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Byrne CJ, Sani F, Flynn T, Malaguti A. 'It was like coming back from the clouds': a qualitative analysis of the lived experience of overdose consequent to drug use among a cohort of people who use drugs in Scotland. Harm Reduct J 2024; 21:112. [PMID: 38849877 PMCID: PMC11157918 DOI: 10.1186/s12954-024-01033-7] [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: 01/08/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Globally, non-fatal overdose (NFOD) rates consequent to drug use, typically opioids, continue increasing at a startling rate. Existing quantitative research has revealed myriad factors and characteristics linked to experiencing NFOD, but it is critically important to explore the lived context underlying these associations. In this qualitative study, we sought to understand the experiences of NFOD among people who use drugs in a Scottish region in order to: enhance public policy responses; inform potential intervention development to mitigate risk; and contribute to the literature documenting the lived experience of NFOD. METHODS From June to July 2021, two peer researchers conducted face-to-face semi-structured interviews with people who use drugs who had experienced recent NFOD attending harm reduction services in Tayside, Scotland. These were transcribed verbatim and evaluated using thematic analysis with an inductive approach which had an experiential and essentialist orientation. RESULTS Twenty people were interviewed across two sites. Of those, 15 (75%) were male and mean age was 38.2 (7.7) years. All had experienced at least one NFOD in the prior six months, and all reported polydrug use. Five themes were identified, within which 12 subthemes were situated. The themes were: social context; personal risk-taking triggers; planned and impulsive consumption; risk perception; and overdose reversal. The results spoke to the environmental, behavioural, cognitive, economic, and marketplace, factors which influence the context of NFOD in the region. CONCLUSIONS A complex interplay of behavioural, psychological, and situational factors were found to impact the likelihood of experiencing NFOD. Structural inequities which policy professionals and civic leaders should seek to remedy were identified, while service providers may seek to reconfigure healthcare provision for people who use drugs to account for the interpersonal, psychological, and social factors identified, which appear to precipitate NFOD. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Christopher J Byrne
- Division of Molecular and Clinical Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Directorate of Public Health, NHS Tayside, Kings Cross Hospital, Dundee, UK.
| | - Fabio Sani
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
| | | | - Amy Malaguti
- Division of Psychology, School of Humanities, Social Sciences and Law, University of Dundee, Scrymgeour Building, Dundee, UK
- Tayside Drug and Alcohol Recovery Psychology Service, NHS Tayside, Dundee, UK
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2
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Douglass CH, Block K, Eghrari D, Horyniak D, Hellard ME, Lim MSC. "You have to drink with a little bit of shame": Alcohol and other drug use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. J Ethn Subst Abuse 2024; 23:340-364. [PMID: 35758222 DOI: 10.1080/15332640.2022.2091703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Migrant and ethnic minority groups are underrepresented in alcohol and other drug (AOD) research. This qualitative study explored AOD use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. We conducted one focus group and 16 interviews and thematically analyzed data drawing on the social-ecological model of health. Theme one showed AOD use was considered a "normal" part of youth identity, particularly for participants who had grown up with peer groups in Australia. Theme two highlighted participant's sense of responsibility to meet expectations and make informed decisions about AOD use to protect themselves and their friends. Theme three highlighted participant's risk of experiencing AOD-related stigma through negative stereotypes and fear of consequences within families and communities, particularly among female participants. Participants' perceptions and experiences differed by individual factors, interpersonal relationships, AOD accessibility across settings and broader gender, cultural and religious norms. Interventions developed with young people from migrant and ethnic minority backgrounds are needed to target the social-ecological factors underpinning AOD use, particularly stigma.
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Affiliation(s)
- Caitlin H Douglass
- Burnet Institute, Melbourne, Victoria, Australia
- University of Melbourne, Carlton, Victoria, Australia
| | - Karen Block
- University of Melbourne, Carlton, Victoria, Australia
| | - Donya Eghrari
- University of Melbourne, Carlton, Victoria, Australia
| | - Danielle Horyniak
- Burnet Institute, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- University of Melbourne, Carlton, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- University of Melbourne, Carlton, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
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3
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Saseetharran A, Hiebert L, Gupta N, Nyirahabihirwe F, Kamali I, Ward JW. Prevention, testing, and treatment interventions for hepatitis B and C in refugee populations: results of a scoping review. BMC Infect Dis 2023; 23:866. [PMID: 38071291 PMCID: PMC10709891 DOI: 10.1186/s12879-023-08861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND AIMS Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally. METHODS A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included. RESULTS There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing (n = 30) or referral (n = 24) component. Frequently reported features to promote program accessibility included bilingual services (n = 25), community partnerships (n = 21), and multidisciplinary staff members (n = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees (n = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance. CONCLUSIONS This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.
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Affiliation(s)
- Ankeeta Saseetharran
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA.
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | - Neil Gupta
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
| | | | | | - John W Ward
- Coalition for Global Hepatitis Elimination, 330 W Ponce de Leon Ave, Decatur, GA 30030, USA
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4
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Douglass CH, Win TM, Goutzamanis S, Lim MSC, Block K, Onsando G, Hellard M, Higgs P, Livingstone C, Horyniak D. Stigma Associated with Alcohol and Other Drug Use Among People from Migrant and Ethnic Minority Groups: Results from a Systematic Review of Qualitative Studies. J Immigr Minor Health 2023; 25:1402-1425. [PMID: 36976449 PMCID: PMC10632266 DOI: 10.1007/s10903-023-01468-3] [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: 03/02/2023] [Indexed: 03/29/2023]
Abstract
Stigma reduces access to alcohol and other drug (AOD) support. This systematic review explored perceptions and experiences of stigma associated with AOD use among migrant and ethnic minority groups. Qualitative studies published in English were identified using six databases. Two reviewers screened and critically appraised articles using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies. Data were synthesised using best fit framework synthesis. Twenty-three studies were included. Stigma drivers and facilitators included stereotypes, socio-cultural norms, legal responses and precarious lived experiences. Stigma intersected with gender, citizenship, race and ethnicity and manifested though shame, exclusion, secondary stigma and discrimination in treatment. Outcomes and impacts included avoidance of services, emotional distress, isolation and loneliness. This review identified similar stigma experiences to other populations, however outcomes were complicated by precarious lived experiences and multiple stigmatised identities. Multi-level interventions are required to reduce AOD-related stigma for migrant and ethnic minority groups.
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Affiliation(s)
- Caitlin H Douglass
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Thin Mar Win
- Burnet Institute Myanmar, 226 Wizaya Plaza, U Wisara Road, Yangon, Myanmar
| | | | - Megan S C Lim
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Gerald Onsando
- Melbourne School of Social and Political Sciences, University of Melbourne, 420 John Medley Building, Parkville, VIC, 3010, Australia
| | - Margaret Hellard
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Peter Higgs
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Public Health Department, La Trobe University, Plenty Road, Bundoora, VIC, 3086, Australia
| | - Charles Livingstone
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danielle Horyniak
- Burnet Institute Australia, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Monash School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Ibrahim M. Dhagan Celis (Cultural Rehabilitation): Somali Canadians Transnational Approach to Youth Substance Use. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01843-8. [PMID: 37935946 DOI: 10.1007/s40615-023-01843-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/01/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Evidence suggests that some Somali youth who settled in Canada struggle with substance use problems, yet research remains limited in understanding the Somali community's experiences and struggles in supporting their youth affected by substance use. OBJECTIVE This study aims to contribute important knowledge in understanding substance use among Somali Canadian youth and access to treatments in Canada and the transnational cultural healing services available in East Africa. METHODS Qualitative interviews (n = 37) were conducted in a metropolitan Canadian city and Nairobi, Kenya, from May 2016 to May 2017. In addition, a field study (n = 4) of rehabilitation centers in Kenya was carried out. RESULTS Through thematic analysis, five main themes were identified: (i) discrimination and racism in the school environment, (ii) emotional pain and self-medication, (iii) low literacy on substance use and treatment in the Canadian context, (iv) stigma, and (v) dhagan celis (cultural rehabilitation) in transnational setting. CONCLUSIONS The study provides evidence of the need to address substance use and trauma among refugee youth in the post-resettlement context especially as Canada currently deals with a significant public health crisis in the form of opioid overdose and substance use.
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Affiliation(s)
- Mohamed Ibrahim
- School of Social Work, The University of British Columbia, 2080 West Mall, Vancouver, V6T 1Z2, Canada.
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6
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Saleh EA, Lazaridou FB, Klapprott F, Wazaify M, Heinz A, Kluge U. A systematic review of qualitative research on substance use among refugees. Addiction 2023; 118:218-253. [PMID: 35929580 DOI: 10.1111/add.16021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/27/2022] [Indexed: 01/05/2023]
Abstract
AIMS To evaluate qualitative research on substance use and substance use disorders (SUDs) among refugees in terms of practitioners' and substance users' attitudes, beliefs and experiences. METHODS Six medical, allied health and social sciences databases (EBSCO, PubMed, ScienceDirect, Web of Science, Scholar and the Cochrane Library) were systematically searched in a time frame between January and April 2021 to identify original peer-reviewed articles describing qualitative findings related to substance use among refugees (alcohol, illicit drugs, tobacco and prescription drugs). Study selection, critical appraisal and detailed extraction were performed via the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Systematic Reviews (PRISMA) (2018). Three independent reviewers selected the relevant abstracts and articles. Synthesis of the evidence identified prominent themes relating to the context and consequences of substance use. RESULTS Twenty-six studies were included in this review. Twenty-three studies applied qualitative methods and three applied mixed methods. Synthesis of the evidence from the included studies resulted in four main findings: there is a considerable susceptibility of refugees to substance use and SUDs; the harmful consequences of substance use are complicated by the social insecurities of refugees; there are rather high barriers to treatment and health facilities for refugees in many host countries; and there is a strong need to improve effective access to treatment, interventions and prevention approaches. CONCLUSIONS Refugees are at high risk for substance use and substance use disorders and often face high barriers to treatment and interventions in host countries.
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Affiliation(s)
- Ebtesam A Saleh
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Berlin, Germany.,Department of Pharmacology, Faculty of Pharmacy, Aden University, Yemen
| | - Felicia Boma Lazaridou
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Berlin, Germany.,Berlin Institute for Integration and Migration Research (BIM), Humboldt University of Berlin, Berlin, Germany.,Department of Conflict and Consensus, German Centre for Integration and Migration Research, Berlin, Germany
| | - Felix Klapprott
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Berlin, Germany
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Berlin, Germany.,Berlin Institute for Integration and Migration Research (BIM), Humboldt University of Berlin, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Psychotherapy, Charité University Medical Center, Berlin, Germany.,Berlin Institute for Integration and Migration Research (BIM), Humboldt University of Berlin, Berlin, Germany
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7
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Bennett H, Allitt B, Hanna F. A perspective on mental health literacy and mental health issues among Australian youth: Cultural, social, and environmental evidence! Front Public Health 2023; 11:1065784. [PMID: 36741953 PMCID: PMC9891461 DOI: 10.3389/fpubh.2023.1065784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
Mental health literacy (MHL) helps improve mental health outcomes and reduce the impacts of mental illness. This study aims to reflect on scientific evidence on MHL levels, barriers to MHL, their impacts on mental health among Australian youth and interventions to overcome these barriers. The factors explored in the Perspective included; influence of social determinants, culturally and linguistically diverse (CALD) communities, help-seeking attitudes and behaviors. MHL intervention programs and MHL for improving mental health outcomes due to the recent COVID-19 pandemic were also explored. Adequate levels of youth MHL significantly improved one's ability to recognize own mental health status as well as provide peer support. Practical considerations such as designing more gender and culturally specific youth MHL programs are proposed.
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Affiliation(s)
- Hirukshi Bennett
- Public Health Program, Torrens University Australia, Melbourne, VIC, Australia
| | - Ben Allitt
- Higher Education College, Chisholm Institute, Dandenong, VIC, Australia
| | - Fahad Hanna
- Public Health Program, Torrens University Australia, Melbourne, VIC, Australia,Higher Education College, Chisholm Institute, Dandenong, VIC, Australia,*Correspondence: Fahad Hanna ✉
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8
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Pouille A, De Ruysscher C, Vander Laenen F, Vanderplasschen W. “Watch out for the boogieman”: stigma and substance use recovery among migrants and ethnic minorities. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1002/casp.2657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aline Pouille
- Department of Special Needs Education Ghent University Ghent Belgium
| | | | - Freya Vander Laenen
- Department of Criminology, Criminal Law and Social Law Ghent University Ghent Belgium
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9
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Douglass CH, Lim MSC, Block K, Onsando G, Hellard M, Higgs P, Livingstone C, Horyniak D. Exploring stigma associated with mental health conditions and alcohol and other drug use among people from migrant and ethnic minority backgrounds: a protocol for a systematic review of qualitative studies. Syst Rev 2022; 11:12. [PMID: 35042545 PMCID: PMC8767730 DOI: 10.1186/s13643-021-01875-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stigma is a social process that impedes access to support for mental health conditions and alcohol and other drug (AOD) use, particularly for people from migrant and ethnic minority backgrounds. There is limited understanding, however, of people's experiences of stigma, the underlying drivers, intersections with ethnicity, gender, and citizenship status, and how powerful discourses and social institutions create and perpetuate systems of stigma. This review aims to synthesise and critically analyse qualitative evidence to understand how stigma associated with mental health conditions and AOD use operates among people from migrant and ethnic minority groups. METHODS Qualitative evidence will be identified using MEDLINE, Embase, PsycINFO, CINAHL, Applied Social Sciences Index and Sociological Abstracts. Two reviewers will screen the titles, abstracts and full-text articles. Eligible studies will include original, empirical, peer-reviewed qualitative evidence, published in English since 1990. Studies must examine stigma in relation to mental health conditions, illicit drug use or alcohol consumption among participants who are from migrant and ethnic minority backgrounds. Studies will be critically appraised using the Joanna Briggs Institute Critical Appraisal Checklist for qualitative studies and the level of confidence in the findings will be assessed using Confidence in the Evidence from Reviews of Qualitative research. Data will be analysed using the 'best fit' framework synthesis approach, drawing on the Health Stigma and Discrimination Framework. DISCUSSION This review will provide an in-depth understanding of the stigma associated with mental health conditions and AOD use among people from migrant and ethnic minority backgrounds. The findings will inform culturally responsive interventions that aim to reduce the negative impact of stigma on individuals, families and communities. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021204057.
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Affiliation(s)
- Caitlin H Douglass
- Burnet Institute, Melbourne, Victoria, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Block
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gerald Onsando
- Melbourne School of Social and Political Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter Higgs
- Burnet Institute, Melbourne, Victoria, Australia.,Public Health Department, La Trobe University, Bundoora, Victoria, Australia
| | - Charles Livingstone
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danielle Horyniak
- Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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10
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Pittaway T, Dantas JAR. "I don't think marijuana counts as a drug": Drug & alcohol use amongst South Sudanese youth in Australia. J Ethn Subst Abuse 2021:1-18. [PMID: 34459352 DOI: 10.1080/15332640.2021.1965932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To understand alcohol and other drug (AOD) use and its impact among South Sudanese youth in Melbourne, Australia. METHODS This qualitative exploratory study was underpinned by the psychosocial conceptual framework. We undertook semi-structured interviews with 23 South Sudanese youth aged 14-21 years to explore attitudes and potential harms of AOD use. We also undertook focus groups with these participants and a focus group of 11 South Sudanese community elders and parents. Feedback on results was obtained through two forums with community members. The data collected were analyzed using thematic analysis. RESULTS The participants revealed that AOD use was common, specifically the use of cannabis. The participants believed that there was a lack of basic understanding of the potential harm of cannabis use. The results also highlighted that the community was unaware how the use of drugs and alcohol can contribute and exacerbate poor mental health. Cannabis was a regular drug of choice used by young South Sudanese in this study. It was used daily as a coping mechanism both for stress and for undiagnosed mental health. CONCLUSION The results of this study indicate increased potential harm for South Sudanese youth from AOD use. Of concern was a lack of diagnosis and treatment for mental health wellbeing due to the beliefs around AOD use. Without targeted interventions this has significant implications for the South Sudanese community and the young people affected. The significance of these findings may assist in the delivery of AOD treatment and improve health education for refugee youth.
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Affiliation(s)
- Troy Pittaway
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Western Australia
| | - Jaya A R Dantas
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Western Australia
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11
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No One Smiles at Me: The Double Displacement of Iranian Migrant Men as Refugees Who Use Drugs in Australia. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10030085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Drawing on relevant sociological and feminist theories namely a social constructivist and intersectional framework, this article explores ways in which migrant Iranian men as ‘refugees’ ‘who use drugs’ navigate the complex terrain of ‘double displacement’ in the Australian contemporary context. It presents findings from a series of community based participatory and culturally responsive focus groups and in-depth interviews of twenty-seven participants in Sydney, Australia. Results highlight the ways in which social categories of gender, language, class, ethnicity, race, migration status and their relationship to intersubjective hierarchies and exclusion in Australia circumnavigate and intervene with participants’ alcohol and other drugs’ (AOD) use and related harms. The article argues that there is a need to pay greater attention to the implications of masculinities, power relations and the resultant material, social and affective emotional impacts of displacement for refugee men within Australian health care responses.
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12
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Barnes DM, Des Jarlais DC, Wolff M, Feelemyer J, Tross S. A qualitative study of persons who inject drugs but who have never helped others with first injections: how their views on helping contrast with the views of persons who have helped with first injections, and implications for interventions. Harm Reduct J 2018; 15:43. [PMID: 30153826 PMCID: PMC6114536 DOI: 10.1186/s12954-018-0250-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 08/20/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Transitioning from non-injection to injection drug use dramatically escalates health risks. Evidence suggests that people who inject drugs (PWID) help in a majority of others' first injections, yet these helpers represent only a minority of experienced PWID. Recent research has provided insight into this helping process, as reported by helpers. PWID who have never helped, although the majority of PWID, have not previously been the focus of study. To address this gap, we give primary voice to non-helpers' perspectives on the helping process, while also comparing their views with persons in our sample who have helped with first injections. Finally, we consider how non-helpers' perspectives can inform harm reduction interventions to reduce, or make safer, initiation into injecting drug use. METHODS We conducted audio-recorded, qualitative interviews with 23 current opioid injectors on Staten Island, NY, where the opioid epidemic is pronounced. Seventeen had never helped with first injections and 6 had. Interviews were transcribed verbatim, and three coders used a consensus-developed codebook to code all interviews. Framework analysis was used to identify overarching themes. RESULTS We identified three key themes in non-helpers' discourse around not helping: altruistic motivations to prevent immediate and delayed harms to individuals injecting for the first time; inhibition due to negative assessments of their own injecting skills; and absolutist ethical convictions against helping. Non-helpers differed from helpers on each theme. CONCLUSIONS Because most PWID have never helped with first injections, their perspectives on helping warrant consideration and can inform harm reduction interventions to reduce, or make safer, transitions to injection drug use. Their perspectives can be used to broaden the factors PWID consider around questions of promoting injection and helping with others' first injections, including considerations of the moral issues involved in choosing to help or not to help.
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Affiliation(s)
- David M. Barnes
- Department of Epidemiology, College of Global Public Health, New York University, 665 Broadway, 8th floor, New York, NY 10012 USA
| | - Don C. Des Jarlais
- Department of Epidemiology, College of Global Public Health, New York University, 665 Broadway, 8th floor, New York, NY 10012 USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 39 Broadway, Suite 530, New York, NY 10006 USA
| | - Margaret Wolff
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 39 Broadway, Suite 530, New York, NY 10006 USA
- HIV Center for Clinical and Behavioral Studies, The New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032 USA
| | - Jonathan Feelemyer
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 39 Broadway, Suite 530, New York, NY 10006 USA
| | - Susan Tross
- HIV Center for Clinical and Behavioral Studies, The New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032 USA
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13
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Melo JS, Mittal ML, Horyniak D, Strathdee SA, Werb D. Injection Drug Use Trajectories among Migrant Populations: A Narrative Review. Subst Use Misuse 2018; 53:1558-1570. [PMID: 29364762 PMCID: PMC6033671 DOI: 10.1080/10826084.2017.1416404] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dual epidemics of injection drug use and blood-borne disease, characterized as "syndemics," are present in a range of settings. Behaviors that drive such syndemics are particularly prevalent among mobile drug-using populations, for whom cross-border migration may pose additional risks. OBJECTIVES This narrative review aims to characterize the risk factors for injection drug use initiation associated with migration, employing a risk environment framework and focusing on the San Diego-Tijuana border region as the most dynamic example of these phenomena. METHODS Based on previous literature, we divide migration streams into three classes: intra-urban, internal, and international. We synthesized existing literature on migration and drug use to characterize how mobility and migration drive the initiation of injection drug use, as well as the transmission of hepatitis and HIV, and to delineate how these might be addressed through public health intervention. RESULTS Population mixing between migrants and receiving communities and the consequent transmission of social norms about injection drug use create risk environments for injection drug use initiation. These risk environments have been characterized as a result of local policy environments, injection drug use norms in receiving communities, migration-related stressors, social dislocation, and infringement on the rights of undocumented migrants. CONCLUSION Policies that exacerbate risk environments for migrants may inadvertently contribute to the expansion of epidemics of injection-driven blood-borne disease. Successful interventions that address emerging syndemics in border regions may therefore need to be tailored to migrant populations and distinguish between the vulnerabilities experienced by different migration classes and border settings.
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Affiliation(s)
- Jason S Melo
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Maria Luisa Mittal
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,b School of Medicine, Universidad Xochicalco , Tijuana , Baja California , Mexico
| | - Danielle Horyniak
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,c Centre for Population Health, Burnet Institute , Melbourne , Victoria , Australia.,d School of Public Health and Preventive Medicine, Monash University , Melbourne , Victoria , Australia
| | - Steffanie A Strathdee
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA
| | - Dan Werb
- a Division of Global Public Health, Department of Medicine , University of California San Diego , La Jolla , California , USA.,e Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
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McCann TV, Renzaho A, Mugavin J, Lubman DI. Stigma of mental illness and substance misuse in sub-Saharan African migrants: A qualitative study. Int J Ment Health Nurs 2018; 27:956-965. [PMID: 28990293 DOI: 10.1111/inm.12401] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
Abstract
Stigma of mental illness and substance misuse can deter help seeking, especially in immigrants who are often reluctant to seek help early for these issues. The aim of the present study was to explore the stigma experience surrounding mental illness and substance misuse, and its implications for improving help seeking, for youths and parents from sub-Saharan African immigrant communities. A qualitative, descriptive design was used. Individual interviews were undertaken with 28 youths, and focus group discussions were held with 41 parents and community leaders in Melbourne, Australia. The findings indicated that public stigma and self-stigma were common and deterred participants' help seeking within sub-Saharan African communities. There was concern about the consequences of disclosure. Personal shame, fear of community rejection, and being labelled a 'lunatic' deterred help seeking. Programmes are needed to address stigma, promote help seeking, and increase mental health knowledge. Mental health nurses and other clinicians in the mental health and alcohol and other drug fields can make an important contribution. Steps are needed to employ more sub-Saharan African immigrant clinicians to help increase help seeking from their communities.
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Affiliation(s)
- Terence V McCann
- Centre for Chronic Disease, Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| | - Andre Renzaho
- Humanitarian and Development Studies, Western Sydney University, Sydney, Australia
| | - Janette Mugavin
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.,Turning Point, Monash University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Monash University, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
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15
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Guise A, Horyniak D, Melo J, McNeill R, Werb D. The experience of initiating injection drug use and its social context: a qualitative systematic review and thematic synthesis. Addiction 2017; 112:2098-2111. [PMID: 28734128 PMCID: PMC5673537 DOI: 10.1111/add.13957] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/03/2017] [Accepted: 07/14/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIM Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We reviewed and synthesized existing qualitative scientific literature systematically to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. METHODS We searched six databases (Medline, Embase, PsychINFO, CINAHL, IBSS and SSCI) systematically, along with a manual search, including key journals and subject experts. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes throughout studies. RESULTS From 1731 initial results, 41 studies reporting data from 1996 participants were included. We developed eight descriptive themes and two analytical (higher-order) themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity and coping with pain and trauma. CONCLUSIONS Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,Division of Health and Social Care, King’s College London, Addison House, Guy’s campus, London, UK
| | - Danielle Horyniak
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,Behaviours and Health Risks Program, Burnet Institute, 85 Commercial Rd, Melbourne VIC 3004, Australia,School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne VIC 3004, Australia
| | - Jason Melo
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA
| | - Ryan McNeill
- British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia Canada,Division of AIDS, Department of Medicine, University of British Columbia, 2775 Laurel St, Vancouver, British Columbia Canada
| | - Dan Werb
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, 92093, USA,International Centre for Science in Drug Policy, St. Michael’s Hospital, 30 Bond St, Toronto, Canada
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16
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Posselt M, McDonald K, Procter N, de Crespigny C, Galletly C. Improving the provision of services to young people from refugee backgrounds with comorbid mental health and substance use problems: addressing the barriers. BMC Public Health 2017; 17:280. [PMID: 28340567 PMCID: PMC5366135 DOI: 10.1186/s12889-017-4186-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Australia (SA) has resettled 151,134 refugees in the last ten years (Department of Immigration and Border Protection, Settlement reporting facility, 2014). Northern metropolitan Adelaide, an area which experiences significant social disadvantage, has received a significant number of (predominantly young) refugees. Research indicates that refugee youth are at elevated risk of mental health (MH) and alcohol and other drug (AOD) problems. These factors, along with the low socio-economic status of northern Adelaide, the number of refugee youth residing there, and the added complexity of treating comorbid MH and AOD problems (comorbidity) prompted this research. We investigated the barriers and facilitators to culturally responsive comorbidity care for these youth and whether the MH and AOD services were equipped to provide such support. METHODS This mixed-methods study employed semi-structured interviews with refugee youth and service providers and an online survey with managers of services. Thirty participants (15 refugee youth, 15 service providers) took part in the semi-structured interviews and 56 (40 complete, 16 partially-complete) in the survey. RESULTS Thematic analysis of the interview data revealed the most commonly reported barriers related to four broad areas: (1) organisational and structural, (2) access and engagement, (3) treatment and service delivery, and (4) training and resources. Survey data supported the barriers identified in the qualitative findings. CONCLUSIONS This research highlights significant gaps in the response of MH and AOD services to refugee youth with comorbidity. Based on the findings, ways of overcoming the barriers are discussed, and are of particular relevance to policy makers, organisations and clinicians.
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Affiliation(s)
- Miriam Posselt
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Level 4, Eleanor Harrald Building, Frome Rd, Adelaide, South Australia Australia
| | - Karalyn McDonald
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Nicholas Procter
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia Australia
| | | | - Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Level 4, Eleanor Harrald Building, Frome Rd, Adelaide, South Australia Australia
- Ramsay Health Care, Adelaide, Australia
- Northern Adelaide Local Health Network, Adelaide, Australia
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17
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Jaworski A, Brown T, Norman C, Hata K, Toohey M, Vasiljevic D, Rowe R. Developing a guide for community-based groups to reduce alcohol-related harm among African migrants. Health Promot J Austr 2017; 27:21-28. [PMID: 26726816 DOI: 10.1071/he15030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Alcohol-related harm is an issue of concern for African migrant communities living in Australia. However, there has been little information available to guide workers in developing culturally sensitive health promotion strategies. Methods A three-step approach, comprising a literature review, community consultations and an external review, was undertaken to develop a guide to assist organisations and health promotion groups working with African migrant communities to address alcohol-related harms. Discussion There was a high level of agreement between the three steps. Addressing alcohol harms with African migrant communities requires approaches that are sensitive to the needs, structures and experiences of communities. The process should incorporate targeted approaches that enable communities to achieve their resettlement goals as well as strengthening mainstream health promotion efforts. Conclusions The resource produced guides alcohol harm prevention coalitions and workers from the first steps of understanding the influences of acculturation and resettlement on alcohol consumption, through to planning, developing and evaluating an intervention in partnership with communities. So what? This paper advances knowledge by providing a precise summary of Australian African migrant focused alcohol and other drug research to date. It also describes a three-step approach that aimed to incorporate a diversity of community views in the creation of a health promotion and community capacity-building resource.
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Affiliation(s)
- Alison Jaworski
- Drug and Alcohol Multicultural Education Centre, PO Box 2315, Strawberry Hills NSW 2012, Australia
| | - Tony Brown
- Hunter Multicultural Community Drug Action Team, c/o Hunter Multicultural Community Drug Action Team Secretary, PO Box 119, Wallsend, NSW 2287, Australia
| | - Catherine Norman
- Hunter New England Local Health District, PO Box 119, Wallsend, NSW 2287, Australia
| | - Kiri Hata
- Penola House, Catholic Diocese of Maitland/Newcastle, 3 Wilson Street, Mayfield, NSW 2304, Australia
| | - Mark Toohey
- Ethnic Communities Council Newcastle & Hunter Inc., 2a Platt Street, Waratah, NSW 2298, Australia
| | - Dubravka Vasiljevic
- Hunter New England Local Health District, PO Box 119, Wallsend, NSW 2287, Australia
| | - Rachel Rowe
- Drug and Alcohol Multicultural Education Centre, PO Box 2315, Strawberry Hills NSW 2012, Australia
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18
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Horyniak D, Higgs P, Cogger S, Dietze P, Bofu T. Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking. ETHNICITY & HEALTH 2015; 21:284-299. [PMID: 26169071 DOI: 10.1080/13557858.2015.1061105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Little is known about substance use among resettled refugee populations. This study aimed to describe motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking among marginalised African refugee young people in Melbourne, Australia. DESIGN Face-to-face interviews were conducted with 16 self-identified African refugees recruited from street-based settings in 2012-2013. Interview transcripts were analysed inductively to identify key themes. RESULTS Participants gathered in public spaces to consume alcohol on a daily or near-daily basis. Three key motivations for heavy alcohol consumption were identified: drinking to cope with trauma, drinking to cope with boredom and frustration and drinking as a social experience. Participants reported experiencing a range of health and social consequences of their alcohol consumption, including breakdown of family relationships, homelessness, interpersonal violence, contact with the justice system and poor health. Strategies for managing drinking included attending counselling or residential detoxification programmes, self-imposed physical isolation and intentionally committing crime in order to be incarcerated. CONCLUSION These findings highlight the urgent need for targeted harm reduction education for African young people who consume alcohol. Given the importance of social relationships within this community, use of peer-based strategies are likely to be particularly effective. Development and implementation of programmes that address the underlying health and psychosocial causes and consequences of heavy alcohol use are also needed.
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Affiliation(s)
- Danielle Horyniak
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
- b School of Public Health and Preventive Medicine , Monash University , 99 Commercial Rd, Melbourne , VIC 3004 , Australia
| | - Peter Higgs
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
- b School of Public Health and Preventive Medicine , Monash University , 99 Commercial Rd, Melbourne , VIC 3004 , Australia
- c National Drug Research Institute (Melbourne Office) , Curtin University , Suite 6, 19-35 Gertrude Street, Fitzroy , VIC 3065 , Australia
| | - Shelley Cogger
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
| | - Paul Dietze
- a Centre for Population Health, Burnet Institute , 85 Commercial Rd, Melbourne , VIC 3004 , Australia
- b School of Public Health and Preventive Medicine , Monash University , 99 Commercial Rd, Melbourne , VIC 3004 , Australia
| | - Tapuwa Bofu
- d Centre for Culture, Ethnicity and Health , 23 Lennox St, Richmond , VIC 3121 , Australia
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