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Lanni S, Stone M, Berger AF, Wilson RLH, Wilens TE, Philpotts LL, Burke CW. Design, Recruitment, and Implementation of Research Interventions Among Youth Experiencing Homelessness: A Systematic Review. Community Ment Health J 2024; 60:722-742. [PMID: 38332393 PMCID: PMC11017793 DOI: 10.1007/s10597-023-01224-9] [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: 09/14/2023] [Accepted: 12/23/2023] [Indexed: 02/10/2024]
Abstract
Transitional age youth experiencing homelessness (TAY-EH) represent an underserved and understudied population. While an increasing number of empirical interventions have sought to address the high burden of psychopathology in this population, findings remain mixed regarding intervention effectiveness. In this systematic review of behavioral health interventions for TAY-EH, we sought to examine the structural framework in which these interventions take place and how these structures include or exclude certain populations of youth. We also examined implementation practices to identify how interventions involving youth and community stakeholders effectively engage these populations. Based on PRISMA guidelines, searches of Medline, PsycInfo, Embase, Cochrane Central, Web of Science, and ClinicalTrials.gov databases were conducted, including English language literature published before October 2022. Eligible studies reported on interventions for adolescent or young adult populations ages 13-25 years experiencing homelessness. The initial search yielded 3850 citations; 353 underwent full text review and 48 met inclusion criteria, of which there were 33 unique studies. Studies revealed a need for greater geographic distribution of empirically based interventions, as well as interventions targeting TAY-EH in rural settings. Studies varied greatly regarding their operationalizations of homelessness and their method of intervention implementation, but generally indicated a need for increased direct-street outreach in participant recruitment and improved incorporation of youth feedback into intervention design. To our knowledge, this is the first systematic review to examine the representation of various groups of TAY-EH in the literature on substance use and mental health interventions. Further intervention research engaging youth from various geographic locations and youth experiencing different forms of homelessness is needed to better address the behavioral health needs of a variety of TAY-EH.
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Affiliation(s)
- Sylvia Lanni
- Department of Psychiatry, Massachusetts General Hospital, Warren Building, Room 628, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Mira Stone
- Department of Psychiatry, Massachusetts General Hospital, Warren Building, Room 628, 55 Fruit Street, Boston, MA, 02114, USA
| | - Amy F Berger
- Department of Psychiatry, Massachusetts General Hospital, Warren Building, Room 628, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ronan L H Wilson
- Department of Psychiatry, Massachusetts General Hospital, Warren Building, Room 628, 55 Fruit Street, Boston, MA, 02114, USA
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Warren Building, Room 628, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Colin W Burke
- Department of Psychiatry, Massachusetts General Hospital, Warren Building, Room 628, 55 Fruit Street, Boston, MA, 02114, USA
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Pedersen ER, DiGuiseppi G, D'Amico EJ, Rodriguez A, Tran DD, Jose R, Tucker JS. Predictors of Housing Trajectories Among Young Adults Experiencing Homelessness in Los Angeles. J Behav Health Serv Res 2024; 51:31-43. [PMID: 37803216 PMCID: PMC10733216 DOI: 10.1007/s11414-023-09863-2] [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: 09/18/2023] [Indexed: 10/08/2023]
Abstract
Experiencing homelessness during young adulthood is associated with negative health outcomes and understanding housing trajectories of young adults experiencing homelessness may aid in the development of evidence-based public health programs designed to serve this at-risk age group. In the present study, the authors examined baseline predictors of 24-month trajectories of housing stability and unsheltered housing among a sample of 271 young adults aged 18 to 25 recruited from drop-in centers in Los Angeles. In multivariate models, the authors found that identifying as multi-racial/other and better friendship quality at baseline were associated with less steep increases in the likelihood of stable housing over time. Being employed at baseline was associated with a less steep decrease in the probability of being unsheltered over time, while illicit drug use days associated with a steeper decrease in the probability of being unsheltered over time. Continued research is needed to establish important factors determining young adults' long-term housing trajectories in the effort to promote greater access and engagement with housing services.
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Affiliation(s)
- Eric R Pedersen
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA.
| | - Graham DiGuiseppi
- School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | | | - Denise D Tran
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Rupa Jose
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
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Zeifman RJ, Kettner H, Pagni BA, Mallard A, Roberts DE, Erritzoe D, Ross S, Carhart-Harris RL. Co-use of MDMA with psilocybin/LSD may buffer against challenging experiences and enhance positive experiences. Sci Rep 2023; 13:13645. [PMID: 37608057 PMCID: PMC10444769 DOI: 10.1038/s41598-023-40856-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023] Open
Abstract
Psilocybin and lysergic acid diethylamide (LSD) experiences can range from very positive to highly challenging (e.g., fear, grief, and paranoia). These challenging experiences contribute to hesitancy toward psychedelic-assisted psychotherapy among health care providers and patients. Co-use of 3,4-Methylenedioxy methamphetamine (MDMA) with psilocybin/LSD anecdotally reduces challenging experiences and enhances positive experiences associated with psilocybin/LSD. However, limited research has investigated the acute effects of co-use of MDMA and psilocybin/LSD. In a prospective convenience sample (N = 698) of individuals with plans to use psilocybin/LSD, we examined whether co-use of MDMA with psilocybin/LSD (n = 27) is associated with differences in challenging or positive experiences. Challenging experiences were measured using the Challenging Experiences Questionnaire and positive experiences were measured using the Mystical Experience Questionnaire and single-item measures of self-compassion, compassion, love, and gratitude. Potentially confounding variables were identified and included as covariates. Relative to psilocybin/LSD alone, co-use of psilocybin/LSD with a self-reported low (but not medium-high) dose of MDMA was associated with significantly less intense total challenging experiences, grief, and fear, as well as increased self-compassion, love and gratitude. Co-use of psilocybin/LSD and MDMA was not associated with differences in mystical-type experiences or compassion. Findings suggest co-use of MDMA with psilocybin/LSD may buffer against some aspects of challenging experiences and enhance certain positive experiences. Limitations include use of a convenience sample, small sample size, and non-experimental design. Additional studies (including controlled dose-response studies) that examine the effects and safety of co-administering MDMA with psilocybin/LSD (in healthy controls and clinical samples) are warranted and may assist the development of personalized treatments.
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Affiliation(s)
- Richard J Zeifman
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA.
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California, San Francisco, USA
| | - Broc A Pagni
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Austin Mallard
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Daniel E Roberts
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Ross
- NYU Langone Center for Psychedelic Medicine, Department of Psychiatry, NYU Grossman School of Medicine, 1 Park Avenue, New York, NY, 10016, USA
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California, San Francisco, USA
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Chassman S, Barman-Adhikari A, Hsu HT, Ferguson KM, Narendorf SC, Maria DS, Shelton J, Petering R, Bender K. Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211049355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample. Methods This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use. Results Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use). Conclusion Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.
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Affiliation(s)
| | | | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| | | | - Sarah C. Narendorf
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Diane Santa Maria
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, New York, NY, USA
| | | | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, CO, USA
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Pedersen ER, Linnemayr S, Shadel WG, Zutshi R, DeYoreo M, Cabreros I, Tucker JS. Substance Use and Mental Health Outcomes from a Text Messaging-Based Intervention for Smoking Cessation Among Young People Experiencing Homelessness. Nicotine Tob Res 2021; 24:130-134. [PMID: 34375409 DOI: 10.1093/ntr/ntab160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/09/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Cigarette smoking and associated high-risk behaviors are prevalent among youth experiencing homelessness (YEH), making appropriately tailored interventions targeting smoking behavior important for this group. We pilot tested a brief text-messaging intervention (TMI) as an adjunct to standard care for YEH who smoke and found promising preliminary effects of the intervention on smoking cessation. The purpose of the present study was to test the TMI's effect on the secondary outcomes of other substance use (including use of other tobacco/nicotine devices) and mental health symptoms. METHODS A total of 77 participants completed the pilot randomized controlled trial, with 40 receiving the TMI (174 automated text messages plus a group smoking counseling session and provision of nicotine patches). They completed an assessment at baseline and another three months later that evaluated use of other tobacco/nicotine devices, alcohol, marijuana, and anxiety and depression symptoms. RESULTS We found that the TMI helped to reduce secondary substance use behaviors and mental health symptoms among the participants; mainly there were medium effects of the intervention on changes in other tobacco/nicotine use, drinking, and anxiety and depression symptoms. The intervention did not have an effect on number of marijuana use days in the past month; however, past 30-day marijuana users who received the intervention benefited by reducing the number of times they used marijuana per day. CONCLUSIONS In addition to helping reduce cigarette smoking, we found that a TMI for YEH was helpful in improving secondary outcomes, suggesting the promise of the TMI on benefiting YEH even beyond targeted smoking behavior. IMPLICATIONS This pilot study demonstrates that by targeting cigarette smoking using a text message-based intervention among youth experiencing homelessness, effects may be seen in other areas of functioning such as other substance use and mental health.
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Affiliation(s)
- Eric R Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, Los Angeles, CA
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Tucker JS, D'Amico EJ, Pedersen ER, Rodriguez A, Garvey R. Study protocol for a group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among young adults experiencing homelessness. Addict Sci Clin Pract 2020; 15:26. [PMID: 32723349 PMCID: PMC7390162 DOI: 10.1186/s13722-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/17/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. METHODS/DESIGN In a cluster-cross-over randomized controlled trial, 18-25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. DISCUSSION This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered).
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.,Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, United States
| | - Rick Garvey
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
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Push and Pull: Migration Patterns and Links to Harm Reduction Services Among People Who Use Drugs. CANADIAN JOURNAL OF ADDICTION 2018. [DOI: 10.1097/cxa.0000000000000018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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'Hello, you're not supposed to be here': homeless emerging adults' experiences negotiating food access. Public Health Nutr 2018; 21:1943-1951. [PMID: 29502547 DOI: 10.1017/s1368980018000356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We aimed to examine the food-seeking experiences of homeless emerging adults (age 18-24 years) in a US urban context. DESIGN The study used a qualitative descriptive design, combining semi-structured interviews with a standardized quantitative measure of food insecurity. Interview data were coded using constant comparative methods to identify patterns across and within interviews. Emerging themes were confirmed and refined through member checking. SETTING Buffalo, a mid-sized city in the Northeastern USA. SUBJECTS A sample of thirty participants was recruited through community-based methods. Eligibility criteria specified that participants were aged 18-24 years and did not have a stable place to live. The sample was demographically diverse and included participants who were couch-surfing, staying on the streets and/or using shelters. RESULTS Participants' food access strategies varied across their living circumstances. Common strategies included purchasing food with cash or benefits (reported by 77 %), using free meal programmes (70 %) and eating at friends' or relatives' homes (47 %). Although 70 % of participants received Supplemental Nutrition Assistance Program benefits, several reported access barriers, including initial denials of eligibility due to being listed on a parent's application even when the participant no longer resided in the household. Participants described a stigma associated with using food pantries and free meal programmes and expressed preference for less institutionalized programmes such as Food Not Bombs. CONCLUSIONS Given endemic levels of food insecurity among homeless youth and young adults, policy modifications and service interventions are needed to improve food access for this population.
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Kecojevic A, Jun HJ, Reisner SL, Corliss HL. Concurrent polysubstance use in a longitudinal study of US youth: associations with sexual orientation. Addiction 2017; 112:614-624. [PMID: 27790758 PMCID: PMC5339035 DOI: 10.1111/add.13681] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/29/2016] [Accepted: 10/26/2016] [Indexed: 01/08/2023]
Abstract
AIMS To estimate longitudinal associations between self-reported sexual orientation and past-year polysubstance use among youth, and test how gender, age and early onset of tobacco and alcohol use contributed to variation in polysubstance use. DESIGN Longitudinal community-based cohort of US adolescents from the Growing Up Today Study (GUTS 1) (n = 16 873) followed from ages 12-29 years. SETTING United States of America. PARTICIPANTS A total of 13 519 individuals (7839 females; 5680 males) who responded to at least one of five self-administered questionnaires from 1999 to 2010. Ninety-three per cent reported their race/ethnicity as non-Hispanic white. MEASUREMENTS Multivariable repeated measures generalized estimating equations estimated relative risks (RRs) of concurrent polysubstance use (i.e. past 12-month use of three or more substances) comparing sexual orientation minority youth [i.e. mostly heterosexual (MH), bisexual (BI), gay/lesbian (GL)] to their same-gender, completely heterosexual (CH) counterparts. Mediation analyses tested whether early onset of tobacco and/or alcohol use explained relationships between sexual orientation and concurrent polysubstance use. FINDINGS Compared with their same-gender CH peers, sexual minorities evidenced higher risk for concurrent polysubstance use over all repeated measures [risk ratios (RRs) for sexual minority subgroups: from 1.63-2.91, P-values: <0.001] and for all age groups (RRs: from 1.50-4.04, P-values: < 0.05-< 0.001), except GL males aged 18-20 years. Differences between sexual minorities and CHs were larger among females than males (P-values for sexual orientation × gender interactions were < 0.05 for MHs and BIs), and among younger versus older ages (P-values for sexual orientation × age interactions were < 0.05, except for BI males). Sexual minorities' younger age of smoking and/or drinking initiation contributed to their elevated polysubstance use (% of effect explained was between 9.4-24.3, P-values: 0.04-< 0.001), except among GL males. CONCLUSIONS Sexual minority youth in the United States, and in particular younger females, appear to be at disproportionate risk for concurrent past-year polysubstance use. Early onset of smoking and drinking may contribute to elevated risk of polysubstance use among sexual minorities.
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Affiliation(s)
- Aleksandar Kecojevic
- William Paterson University New Jersey, Department of Public Health, University Hall 369, 300 Pompton Rd, Wayne, NJ 07470
| | - Hee-Jin Jun
- San Diego State University, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, 9245 Sky Park Court, Suite 100, San Diego, CA 92123
| | - Sari L Reisner
- Boston Children’s Hospital/Harvard Medical School, Division of General Pediatrics, 300 Longwood Ave, BCH3201, Boston, MA 02115,Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Ave, Kresge Room 911, Boston, MA 02115,Fenway Health, The Fenway Institute, 1340 Boylston St, Ansin Building 8 Floor, Boston, MA 02115
| | - Heather L Corliss
- San Diego State University, Graduate School of Public Health, Division of Health Promotion and Behavioral Science, 9245 Sky Park Court, Suite 100, San Diego, CA 92123,Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Avenue, Boston, MA 02115
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Mello ZR, Walker EB, Finan LJ, Stiasny A, Wiggers ICS, McBroom KA, Worrell FC. Time perspective, psychological outcomes, and risky behavior among runaway adolescents. APPLIED DEVELOPMENTAL SCIENCE 2017. [DOI: 10.1080/10888691.2016.1276455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barman-Adhikari A, Begun S, Rice E, Yoshioka-Maxwell A, Perez-Portillo A. Sociometric network structure and its association with methamphetamine use norms among homeless youth. SOCIAL SCIENCE RESEARCH 2016; 58:292-308. [PMID: 27194667 PMCID: PMC4873723 DOI: 10.1016/j.ssresearch.2016.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 01/05/2016] [Accepted: 01/22/2016] [Indexed: 05/25/2023]
Abstract
Homeless youths' social networks are consistently linked with their substance use. Social networks influence behavior through several mechanisms, especially social norms. This study used sociometric analyses to understand whether social norms of drug use behaviors are clustered in network structures and whether these perceived norms (descriptive and injunctive) influence youths' drug use behaviors. An event-based approach was used to delineate boundaries of the two sociometric networks of homeless youth, one in Los Angeles, CA (n = 160) and the other in Santa Monica, CA (n = 130). Network characteristics included centrality (i.e., popularity) and cohesiveness (location in dense subnetworks). The primary outcome was recent methamphetamine use. Results revealed that both descriptive and injunctive norms influenced methamphetamine use. Network cohesion was found to be associated with perception of both descriptive and injunctive norms in both networks, however in opposite directions. Network interventions therefore might be effective if designed to capitalize on social influence that naturally occurs in cohesive parts of networks.
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Affiliation(s)
| | - Stephanie Begun
- School of Social Work, University of Denver, Denver, CO, USA.
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
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Quek LH, Chan GCK, White A, Connor JP, Baker PJ, Saunders JB, Kelly AB. Concurrent and simultaneous polydrug use: latent class analysis of an Australian nationally representative sample of young adults. Front Public Health 2013; 1:61. [PMID: 24350230 PMCID: PMC3860005 DOI: 10.3389/fpubh.2013.00061] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/14/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol use and illicit drug use peak during young adulthood (around 18-29 years of age), but comparatively little is known about polydrug use in nationally representative samples of young adults. Drawing on a nationally representative cross-sectional survey (Australian National Drug Strategy Household Survey), this study examines polydrug use patterns and associated psychosocial risk factors among young adults (n = 3,333; age 19-29). METHOD The use of a broad range of licit and illicit drugs were examined, including alcohol, tobacco, cannabis, cocaine, hallucinogens, ecstasy, ketamine, GHB, inhalants, steroids, barbiturates, meth/amphetamines, heroin, methadone/buprenorphine, other opiates, painkillers, and tranquilizers/sleeping pills. Latent class analysis was employed to identify patterns of polydrug use. RESULTS Polydrug use in this sample was best described using a 5-class solution. The majority of young adults predominantly used alcohol only (52.3%), alcohol and tobacco (34.18%). The other classes were cannabis, ecstasy, and licit drug use (9.4%), cannabis, amphetamine derivative, and licit drug use (2.8%), and sedative and alcohol use (1.3%). Young adult males with low education and/or high income were most at risk of polydrug use. CONCLUSION Almost half of young adults reported polydrug use, highlighting the importance of post-high school screening for key risk factors and polydrug use profiles, and the delivery of early intervention strategies targeting illicit drugs.
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Affiliation(s)
- Lake-Hui Quek
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
| | - Gary C. K. Chan
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
| | - Angela White
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jason P. Connor
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Peter J. Baker
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Health Sciences, School of Population Health, The University of Queensland, Brisbane, QLD, Australia
| | - John B. Saunders
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
| | - Adrian B. Kelly
- Faculty of Health Sciences, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, QLD, Australia
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Montgomery ME, Fatch RS, Evans JL, Yu M, Davidson PJ, Page K, Hahn JA. Injecting risk behavior among traveling young injection drug users: travel partner and city characteristics. J Urban Health 2013; 90:500-15. [PMID: 22744293 PMCID: PMC3665972 DOI: 10.1007/s11524-012-9718-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Young injection drug users (IDUs), a highly mobile population, engage in high levels of injecting risk behavior, yet little is understood about how such risk behavior may vary by the characteristics of the cities to which they travel, including the existence of a syringe exchange program (SEP), as well as travel partner characteristics. In 2004-2005, we conducted a 6-month prospective study to investigate the risk behavior of 89 young IDUs as they traveled, with detailed information gathered about 350 city visits. In multivariable analyses, travel to larger urban cities with a population of 500,000-1,000,000 was significantly associated with injecting drugs (adjusted odds ratio (AOR) = 3.71; 95 % confidence interval (CI), 1.56-8.82), ancillary equipment sharing (AES; AOR = 7.05; 95 % CI, 2.25-22.06) and receptive needle sharing (RNS; AOR = 5.73; 95 % CI, 1.11-27.95), as compared with visits to smaller cities with populations below 50,000. Region of the country, and the existence of a SEP within the city visited, were not independently associated with injecting drugs, AES, or RNS during city visits. Traveling with more than one injecting partner was associated with injecting drugs during city visits (AOR = 2.77; 95 % CI, 1.46-5.27), when compared with traveling alone. Additionally, both non-daily and daily/almost daily alcohol use during city visits were associated with AES (AOR = 3.37; 95 % CI, 1.42-7.68; AOR = 3.03; 95 % CI, 1.32-6.97, respectively) as compared with no alcohol consumption. Traveling young IDUs are more likely to inject when traveling with other IDUs and to engage in higher risk injection behavior when they are in large cities. Risk behavior occurring in city visits, including equipment sharing and alcohol consumption, suggests further need for focused interventions to reduce risk for viral infection among this population.
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Affiliation(s)
- Martha E Montgomery
- University of California, Berkeley and University of California, San Francisco Joint Medical Program, Berkeley and San Francisco, CA, USA
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Abstract
Gang membership is an indicator of chronic substance use. Evidence from North America and Europe indicates that gang youth, in comparison to their non-gang peers, are more likely to report alcohol and illicit drug use (Bendixen, Endresen, & Olweus, 2006; Gatti, Tremblay, Vitaro, & McDuff, 2005; Gordon, et al., 2004; Hall, Thornberry, & Lizotte, 2006; Sharp, Aldridge, & Medina, 2006). Qualitative studies focusing specifically on gang members have also noted high frequencies of lifetime rates of use for a variety of illegal substances (De La Rosa, Rugh, & Rice, 2006; Hagedorn, Torres, & Giglio, 1998; Hunt, Jo-Laidler, & Evans, 2002; Mata et al., 2002; Valdez, Kaplan, & Cepeda, 2006). Gang youth, however, have differential attitudes towards the use of various illegal drugs. Marijuana, for instance, has remained a staple within gang culture, but the use of other drugs has been heavily stigmatized, especially heroin, methamphetamine, and crack cocaine (MacKenzie, Hunt, & Joe-Laidler, 2005; Moore, 1978; Taylor, 1990; Waldorf, 1993). Perspectives with good explanatory power should be flexible enough to elucidate these distinctions regarding illicit substance use patterns and preferences.
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Affiliation(s)
- Bill Sanders
- School of Criminal Justice, California State University Los Angeles
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Martino SC, Tucker JS, Ryan G, Wenzel SL, Golinelli D, Munjas B. Increased substance use and risky sexual behavior among migratory homeless youth: exploring the role of social network composition. J Youth Adolesc 2011; 40:1634-48. [PMID: 21400037 PMCID: PMC3143210 DOI: 10.1007/s10964-011-9646-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
Abstract
Travelers are a migratory subgroup of homeless youth who may be especially prone to engaging in risky behavior. This study compared the substance use and sexual behavior of young homeless travelers and non-travelers to evaluate the extent and possible sources of travelers' increased risk. Data came from face-to-face interviews with 419 homeless youth (36.6% female, 34.0% white, 23.9% African American, and 20.0% Hispanic) between the ages of 13 and 24 years (M = 20.1 years, SD = 2.5) who were randomly sampled from 41 shelters, drop-in centers, and street sites in Los Angeles. Travelers were almost twice as likely as non-travelers to exhibit recent heavy drinking, 37% more likely to exhibit recent marijuana use, and five times as likely to have injected drugs. Travelers also had more recent sex partners and were more likely to report having casual or need-based sexual partners and combining sex with substance use. Mediation analyses suggest that travelers' deviant peer associations and disconnection to conventional individuals and institutions may drive their elevated substance use. Differences in sexual risk behaviors are likely attributable to demographic differences between the two groups. Overall, these differences between travelers and non-travelers suggest different service needs and the need for different service approaches.
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Lankenau SE, Bloom JJ, Shin C. Longitudinal trajectories of ketamine use among young injection drug users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:306-14. [PMID: 20138747 PMCID: PMC2890290 DOI: 10.1016/j.drugpo.2010.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 11/24/2009] [Accepted: 01/11/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ketamine is a dissociative anaesthetic that became increasingly popular in the club and rave scene in the 1980s and 1990s. Reports surfaced in the late 1990s indicating that ketamine was being injected in several U.S. cities by young injection drug users (IDUs). Since all studies on ketamine injection were cross-sectional, a longitudinal study was undertaken in 2005 to determine: characteristics of young IDUs who continue to inject ketamine; frequency of ketamine injection over an extended time period; risks associated with ongoing ketamine injection; and environmental factors that impact patterns of ketamine use. METHODS Young IDUs aged 16-29 with a history of injecting ketamine (n=101) were recruited from public locations in Los Angeles and followed during a 2-year longitudinal study. A semi-structured instrument captured quantitative and qualitative data on patterns of ketamine injection and other drug use. A statistical model sorted IDUs who completed three or more interviews (n=66) into three groups based upon patterns of ketamine injection at baseline and follow-up. Qualitative analysis focused on detailed case studies within each group. RESULTS IDUs recruited at baseline were typically in their early 20s, male, heterosexual, white, and homeless. Longitudinal injection trajectories included: "Moderates," who injected ketamine several times per year (n=5); "Occasionals," who injected ketamine approximately once per year (n=21); and "Abstainers," who did not inject any ketamine during follow-up (n=40). Findings suggest that ketamine is infrequently injected compared to other drugs such as heroin, cocaine, and methamphetamine. Most IDUs who begin injecting ketamine will stop or curb use due to: negative or ambivalent experiences associated with ketamine; an inability to find the drug due to declining supply; or maturing out of injecting drugs more generally. CONCLUSION Reducing ketamine injection among young IDUs may best be accomplished by targeting particular groups of IDUs identified in this study, such as homeless youth and homeless travellers.
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Affiliation(s)
- Stephen E Lankenau
- School of Public Health, Department of Community Health and Prevention, Drexel University, 1505 Race Street, Philadelphia, PA 19102, USA.
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Sanders B, Lankenau SE, Jackson-Bloom J. Putting in work: qualitative research on substance use and other risk behaviors among gang youth in Los Angeles. Subst Use Misuse 2010; 45:736-53. [PMID: 20222782 PMCID: PMC3176670 DOI: 10.3109/10826081003595267] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Gang youth are notoriously difficult to access for research purposes. Despite this difficulty, qualitative research about substance use among gang youth is important because research indicates that such youth use more substances than their nongang peers. This manuscript discusses how a small sample of gang youth (n = 60) in Los Angeles was accessed and interviewed during a National Institute of Drug Abuse-funded pilot study on substance use and other risk behaviors. Topics discussed include the rationale and operationalization of the research methodology, working with community-based organizations, and the recruitment of different gang youth with varying levels of substance use.
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Affiliation(s)
- Bill Sanders
- School of Criminal Justice and Criminalistics, California State University, Los Angeles, California 90032, USA.
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Lankenau SE, Sanders B, Hathazi D, Bloom JJ. Recruiting and retaining mobile young injection drug users in a longitudinal study. Subst Use Misuse 2010; 45:684-99. [PMID: 20222779 PMCID: PMC3139269 DOI: 10.3109/10826081003594914] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Longitudinal studies that research homeless persons or transient drug users face particular challenges in retaining subjects. Between 2005 and 2006, 101 mobile young injection drug users were recruited in Los Angeles into a 2-year longitudinal study. Several features of ethnographic methodology, including fieldwork and qualitative interviews, and modifications to the original design, such as toll-free calls routed directly to ethnographer cell phones and wiring incentive payments, resulted in retention of 78% of subjects for the first follow-up interview. Longitudinal studies that are flexible and based upon qualitative methodologies are more likely to retain mobile subjects while also uncovering emergent research findings.
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Affiliation(s)
- Stephen E Lankenau
- Drexel University, School of Public Health, Department of Community Health and Prevention, Philadelphia, PA 19102, USA.
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Lankenau SE, Wagner KD, Jackson Bloom J, Sanders B, Hathazi D, Shin C. THE FIRST INJECTION EVENT: DIFFERENCES AMONG HEROIN, METHAMPHETAMINE, COCAINE, AND KETAMINE INITIATES. JOURNAL OF DRUG ISSUES 2010; 40:241-262. [PMID: 21423792 PMCID: PMC3059319 DOI: 10.1177/002204261004000201] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes how the drug type injected at the first injection event is related to characteristics of the initiate, risk behaviors at initiation, and future drug-using trajectories. A diverse sample (n=222) of young injection drug users (IDUs) were recruited from public settings in New York, New Orleans, and Los Angeles during 2004 and 2005. The sample was between 16 and 29 years old, and had injected ketamine at least once in the preceding two years. Interview data was analyzed both quantitatively and qualitatively. Young IDUs initiated with four primary drug types: heroin (48.6%), methamphetamine (20.3%), ketamine (17.1%), and cocaine (14%). Several variables evidenced statistically significant relationships with drug type: age at injection initiation, level of education, region of initiation, setting, mode of administration, patterns of self-injection, number of drugs ever injected, current housing status, and their hepatitis C virus (HCV) status. Qualitative analyses revealed that rationale for injection initiation and subjective experiences at first injection differed by drug type.
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Sanders B, Lankenau SE, Jackson Bloom J, Hathaz DS. A TYPOLOGY OF DRUG-RELATED OFFENDING AMONG YOUNG HOMELESS INJECTION DRUG USERS. JOURNAL OF DRUG ISSUES 2009; 39:777-802. [PMID: 21423855 PMCID: PMC3059324 DOI: 10.1177/002204260903900401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research indicates a link between drug use and offending, particularly amongst high-risk individuals, such as homeless youth. The extent to which such youth interpret their offending as being related to their drug use, though, is understudied. This manuscript investigates the interpretations of drug-related offenses offered by 151 primarily white, male, homeless IDUs aged 16-29 years. Youth were asked specific questions about their drug-related offenses during in-depth interviews as part of a larger study investigating health risks surrounding drug injection between 2004 and 2006. The first section of the manuscript outlines offenses youth revealed committing either in pursuit of or after using a variety of substances. The second part of the manuscript examines the overall context (motivation, environment), and provides a seven-tiered typology of drug-related offending based on youth's interpretations, linking certain drugs to specific offenses within particular contexts. From here, some theoretical and practical implications of the findings are discussed.
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Hathazi D, Lankenau SE, Sanders B, Jackson Bloom J. Pregnancy and sexual health among homeless young injection drug users. J Adolesc 2008; 32:339-55. [PMID: 18692891 DOI: 10.1016/j.adolescence.2008.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 01/26/2008] [Accepted: 02/08/2008] [Indexed: 11/18/2022]
Abstract
Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting.
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Affiliation(s)
- Dodi Hathazi
- Childrens Hospital Los Angeles, The Saban Research Institute, Community, Health Outcomes, and Intervention Research Program, 6430 Sunset Boulevard, Suite 1500, Los Angeles, CA 90028, USA
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Hahn JA, Page-Shafer K, Ford J, Paciorek A, Lum PJ. Traveling young injection drug users at high risk for acquisition and transmission of viral infections. Drug Alcohol Depend 2008; 93:43-50. [PMID: 17980513 PMCID: PMC2247437 DOI: 10.1016/j.drugalcdep.2007.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 08/15/2007] [Accepted: 08/16/2007] [Indexed: 01/11/2023]
Abstract
BACKGROUND Young injection drug users (IDU) are highly mobile. It is not known how mobility affects their risk of acquiring and transmitting viral infections. METHODS We conducted a cross-sectional study of young (under age 30) IDU in San Francisco (2004-2006). Participants completed a semi-structured interview and testing for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infection. We examined whether travel was independently associated with drug, alcohol, sexual risk behaviors, and infection status, after adjusting for demographic characteristics and years injecting. RESULTS Two-thirds (62%) reported past (3 months) travel outside of San Francisco (n=355). Travelers, as compared to non-travelers, were more likely to be under age 20, female, and planned to leave San Francisco in the coming months. Travel was independently associated with heavy alcohol consumption, drinking alcohol until blackout, poly-substance use, more sexual and injecting partners, and receptive needle/syringe sharing, sharing drug preparation equipment, backloading syringes and pooling money to buy drugs. In an analysis of interactions with travel, younger travelers were more likely to be HCV positive than younger non-travelers. DISCUSSION Traveling young IDU are at exceptionally high risk for acquiring and transmitting viral infections, while their mobility makes it challenging to effectively deliver interventions.
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Affiliation(s)
- Judith A. Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143
| | - Kimberly Page-Shafer
- Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143
| | - Jamye Ford
- Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143
| | - Alan Paciorek
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94143
| | - Paula J. Lum
- Department of Medicine, University of California, San Francisco, San Francisco, CA, 94143
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