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Guerin AA, Bridson T, Plapp HM, Bedi G. A systematic review and meta-analysis of health, functional, and cognitive outcomes in young people who use methamphetamine. Neurosci Biobehav Rev 2023; 153:105380. [PMID: 37678571 DOI: 10.1016/j.neubiorev.2023.105380] [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] [Received: 05/22/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023]
Abstract
Methamphetamine use typically starts in adolescence, and early onset is associated with worse outcomes. Yet, health, functional, and cognitive outcomes associated with methamphetamine use in young people are not well understood. The aim of this study was to comprehensively assess the evidence on health, functional, and cognitive outcomes in young people (10-25 years-old) who use methamphetamine. Sixty-six studies were included. The strongest association observed was with conduct disorder, with young people who use methamphetamine some 13 times more likely to meet conduct disorder criteria than controls. They were also more likely to have justice system involvement and to perpetrate violence against others. Educational problems were consistently associated with youth methamphetamine use. The cognitive domain most reliably implicated was inhibitory control. Key limitations in the literature were identified, including heterogenous measurement of exposure and outcomes, lack of adequate controls, and limited longitudinal evidence. Outcomes identified in the present review - suggesting complex and clinically significant behavioural issues in this population - are informative for the development of future research and targeted treatments.
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Affiliation(s)
- Alexandre A Guerin
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, Melbourne, Australia.
| | - Tahnee Bridson
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, Melbourne, Australia
| | - Helena M Plapp
- Orygen, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia
| | - Gillinder Bedi
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen, Melbourne, Australia
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2
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Ahrens K, Blackburn N, Aalsma M, Haggerty K, Kelleher K, Knight DK, Joseph E, Mulford C, Ryle T, Tolou-Shams M. Prevention of Opioid Use and Disorder Among Youth Involved in the Legal System: Innovation and Implementation of Four Studies Funded by the NIDA HEAL Initiative. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:99-110. [PMID: 37393415 PMCID: PMC10961647 DOI: 10.1007/s11121-023-01566-6] [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] [Accepted: 06/11/2023] [Indexed: 07/03/2023]
Abstract
Youth involved in the legal system (YILS) experience rates of opioid and substance use disorders (OUD/SUDs) and overdose that is well above those in the general population. Despite the dire need, and the existing programs that focus on treatment of these problems in YILS, research on opioid initiation, and OUD prevention, including feasibility and sustainability, are severely limited. We present four studies testing interventions that, while not necessarily novel as SUD treatments, test novel structural and interpersonal strategies to prevent opioid initiation/OUD precursors: (1) ADAPT (Clinical Trial No. NCT04499079) provides real-time feedback using community-based treatment information system data to create a more effective mental health and SUD treatment cascade to prevent opioid use; (2) HOME (Clinical Trial No. NCT04135703) provides youth experiencing homelessness, including YILS, with direct access to shelter in independent living without prerequisites as an opioid initiation prevention strategy; (3) LeSA (Clinical Trial No. NCT04678960) uses the Trust-Based Relational Intervention® to equip YILS and their caregivers with self-regulatory and communication skills during the transition from secure confinement to reduce opioid initiation/re-initiation; and (4) POST (Clinical Trial No. NCT04901312) tests two interventions integrating interpersonal/drinking and drug refusal skills, case management, and goal setting among YILS in transitioning out of secure detention as opioid initiation prevention strategies. We discuss early implementation barriers and facilitators, including complexities of prevention research with YILS and adaptations due to COVID-19. We conclude by describing anticipated end products, including implementation of effective prevention interventions and integration of data from multiple projects to address larger, multi-site research questions.
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Affiliation(s)
- Kym Ahrens
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA.
| | | | - Matthew Aalsma
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin Haggerty
- University of Washington Social Development Research Group, Seattle, WA, USA
| | | | - Danica K Knight
- Texas Christian University Karyn Purvis Institute of Child Development, Fort Worth, TX, USA
| | - Elizabeth Joseph
- Texas Christian University Institute of Behavioral Research, Fort Worth, TX, USA
| | | | - Ted Ryle
- Washington State Dept. of Children, Youth and Families/Juvenile Rehabilitation, Olympia, WA, USA
| | - Marina Tolou-Shams
- University of California San Francisco Weill Institute for Neurosciences, San Francisco, CA, USA
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Dahlby L, Boyd J, Knight R, Philbin M, Small W, Kerr T, McNeil R. The perspectives of street-involved youth who use drugs regarding the acceptability and feasibility of HIV pre-exposure prophylaxis: a qualitative study. AIDS Care 2023; 35:480-487. [PMID: 35698454 PMCID: PMC9930182 DOI: 10.1080/09540121.2022.2085868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Street-involved youth who use drugs (YWUD) face an elevated risk of HIV acquisition and represent a key population for HIV prevention initiatives, including pre-exposure prophylaxis (PrEP). However, little is known regarding the acceptability and feasibility of PrEP uptake and adherence among this multiply-marginalized population. Semi-structured qualitative interviews were conducted with 24 street-involved YWUD (ages 17-24) to examine their perspectives toward PrEP; youth were recruited through a longitudinal prospective cohort study in Vancouver, Canada. Youth reported high levels of ambivalence toward PrEP despite engagement in HIV-related risk behaviors. This ambivalence was driven by misperceptions regarding HIV transmission, including stigmatizing associations between HIV transmission and personal hygiene. Such misperceptions led participants to enact strategies that were ineffective in preventing HIV transmission. Participants contested their inclusion as a "key population" for PrEP, which limited their enthusiasm for PrEP uptake and adherence. Participants also highlighted that wider social-structural inequities (e.g., housing vulnerability, poverty) that produced HIV-related risks were likely to undermine sustained PrEP use. Findings demonstrate the need for tailored implementation strategies to increase PrEP acceptability, including targeted education and anti-stigma interventions to increase awareness about HIV transmission. Interventions should also target structural inequities in order to fully address HIV risk and PrEP ambivalence.
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Affiliation(s)
- Lucia Dahlby
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Morgan Philbin
- Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 West 168th St. NY, NY 10032
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
- Yale School of Medicine (Internal Medicine), 367 Cedar St, New Haven, CT, 06510
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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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Madison T, Reith C, Haleigh A, Rainbow D, Katey K, Kali S, Rod K, Danya F. Navigating treatment in the shadow of the overdose crisis: Perspectives of youth experiencing street-involvement across British Columbia. CANADIAN JOURNAL OF ADDICTION 2022; 13:S62-S71. [PMID: 36506907 PMCID: PMC9731385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective Youth experiencing street-involvement are particularly vulnerable to substance use-related harms. Since an overdose public health emergency was declared in British Columbia (BC) in 2016, there have been concerted efforts to expand youths' access to integrated mental health and substance use treatment across the province. The present study sought to explore how youth were navigating this rapidly evolving treatment landscape. Methods Focus groups were conducted with youth experiencing street-involvement in three BC cities, followed by a summit event in Vancouver. Audio recordings were transcribed verbatim and coded thematically alongside observational field notes. All activities were undertaken in collaboration with a Youth Advisory Council. Results Across BC, youth expressed desires to achieve aspects of what some called a "normal life" following treatment, which required having "somewhere to go next." In the absence of desirable housing and adequate income, youth were often left with the crushing sense that, despite their efforts, treatment would not ultimately help them to "get somewhere better." Negative experiences in treatment settings were also shaped by the files that "followed" youth across care settings, inappropriate information sharing between providers, and an overemphasis on pharmacotherapies (namely, opioid agonist therapies and psychotropic medications). Conclusion Our findings point to the inability of existing services and systems to address entrenched marginalization and chronic instability, and underscore the importance of relationship-, trust-, and future-building to providing treatment and care to youth. Young people must be empowered with control over their treatment trajectories, including decision-making surrounding pharmacotherapies and information sharing.
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Affiliation(s)
| | | | | | | | | | - Sedgemore Kali
- Youth Health Advisory Council, Vancouver, Canada,Coalition of Peers Dismantling the Drug War, Vancouver, Canada
| | - Knight Rod
- British Columbia Center on Substance Use, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Fast Danya
- British Columbia Center on Substance Use, Vancouver, Canada,Department of Medicine, University of British Columbia, Vancouver, Canada
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Almquist L, Walker SC. Reciprocal associations between housing instability and youth criminal legal involvement: a scoping review. HEALTH & JUSTICE 2022; 10:15. [PMID: 35394569 PMCID: PMC8991975 DOI: 10.1186/s40352-022-00177-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Youth experiencing homelessness have disproportionate contact with the criminal legal system. This system contact represents a critical inflection point for enhancing risk or opportunities for stabilization; however, the policy and scholarly traditions examining the criminal legal system have not traditionally incorporated housing or other social determinants as a central focus of intervention. METHODS We conducted a scoping review using PRISMA-ScR guidelines to examine how the research literature is currently addressing housing within the context of youth involvement in the legal system. Databases searched included PubMed, Web of Science, and Academic Search Complete. Google Scholar was used to identify papers not indexed in the academic databases of interest. Database searches were conducted between September and December 2019 and articles were restricted to those published in English between the year 2000 and 2019. Key study components extracted included demographic information regarding each sample, type of article, study methodology, direction of effects of interest, outcome measures and primary findings, as well as theoretical frameworks engaged by the authors. RESULTS The search results returned 2154 titles for review. After screening all 2154 titles, 75 met eligibility for inclusion. Abstract reviews were conducted for all 75 papers. 36 abstracts met eligibility criteria and underwent full-text review. Ultimately, 29 articles satisfied eligibility criteria and were included in this scoping review. CONCLUSIONS Publications are primarily focused on the social epidemiology of risk factors and behaviors determining youth justice contact, but relatively less so on studies of interventions targeting youth delinquency, crime reduction, or recidivism that included housing support. The lack of continuity in theorizing from epidemiology to applied science in this area represents a gap in the literature that is likely reducing the effectiveness of interventions to interrupt patterns of legal system contact for youth. Integrating a public health framework that emphasizes the upstream social determinants leading to contact with the youth justice system would represent a paradigm shift for the field that would have beneficial effects on long term health outcomes for youth.
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Affiliation(s)
- Lars Almquist
- Department of Health Systems and Population Health, University of Washington, Seattle, United States.
| | - Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, United States
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Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults. AIDS Behav 2021; 25:165-174. [PMID: 34302283 PMCID: PMC8542003 DOI: 10.1007/s10461-021-03364-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/14/2023]
Abstract
This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18–27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.
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Gjersing L, Bretteville-Jensen AL. Characteristics and risk of incarceration among "hard-to-reach" people who use drugs: A five-year prospective cohort study combining self-reports and registry data. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103288. [PMID: 34004380 DOI: 10.1016/j.drugpo.2021.103288] [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: 08/20/2020] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Incarcerations are associated with an increased risk of morbidity and mortality among people who use drugs (PWUD). In a sample of 884 PWUD, we examine and estimate the risk of incarcerations (i.e., number, duration, and most serious offense). METHODS In this prospective cohort study, PWUD were recruited from street- and low-threshold services in seven Norwegian cities in 2013 (Sept-Nov), and followed through the Correctional Service Registry until 20.12.2018. The risk of incarceration during follow-up was examined with multivariable logistic (no incarceration vs. at least one) and multinomial regression models ("no incarcerations", vs. "1″, "≥2″), while accounting for gender, age, homelessness/shelter use, opioid substitution treatment, illegal income sources, injecting behaviours, previous incarcerations, and recruitment city. RESULTS During follow-up, there were in total 662 incarceration episodes, and 44.7% of the participants were incarcerated at least once. Overall, 37.5% of those incarcerated had at least one episode due to a drug offense. The average incarceration duration was 65.2 days with 3.5% of the episodes lasting ≥one year. Gender (male), homelessness/shelter use, illegal income sources, injecting stimulants, and previous incarcerations increased the odds of incarceration, while older age decreased the odds. Gender (male), younger age, self-reported theft or theft and dealing, injecting stimulants or heroin and stimulants and previous incarcerations increased the risk of multiple incarcerations. CONCLUSION In a five-year prospective study of PWUD, incarcerations were common, and short-term sentences and recidivism were the norm. This is of concern as incarcerations add to an already elevated morbidity and mortality risk in this population.
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Affiliation(s)
- Linn Gjersing
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway.
| | - Anne Line Bretteville-Jensen
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Postboks 222 Skøyen, 0213 Oslo, Norway
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Semborski S, Henwood B, Rhoades H, Mason T, Wenzel S, Rice E. Construct, concurrent, and real-world predictive validity of the Difficulties in Emotion Regulation (DERS-18) among young adults with history of homelessness. Psychol Assess 2021; 33:385-394. [PMID: 33630634 PMCID: PMC8418354 DOI: 10.1037/pas0000991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Skills in emotional regulation are vitally important for enabling homeless young adults to navigate the complex and chaotic settings associated with homelessness. The current study seeks to test the construct, concurrent, and predictive validity of the Difficulties in Emotional Regulation Scale (DERS-18) in a sample of formerly and currently homeless young adults. Data come from a study of HIV risk among young adults who have experienced homelessness, including both those currently experiencing homelessness (n = 99) and in permanent housing (n = 120), collected between 2017 and 2019 in Los Angeles, CA. Structural Equation Modeling was used to complete Confirmatory Factor Analysis and Path Models focused on the relationship between mental health symptomatology and emotional regulation. Linear regression models tested the link between affective intensity and instability and the DERS-18. Model fit indices pointed to the five-factor solution of the DERS-18, excluding the Awareness subscale. Clinical scores of anxiety, depression, and PTSD were found to have a significant, positive correlation with DERS. Both intensity and instability of negative affect were associated with greater difficulty in emotional regulation, while the increased intensity of positive affect was associated with increased skills in emotional regulation. This study addressed several gaps in both homelessness and emotional regulation literature. The DERS-18 was found to have construct, concurrent, and predictive validity in our sample. Future work should consider the use of the DERS-18 to assess skills in emotional regulation, understand outcomes, and better tailor interventions for young adults who have experienced homelessness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Sara Semborski
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Tyler Mason
- Department of Preventive Medicine, University of Southern California
| | - Suzanne Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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Papadimitriou D, Parpa E, Papanastasatos G, Tsilika E, Galanos A, Mystakidou K. The study of economic crisis in Greek population of drug users approaching KETHEA: socioeconomic factors and comorbidity between 2009 and 2014. JOURNAL OF SUBSTANCE USE 2020. [DOI: 10.1080/14659891.2020.1808723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Efi Parpa
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Gerasimos Papanastasatos
- KETHEA Research Department Director, Department of Research, Therapy Center for Dependent Individuals (KETHEA), Athens, Greece
| | - Eleni Tsilika
- Health Psychologist, Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Galanos
- Biostatistician, Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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AKÇAY BÜLENTDEVRIM, AKÇAY DUYGU. What are the factors that contribute to aggression in patients with co-occurring antisocial personality disorder and substance abuse? ARCH CLIN PSYCHIAT 2020. [DOI: 10.1590/0101-60830000000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Bouck Z, Jain S, Sun X, Milloy MJ, Werb D, Hayashi K. Recent incarceration and risk of first-time injection initiation assistance: A prospective cohort study of persons who inject drugs. Drug Alcohol Depend 2020; 212:107983. [PMID: 32380374 PMCID: PMC7293943 DOI: 10.1016/j.drugalcdep.2020.107983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given the prevalence and harms of incarceration among persons who inject drugs (PWID) and their role in injection drug use initiation, we aimed to investigate whether recent incarceration influences the likelihood PWID assist others in their first-ever injection. METHODS Prospective cohort study of PWID in Vancouver, Canada who had their PReventing Injecting by Modifying Existing Responses (PRIMER) baseline visit between December 2014 and May 2017, reported never providing injection initiation assistance previously, and had ≥1 follow-up visit. The primary outcome, provision of injection initiation assistance, was defined via self-report as helping anybody inject for the first time in the past six months. The primary exposure was recent incarceration, i.e., self-report of being jailed, imprisoned or detained in the past six months. Participants were assessed biannually until November 2017, drop-out, or their first report of the primary outcome. RESULTS 1,199 PWID (62.1% male; mean (SD) age, 44.4 (12.3) years) were included in our study. Across 4,171 follow-up visits, 67 participants (5.6%) reported providing injection initiation assistance. The proportion of participants reporting recent incarceration varied between 2.4% to 5.1% per follow-up visit. Based on a multivariable discrete-time proportional hazards regression analysis, recent incarceration was associated with an increased risk of providing injection initiation assistance during the same six-month period (adjusted hazard ratio, 2.64; 95% CI, 1.19 to 5.86). CONCLUSIONS The observed association between recent incarceration and risk of providing injection initiation assistance suggests that incarceration could be contributing to the expansion of injection drug use practices within vulnerable populations over time.
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Affiliation(s)
- Zachary Bouck
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada; Dalla Lana School of Public Health, University of Toronto, 55 College St Room 500, Toronto, ON M5T 3M7, Canada
| | - Sonia Jain
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Xiaoying Sun
- Biostatistics Research Center, Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3, Canada
| | - Dan Werb
- Centre for Drug Policy and Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, ON M5B 1T8, Canada; Division of Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA.
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC V5A 1S6, Canada
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13
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Card KG, Selfridge M, Greer AM, Hepburn KJ, Fournier AB, Sorge J, Urbanoski K, Pauly B, Benoit C, Lachowsky NJ, Macdonald S. Event-level outcomes of police interactions with young people in three non-metropolitan cities across British Columbia, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 91:102824. [PMID: 32591221 DOI: 10.1016/j.drugpo.2020.102824] [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: 12/10/2019] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
This study examines encounters between youth and police to identify individual, contextual, and social factors that predict the outcome of these encounters. Young people aged 16-30 years were surveyed between May 2017 and June 2018 in three non-metropolitan cities across British Columbia, Canada. Outcomes were analysed using multinomial logistic generalized estimating equations. A total of 675 encounters were reported by 360 participants. These outcomes resulted in participants being questioned (n = 227; 33.6%); given warnings (n = 132; 19.6%); being searched (n = 104; 15.4%); being given a ticket (n = 101; 15.0%); and being handcuffed or arrested (n = 111; 16.4%). Young Indigenous people (vs. white) were significantly more likely to be handcuffed or arrested (OR=3.26; 1.43, 7.43). Statistical significance held after adjusting for history of police encounters and contextual factors. Findings suggest that police discretion, which has the potential to benefit youth, may be undermined by discriminatory applications of discretion.
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Affiliation(s)
- Kiffer G Card
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada.
| | - Marion Selfridge
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Alissa M Greer
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Criminology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby BC, Canada
| | - Kirk J Hepburn
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada; School of Criminology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby BC, Canada; School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada; Department of Sociology, Faculty of Social Sciences, University of Victoria, Victoria, BC, Canada; School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Anabelle Bernard Fournier
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Justin Sorge
- Canadian Institute for Substance Use Research, Victoria, BC, Canada
| | - Karen Urbanoski
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Bernie Pauly
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Cecilia Benoit
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; Department of Sociology, Faculty of Social Sciences, University of Victoria, Victoria, BC, Canada
| | - Nathan J Lachowsky
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Scott Macdonald
- Canadian Institute for Substance Use Research, Victoria, BC, Canada; School of Health Information Science, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
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Pilarinos A, Kendall P, Fast D, DeBeck K. Secure care: more harm than good. CMAJ 2019; 190:E1219-E1220. [PMID: 30322985 DOI: 10.1503/cmaj.180700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
| | - Perry Kendall
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
| | - Danya Fast
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
| | - Kora DeBeck
- British Columbia Centre on Substance Use (Pilarinos, Fast, DeBeck), Vancouver, BC; Interdisciplinary Studies Graduate Pro gram (Pilarinos); School of Population and Public Health (Kendall), The University of British Columbia, Vancouver, BC; School of Public Policy (DeBeck), Simon Fraser University, Vancouver, BC
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Goldman-Hasbun J, Nosova E, Kerr T, Wood E, DeBeck K. Homelessness and incarceration associated with relapse into stimulant and opioid use among youth who are street-involved in Vancouver, Canada. Drug Alcohol Rev 2019; 38:428-434. [PMID: 30896070 DOI: 10.1111/dar.12921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS While much research has sought to identify the factors associated with initiation and cessation of various forms of drug use among vulnerable youth, little is known about relapse into drug use in this population. We sought to characterise relapse into stimulant and opioid use among street-involved youth in Vancouver, Canada. DESIGN AND METHODS Data were collected between 2005 and 2017 from the At-Risk Youth Study, a prospective cohort study of street-involved youth who use illicit drugs in Vancouver. Multivariable extended Cox regression was utilised to identify factors associated with relapse into illegal stimulants and/or opioids among youth who had previously ceased using stimulants and/or opioids for 6 months or longer. RESULTS Among 246 participants who reported a period of cessation lasting 6 months or longer, 165 (67.1%) relapsed at some point during study follow-up. Youth who were recently incarcerated (adjusted hazard ratio [AHR]: 1.46), homeless (AHR: 1.43), or had a history of daily stimulant use (AHR: 1.48) were significantly more likely to report relapse, while youth of who identified as white (AHR: 0.74) were significantly less likely to report relapse (all P < 0.05). DISCUSSION AND CONCLUSIONS Relapse into stimulants and/or opioids was common among youth in our setting, and incarceration, homelessness, and daily stimulant use were found to be positively associated with relapse among youth. Findings suggest that increased access to youth housing supports and alternatives to the criminalisation of drug use may help to reduce the rates of relapse into stimulants and/or opioids in this population.
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Affiliation(s)
| | | | - Thomas Kerr
- B.C. Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- B.C. Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- B.C. Centre on Substance Use, Vancouver, Canada.,School of Public Policy, Simon Fraser University, Vancouver, Canada
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Harris RE, Richardson J, Frasso R, Anderson ED. Experiences with skin and soft tissue infections among people who inject drugs in Philadelphia: A qualitative study. Drug Alcohol Depend 2018; 187:8-12. [PMID: 29626746 DOI: 10.1016/j.drugalcdep.2018.01.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 01/06/2018] [Accepted: 01/11/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To understand how people who inject drugs (PWID) experience skin and soft tissue infections (SSTI) and make decisions to seek or delay medical treatment. METHODS We conducted semi-structured, in-depth interviews in 2015 with 19 PWID at a syringe exchange program in Philadelphia. We analyzed the data using standard qualitative techniques. RESULTS PWID described adequate knowledge about SSTI, although they could not always implement knowledge about SSTI prevention due to environmental constraints. Participants reported different experiences with incident SSTI. Some sought immediate medical care at initial presentation. Most, however, waited to seek care. Previous positive and negative healthcare experiences, both in general -including stigma and withdrawal- and specific to SSTI, influenced this decision. Among those who delayed medical care, some reported self-treatment, including increased drug use for pain control, and lancing and draining their own wounds. CONCLUSION Reducing the incidence of SSTI and promoting earlier treatment are important public health priorities. Both require ongoing attention and improvements to the environments in which PWID inject and receive care.
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Affiliation(s)
- Robert E Harris
- University of Pennsylvania School of Medicine, MPH Program, 3620 Hamilton Walk, Anatomy Chemistry Room 141, Philadelphia, PA, 19104, USA; University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Jessica Richardson
- University of Pennsylvania School of Medicine, MPH Program, 3620 Hamilton Walk, Anatomy Chemistry Room 141, Philadelphia, PA, 19104, USA; Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Anatomy Chemistry Room 141, Philadelphia, PA, 19104, USA
| | - Rosemary Frasso
- Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Anatomy Chemistry Room 141, Philadelphia, PA, 19104, USA; College of Population Health, Jefferson University, 901 Walnut St, Philadelphia, PA 19107, USA
| | - Evan D Anderson
- University of Pennsylvania School of Medicine, MPH Program, 3620 Hamilton Walk, Anatomy Chemistry Room 141, Philadelphia, PA, 19104, USA; Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Anatomy Chemistry Room 141, Philadelphia, PA, 19104, USA; University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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17
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Harris RE, Richardson J, Frasso R, Anderson ED. Perceptions about supervised injection facilities among people who inject drugs in Philadelphia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 52:56-61. [PMID: 29241143 DOI: 10.1016/j.drugpo.2017.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/30/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at high risk for infectious diseases, skin and soft tissue infections, and overdose. However, these harms are all avoidable when sterile injection equipment, hygienic places to inject, and medical care are accessible. Unfortunately, many PWID in the U.S lack these resources. The most vulnerable are forced to inject in public spaces, where individual risks are high and communal harms are sometimes many. Supervised Injection Facilities (SIFs) are an established intervention for reducing these harms. Despite positive experiences in other countries, little research explores how PWID in the U.S. perceive the value of such facilities. METHODS We conducted a freelisting exercise with PWID (n=42) and healthcare providers (n=20) at a syringe exchange program (SEP) that provides comprehensive clinical and social services in Philadelphia to inform in-depth semi-structured interviews with PWID (n=19) at the same location. RESULTS Participants expressed support for a potential SIF as a valuable public health intervention. They suggested that an SIF would improve PWID health while reducing the public disorder associated with injecting drugs in public. The latter was especially important to participants without stable housing, whose decision to inject furtively in secluded places was often motivated by desire not to upset community members, and particularly children. These participants acknowledged that such seclusion elevated the risk of fatal overdose. Despite similarly positive perceptions about an SIF, participants with stable housing reported that they would prefer to continue injecting at home. CONCLUSION Results both confirm and extend prior research about PWID and SIFs. Participants expressed support for SIFs as in prior survey research in the U.S. and in other countries. Facility location and housing status were identified as important determinants of facility use. Results extend prior research by illuminating PWID perceptions in the U.S. including motivations grounded in concern for public order.
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Affiliation(s)
- Robert E Harris
- Johns Hopkins School of Medicine-Department of Infectious Disease, United States; University of Pennsylvania School of Medicine, MPH Program, United States.
| | - Jessica Richardson
- University of Pennsylvania School of Medicine, MPH Program, United States; Center for Public Health Initiatives, University of Pennsylvania, United States
| | - Rosemary Frasso
- Center for Public Health Initiatives, University of Pennsylvania, United States; College of Population Health, Jefferson University, United States
| | - Evan D Anderson
- University of Pennsylvania School of Medicine, MPH Program, United States; Center for Public Health Initiatives, University of Pennsylvania, United States; University of Pennsylvania School of Nursing, United States
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18
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Gamarel KE, Nelson KM, Brown L, Fernandez MI, Nichols S. The Usefulness of the CRAFFT in Screening for Problematic Drug and Alcohol Use Among Youth Living with HIV. AIDS Behav 2017; 21:1868-1877. [PMID: 27981399 PMCID: PMC5472507 DOI: 10.1007/s10461-016-1640-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Substance use is highly prevalent among youth living with HIV (YLWH) and negatively impacts HIV care. This study sought to determine whether the CRAFFT (Car, Relax, Alone, Forget, Friends, and Trouble), designed to screen for problematic substance use, is reliably associated with substance use behaviors among YLWH. A cross-sectional sample of 2216 youth (ages 12-26) were recruited through the adolescent medicine trials network for HIV/AIDS Interventions. Participants completed a self-administered survey. Over half screened positive on the CRAFFT (i.e., ≥2). Among frequent substance users, those older in age, behaviorally infected, with history of incarceration or unstably housed were more likely to screen positive on the CRAFFT. Study findings suggest that the CRAFFT reliably identifies youth who use substances. Thus, screening measures such as the CRAFFT should be utilized routinely in HIV clinical settings for youth.
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Affiliation(s)
- Kristi E Gamarel
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02129, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02129, USA.
| | - Kimberly M Nelson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, RI, USA
| | - Larry Brown
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - M Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego, CA, USA
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Janik P, Kosticova M, Pecenak J, Turcek M. Categorization of psychoactive substances into “hard drugs” and “soft drugs”: a critical review of terminology used in current scientific literature. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017. [DOI: 10.1080/00952990.2017.1335736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Peter Janik
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michaela Kosticova
- Institute of Social Medicine and Medical Ethics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jan Pecenak
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Michal Turcek
- Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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Hoy C, Barker B, Regan J, Dong H, Richardson L, Kerr T, DeBeck K. Elevated risk of incarceration among street-involved youth who initiate drug dealing. Harm Reduct J 2016; 13:32. [PMID: 27876062 PMCID: PMC5120458 DOI: 10.1186/s12954-016-0120-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Street-involved youth are known to be an economically vulnerable population that commonly resorts to risky activities such as drug dealing to generate income. While incarceration is common among people who use illicit drugs and associated with increased economic vulnerability, interventions among this population remain inadequate. Although previous research has documented the role of incarceration in further entrenching youth in both the criminal justice system and street life, less is known whether recent incarceration predicts initiating drug dealing among vulnerable youth. This study examines the relationship between incarceration and drug dealing initiation among street-involved youth. Methods Between September 2005 and November 2014, data were collected through the At-Risk Youth Study, a cohort of street-involved youth who use illicit drugs, in Vancouver, Canada. An extended Cox model with time-dependent variables was used to examine the relationship between recent incarceration and initiation into drug dealing, controlling for relevant confounders. Results Among 1172 youth enrolled, only 194 (16.6%) were drug dealing naïve at baseline and completed at least one additional study visit to facilitate the assessment of drug dealing initiation. Among this sample, 56 (29%) subsequently initiated drug dealing. In final multivariable Cox regression analysis, recent incarceration was significantly associated with initiating drug dealing (adjusted hazard ratio = 2.31; 95% confidence interval (CI) 1.21–4.42), after adjusting for potential confounders. Measures of recent incarceration lagged to the prior study follow-up were not found to predict initiation of drug dealing (hazard ratio = 1.50; 95% CI 0.66–3.42). Conclusions These findings suggest that among this study sample, incarceration does not appear to significantly propel youth to initiate drug dealing. However, the initiation of drug dealing among youth coincides with an increased risk of incarceration and their consequent vulnerability to the significant harms associated therein. Given that existing services tailored to street-involved youth are inadequate, evidence-based interventions should be invested and scaled up as a public health priority.
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Affiliation(s)
- Carly Hoy
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Brittany Barker
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, BC, Canada
| | - Jackie Regan
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Lindsey Richardson
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Department of Sociology, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kora DeBeck
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada.
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Hepburn K, Barker B, Nguyen P, Dong H, Wood E, Kerr T, DeBeck K. Initiation of drug dealing among a prospective cohort of street-involved youth. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:507-512. [PMID: 27315200 PMCID: PMC5055453 DOI: 10.1080/00952990.2016.1186684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population. OBJECTIVES This longitudinal study examines drug dealing initiation among street-involved youth. METHODS Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14-26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing. RESULTS Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% confidence interval [CI]: 9.9-17.2). In multivariable Cox regression analysis, male gender (adjusted hazard ratio [AHR] = 1.90, 95% CI: 1.06-3.42), homelessness (AHR = 1.88, 95% CI: 1.05-3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47-4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38-4.00) were positively and independently associated with initiating drug dealing. CONCLUSION Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.
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Affiliation(s)
- Kirk Hepburn
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b School of Public Policy , Simon Fraser University , Vancouver , Canada
| | - Brittany Barker
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- c Interdisciplinary Studies Graduate Program , University of British Columbia , Vancouver , Canada
| | - Paul Nguyen
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Huiru Dong
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Evan Wood
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Thomas Kerr
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Kora DeBeck
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b School of Public Policy , Simon Fraser University , Vancouver , Canada
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Eviction and loss of income assistance among street-involved youth in Canada. J Public Health Policy 2016; 37:244-59. [PMID: 26961260 DOI: 10.1057/jphp.2016.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Loss of housing and income assistance among vulnerable youth has not been well described in the literature, yet it is a crucial issue for public health. This study examines the prevalence and correlates of loss of income assistance as well as eviction among street-involved youth. We collected data from a prospective cohort of street-involved youth aged 14-26. Among 770 participants, 64.3 per cent reported having housing and 77.1 per cent reported receiving income assistance at some point during the study period. Further, 28.6 and 20.0 per cent of youth reported having been evicted and losing income assistance, respectively. In multivariable generalized estimating equations analysis, heavy alcohol use, unprotected sex, being a victim of violence, and homelessness were all independently associated with eviction. Separately, homelessness, recent incarceration, and drug dealing were independently associated with loss of income assistance. Eviction and loss of income assistance are common experiences among street-involved youth with multiple vulnerabilities. Our findings highlight the importance of improving continued engagement with critical social services.
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Cheng T, Kerr T, Small W, Nguyen P, Wood E, DeBeck K. High prevalence of risky income generation among street-involved youth in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 28:91-7. [PMID: 26806639 DOI: 10.1016/j.drugpo.2015.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous research has found a range of barriers to mainstream employment among street-involved youth; however, less is known about the characteristics of street-involved youth who engage in risky income generation and the potential role of substance use in perpetuating engagement in these activities. METHODS Data were collected between 2005 and 2012 from the At-Risk Youth Study (ARYS), which is a prospective cohort study of street-involved youth aged 14-26 in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with risky quasi-legal and illegal income generation. Participants also reported their willingness to give up these sources of income if they were not using drugs. RESULTS Among 1008 participants, 826 (82%) reported engaging in risky income generation activities during the study period. Factors associated with risky income generation included: homelessness, binge drug use, injection drug use, crack use, crystal methamphetamine, overdose, interactions with police, and experiencing violence; regular employment was negatively associated with this outcome (all p<0.05). Among those who reported risky income generation, 440 (53%) were willing to give up these income sources if they were not using drugs. CONCLUSION Risky income generation was alarmingly prevalent in our sample, and associated with higher intensity drug use and other markers of vulnerability. The majority of participants (53%) reported willingness to give up their risky income sources if they were not using drugs; however, a substantial proportion of youth (47%) indicated that they would continue to engage in risk income generation regardless of their substance use suggesting that both substance use and economic insecurity likely perpetuate risky income generation among our sample. Findings highlight opportunities to reduce risky income generation by addressing problematic substance use through better access and engagement with evidence-based addiction treatment, and exploring, monitoring and evaluating innovative interventions to improve the overall economic security of street-involved youth.
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Affiliation(s)
- Tessa Cheng
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, Canada V5A 1S6.
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3.
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, Canada V5A 1S6.
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6.
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3.
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6; School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC, Canada V6B 5K3.
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Boyd J, Fast D, Small W. Pathways to criminalization for street-involved youth who use illicit substances. CRITICAL PUBLIC HEALTH 2015. [DOI: 10.1080/09581596.2015.1110564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
In light of the emphasis on enforcement-based approaches towards sex work, and the well-known negative impacts of these approaches on women's health, safety and well-being, we conducted a study to investigate the prevalence and correlates of recent incarceration among a cohort of women sex workers in Vancouver, Canada. Data were obtained from an open prospective community cohort of female and transgender women sex workers, known as An Evaluation of Sex Workers' Health Access (AESHA). Bivariate and multivariable logistic regression analyses, using generalized estimating equations (GEE), were used to model the effect of social and structural factors on the likelihood of incarceration over the 44-month follow-up period (January 2010-August 2013). Among 720 sex workers, 62.5 % (n = 450) reported being incarcerated in their lifetime and 23.9 % (n = 172) being incarcerated at least once during the study period. Of the 172 participants, about one third (36.6 %) reported multiple episodes of incarceration. In multivariable GEE analyses, younger age (adjusted odds ratio [AOR] = 1.04 per year younger, 95 % confidence interval [CI] 1.02-1.06), being of a sexual/gender minority (AOR = 1.62, 95 % CI 1.13-2.34), heavy drinking (AOR = 1.99, 95 % CI 1.20-3.29), being born in Canada (AOR = 3.28, 95 % CI 1.26-8.53), living in unstable housing conditions (AOR = 4.32, 95 % CI 2.17-8.62), servicing clients in public spaces (versus formal sex work establishments) (AOR = 2.33, 95 % CI 1.05-5.17) and experiencing police harassment without arrest (AOR = 1.82, 95 % CI 1.35-2.45) remain independently correlated with incarceration. This prospective study found a very high prevalence and frequency of incarceration among women sex workers in Vancouver, Canada, with the most vulnerable and marginalized women at increased risk of incarceration. Given the well-known social and health harms associated with incarceration, and associations between police harassment and incarceration in this study, our findings further add to growing calls to move away from criminalized and enforcement-based approaches to sex work in Canada and globally.
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Barker B, Alfred GT, Fleming K, Nguyen P, Wood E, Kerr T, DeBeck K. Aboriginal street-involved youth experience elevated risk of incarceration. Public Health 2015; 129:1662-8. [PMID: 26390949 DOI: 10.1016/j.puhe.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Past research has identified risk factors associated with incarceration among adult Aboriginal populations; however, less is known about incarceration among street-involved Aboriginal youth. Therefore, we undertook this study to longitudinally investigate recent reports of incarceration among a prospective cohort of street-involved youth in Vancouver, Canada. STUDY DESIGN Prospective cohort study. METHODS Data were collected from a cohort of street-involved, drug-using youth from September 2005 to May 2013. Multivariate generalized estimating equation analyses were employed to examine the potential relationship between Aboriginal ancestry and recent incarceration. RESULTS Among our sample of 1050 youth, 248 (24%) reported being of aboriginal ancestry, and 378 (36%) reported being incarcerated in the previous six months at some point during the study period. In multivariate analysis controlling for a range of potential confounders including drug use patterns and other risk factors, Aboriginal ancestry remained significantly associated with recent incarceration (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI]: 1.12-1.86). CONCLUSIONS Even after adjusting for drug use patterns and other risk factors associated with incarceration, this study found that Aboriginal street-involved youth were still significantly more likely to be incarcerated than their non-Aboriginal peers. Given the established harms associated with incarceration these findings underscore the pressing need for systematic reform including culturally appropriate interventions to prevent Aboriginal youth from becoming involved with the criminal justice system.
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Affiliation(s)
- B Barker
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Canada
| | - G T Alfred
- Indigenous Governance Program, University of Victoria, Canada
| | - K Fleming
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada
| | - P Nguyen
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada
| | - E Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Canada
| | - T Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; Division of AIDS, Department of Medicine, University of British Columbia, Canada
| | - K DeBeck
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada.
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Shields RT, Letourneau EJ. Commercial sexual exploitation of children and the emergence of safe harbor legislation: implications for policy and practice. Curr Psychiatry Rep 2015; 17:553. [PMID: 25652252 DOI: 10.1007/s11920-015-0553-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Commercial sexual exploitation of children is an enduring social problem that has recently become the focus of numerous legislative initiatives. In particular, recent federal- and state-level legislation have sought to reclassify youth involved in commercial sexual exploitation as victims rather than as offenders. So-called Safe Harbor laws have been developed and centered on decriminalization of "juvenile prostitution." In addition to or instead of decriminalization, Safe Harbor policies also include diversion, law enforcement training, and increased penalties for adults seeking sexual contact with minors. The purpose of this paper is to review the underlying rationale of Safe Harbor laws, examine specific policy responses currently enacted by the states, and consider the effects of policy variations. Directions for future research and policy are addressed.
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Affiliation(s)
- Ryan T Shields
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 415 N. Washington Street Room 519, Baltimore, MD, 21231, USA,
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Delany-Moretlwe S, Cowan FM, Busza J, Bolton-Moore C, Kelley K, Fairlie L. Providing comprehensive health services for young key populations: needs, barriers and gaps. J Int AIDS Soc 2015; 18:19833. [PMID: 25724511 PMCID: PMC4344539 DOI: 10.7448/ias.18.2.19833] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/08/2015] [Accepted: 01/21/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both. METHODS We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs. RESULTS YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels. DISCUSSION YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.
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Affiliation(s)
- Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
| | - Frances M Cowan
- CeSHHAR Zimbabwe, Harare, Zimbabwe
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Joanna Busza
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Karen Kelley
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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