Gynecology & Reproductive Services, University of California San
Francisco and San Francisco General Hospital, 1001 Potrero Avenue Ward 6D, San
Francisco, CA 94110, USA.
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Arnos D, Acevedo A. Homelessness and Gender: Differences in Characteristics and Comorbidity of Substance Use Disorders at Admission to Services. Subst Use Misuse 2023; 58:27-35. [PMID: 36519365 DOI: 10.1080/10826084.2022.2136491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Substance use disorders and homelessness are two closely related behavioral health issues. This study examines associations between homelessness and severity of substance use disorder (SUD) characteristics (inclusive of alcohol and other legal and illegal drugs) and presence of mental health comorbidity among individuals entering treatment for SUD. We also examine differences in SUD and mental health comorbidity by gender within a sample of clients experiencing homelessness upon admission to treatment. Methods: Using the 2017 Treatment Episodes Data Set, we used logistic regression models to examine the association between homelessness and indicators of severity (e.g., frequency of use, route of transmission) and the presence of mental health conditions, and to examine the association between gender and these dependent variables among only individuals experiencing homelessness at treatment admission. Results: After controlling for covariates, homelessness is significantly associated with increased odds of cocaine and methamphetamine use compared to all other substances, higher frequency of use, younger age of first use, use of more substances, injection drug use, and co-occurring mental health conditions. Female gender is inversely associated with younger age at first use and highly associated with co-occurring mental health conditions among those experiencing homelessness at admission to treatment. Conclusions: Individuals experiencing homelessness enter substance use services with different characteristics of substance use disorders, different patterns of use, and with higher rates of mental health comorbidity. Within homeless admissions, women have significant differences in substance use and higher likelihood of mental health comorbidity than men. Future research should focus on the specific treatment needs of individuals experiencing homelessness, and how the combination of homelessness and gender affects barriers and challenges to treatment.
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Affiliation(s)
- Diane Arnos
- School of Public Health, University of California, Berkeley, California, USA
| | - Andrea Acevedo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors. PLoS One 2023; 18:e0281107. [PMID: 36877700 PMCID: PMC9987824 DOI: 10.1371/journal.pone.0281107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana. METHODS 305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression. RESULTS Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001). CONCLUSIONS Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.
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Riley ED, Kizer JR, Tien PC, Vittinghoff E, Lynch KL, Wu AHB, Coffin PO, Beck-Engeser G, Braun C, Hunt PW. Multiple substance use, inflammation and cardiac stretch in women living with HIV. Drug Alcohol Depend 2022; 238:109564. [PMID: 35872529 PMCID: PMC9924802 DOI: 10.1016/j.drugalcdep.2022.109564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/10/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and heart failure (HF) are disproportionately high in people living with HIV and differ by sex. Few CVD-related studies focus on drug use, yet it is common in low-income women living with HIV (WLWH) and increases cardiac dysfunction. SETTING We recruited unsheltered and unstably housed WLWH from San Francisco community venues to participate in a six-month cohort study investigating linkages between drug use, inflammation, and cardiac dysfunction. METHODS Adjusting for CVD risk factors, co-infections, medications, and menopause, we examined the effects of toxicology-confirmed drug use and inflammation (C-reactive protein, sCD14, sCD163 and sTNFR2) on levels of NT-proBNP, a biomarker of cardiac stretch and HF. RESULTS Among 74 WLWH, the median age was 53 years and 45 % were Black. At baseline, 72 % of participants had hypertension. Substances used included tobacco (65 %), cannabis (53 %), cocaine (49 %), methamphetamine (31 %), alcohol (28 %), and opioids (20 %). Factors significantly associated with NT-proBNP included cannabis use (Adjusted Relative Effect [ARE]: -39.6 %) and sTNFR2 (ARE: 65.5 %). Adjusting for heart failure and restricting analyses to virally suppressed persons did not diminish effects appreciably. Cannabis use was not significantly associated with sTNFR2 and did not change the association between sTNFR2 and NT-proBNP. CONCLUSIONS Among polysubstance-using WLWH, NT-proBNP levels signaling cardiac stretch were positively associated with sTNFR2, but 40 % lower in people who used cannabis. Whether results suggest that cardiovascular pathways associated with cannabis use mitigate cardiac stress and dysfunction independent of inflammation in WLWH who use multiple substances merits further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA.
| | - Jorge R Kizer
- San Francisco VA Health Care System, Division of Cardiology, San Francisco, CA, USA; University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Phyllis C Tien
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Eric Vittinghoff
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Kara L Lynch
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, CA, USA
| | - Alan H B Wu
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, CA, USA
| | - Phillip O Coffin
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Gabriele Beck-Engeser
- University of California, San Francisco, School of Medicine, Department of Experimental Medicine, San Francisco, CA, USA
| | - Carl Braun
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Peter W Hunt
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA; University of California, San Francisco, School of Medicine, Department of Experimental Medicine, San Francisco, CA, USA
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Carrillo Beck R, Szlapinski J, Pacheco N, Sabri Laghaei S, Isard R, Oudshoorn A, Marshall CA. Violence and victimisation in the lives of persons experiencing homelessness who use methamphetamine: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1619-1636. [PMID: 35032080 DOI: 10.1111/hsc.13716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/30/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Methamphetamine (MA) use among individuals who experience homelessness has tripled in recent years. This is a problematic trend given the harmful impacts of this substance on health and social well-being. While there is a large body of literature on the relationship between substance use and trauma, little is known about the scope of existing empirical literature exploring this topic related to MA use. Anecdotally, MA is frequently associated with violence and victimisation, which may be related to stigma associated with using MA. However, little is known about the scope of empirical literature exploring violence and victimisation in the lives of individuals who experience homelessness and use MA. We conducted a scoping review to fill this gap in existing literature using Arksey and O'Malley's methodological framework. Our search was conducted between January 2021 and March 2021 and was deployed in seven databases: Medline, Embase, CINAHL, PsycINFO, Sociological Abstracts, Nursing and Allied Health and AMED. Two independent raters screened 700 titles and abstracts after the removal of duplicates. A total of 54 articles were subjected to a full-text review and 20 articles met the inclusion criteria. We generated two themes: methamphetamine and victimisation and challenging behaviours. Six (30%) of the included articles explored MA use in relation to violence, while 18 (90%) explored experiences of victimisation among persons experiencing homelessness. Our findings highlight that individual who experience homelessness and use MA are particularly vulnerable to experiences of trauma. Though existing literature does acknowledge the challenging behaviour associated with MA use, only three existing studies demonstrated a relationship between MA use and physical violence. Research exploring the impacts of MA use on victimisation among persons who experience homelessness, and the development of interventions for managing challenging behaviours associated with MA use are needed.
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Affiliation(s)
- Rozelen Carrillo Beck
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Jessica Szlapinski
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Nicole Pacheco
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Shahriar Sabri Laghaei
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
| | - Roxanne Isard
- Weldon Library, Western University, London, Ontario, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- Social Justice in Mental Health Research Lab, Faculty of Health Sciences, School of Occupational Therapy, London, Ontario, Canada
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Coelho Moreira AL, da Silva Soares Alves N, Macêdo ML, Soares Fernandes Reis AE, Veloso Holanda N, Gandolfo Conceição MI. The Hidden Face of the Moon: Unveiling the Minutiae of a Black Woman’s Experience on the Streets. TRENDS IN PSYCHOLOGY 2022. [PMCID: PMC9213047 DOI: 10.1007/s43076-022-00191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The homeless population is mostly male. When it comes to the female presence, especially when considering the markers of race, gender and class, the invisibility and delegitimization are even more insidious. The aim of this article is to identify the singularities of a black woman living on the streets and to understand them based on the relationships she establishes with the territory. The method used was the case study of a homeless black woman, constructed through body map storytelling. Thematic analysis of the empirical content was used in the light of decolonial criticism. Luna, the protagonist of the story, reveals in her narratives, the multiple dimensions of the presence of the female body on the street, the process of taking care of oneself and the other, considering the intrinsic relationships with the territory, with the use of drugs and with the male figure. Thus, unveiling society’s views in relation to the place of invisibility of these women and creating strategies to face the colonial, racist and patriarchal logic of valuing knowledge is what Luna makes explicit with her trajectory of struggle, survival, and resilience on the streets.
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Adams EA, Spencer L, Addison M, McGovern W, Alderson H, Adley M, McGovern R, Gilvarry E, Kaner E, O’Donnell A. Substance Use, Health, and Adverse Life Events amongst Amphetamine-Type Stimulant Users in North East England: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19126996. [PMID: 35742245 PMCID: PMC9222392 DOI: 10.3390/ijerph19126996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
Amphetamine-type stimulants (ATS) are the second most commonly used class of illicit drugs globally, yet there is limited understanding of which factors contribute to different pathways of ATS use. We sought to compare current, former, and exposed non-ATS users’ substance use, mental/physical health, and adverse life experiences. A cross-sectional survey, using computer-assisted personal interview software, was conducted between June 2018 and March 2019 in North East England. Quota-based sampling was used to recruit 389 individuals (aged 18 to 68; 52.6% male): 137 current ATS users; 174 former users; and 78 exposed non-users. Standardized screening questionnaires captured current/prior substance use. Participants self-reported diagnoses of selected physical and mental health disorders and specific adverse life experiences. Analysis used descriptive statistics and comparative tests (including chi-square, Kruskal–Wallis and Mann–Whitney U). Early exposure to illicit substances, challenging mental health, and certain adverse life experiences (such as growing up in statutory care) were more common in individuals currently using ATS compared to those who had never used or stopped using stimulants. Multi-level interventions are needed that address the mental health, social, and economic needs of people with dependent drug use. These could include targeted efforts to support children growing up under care, integrated mental health and substance use support, and joined-up substance use interventions reflective of wider structural factors.
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Affiliation(s)
- Emma Audrey Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | | | - William McGovern
- Department of Social Work, Education and Community Studies, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Mark Adley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Eilish Gilvarry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE3 4ES, UK; (E.A.A.); (L.S.); (H.A.); (M.A.); (R.M.); (E.G.); (E.K.)
- Correspondence:
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13
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Austin AE, Shiue KY, Naumann RB, Figgatt MC, Gest C, Shanahan ME. Associations of housing stress with later substance use outcomes: A systematic review. Addict Behav 2021; 123:107076. [PMID: 34385075 DOI: 10.1016/j.addbeh.2021.107076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 12/20/2022]
Abstract
A synthesis of existing evidence regarding the association of housing stress with later substance use outcomes can help support and inform housing interventions as a potential strategy to address problematic substance use. We conducted a comprehensive search of PubMed, Web of Science, PsycInfo, CINAHL, Social Work Abstracts, and Sociological Abstracts and systematically screened for articles examining housing stress and later substance use outcomes among U.S. adults. Across 38 relevant articles published from 1991 to 2020, results demonstrated an association of homelessness with an increased likelihood of substance use, substance use disorders (SUD), and overdose death. Results regarding the association of homelessness with receipt and completion of SUD treatment were mixed, and one study indicated no association of homelessness with motivation to change substance use behaviors. Several studies did not find an association of unstable housing with substance use or receipt of SUD treatment, while others found an association of unstable housing with intensified SUD symptoms and a decreased likelihood of completing SUD treatment. Overall, while there is evidence of an association of homelessness with later substance use, SUD, and overdose death, results for other forms of housing stress and some substance use outcomes are less consistent. There are several methodological considerations specific to selected measures of housing stress and substance use, study populations, and analytic approaches that have implications for results and directions for future research. Despite these considerations, results collectively suggest that innovative interventions to address housing stress, namely homelessness, may help mitigate some substance use outcomes.
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Affiliation(s)
- Anna E Austin
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States.
| | - Kristin Y Shiue
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Rebecca B Naumann
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Mary C Figgatt
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Caitlin Gest
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Meghan E Shanahan
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Injury Prevention Research Center, University of North Carolina at Chapel Hill, United States
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14
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Riley ED, Chow FC, Josephson SA, Dilworth SE, Lynch KL, Wade AN, Braun C, Hess CP. Cocaine Use and White Matter Hyperintensities in Homeless and Unstably Housed Women. J Stroke Cerebrovasc Dis 2021; 30:105675. [PMID: 33677311 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cocaine use has been linked to stroke in several studies. However, few studies have considered the influence of cocaine use on stroke mechanisms such as small vessel disease (SVD). We conducted a study to assess associations between the toxicology-confirmed use of multiple drugs, including cocaine, and a marker of SVD, white matter hyperintensities (WMH). MATERIALS AND METHODS We conducted a nested case-control study (n = 30) within a larger cohort study (N = 245) of homeless and unstably housed women recruited from San Francisco community venues. Participants completed six monthly study visits consisting of an interview, blood draw, vital sign assessment and baseline brain MRI. We examined associations between toxicology-confirmed use of multiple substances, including cocaine, methamphetamine, heroin, alcohol and tobacco, and WMH identified on MRI. RESULTS Mean study participant age was 53 years, 70% of participants were ethnic minority women and 86% had a history of cocaine use. Brain MRIs indicated the presence of WMH (i.e., Fazekas score>0) in 54% (18/30) of imaged participants. The odds of WMH were significantly higher in women who were toxicology-positive for cocaine (Odd Ratio=7.58, p=0.01), but not in women who were toxicology-positive for other drugs or had several other cerebrovascular risk factors. CONCLUSIONS Over half of homeless and unstably housed women showed evidence of WMH. Cocaine use is highly prevalent and a significant correlate of WMH in this population, while several traditional CVD risk factors are not. Including cocaine use in cerebrovascular risk calculators may improve stroke risk prediction in high-risk populations and warrants further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Felicia C Chow
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA; University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - S Andrew Josephson
- University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - Samantha E Dilworth
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Kara L Lynch
- University of California, San Francisco, Department of Laboratory Medicine, San Francisco, CA, USA.
| | - Amanda N Wade
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Carl Braun
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Christopher P Hess
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA.
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Dickins KA, Philpotts LL, Flanagan J, Bartels SJ, Baggett TP, Looby SE. Physical and Behavioral Health Characteristics of Aging Homeless Women in the United States: An Integrative Review. J Womens Health (Larchmt) 2020; 30:1493-1507. [PMID: 33290147 DOI: 10.1089/jwh.2020.8557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The average age of the homeless population is and will continue to rise. Although women comprise a significant and growing percentage of this vulnerable population, their age- and sex-specific health characteristics are poorly understood. Materials and Methods: This integrative review appraises published research addressing the physical and behavioral health characteristics of aging homeless women (≥50 years) in the United States (2000-2019). The authors searched six electronic databases to identify eligible studies. Studies were screened for methodological quality by using the Johns Hopkins Nursing Evidence-Based Practice model. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: Ten primary studies met the review eligibility criteria. All were level III (non-experimental); nine appraised as "good" quality (level B), and one as "lower" quality (level C). Aging homeless women demonstrate elevated rates of physical health conditions, related to suboptimal nutrition, lower than expected preventive health screening uptake, and geriatric concerns. Disproportionate rates of mental health conditions are compounded by substance use and interpersonal trauma. Familial and social dynamics and socioeconomic disadvantage contribute to social health concerns. Spiritual health is a critically important yet underexplored protective factor. Conclusions: Studies are limited, though collective findings suggest that aging homeless women endure a disproportionate physical, behavioral, and social health burden compared with aging non-homeless women and aging homeless men. Implications for research on early aging, preventative health strategies, and homelessness among women, and clinical practice in the context of geriatric and women's health are described.
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Affiliation(s)
- Kirsten A Dickins
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jane Flanagan
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Stephen J Bartels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Travis P Baggett
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
| | - Sara E Looby
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Riley ED, Vittinghoff E, Wu AHB, Coffin PO, Hsue PY, Kazi DS, Wade A, Braun C, Lynch KL. Impact of polysubstance use on high-sensitivity cardiac troponin I over time in homeless and unstably housed women. Drug Alcohol Depend 2020; 217:108252. [PMID: 32919207 PMCID: PMC7873814 DOI: 10.1016/j.drugalcdep.2020.108252] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The use of controlled substances like cocaine increases the risk of cardiovascular disease (CVD) and myocardial infarction (MI). However, outside of alcohol and tobacco, substance use is not included in CVD risk assessment tools. We identified the effects of using multiple substances (nicotine/cotinine, cannabis, alcohol, cocaine, methamphetamine, heroin and other opioids) on cardiac injury measured by high-sensitivity troponin (hsTnI) in homeless and unstably housed women. METHODS We recruited 245 homeless and unstably housed women from shelters, free meal programs and street encampments. Participants completed six monthly study visits. Adjusting for traditional CVD risk factors, we examined longitudinal associations between substance use and hsTnI. RESULTS Median participant age was 53 years and 74 % were ethnic minority women. At baseline, 76 % of participants had hypertension, 31 % were HIV-positive, 8% had a history of a prior MI and 12 % of prior stroke. The most commonly used substances were cotinine/nicotine (80 %), cannabis (68 %) and cocaine (66 %). HsTnI exceeding the 99th percentile (14.7 ng/L) - a level high enough to signal possible MI - was observed in 14 participants during >1 study visit (6%). In adjusted analysis, cocaethylene and fentanyl were significantly associated with higher hsTnI levels. CONCLUSIONS Fentanyl use and the co-use of cocaine and alcohol are associated with myocardial injury, suggesting that the use of these substances may act as long-term cardiac insults. Whether risk counseling on these specific substances and/or including their use in CVD risk stratification would improve CVD outcomes in populations where substance use is high merits further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA.
| | - Eric Vittinghoff
- University of California, San Francisco, School of Medicine, Department of Epidemiology and Biostatistics, San Francisco, CA, USA
| | - Alan H B Wu
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, CA, USA
| | - Phillip O Coffin
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Priscilla Y Hsue
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of Cardiology, San Francisco, CA, USA
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA, USA
| | - Amanda Wade
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Carl Braun
- University of California, San Francisco, School of Medicine, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco, CA, USA
| | - Kara L Lynch
- University of California, San Francisco, School of Medicine, Department of Laboratory Medicine, San Francisco, CA, USA
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Hungaro AA, Gavioli A, Christóphoro R, Marangoni SR, Altrão RF, Rodrigues AL, Oliveira MLFD. Homeless population: characterization and contextualization by census research. Rev Bras Enferm 2020; 73:e20190236. [PMID: 32609214 DOI: 10.1590/0034-7167-2019-0236] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze characteristics of homeless people and factors associated with living on the streets. METHODS a census-type sectional survey carried out between 2015 and 2018, in the municipality of Maringá-Paraná. A total of 701 homeless answered a structured questionnaire with sociodemographic data, living conditions, and drug use. We used Pearson's correlation test for the association analysis of the variables at a 95% confidence level. RESULTS men (90.7%) the average age of 37.7 years had been homeless for an average of 5.39 years. Most had little education (54.2%), and homelessness was due to drug use (47.2%) and family disagreements (38.9%). CONCLUSIONS drug use and family disagreements were the main reasons for homelessness. Time on the street, gender, and drugs were associated with a negative correlation to be homeless; and age, mean daily income, the number of daily meals, having been in prison, and having an income source were associated with positive correlation.
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Affiliation(s)
| | - Aroldo Gavioli
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
| | | | | | | | - Ana Lúcia Rodrigues
- Universidade Estadual de Maringá, Observatório das Metrópoles. Maringá, Paraná, Brazil
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Guillén AI, Marín C, Panadero S, Vázquez JJ. Substance use, stressful life events and mental health: A longitudinal study among homeless women in Madrid (Spain). Addict Behav 2020; 103:106246. [PMID: 31838444 DOI: 10.1016/j.addbeh.2019.106246] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/23/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
The objectives of this study were: (1) to assess the prevalence of substance use among homeless women; (2) to examine the correlates for drug abuse; (3) to analyze paths between early stressful life events, drug abuse and mental health. The methodology was a longitudinal study of women homeless in Madrid (Spain), who were followed for a 24 months period. There were 138 participants interviewed at baseline and 73 participants interviewed at follow-up. We ran bivariate and multivariate analysis to examine the correlates for drug abuse. We also performed path analysis to test the interconnections between stressful life events, drug abuse and mental health. Results at baseline showed that 83.3% of participants had consumed at least one substance in the previous month. Tobacco was the most common substance consumed (70.1%), followed by sedatives (48.6%), alcohol (36.2%), methadone (13.7%), cocaine (7.2%), cannabis (6.5%) and heroin (5.1%). In addition, women who met criteria for drug abuse (19.6% of the sample) were more likely to be younger, have suffered adverse experiences during childhood, have engaged in prostitution, and have ever attempted suicide, in comparison with women who did not meet criteria for drug abuse. Path analysis supported that early stressful life events increased the vulnerability for subsequent negative outcomes among homeless women. These findings have significant implications for understanding how to implement programs for homeless women in Spain.
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Patrício ACFDA, Silva RARD, Araújo RFD, Silva RFD, Nascimento GTDS, Rodrigues TDDB, Leite MAP. Common mental disorders and resilience in homeless persons. Rev Bras Enferm 2019; 72:1526-1533. [DOI: 10.1590/0034-7167-2018-0541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 02/03/2019] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To identify common mental disorders and resilience in homeless persons. Method: Cross-sectional study with 49 homeless persons, assisted in the Casa da Acolhida Adulta and the Specialized Reference Center in a municipality in the Northeast of Brazil. Data collection performed between February and March 2018, using SRQ20 scales for common mental disorders and another for Resilience. Kruskal Wallis test, Student’s T-test and Chi-Square test were used. Results: In the study, 61.2% (30) participants have poor sleep; 69.4% (34) feel nervous, tense or worried; 71.4% (35) feel unhappy; 63.3% are unable to play a useful role in their lives; 71.4% (35) have common mental disorders, and 44.9% (22) presented low resilience. Resilience influences common mental disorders, which, in turn, are influenced by gender and age. Conclusion: Professionals who assist homeless persons need to have a look directed at common mental disorders and resilience.
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Carolina Maria Motta Stoffel B, Felix Henrique PK, Flavio P, Lisia VD, Maria Fátima Olivier S, Tatiana HL, Marcelo SC, Marcelo SC. Crack users and violence. What is the relationship between trauma, antisocial personality disorder and posttraumatic stress disorder? Addict Behav 2019; 98:106012. [PMID: 31233950 DOI: 10.1016/j.addbeh.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
TITLE Crack users and violence. What is the relationship between trauma, antisocial personality disorder and posttraumatic stress disorder? BACKGROUND Crack use is frequently related to severe social and psychiatric conditions including Antisocial Personality Disorder (ASPD) and Posttraumatic Stress Disorder (PTSD). Social vulnerabilities increase the frequency of traumatic exposure. The relationship of trauma and psychiatric disorders among crack users is still unclear. OBJECTIVES To describe the characteristics of crack users with ASPD and to verify of the association between ASPD and PTSD, ASPD and each type of traumatic event and the temporality of these events. METHODS Data from a multicenter cross-sectional sample of 733 crack users under treatment in six Brazilian capitals was obtained via interviews with Addiction Severity Index (ASI) 6 and Mini International Neuropsychiatric Interview (MINI). Demographic characteristics, psychiatric diagnosis and trauma history were examined. Descriptive and bivariate analyses were used to assess the relationship between the studied variables. RESULTS More than 80% of crack users with ASPD and >65% without this diagnosis report traumatic experiences. The prevalence of PTSD disorder among those with ASPD (47.3%) is lower than among those without (52.7%) this diagnosis. The traumatic experiences occur either before or after the first episode of drug use. CONCLUSIONS The high prevalence of ASPD and PTSD among crack users and their frequent exposure to severe traumatic events was verified as well as the fact that they are often victims and sometimes perpetrators of violence illustrating the complexity of the relationships between crack use, trauma and comorbidities.
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Whittle HJ, Sheira LA, Frongillo EA, Palar K, Cohen J, Merenstein D, Wilson TE, Adedimeji A, Cohen MH, Adimora AA, Ofotokun I, Metsch L, Turan JM, Wentz EL, Tien PC, Weiser SD. Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States. Addiction 2019; 114:127-136. [PMID: 30109752 PMCID: PMC6516859 DOI: 10.1111/add.14418] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/20/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Few longitudinal studies have examined the relationship between food insecurity and substance use. We aimed to investigate this relationship using longitudinal data among women with or at risk for HIV in the United States. DESIGN Women's Interagency HIV Study (WIHS), a prospective cohort study. SETTING Nine sites across the United States. PARTICIPANTS A total of 2553 women with or at risk for HIV. MEASUREMENTS Semi-annual structured interviews were conducted during April 2013-March 2016. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. Outcomes were: any illicit substance use except cannabis; licit or illicit cannabis use; stimulant use (crack, cocaine, or methamphetamine); opioid use (heroin or methadone in a non-prescribed way); and prescription drug misuse (prescription narcotics, amphetamines, or tranquilizers in a non-prescribed way) since the last visit. We used multivariable logistic regression with random effects to examine longitudinal associations of current and previous FS with the outcomes simultaneously, adjusting for socio-demographic factors, HIV serostatus, physical health and health insurance. FINDINGS Average number of visits was 4.6. At baseline, 71% of participants were HIV-seropositive, 44% reported marginal, low, or very low FS, and 13% were using illicit substances. In adjusted analyses, current low and very low FS were significantly associated with 1.59 [95% confidence interval (CI) = 1.02, 2.46; P = 0.039] and 2.48 (95% CI = 1.52, 4.04; P < 0.001) higher odds of any illicit substance use, compared to high FS, and also with higher odds of cannabis, stimulant and opioid use, exhibiting a consistent dose-response relationship. Marginal, low, and very low FS at the previous visit were associated with 1.66 (95% CI = 1.08, 2.54; P = 0.020), 1.77 (95% CI = 1.14, 2.74; P = 0.011), and 2.28 (95% CI = 1.43, 3.64; P < 0.001) higher odds of current illicit substance use. CONCLUSIONS Food insecurity appears to be longitudinally associated with substance use among US women with or at risk for HIV.
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Affiliation(s)
| | - Lila A. Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Edward A. Frongillo
- Department of Health Promotion, Educaton, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Jennifer Cohen
- Department of Clinical Pharmacy, UCSF, San Francisco, CA, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Tracey E. Wilson
- Department of Community Health Sciences, State University of New York Downstate Medical Center, School of Public Health, Brooklyn, NY, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Adaora A. Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, USA,Grady Healthcare System, Atlanta, GA, USA
| | - Lisa Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janet M. Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eryka L. Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Phyllis C. Tien
- Department of Medicine, UCSF and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA,Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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Conners EE, Gaines TL, Strathdee SA, Magis-Rodriguez C, Brouwer KC. Structural factors associated with methamphetamine smoking among female sex workers in Tijuana, Mexico. Drug Alcohol Rev 2018; 37 Suppl 1:S294-S302. [PMID: 29218799 PMCID: PMC5940512 DOI: 10.1111/dar.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Smoking methamphetamine is associated with increased risk of HIV among female sex workers (FSW). The structural context of substance use is an important shaper of individual behaviour; however, structural determinants of methamphetamine use among FSWs are largely unknown. We identified individual, structural and neighbourhood factors associated with smoking methamphetamine among FSWs in the border city of Tijuana, Baja California, Mexico. DESIGN AND METHODS A prospective cohort of 301 FSWs sampled from indoor and outdoor sex work venues throughout Tijuana participated in quantitative surveys on behaviours and mapping of home and work neighbourhoods across three visits. Multinomial logistic regression using generalised estimating equations identified individual, structural and neighbourhood variables associated with smoking methamphetamine. RESULTS Methamphetamine use, particularly smoking, was highly prevalent among FSWs. Over half (61%) of FSWs had ever used methamphetamine in their lifetime and at baseline, 38% currently smoked methamphetamine. Smoking methamphetamine daily was associated with living in the red light district [adjusted odds ratio (AOR) = 2.72, 95% confidence interval (CI) = 1.23-6.02] and with perceived homelessness, but only among women in a good financial situation (AOR = 4.08, 95% CI = 1.58-10.50). Smoking methamphetamine less than daily was associated with older age (AOR = 1.06, 95% CI = 1.02-1.10). DISCUSSION AND CONCLUSIONS Our findings point to the important dynamic between the residential environment and more severe methamphetamine use. FSWs may prioritise the purchase of methamphetamine over stable housing if they have the financial means. Given the high prevalence of smoking methamphetamine among FSWs in Tijuana, drug treatment options, especially for women living in the red light district, are needed.
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Affiliation(s)
- Erin E. Conners
- Department of Medicine, University of California, San Diego, USA
- San Diego State University, San Diego, USA
| | - Tommi L. Gaines
- Department of Medicine, University of California, San Diego, USA
| | | | - Carlos Magis-Rodriguez
- National Center for the Prevention and Control of HIV and AIDS, Col Anzures, Distrito Federal, Mexico
| | - Kimberly C. Brouwer
- Department of Family Medicine & Public Health, University of California, San Diego, USA
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Meacham MC, Ramo DE, Kral AH, Riley ED. Associations between medical cannabis and other drug use among unstably housed women. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:45-51. [PMID: 29227883 DOI: 10.1016/j.drugpo.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 11/11/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies suggest that U.S. state-level legalization of cannabis for medical purposes may be associated with reductions in opioid use; yet its relationship with stimulant use, particularly in high-risk populations like unstably housed women, has received less attention. The purpose of this study was to estimate independent associations between medical and non-medical use of cannabis and use of stimulants and opioids among unstably housed women. METHODS Cross-sectional data were analyzed from 245 women in the SHADOW study, a community based cohort in San Francisco, CA, in which HIV+ women were oversampled (126 HIV+ and 119 HIV-). RESULTS Compared to no cannabis use in the past 6 months (51%), non-medical cannabis use (28%) was associated with a higher adjusted odds of using stimulants (Adjusted Odds Ratio [AOR]=4.34, 95% confidence interval [CI]: 2.17-8.70) and opioids (AOR=3.81, 95% CI: 1.78-8.15). Compared to no cannabis use, medical cannabis use (21%) was not significantly associated with stimulant or opioid use. Compared to non-medical cannabis use, however, medical cannabis use was associated with lower adjusted odds of using stimulants (AOR=0.42, 95% CI: 0.18-0.96). These associations were not modified by HIV status. CONCLUSIONS Associations between use of cannabis and "street drugs" depend on whether the cannabis is obtained through a medical context. Interventions, research, and policy considering the influence of cannabis on the use of other drugs may benefit by distinguishing between medical and non-medical cannabis use.
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Affiliation(s)
- Meredith C Meacham
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA.
| | - Danielle E Ramo
- Department of Psychiatry and Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | | | - Elise D Riley
- Division of HIV, Infectious Disease & Global Medicine, University of California, San Francisco, CA, USA
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Health outcomes associated with crack-cocaine use: Systematic review and meta-analyses. Drug Alcohol Depend 2017; 180:401-416. [PMID: 28982092 DOI: 10.1016/j.drugalcdep.2017.08.036] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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Abstract
PURPOSE OF REVIEW The study reviews recent publications on methamphetamine use and dependence women in term of their epidemic, physical health impact, psychosocial impacts, and also in the identified vulnerable issues. RECENT FINDINGS Studies of vulnerable populations of women are wide ranging and include sex workers, sexual minorities, homeless, psychiatric patients, suburban women, and pregnant women, in which amphetamine type stimulants (ATSs) are the most commonly reported illicit drug used among them. The prenatal exposure of ATS demonstrated the small for gestational age and low birth weight; however, more research is needed on long-term studies of methamphetamine-exposed children. Intimate partner violence (IPV) is commonly reported by female methamphetamine users as perpetrators and victims. However, statistics and gendered power dynamics suggest that methamphetamine-related IPV indicates a higher chance of femicide. Methamphetamine-abusing women often have unresolved childhood trauma and are introduced to ATS through families or partners. SUMMARY Vulnerable populations of women at risk of methamphetamine abuse and dependence. Impacts on their physical and mental health, IPV, and pregnancy have been reported continuing, which guide that empowering and holistic substance abuse are necessary for specific group.
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Abstract
PURPOSE OF REVIEW Stimulant use disorders are significant contributors to the global burden of disease, with a growing impact on women. Psychosocial interventions are the gold standard for treating this condition, but several barriers may prevent women from accessing appropriate treatment. Therefore, we systematically reviewed the most recent findings about psychosocial interventions for stimulant use disorders, focussing on results relevant to women. RECENT FINDINGS Twenty-two eligible studies were identified. Psychosocial interventions in stimulant use disorders were examined in 17 recent studies, but no analyses for sex-related differences were performed. These aspects were investigated in further five studies, either through secondary analyses on the female subgroup or specifically examining a female-only sample. Contingency management, either alone or in combination with other interventions, provided the most positive results on several outcome measures. Only one pilot study showed good potential for an alternative approach of systemic family therapy, warranting further research in this direction. SUMMARY Research in stimulant use disorders shows an increasing interest in exploring interventions capable of addressing sex-specific issues. Combined therapy including contingency management and other treatments appears the most promising option, but larger secondary studies are needed to rank the efficacy of different psychosocial interventions while considering their feasibility and acceptability in specific subpopulations, including women.
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Young DA, Shumway M, Flentje A, Riley ED. The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2017; 9:613-621. [PMID: 28581316 DOI: 10.1037/tra0000288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Previous studies have established a link between childhood abuse and dissociation. Other work has shown childhood abuse increases the likelihood of violent victimization in adulthood. Although it has been posited that dissociation may mediate childhood abuse and adult violent victimization, research investigating this hypothesis is sparse, particularly for extremely vulnerable populations such as homeless and unstably housed individuals. investigated the relationship between childhood abuse and dissociation on violent victimization in a cohort of homeless and unstably housed women. We also assessed whether dissociation mediated childhood abuse and violent victimization in this sample. METHOD Participants were asked at an initial assessment and a 6-month follow-up to report any physical or sexual violence experienced in the previous 6 months. Questionnaires recording history of specific types of childhood abuse, dissociation, and other factors were also recorded at the initial assessment. RESULTS Hierarchical logistic regression models revealed that childhood sexual abuse (Odds ratio [OR] = 3.10, p < .01) and severe dissociation (OR = 1.99, p < .01) were significantly associated with recent physical violence, and childhood sexual abuse (OR = 3.88, p < .01) and dissociation (OR = 1.87, p < .05) were also associated with recent sexual violence. Dissociation mediated neither childhood abuse on recent physical violence or recent sexual violence. CONCLUSION Developing approaches that effectively identify and treat dissociation as a part of an overall framework of trauma-informed care in homeless and unstably housed women may be an effective way to decrease future physical violence in this vulnerable population. (PsycINFO Database Record
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Affiliation(s)
- Dmitri A Young
- School of Medicine, Department of Psychiatry, University of California, San Francisco
| | - Martha Shumway
- School of Medicine, Department of Psychiatry, University of California, San Francisco
| | - Annesa Flentje
- School of Nursing, Department of Community Health Systems, University of California, San Francisco
| | - Elise D Riley
- School of Medicine, Department of Medicine, University of California, San Francisco
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Riley ED, Hsue PY, Vittinghoff E, Wu AHB, Coffin PO, Moore PK, Lynch KL. Higher prevalence of detectable troponin I among cocaine-users without known cardiovascular disease. Drug Alcohol Depend 2017; 172:88-93. [PMID: 28157591 PMCID: PMC5464776 DOI: 10.1016/j.drugalcdep.2016.11.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND While cocaine use is an established risk factor for acute cardiovascular complications, associations between cocaine use and markers of cardiac injury outside of acute hospital presentation remain poorly characterized. We leveraged advances in cardiac troponin (cTnI) testing to assess low but clinically meaningful levels of cardiac injury among cocaine users and non-users. METHODS We conducted a case control study comparing cTnI levels by the presence of cocaine among patients presenting for non-cardiac care in an urban safety net hospital. Samples were chosen sequentially among those for which urine drug screens were ordered by providers hospital-wide. RESULTS During 2015, 14% of all hospital drug screens ordered were cocaine-positive. Among unique persons providing cocaine-positive (N=100) and cocaine-negative (N=100) samples, 37% were female, 45% were African-American and the median age was 51. Detectable cTnI (> 0.02ng/mL) was observed in 21 samples (11%). It was more common in subjects using cocaine (Adjusted OR=2.81; 95% CI=1.03-7.65), but not other drugs. Moreover, there was a significant correlation between concentrations of cTnI and the cocaine metabolite, benzoylecgonine (Spearman Correlation=0.34, p<0.01). CONCLUSIONS Among urban safety net hospital patients, 11% had detectable cTnI, and cTnI concentration was significantly correlated with benzoylecgonine concentration. While these preliminary results require additional confirmation, they suggest the potential utility of considering cocaine use as more than just an episodic exposure leading to acute cardiac events. The consideration of cocaine use as an ongoing chronic exposure leading to subclinical cardiac injury may improve risk-stratification and patient outcomes in populations where cocaine use is high.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Health, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, San Francisco General Hospital, University of California, SanFrancisco, CA, USA
| | - Phillip O Coffin
- Division of HIV, Infectious Diseases and Global Health, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Peter K Moore
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Hospital Medicine, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, San Francisco General Hospital, University of California, SanFrancisco, CA, USA
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Bird M, Rhoades H, Lahey J, Cederbaum J, Wenzel S. Life Goals and Gender Differences among Chronically Homeless Individuals Entering Permanent Supportive Housing. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2017; 26:9-15. [PMID: 31097899 PMCID: PMC6516855 DOI: 10.1080/10530789.2016.1274570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This research seeks to understand goals and the gender differences in goals among men and women who are transitioning into permanent supportive housing. Because of systemic gender inequality, men and women experience homelessness differently. Data collected for this study come from a longitudinal investigation of HIV risk behavior and social networks among women and men transitioning from homelessness to permanent supportive housing. As part of this study, 421 baseline interviews were conducted in English with homeless adults scheduled to move into permanent supportive housing; participants were recruited between September 2014 and October 2015. This paper uses goals data from the 418 male-or female-identified respondents in this study. Results identified goal differences in education and general health between men and women that should be taken into account when service providers, policy makers, and advocates are addressing the needs of homeless women.
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Affiliation(s)
- Melissa Bird
- School of Social Work, University of Southern California, Los Angeles, USA
| | - Harmony Rhoades
- School of Social Work, University of Southern California, Los Angeles, USA
| | - John Lahey
- School of Social Work, University of Southern California, Los Angeles, USA
| | - Julie Cederbaum
- School of Social Work, University of Southern California, Los Angeles, USA
| | - Suzanne Wenzel
- School of Social Work, University of Southern California, Los Angeles, USA
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Biscotto PR, Jesus MCPD, Silva MHD, Oliveira DMD, Merighi MAB. Understanding of the life experience of homeless women. Rev Esc Enferm USP 2016; 50:749-755. [DOI: 10.1590/s0080-623420160000600006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/31/2016] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To understand the life experience of homeless women. METHOD A social phenomenological study was conducted with 10 women assisted by a shelter. The analysis of the interviews was based on the theoretical framework of social phenomenology of Alfred Schütz and thematic literature. RESULTS The participants face adversities in the street context, with emphasis on the risk of physical and sexual abuse, and seek shelters as a possibility for minimizing difficulties experienced. They hope to leave the streets; however, they see themselves trapped in this social reality, due to the addiction to alcohol and other drugs. CONCLUSION The understanding of the life experience of homeless women shows daily confrontations and reveals the conflict between the desire for leaving and remaining on the streets, given the complexity of the reality that keeps them in this condition.
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