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Aponte-Meléndez Y, Eckhardt B, Fong C, Padilla A, Trinidad-Martínez W, Maldonado-Rodríguez E, Agront N, Mateu-Gelabert P. Prevalence and associated risk factors of hepatitis C antibody and RNA among people who inject drugs in Puerto Rico. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209308. [PMID: 38301921 PMCID: PMC11060894 DOI: 10.1016/j.josat.2024.209308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION As a public health crisis, hepatitis C viral infection (HCV) is highly prevalent among people who inject drugs (PWID). We aimed to assess factors associated with HCV antibody (Ab) and HCV ribonucleic acid (RNA) positivity among PWID in Puerto Rico. METHODS The study recruited a total of 150 persons in rural and peri-urban community settings through the respondent-driven sampling method and administered a structured questionnaire. We conducted HIV and HCV testing using dried blood spots (DBS). We examined correlates of HCV infection with sociodemographics, drug use patterns, and injection practices using regression in bivariate and multivariable analysis. RESULTS Of the 150 participants, 89 % were male; 11 % were female; 72 % identified as mixed race; and the median duration of drug injection was 17.8 years. The mean age was 43.1 years, with 64 % of the population being from 23 to 45 years old. Among study participants (n = 150), the prevalence of HCV Ab was 73 %, and HCV RNA was 53 %. Factors significantly associated with HCV Ab and RNA included older age, increasing years of injection, incarceration, injecting other people, and identifying as Black. The belief that syringe air blowing reduces HCV transmission was also independently associated with HCV Ab positivity. CONCLUSIONS Our findings regarding risk factors associated with HCV infection show the need to enhance prevention and control strategies for reducing transmission among PWID. Direct-acting antiviral treatment, sustained access to harm reduction, and culturally tailored services will be required to substantially reduce rates of HCV. Community-based treatment models and treatment in correctional settings are needed.
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Affiliation(s)
- Yesenia Aponte-Meléndez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA; NYU Rory Meyers College of Nursing, 433 1(st) Ave., New York, NY, 10010, USA.
| | - Benjamin Eckhardt
- New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Adriana Padilla
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Wanda Trinidad-Martínez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Eric Maldonado-Rodríguez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
| | - Nancy Agront
- AbbVie Corp., Paseo Caribe Building Suite 22415 Ave Munoz Rivera San Juan, 00901, Puerto Rico.
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), 55 West 125(th) street, New York, NY 10027, USA.
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Cano M, Mendoza N, Ignacio M, Rahman A, Daniulaityte R. Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US. Drug Alcohol Depend 2023; 251:110955. [PMID: 37699286 DOI: 10.1016/j.drugalcdep.2023.110955] [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: 04/18/2023] [Revised: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND This study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. METHODS Using restricted-access 2018-2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. RESULTS Racial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5-1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9-2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3-1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4-1.6]) populations in the East. Relative to those with a Bachelor's degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4-8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7-13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0-13.7]). CONCLUSION Disparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, USA.
| | - Natasha Mendoza
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Matt Ignacio
- School of Social Work, Arizona State University, Tucson, AZ, USA
| | - Abir Rahman
- Cabell-Huntington Health Department, Huntington, WV, USA
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3
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Aponte-Meléndez Y, Mateu-Gelabert P, Eckhardt B, Fong C, Padilla A, Trinidad-Martínez W, Maldonado-Rodríguez E, Agront N. Hepatitis C virus care cascade among people who inject drugs in puerto rico: Minimal HCV treatment and substantial barriers to HCV care. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 8:100178. [PMID: 37555192 PMCID: PMC10404601 DOI: 10.1016/j.dadr.2023.100178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023]
Abstract
Background People who inject drugs (PWID) in Puerto Rico are disproportionately affected by the hepatitis C virus (HCV) epidemic. However, there is a scarcity of data on the HCV care cascade among PWID in Puerto Rico. This study aims to describe the HCV cascade of care among PWID in Puerto Rico, identify gaps, and explore barriers to HCV care. Methods Participants were recruited using respondent-driven sampling and tested for both HCV antibodies (Ab) and RNA (ribonucleic acid) using rapid testing and dried blood spot samples (DBS). The cascade of care was estimated based on the DBS HCV Ab and RNA results, as well as self-reported data on HCV screening, linkage to care, treatment uptake and sustained virologic response collected through a questionnaire. The cascade was constructed sequentially, with each step using the number of people from the preceding step as the base denominator. The survey also assessed participants' perceived barriers to HCV care. Results Out of 150 participants, 126 (84%) had previously been HCV screened, 87% (109/126) were HCV Ab positive, 72% (79/109) were RNA positive,48% (38/79) were linked to care, 32% (12/38) initiated treatment, 58% (7/12) finished treatment, and 71% (5/7) achieved SVR. Barriers to HCV care included concerns about drug abstinence requirements, access to transportation, stigma in healthcare settings, and lack of knowledge about HCV treatment sites. Conclusion This study provides insights into the HCV cascade of care among PWID in Puerto Rico for the first time and highlights limited diagnosis, treatment uptake, and barriers to care.
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Affiliation(s)
- Yesenia Aponte-Meléndez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
- NYU Rory Meyers College of Nursing 433 1st Ave., New York, NY 10010
| | - Pedro Mateu-Gelabert
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Benjamin Eckhardt
- New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Chunki Fong
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Adriana Padilla
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Wanda Trinidad-Martínez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Eric Maldonado-Rodríguez
- CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health(ISPH) 55 West 125th street, New York, NY 10027,USA
| | - Nancy Agront
- AbbVie Corp., Paseo Caribe Building Suite 22415 Ave Munoz Rivera San Juan, 00901, Puerto Rico
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Walters SM, Kerr J, Cano M, Earnshaw V, Link B. Intersectional Stigma as a Fundamental Cause of Health Disparities: A case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time. STIGMA AND HEALTH 2023; 8:325-343. [PMID: 37744082 PMCID: PMC10516303 DOI: 10.1037/sah0000426] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.
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Affiliation(s)
- Suzan M Walters
- School of Global Public Health, New York University, New York, NY
- Center for Drug Use and HIV/HCV Research, New York, NY
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY
| | - Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, TX
| | - Valerie Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE
| | - Bruce Link
- Department of Sociology, University of California Riverside, Riverside, CA
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Abadie R. "I don't want to die": a qualitative study of coping strategies to prevent fentanyl-related overdose deaths among people who inject drugs and its implications for harm reduction policies. Harm Reduct J 2023; 20:75. [PMID: 37316884 PMCID: PMC10264884 DOI: 10.1186/s12954-023-00805-x] [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: 02/27/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Fentanyl and fentanyl-related analogues are the main drivers of overdose death in the USA, particularly among people who inject drugs (PWID). Despite the fact that non-Hispanic whites exhibit higher population rates of synthetic opioid mortality, overdose deaths have increased among African American and Latinos in urban areas. Yet little attention has been paid to the introduction of fentanyl among rural PWID in Puerto Rico. METHODS We conducted N = 38 in-depth interviews with PWID in rural Puerto Rico to document participants' experiences of injection drug use after the arrival of fentanyl and the strategies they implemented to manage overdose death risks. RESULTS Participants suggest that the arrival of fentanyl in large scale happened after Hurricane Maria in 2017; this coincided with a dramatic increase in overdose episodes and deaths. Fear of overdose deaths motivated some participants to substitute intravenous drug use for other forms of substance use or to seek MOUD. PWID that continued injection use resorted to conducting "hit tests," avoiding injecting alone, using naloxone, and employing fentanyl testing strips. CONCLUSIONS While overdose deaths would have been higher without participants' willingness to adopt harm-reduction strategies, this paper illustrates the limits of these policies to address the current epidemic of fentanyl-related overdose deaths among this population. More studies are needed to understand how health disparities shape overdose risks for minority populations. However, major policy changes, in particular the revision of the harmful role of the War on Drugs and the termination of failed neoliberal economic policies that contribute to deaths of despair, should be addressed if we are to make a dent in this epidemic.
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Affiliation(s)
- R Abadie
- Department of Anthropology, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
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6
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Lee E, Piñeros J, Williams LD, Mackesy-Amiti ME, Molina Y, Boodram B. Network ethnic homophily and injection equipment sharing among Latinx and White non-Latinx people who inject drugs. J Ethn Subst Abuse 2023:1-20. [PMID: 36853193 PMCID: PMC10460831 DOI: 10.1080/15332640.2023.2181259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Latinx people who inject drugs (PWID) are less likely to engage in injection equipment sharing, but are more vulnerable to injection drug use (IDU)-related morbidity and mortality than Whites. Identifying subgroups of Latinx PWID who do engage in equipment sharing and likely bear the brunt of this health burden is a priority. Ethnic disparities may reflect contextual drivers, including injection networks. Latinx PWID with low ethnic homophily (the proportion of individuals with the same ethnic background) may be more likely to share equipment due to forced distancing from health-protective ethnocultural resources and power imbalances within injection networks. The current study offers a framework and examines how associations between network ethnic homophily and injection equipment sharing differ among 74 Latinx and 170 non-Latinx White PWID in the Chicagoland area (N = 244). Latinx had less homophilous than non-Latinx Whites (p <.001). Ethnic homophily was protective for equipment sharing among Latinx (OR = 0.17, 95%CI [0.77, 0.04], p = .02), but not non-Latinx Whites (OR = 1.66, 95%CI [0.40, 6.93], p = .49). Our findings implicate the need for targeted cultured interventions that focus on Latinx PWID who are more vulnerable to morbidity and mortality, potentially due to less access to ethnic peers.
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Affiliation(s)
- Eunhye Lee
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Juliet Piñeros
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Leslie D. Williams
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Mary-Ellen Mackesy-Amiti
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Yamilé Molina
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
| | - Basmattee Boodram
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States
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Correa-Fernández V, Barazi AM, Chandra M, Anthony JC. Similarities and Differences in Alcohol & Other Drug Dependence Among Hispanic/Latino Subgroups: A Disaggregation Approach. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100124. [PMID: 36844160 PMCID: PMC9949341 DOI: 10.1016/j.dadr.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
Background Hispanic/Latino (H/L) heritage civilians out-number all other non-White ethnic groups in the United States. When studied as one group, H/L diversity is ignored, including rates of drug misuse. This study's aim was to examine H/L diversity regarding drug dependence by disaggregating how the burdens of active alcohol or other drug dependence (AODD) might change if we were to address syndromes drug by drug. Method Studying non-institutionalized H/L residents from the National Surveys on Drug Use and Health (NSDUH) 2002-2013 probability samples, we utilized online Restricted-use Data Analysis System variables to identify ethnic heritage subgroups and active AODD via computerized self-interviews. We estimated case counts of AODD with analysis-weighted cross-tabulations and variances from Taylor series. Radar plots disclose AODD variations when we simulate the reductions of drug-specific AODD one by one. Results For all H/L heritage subgroups, the most substantial AODD decline might be achieved by reducing active alcohol dependence syndromes, followed by declines of cannabis dependence. The burdens due to active syndromes attributed to cocaine and pain relievers vary somewhat across subgroups. For the Puerto Rican subgroup, our estimates reveal potentially important burden reduction if active heroin dependence can be decreased. Conclusion A sizeable reduction in the H/L population health burden attributable to AODD syndromes might be achieved via the effective decline of alcohol and cannabis dependence among all subgroups. Future research includes a systematic replication with recent NSDUH survey data, as well as various stratifications. If replicated, the need for targeted drug-specific interventions among H/L will become unequivocal.
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Affiliation(s)
- Virmarie Correa-Fernández
- Department of Psychological, Health and Learning Sciences, University of Houston, 3657 Cullen Blvd, Room 491, Farish Hall, Houston, TX 77204-5029, United States,Corresponding author.
| | - Adnan M. Barazi
- Department of Epidemiology and Biostatistics, Michigan State University; 909 Wilson Road, Room 601, East Lansing, Michigan, 48824, United States,University of Maryland-College Park, United States
| | - Madhur Chandra
- Department of Epidemiology and Biostatistics, Michigan State University; 909 Wilson Road, Room 601, East Lansing, Michigan, 48824, United States,Michigan Department of Health and Human Services - WIC Division, United States
| | - James C. Anthony
- Department of Epidemiology and Biostatistics, Michigan State University; 909 Wilson Road, Room 601, East Lansing, Michigan, 48824, United States
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Abadie R, Cano M, Habecker P, Gelpí-Acosta C. Substance use, injection risk behaviors, and fentanyl-related overdose risk among a sample of PWID post-Hurricane Maria. Harm Reduct J 2022; 19:129. [PMID: 36424666 PMCID: PMC9694860 DOI: 10.1186/s12954-022-00715-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND While natural disasters like hurricanes are increasingly common, their long-term effects on people who inject drugs are not well understood. Although brief in duration, natural disasters can radically transform risk environments, increasing substance use and drug-related harms. METHODS Based on a study of people who inject drugs (PWID) and injection risk behaviors in rural Puerto Rico, the present study uses data from two different phases of the parent study. Data for 110 participants were collected from December 2015 to January 2017, soon before Hurricane Maria landed in September 2017; the 2019 phase, in the aftermath of the hurricane, included a total of 103 participants. The present study's main analyses used data from 66 PWID who participated in both the pre-Maria and post-Maria interviews (66 individuals measured at two time points, for a total of 132 observations), using mixed-effects binomial logistic regression to examine recent overdose experiences pre- and post-Maria. A separate descriptive analysis included all 103 participants from the 2019 interview. RESULTS After Hurricane Maria, some declines in injection frequency were observed (the percentage of people reporting injecting monthly or less increased from 3.0% before Hurricane Maria to 22.7% after Hurricane Maria). However, fewer PWID reported using a new needle for most or all injections. In the pre-Maria interview, 10.6% of participants indicated they had experienced an overdose during the year of the interview and/or the calendar year prior, and this figure increased to 24.2% in the post-Maria interview. In the regression analysis, the odds of reporting an overdose during the interview year and/or calendar year prior were three times as high post-Maria, relative to pre-Maria (odds ratio 3.25, 95% confidence interval 1.06-9.97). CONCLUSION Substance use patterns, injection risk behaviors, and overdose episodes and deaths differed after Hurricane Maria, relative to before the hurricane, yet it is unclear to what extent these changes also reflect the simultaneous arrival of fentanyl. In preparation for future natural disasters, it is imperative to strengthen the health infrastructure by enhancing access and curbing barriers to syringe services programs and medications for opioid use disorder, particularly in rural or underserved locations.
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Affiliation(s)
- Roberto Abadie
- grid.24434.350000 0004 1937 0060University of Nebraska-Lincoln, Lincoln, NE 68588 USA
| | - Manuel Cano
- grid.215654.10000 0001 2151 2636Arizona State University, Central Avenue 800, Phoenix, AZ 85004 USA
| | - Patrick Habecker
- grid.24434.350000 0004 1937 0060University of Nebraska-Lincoln, Lincoln, NE 68588 USA
| | - Camila Gelpí-Acosta
- grid.212340.60000000122985718LaGuardia Community College, City University of New York, 31-10 Thomson Avenue, Long Island City, NY 11101 USA
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Gelpí-Acosta C, Cano M, Hagan H. Racial and ethnic data justice: The urgency of surveillance data disaggregation. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 4:100082. [PMID: 36712292 PMCID: PMC9881686 DOI: 10.1016/j.dadr.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disease and overdose surveillance across industrialized countries, including the United States (US), have historically relied upon racial and ethnic classifications such as Non-Hispanic Black, White, Asian and Hispanic/Latinx to characterize the populations it describes. These categories underestimate significant HIV, hepatitis C (HCV) and drug overdose variance within these groups, by both place of birth and ethnicity. For socioeconomically disadvantaged people of color in the US, frontline workers (i.e., harm reduction outreach workers, case managers, etc.) are a medullar entry point to the HIV, HCV, and drug misuse care continuums. Racial/ethnic data aggregates fail to characterize vulnerable groups in ways that can increase these workers’ efficacy. HIV, HCV, and overdose data disaggregation is urgent to end HIV and to control HCV and drug overdoses more effectively, and to also move closer to an anti-racist epidemiology.
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Affiliation(s)
- Camila Gelpí-Acosta
- LaGuardia Community College, City University of New York, USA,Corresponding author.
| | - Manuel Cano
- School of Social Work, Arizona State University, USA
| | - Holly Hagan
- School of Global Public Health, Center for Drug Use and HIV/HCV Research, NYU, USA
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10
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Variation in US drug overdose mortality within and between Hispanic/Latine subgroups: A disaggregation of national data. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cano M, Agan A, Bandoian L, Larochelle L. Individual and County-Level Disparities in Drug and Opioid Overdose Mortality for Hispanic Men in Massachusetts and the Northeast United States. Subst Use Misuse 2022; 57:1131-1143. [PMID: 35459423 DOI: 10.1080/10826084.2022.2064507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region. METHODS The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast United States; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (from 2015-2019 American Community Survey data). RESULTS At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of educational attainment, birthplace, urbanicity, substance use disorder treatment history, and specific drugs involved in death. At the county level, in the Northeast region, each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality. CONCLUSIONS Findings underscore the importance of equitable interventions and efforts to address inequalities in social determinants of health for Hispanic populations in the Northeast.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anna Agan
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lisa Bandoian
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Lauren Larochelle
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
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12
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Cano M, Gelpí-Acosta C. Risk of Drug Overdose Mortality for Island-Born and US-Born Puerto Ricans, 2013-2019. J Racial Ethn Health Disparities 2021; 9:1403-1414. [PMID: 34081305 DOI: 10.1007/s40615-021-01077-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/06/2023]
Abstract
In the United States (US), individuals of Puerto Rican heritage die of drug overdoses at higher rates than other Hispanic groups or non-Hispanic Whites; yet, little is known about the extent to which drug overdose mortality affects island-born, versus US-born, Puerto Ricans. The distinction between Puerto Rican-born and US-born provides a starting point for culturally tailored services and interventions, as place of birth often informs language preferences and cultural identifications. Therefore, this study analyzed 2013-2019 death certificate data from the National Center for Health Statistics for 415,111 US deaths attributed to drug overdose. Drug overdose deaths were compared for island-born Puerto Ricans (N=3516), US-born Puerto Ricans (N=4949), and individuals not of Puerto Rican heritage (N=406,646). Drug overdose mortality rates, including age-specific and directly age-standardized rates, were calculated for each subgroup using population estimates from the US Census Bureau's American Community Survey. Results indicated that age-adjusted drug overdose mortality rates over the period of 2013-2019 were significantly higher for island-born than US-born Puerto Rican men (46.8 versus 34.6, per 100,000), with rates in both groups significantly higher than for men not of Puerto Rican heritage (24.0 per 100,000). For women, in contrast, drug overdose mortality rates were lower for island-born than US-born Puerto Ricans (8.6 versus 11.1, per 100,000). Within stateside Puerto Rican communities, island-born men experience a disproportionate burden of drug overdose mortality, necessitating targeted, culturally appropriate interventions built around the specific norms, circumstances, and lived experiences shared by Puerto Rican migrants who use drugs.
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Affiliation(s)
- Manuel Cano
- University of Texas at San Antonio, 501 W. César E. Chávez Blvd, San Antonio, TX, 78207, USA.
| | - Camila Gelpí-Acosta
- LaGuardia Community College, City University of New York, 31-10 Thomson Avenue, Long Island City, NY, 11101, USA
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Gelpí-Acosta C, Guarino H, Benoit E, Deren S, Rodríguez A. Toward Community Empowerment: The Puerto Rican Ganchero. CONTEMPORARY DRUG PROBLEMS 2021; 48:38-57. [PMID: 36061616 PMCID: PMC9435813 DOI: 10.1177/0091450920964576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
People who inject drugs (PWID) who migrate from Puerto Rico (PR) to New York City (NYC) are at elevated risk for hepatitis C (HCV), HIV and drug overdose. There is an urgent need to identify a sustainable path toward improving the health outcomes of this population. Peer-driven HIV/HCV prevention interventions for PWID are effective in reducing risk behaviors. Additionally, the concept of intravention-naturally occurring disease prevention activities among PWID (Friedman, 2004)-is a suitable theoretical framework to cast and bolster PWID-indigenous risk reduction norms and practices to achieve positive health outcomes. From 2017-2019, we conducted an ethnographic study in the Bronx, NYC to identify the injection risks of migrant Puerto Rican PWID, institutional barriers to risk reduction and solutions to these barriers. Study components included a longitudinal ethnography with 40 migrant PWID (e.g., baseline and exit interviews and monthly face-to-face follow-ups for 12 months), two institutional ethnographies (IEs) with 10 migrants and six service providers, and three focus groups (FGs) with another 15 migrant PWID. Data were analyzed using a grounded theory approach. In this article, we present findings from the IEs and FGs, specifically regarding a promising intravention pathway to promote health empowerment among these migrants that leverages an existing social role within their networks: the PR-indigenous ganchero. A ganchero is a vein-finding expert who is paid with drugs or cash for providing injection services. Ethnographic evidence from this study suggests that gancheros can occupy harm reduction leadership roles among migrant Puerto Rican PWID, adapting standard overdose and HIV/HCV prevention education to the specific experiences of their community. We conclude by noting the culturally appropriate risk reduction service delivery improvements needed to mitigate the health vulnerabilities of migrants and provide a roadmap for improving service delivery and identifying future research avenues.
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Affiliation(s)
- C Gelpí-Acosta
- LaGuardia Community College, City University of New York (CUNY), Long Island City, NY, USA
- North Jersey Community Research Initiative, Newark, NJ, USA
- Center for Drug Use and HIV/HCV Research, New York University College of Global Public Health, New York, NY, USA
| | - H Guarino
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - E Benoit
- North Jersey Community Research Initiative, Newark, NJ, USA
| | - S Deren
- Center for Drug Use and HIV/HCV Research, New York University College of Global Public Health, New York, NY, USA
| | - A Rodríguez
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
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Drug overdose mortality among stateside Puerto Ricans: Evidence of a health disparity. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 90:103079. [PMID: 33341699 DOI: 10.1016/j.drugpo.2020.103079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study compared drug overdose mortality rates in Puerto Rican-heritage and Non-Hispanic (NH) White individuals in the United States (US), examining time trends and recent variation by age, sex, state of residence, and drugs involved in overdose. METHODS Death certificate data from the National Center for Health Statistics, as well as American Community Survey population estimates, were used to calculate age-specific and age-adjusted drug overdose mortality rates for Puerto Rican-heritage and NH White residents of the 50 United States or District of Columbia (DC). Rates for 2018 were compared between Puerto Rican-heritage and NH White individuals, overall and by sex, age, state, and specific drug involved in overdose. Joinpoint Regression was used to examine trends in drug overdose mortality rates from 2009 to 2018. RESULTS From 2009 to 2018, the age-adjusted drug overdose mortality rate in stateside Puerto Ricans doubled among women (from 6.0 to 12.5 per 100,000) and nearly tripled among men (from 15.3 to 45.2 per 100,000). In 2018, the age-adjusted drug overdose mortality rate was significantly higher in Puerto Rican-heritage than NH White individuals (28.7 vs. 26.2 per 100,000, respectively). The 2018 drug overdose mortality rate was highest among Puerto Rican-heritage men ages 45-54 (104.1 per 100,000). CONCLUSION Findings emphasize the necessity of policies, programs, and interventions to mitigate risk of fatal overdose in stateside Puerto Rican communities.
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Abadie R, Dombrowski K. "Caballo": risk environments, drug sharing and the emergence of a hepatitis C virus epidemic among people who inject drugs in Puerto Rico. Harm Reduct J 2020; 17:85. [PMID: 33097062 PMCID: PMC7582446 DOI: 10.1186/s12954-020-00421-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sharing drug injection equipment has been associated with the transmission of HCV among PWID through blood contained in the cooker and cotton used to prepare and divide up the drug solution. While epidemiologists often subsume this practice under the sharing of "ancillary equipment," more attention should be paid to the fact that indirect sharing takes place within the process of joint drug acquisition and preparation. METHODS We employed an ethnographic approach observing active PWID (N = 33) in four rural towns in Puerto Rico in order to document drug sharing arrangements involved in "caballo", as this practice is locally known. We explored partners' motivation to engage in drug sharing, as well as its social organization, social roles and existing norms. FINDINGS Findings suggest that drug sharing, is one of the main drivers of the HCV epidemic in this population. Lack of financial resources, drug packaging, drug of choice and the desire to avoid the painful effects of heroin withdrawal motivates participants' decision to partner with somebody else, sharing injection equipment-and risk-in the process. Roles are not fixed, changing not only according to caballo partners, but also, power dynamics. CONCLUSION In order to curb the HCV epidemic, harm reduction policies should recognize the particular sociocultural contexts in which people inject drugs and make decisions about risk. Avoiding sharing of injection equipment within an arrangement between PWID to acquire and use drugs is more complex than assumed by harm reduction interventions. Moving beyond individual risk behaviors, a risk environment approach suggest that poverty, and a strict drug policy that encourage users to carry small amounts of illicit substances, and a lack of HCV treatment among other factors, contribute to HCV transmission.
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Affiliation(s)
- R Abadie
- Department of Anthropology, University of Nebraska-Lincoln, 839 Oldfather Hall, Lincoln, NE, 68588, USA.
| | - K Dombrowski
- Department of Anthropology, University of Vermont, 72 University Place, Burlington, VE, 05405, USA
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Gelpí-Acosta C, Rodríguez-Díaz CE, Aponte-Meléndez Y, Abadie R. Puerto Rican Syndemics: Opiates, Overdoses, HIV, and the Hepatitis C Virus in a Context of Ongoing Crises. Am J Public Health 2020; 110:176-177. [PMID: 31913678 DOI: 10.2105/ajph.2019.305487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Camila Gelpí-Acosta
- Camila Gelpí-Acosta is with the Center for Drug Use and HIV and HCV Research, New York University College of Global Public Health, New York, and the Department of Social Sciences, LaGuardia Community College, City University of New York (CUNY), Long Island City. Carlos E. Rodríguez-Díaz is with the Department of Prevention and Community Health, George Washington University-Milken Institute School of Public Health, Washington, DC. Yesenia Aponte-Meléndez is a PhD candidate at The New School for Social Research and a Project Director at the Graduate School of Public Health and Health Policy, CUNY. Roberto Abadie is with the Department of Sociology, University of Nebraska-Lincoln
| | - Carlos E Rodríguez-Díaz
- Camila Gelpí-Acosta is with the Center for Drug Use and HIV and HCV Research, New York University College of Global Public Health, New York, and the Department of Social Sciences, LaGuardia Community College, City University of New York (CUNY), Long Island City. Carlos E. Rodríguez-Díaz is with the Department of Prevention and Community Health, George Washington University-Milken Institute School of Public Health, Washington, DC. Yesenia Aponte-Meléndez is a PhD candidate at The New School for Social Research and a Project Director at the Graduate School of Public Health and Health Policy, CUNY. Roberto Abadie is with the Department of Sociology, University of Nebraska-Lincoln
| | - Yesenia Aponte-Meléndez
- Camila Gelpí-Acosta is with the Center for Drug Use and HIV and HCV Research, New York University College of Global Public Health, New York, and the Department of Social Sciences, LaGuardia Community College, City University of New York (CUNY), Long Island City. Carlos E. Rodríguez-Díaz is with the Department of Prevention and Community Health, George Washington University-Milken Institute School of Public Health, Washington, DC. Yesenia Aponte-Meléndez is a PhD candidate at The New School for Social Research and a Project Director at the Graduate School of Public Health and Health Policy, CUNY. Roberto Abadie is with the Department of Sociology, University of Nebraska-Lincoln
| | - Roberto Abadie
- Camila Gelpí-Acosta is with the Center for Drug Use and HIV and HCV Research, New York University College of Global Public Health, New York, and the Department of Social Sciences, LaGuardia Community College, City University of New York (CUNY), Long Island City. Carlos E. Rodríguez-Díaz is with the Department of Prevention and Community Health, George Washington University-Milken Institute School of Public Health, Washington, DC. Yesenia Aponte-Meléndez is a PhD candidate at The New School for Social Research and a Project Director at the Graduate School of Public Health and Health Policy, CUNY. Roberto Abadie is with the Department of Sociology, University of Nebraska-Lincoln
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