1
|
Gentsch AT, Reed MK, Cunningham A, Chang AM, Kahn S, Kovalsky D, Doty AMB, Mills G, Hollander JE, Rising KL. "Once I take that one bite": the consideration of harm reduction as a strategy to support dietary change for patients with diabetes. BMC Endocr Disord 2024; 24:3. [PMID: 38166864 PMCID: PMC10759378 DOI: 10.1186/s12902-023-01529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Despite well-established guidelines to treat diabetes, many people with diabetes struggle to manage their disease. For many, this struggle is related to challenges achieving nutrition-related lifestyle changes. We examined how people with diabetes describe barriers to maintaining a healthy diet and considered the benefits of using a harm reduction approach to assist patients to achieve nutrition-related goals. METHODS This is a secondary analysis of 89 interviews conducted with adults who had type 1 or type 2 diabetes. Interviews were analyzed using a content analysis approach. Themes regarding food or diet were initially captured in a "food" node. Data in the food node were then sub-coded for this analysis, again using a content analysis approach. RESULTS Participants frequently used addiction language to talk about their relationship with food, at times referring to themselves as "an addict" and describing food as "their drug." Participants perceived their unhealthy food choices either as a sign of weakness or as "cheating." They also identified food's ability to comfort them and an unwillingness to change as particular challenges to sustaining a healthier diet. CONCLUSION Participants often described their relationship with food through an addiction lens. A harm reduction approach has been associated with positive outcomes among those with substance abuse disorder. Patient-centered communication incorporating the harm reduction model may improve the patient-clinician relationship and thus improve patient outcomes and quality-of-life while reducing health-related stigma in diabetes care. Future work should explore the effectiveness of this approach in patients with diabetes. TRIAL REGISTRATION Registered on ClinicalTrials.gov, NCT02792777. Registration information submitted 02/06/2016, with the registration first posted on the ClinicalTrials.gov website 08/06/2016. Data collection began on 29/04/2016.
Collapse
Affiliation(s)
- Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA.
| | - Megan K Reed
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Anna Marie Chang
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Stephanie Kahn
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Danielle Kovalsky
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
- Present address: Department of Emergency Medicine, Tower Health Hospital, West Reading, USA
| | - Amanda M B Doty
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Geoffrey Mills
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, USA
| | - Judd E Hollander
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, 1015 Walnut Street, Suite 704, Philadelphia, PA, 19107, USA
| |
Collapse
|
2
|
McAdam E, Small W, Mullins G, Graham B, Greer A, Winder N, DeBeck K. Decriminalization thresholds for drug possession: A multi-criteria policy analysis framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104126. [PMID: 37454608 PMCID: PMC10529211 DOI: 10.1016/j.drugpo.2023.104126] [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: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Decriminalization of personal possession of drugs has been proposed as an approach to mitigate the harms of drug prohibition. Despite growing interest, particularly in Canadian settings, analyses of approaches to defining the parameters of what constitutes personal possession within decriminalization models are lacking. Using the Province of British Columbia, Canada, as a case study, we undertook an evidence-based multi-criteria policy analysis of three models for defining personal possession: 1) a model that defines personal possession as the absence of evidence of drug trafficking; 2) a cumulative threshold of 15 grams; and 3) a cumulative threshold of 2.5 grams. METHODS We utilized data from four sources: qualitative interviews with 16 experts, including representatives from government and law enforcement; Vancouver Police drug seizure data; self-reported drug consumption data from longitudinal cohorts of people who use drugs in Vancouver; and publicly available government documents (e.g., the Government of BC's submission for decriminalization). Data was used to identify and define evaluation criteria which reflect the stated policy objectives of decriminalization alongside other policy considerations. This framework was used to conduct a multi-criteria policy analysis of the three different models. RESULTS The seven evaluation criteria included: 1) reduction in interactions with police; 2) reduction of police drug seizures; 3) coverage for those with high consumption; 4) impact on equity-deserving groups; and acceptance on the part key stakeholders, including: 5) people who use drugs; 6) law enforcement; and 7) the public. The model that performed the best was the cumulative threshold model of 15 grams. CONCLUSION Findings highlight that different threshold models advance and constrain the stated policy objectives of drug decriminalization to varying degrees. This analysis provides a framework that other jurisdictions considering decriminalization could use to help inform determinations of threshold levels based on stated policy objectives.
Collapse
Affiliation(s)
- Erica McAdam
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada.
| | - Will Small
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada
| | - Garth Mullins
- Vancouver Area Network of Drug Users (VANDU), Vancouver, BC, Canada; BC Association of People on Opioid Maintenance (BCAPOM), Vancouver, BC, Canada; Crackdown Podcast, Vancouver, BC, Canada
| | - Brittany Graham
- Vancouver Area Network of Drug Users (VANDU), Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Natahnee Winder
- School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada; Department of Indigenous Studies, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC V6Z 2A9, Canada; School of Public Policy, Simon Fraser University, 515 West Hastings St., Vancouver, BC V6B 5K3, Canada
| |
Collapse
|
3
|
Douglas S, Hayashi K, Richardson L, DeBeck K, Kerr T. Social-Structural Predictors of Fentanyl Exposure among Street Involved Youth. Subst Use Misuse 2022; 57:21-26. [PMID: 34738494 PMCID: PMC8884258 DOI: 10.1080/10826084.2021.1975746] [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: 01/03/2023]
Abstract
ObjectiveThe emergence of synthetic fentanyl has been a main contributor to North America's rising overdose death rates. While increasing attention has been given to drug-related harm among youth, little is known about how social-structural conditions influence their risk of fentanyl exposure. Therefore, we evaluated potential relationships between social-structural conditions and fentanyl exposure among youth who use illicit drugs in Vancouver, BC. Methods: Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort study. The ARYS cohort involves street-involved youth, who use illicit substances in Vancouver, Canada. A multivariable logic regression analysis model was used to identify social factors associated with recent fentanyl exposure as determined through urine drug screening. Results: Overall, 423 participants were included in this analysis, with 380 (38.23%) testing positive for recent fentanyl exposure. In a multivariable relative risk analysis, living in Vancouver's Downtown Eastside in the last six months (RR = 1.16, 95% CI: 1.03-1.32) and daily heroin injection drug use (RR = 1.31, 95% CI: 1.15 - 1.50) were positively associated with fentanyl exposure. As a secondary measure, we found that within the encounters who denied using fentanyl (92.25% of total encounters), 321 (35.05%) still tested positive. Conclusions: We found that youth residing in Vancouver's Downtown Eastside was positively associated with being exposed to fentanyl. Our findings highlight the need to support youth in finding secure housing outside of Vancouver's drug use epicenter to reduce fentanyl exposure.
Collapse
Affiliation(s)
- Sarah Douglas
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital Chair in Substance Use Research, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lindsey Richardson
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.,School of Public Policy, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| |
Collapse
|