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Sauer J, Stewart K. Geographic information science and the United States opioid overdose crisis: A scoping review of methods, scales, and application areas. Soc Sci Med 2023; 317:115525. [PMID: 36493502 DOI: 10.1016/j.socscimed.2022.115525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/23/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Opioid Overdose Crisis (OOC) continues to generate morbidity and mortality in the United States, outpacing other prominent accident-related reasons. Multiple disciplines have applied geographic information science (GIScience) to understand geographical patterns in opioid-related health measures. However, there are limited reviews that assess how GIScience has been used. OBJECTIVES This scoping review investigates how GIScience has been used to conduct research on the OOC. Specific sub-objectives involve identifying bibliometric trends, the location and scale of studies, the frequency of use of various GIScience methodologies, and what direction future research can take to address existing gaps. METHODS The review was pre-registered with the Open Science Framework ((https://osf.io/h3mfx/) and followed the PRISMA-ScR guidelines. Scholarly research was gathered from the Web of Science Core Collection, PubMed, IEEE Xplore, ACM Digital Library. Inclusion criteria was defined as having a publication date between January 1999 and August 2021, using GIScience as a central part of the research, and investigating an opioid-related health measure. RESULTS 231 studies met the inclusion criteria. Most studies were published from 2017 onward. While many (41.6%) of studies were conducted using nationwide data, the majority (58.4%) occurred at the sub-national level. California, New York, Ohio, and Appalachia were most frequently studied, while the Midwest, north Rocky Mountains, Alaska, and Hawaii lacked studies. The most common GIScience methodology used was descriptive mapping, and county-level data was the most common unit of analysis across methodologies. CONCLUSIONS Future research of GIScience on the OOC can address gaps by developing use cases for machine learning, conducting analyses at the sub-county level, and applying GIScience to questions involving illicit fentanyl. Research using GIScience is expected to continue to increase, and multidisciplinary research efforts amongst GIScientists, epidemiologists, and other medical professionals can improve the rigor of research.
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Affiliation(s)
- Jeffery Sauer
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
| | - Kathleen Stewart
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
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Stopka TJ, Jacque E, Kelley J, Emond L, Vigroux K, Palacios WR. Examining the spatial risk environment tied to the opioid crisis through a unique public health, EMS, and academic research collaborative: Lowell, Massachusetts, 2008–2018. Prev Med Rep 2021; 24:101591. [PMID: 34976650 PMCID: PMC8683861 DOI: 10.1016/j.pmedr.2021.101591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/20/2022] Open
Abstract
Between 2015 and 2018, Lowell Massachusetts experienced outbreaks in opioid overdoses, HIV, and hepatitis C virus infections (HCV) among people who inject drugs. Through an innovative collaboration between emergency medical services (EMS), public health, and academic partners, we assessed the geographic distribution of opioid-related risks to inform intervention efforts. We analyzed data from three unique data sources for publicly discarded syringes, opioid-related incidents (ORIs), and fatal opioid overdoses in Lowell between 2008 and 2018. We assessed the risk environment over time using a geographic information system to identify and characterize hotspots and noted parallel trends within the syringe discard and ORI data. We identified two notable increases in ORIs per day: the first occurring between 2008 and 2010 (from 0.3 to 0.5), and the second between 2011 and 2014 (from 0.9 to 1.3), following the introduction of fentanyl within local drug markets. We also identified seasonal patterns in the syringe discard, ORI, and overdose data. Through our spatial analyses, we identified significant clusters of discarded syringes, ORIs, and fatal overdoses (p < 0.05), and neighborhoods where high densities of these outcomes overlapped. We found that areas with the highest densities shifted over time, expanding beyond the epicenter of the Downtown neighborhood. Data sharing and analyses among EMS, public health, and academic partners can foster better assessments of local risk environments. Our work, along with new public health efforts in Lowell, led to a city-funded position to improve pick-up and proper disposal of publicly discarded syringes, and better targeted harm reduction services.
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Affiliation(s)
- Thomas J. Stopka
- Dept. of Public Health and Community Medicine, Tufts University School of Medicine, United States
- Corresponding author at: Department of Public Health and Community Medicine, Clinical and Translational Science Institute, Tufts University School of Medicine, 136 Harrison Avenue, MV244 Boston, MA 02111, United States.
| | - Erin Jacque
- Dept. of Public Health and Community Medicine, Tufts University School of Medicine, United States
| | - Jon Kelley
- Trinity Emergency Medical Services, United States
| | | | | | - Wilson R. Palacios
- School of Criminology & Justice Studies, University of Massachusetts, Lowell, United States
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3
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Crawford ND, Myers S, Young H, Klepser D, Tung E. The Role of Pharmacies in the HIV Prevention and Care Continuums: A Systematic Review. AIDS Behav 2021; 25:1819-1828. [PMID: 33386509 DOI: 10.1007/s10461-020-03111-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/26/2022]
Abstract
The role of pharmacists in the treatment of HIV has expanded beyond medication dispensing to include a host of cost-effective, evidence-based strategies across the HIV prevention and care continuums. However, wide-scale adoption of pharmacy-based HIV prevention and treatment interventions has been slow. We conducted a systematic review to evaluate the evidence on the role of pharmacists across the HIV prevention and care continuums. Thirty-two studies were identified, most of which provided evidence of feasibility of HIV testing and efficacy of non-prescription syringe sale services in pharmacies. However, only two studies implemented an experimental design to rigorously test pharmacy-based strategies. Notably, no pharmacy-based strategies have specifically targeted the highest HIV risk populations such as black and Latinx men who have sex with men, women, or trans populations. Efficacy trials and effectiveness studies should rigorously test existing pharmacy-based strategies to build greater support for wide-scale adoption and implementation. Moreover, in order to integrate pharmacies into the strategy to end the HIV epidemic, studies are needed to ensure that pharmacy-based HIV prevention and treatment services can reach the highest risk populations.
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Affiliation(s)
- Natalie D Crawford
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Ann Arbor, MI, USA.
| | - Sky Myers
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Henry Young
- College of Pharmacy, University of Georgia, Athens, GA, USA
| | - Donald Klepser
- College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Elyse Tung
- Kelley-Ross Pharmacy, Seattle, WA, 98102, USA
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Agustí C, Font-Casaseca N, Belvis F, Julià M, Vives N, Montoliu A, Pericàs JM, Casabona J, Benach J. The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain). BMC Public Health 2020; 20:1533. [PMID: 33036599 PMCID: PMC7547437 DOI: 10.1186/s12889-020-09603-7] [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: 05/29/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. METHODS Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. RESULTS New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. CONCLUSIONS Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.
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Affiliation(s)
- Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain. .,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.
| | | | - Francesc Belvis
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Julià
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vives
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Montoliu
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Juan M Pericàs
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain.,Infectious Disease Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.,Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Stopka TJ, Brinkley-Rubinstein L, Johnson K, Chan PA, Hutcheson M, Crosby R, Burke D, Mena L, Nunn A. HIV Clustering in Mississippi: Spatial Epidemiological Study to Inform Implementation Science in the Deep South. JMIR Public Health Surveill 2018; 4:e35. [PMID: 29615383 PMCID: PMC5904450 DOI: 10.2196/publichealth.8773] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/21/2018] [Accepted: 02/04/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. OBJECTIVE The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. METHODS We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. RESULTS There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P<.05). In multivariable models for all HIV cases, HIV hotspots were significantly more likely to include urban census tracts (adjusted odds ratio [AOR] 2.01, 95% CI 1.20-3.37) and census tracts that had a higher proportion of African Americans (AOR 3.85, 95% CI 2.23-6.65). The HIV hotspots were less likely to include census tracts with residents who had less than a high school education (AOR 0.95, 95% CI 0.92-0.98), census tracts with residents belonging to two or more racial/ethnic groups (AOR 0.46, 95% CI 0.30-0.70), and census tracts that had a higher percentage of the population living below the poverty level (AOR 0.51, 95% CI 0.28-0.92). CONCLUSIONS We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.
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Affiliation(s)
- Thomas J Stopka
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
- Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, United States
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, United States
- Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, United States
| | - Kendra Johnson
- Mississippi State Department of Health, Jackson, MS, United States
| | - Philip A Chan
- School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Brown University, Providence, RI, United States
| | - Marga Hutcheson
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
| | - Richard Crosby
- College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Deirdre Burke
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, United States
| | - Leandro Mena
- John D Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Amy Nunn
- School of Public Health, Brown University, Providence, RI, United States
- Department of Medicine, Brown University, Providence, RI, United States
- Rhode Island Public Health Institute, Providence, RI, United States
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6
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Peiper NC, Baumgartner PM, Chew RF, Hsieh YP, Bieler GS, Bobashev GV, Siege C, Zarkin GA. Patterns of Twitter Behavior Among Networks of Cannabis Dispensaries in California. J Med Internet Res 2017; 19:e236. [PMID: 28676471 PMCID: PMC5516098 DOI: 10.2196/jmir.7137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/06/2017] [Accepted: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
Background Twitter represents a social media platform through which medical cannabis dispensaries can rapidly promote and advertise a multitude of retail products. Yet, to date, no studies have systematically evaluated Twitter behavior among dispensaries and how these behaviors influence the formation of social networks. Objectives This study sought to characterize common cyberbehaviors and shared follower networks among dispensaries operating in two large cannabis markets in California. Methods From a targeted sample of 119 dispensaries in the San Francisco Bay Area and Greater Los Angeles, we collected metadata from the dispensary accounts using the Twitter API. For each city, we characterized the network structure of dispensaries based upon shared followers, then empirically derived communities with the Louvain modularity algorithm. Principal components factor analysis was employed to reduce 12 Twitter measures into a more parsimonious set of cyberbehavioral dimensions. Finally, quadratic discriminant analysis was implemented to verify the ability of the extracted dimensions to classify dispensaries into their derived communities. Results The modularity algorithm yielded three communities in each city with distinct network structures. The principal components factor analysis reduced the 12 cyberbehaviors into five dimensions that encompassed account age, posting frequency, referencing, hyperlinks, and user engagement among the dispensary accounts. In the quadratic discriminant analysis, the dimensions correctly classified 75% (46/61) of the communities in the San Francisco Bay Area and 71% (41/58) in Greater Los Angeles. Conclusions The most centralized and strongly connected dispensaries in both cities had newer accounts, higher daily activity, more frequent user engagement, and increased usage of embedded media, keywords, and hyperlinks. Measures derived from both network structure and cyberbehavioral dimensions can serve as key contextual indicators for the online surveillance of cannabis dispensaries and consumer markets over time.
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Affiliation(s)
- Nicholas C Peiper
- RTI International, Behavioral Health and Criminal Justice Research Division, Research Triangle Park, NC, United States
| | - Peter M Baumgartner
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Robert F Chew
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Yuli P Hsieh
- RTI International, Survey Research Division, Research Triangle Park, NC, United States
| | - Gayle S Bieler
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Georgiy V Bobashev
- RTI International, Center for Data Science, Research Triangle Park, NC, United States
| | - Christopher Siege
- RTI International, Research Computing Division, Research Triangle Park, NC, United States
| | - Gary A Zarkin
- RTI International, Behavioral Health and Criminal Justice Research Division, Research Triangle Park, NC, United States
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Stopka TJ, Donahue A, Hutcheson M, Green TC. Nonprescription naloxone and syringe sales in the midst of opioid overdose and hepatitis C virus epidemics: Massachusetts, 2015. J Am Pharm Assoc (2003) 2017; 57:S34-S44. [PMID: 28189540 DOI: 10.1016/j.japh.2016.12.077] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the prevalence of nonprescription naloxone and sterile syringe sales, factors associated with nonprescription sales, geospatial access to nonprescription naloxone and syringe-selling pharmacies, and targets for potential interventions. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS Massachusetts has experienced steep increases in reported opioid overdoses and hepatitis C virus cases in the past decade. Pharmacists have the potential to play a substantial role in increasing access to nonprescription naloxone and sterile syringes, which can reverse opioid overdoses and decrease hepatitis C virus transmission, respectively. We completed brief telephone surveys with 809 of 1042 retail pharmacies across Massachusetts (response rate = 77.6%) during 2015 to assess experience with nonprescription sales of naloxone and sterile syringes. OUTCOME MEASURES Our primary outcomes were the stocking and selling of naloxone in the pharmacy (yes or no) for nonprescription sales and nonprescription syringe sales (yes or no). We conducted multivariable regression analyses and created maps using a geographic information system to identify factors associated with nonprescription sales of naloxone and sterile syringes, and to improve our understanding of geospatial access to pharmacy-based naloxone and syringe sales. RESULTS More than 97% of pharmacies reported selling sterile syringes without requiring a prescription, and 45% of pharmacies reported stocking and selling naloxone. Factors associated with nonprescription sales included hours of operation, experience with and interest in harm reduction activities, and presence in an opioid overdose hotspot. Geographic access to nonprescription sale of sterile syringes is widespread, whereas geospatial access to naloxone is limited. Training to understand the benefits, applications, and distribution needs of naloxone is of interest to surveyed pharmacists. CONCLUSION Access to sterile syringes through nonprescription sales is strong across Massachusetts, and although more than 350 pharmacies (45%) reported stocking and selling naloxone to prevent opioid overdose deaths, there is much room for improvement in access and training among pharmacy staff members.
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Rowe C, Santos GM, Vittinghoff E, Wheeler E, Davidson P, Coffin PO. Neighborhood-Level and Spatial Characteristics Associated with Lay Naloxone Reversal Events and Opioid Overdose Deaths. J Urban Health 2016; 93:117-30. [PMID: 26800987 PMCID: PMC4794468 DOI: 10.1007/s11524-015-0023-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
There were over 23,000 opioid overdose deaths in the USA in 2013, and opioid-related mortality is increasing. Increased access to naloxone, particularly through community-based lay naloxone distribution, is a widely supported strategy to reduce opioid overdose mortality; however, little is known about the ecological and spatial patterns of the distribution and utilization of lay naloxone. This study aims to investigate the neighborhood-level correlates and spatial relationships of lay naloxone distribution and utilization and opioid overdose deaths. We determined the locations of lay naloxone distribution sites and the number of unintentional opioid overdose deaths and reported reversal events in San Francisco census tracts (n = 195) from 2010 to 2012. We used Wilcoxon rank-sum tests to compare census tract characteristics across tracts adjacent and not adjacent to distribution sites and multivariable negative binomial regression models to assess the association between census tract characteristics, including distance to the nearest site, and counts of opioid overdose deaths and naloxone reversal events. Three hundred forty-two opioid overdose deaths and 316 overdose reversals with valid location data were included in our analysis. Census tracts including or adjacent to a distribution site had higher income inequality, lower percentage black or African American residents, more drug arrests, higher population density, more overdose deaths, and more reversal events (all p < 0.05). In multivariable analysis, greater distance to the nearest distribution site (up to a distance of 4000 m) was associated with a lower count of Naloxone reversals [incidence rate ratio (IRR) = 0.51 per 500 m increase, 95% CI 0.39-0.67, p < 0.001] but was not significantly associated with opioid overdose deaths. These findings affirm that locating lay naloxone distribution sites in areas with high levels of substance use and overdose risk facilitates reversals of opioid overdoses in those immediate areas but suggests that alternative delivery methods may be necessary to reach individuals in other areas with less concentrated risk.
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Affiliation(s)
- Christopher Rowe
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA.
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Eric Vittinghoff
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Eliza Wheeler
- Drug Overdose Prevention and Education Project, Harm Reduction Coalition, 1440 Broadway, Suite 902, Oakland, CA, 94612, USA
| | - Peter Davidson
- University of California, San Diego, 9500 Gilman Drive, La Jolla, California, CA, 92093, USA
| | - Philip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Ste. 500, San Francisco, CA, 94102, USA
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, USA
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Abstract
Prior research has explored spatial access to syringe exchange programs (SEPs) among persons who inject drugs (PWID), but these studies have been based on limited data from short periods of time. No research has explored changes in spatial access to SEPs among PWID longitudinally. The purpose of this research is to examine spatial access to SEPs among PWID who accessed services at a SEP in Washington, District of Columbia (DC), from 1996 to 2010. The geometric point distance estimation technique was used to calculate the mean walking distance PWID traveled from the centroid point of their zip code of home residence to the mobile exchange site where they accessed SEP services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by year. The results of this research suggest that the distance DC PWID traveled to access SEP services remained relatively constant (approximately 2.75 mi) from 2003 to 2008, but increased to just over 4 mi in 2010. This research provides support for expanding SEP operations such that PWID have increased access to their services. Increasing SEP accessibility may help resolve unmet needs among injectors.
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Mirzazadeh A, Grasso M, Johnson K, Briceno A, Navadeh S, McFarland W, Page K. Acceptability of Global Positioning System technology to survey injecting drug users' movements and social interactions: a pilot study from San Francisco, USA. Technol Health Care 2015; 22:689-700. [PMID: 24990173 DOI: 10.3233/thc-140838] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite potential applications for improving health services using GPS technology, little is known about ethical concerns, acceptability, and logistical barriers for their use, particularly among marginalized groups. OBJECTIVES We garnered the insights of people who inject drug (PWID) in San Francisco on these topics. METHODS PWID were enrolled through street-outreach (n=20) and an ongoing study (n=4) for 4 focus group discussions. Participants also completed a self-administered questionnaire on demographic characteristics and their numbers and types of interactions with other PWID. RESULTS Median age was 30.5 years, majorities were male (83.3%) and white (68.2%). Most interacted with other PWID for eating meals and purchasing drugs over the last week; fewer reported interactions such as sexual contact, drug treatment, or work. Participants identified several concerns about carrying GPS devices, including what authorities might do with the data, that other PWID and dealers may suspect them as informants, and adherence to carrying and use. Most felt concerns were surmountable with detailed informed consent on the purpose of the study and practical ways to carry, charge, and hide devices. CONCLUSIONS PWID felt data collection on their movements and social interactions with other PWID using GPS can be acceptable with addressing specific concerns. The technology is now in hand to greatly expand the ability to monitor health conditions with respect to the environment and improve the location of prevention, care, and treatment facilities to serve hard to reach, mobile, and hidden populations.
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Affiliation(s)
- A Mirzazadeh
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA Global Health Sciences, University of California, San Francisco California, San Francisco, CA, USA Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - M Grasso
- Global Health Sciences, University of California, San Francisco California, San Francisco, CA, USA
| | - K Johnson
- Global Health Sciences, University of California, San Francisco California, San Francisco, CA, USA
| | - A Briceno
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - S Navadeh
- Global Health Sciences, University of California, San Francisco California, San Francisco, CA, USA Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - W McFarland
- Global Health Sciences, University of California, San Francisco California, San Francisco, CA, USA
| | - K Page
- Global Health Sciences, University of California, San Francisco California, San Francisco, CA, USA Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Martinez AN, Mobley LR, Lorvick J, Novak SP, Lopez A, Kral AH. Spatial analysis of HIV positive injection drug users in San Francisco, 1987 to 2005. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3937-55. [PMID: 24722543 PMCID: PMC4024992 DOI: 10.3390/ijerph110403937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/21/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022]
Abstract
Spatial analyses of HIV/AIDS related outcomes are growing in popularity as a tool to understand geographic changes in the epidemic and inform the effectiveness of community-based prevention and treatment programs. The Urban Health Study was a serial, cross-sectional epidemiological study of injection drug users (IDUs) in San Francisco between 1987 and 2005 (N = 29,914). HIV testing was conducted for every participant. Participant residence was geocoded to the level of the United States Census tract for every observation in dataset. Local indicator of spatial autocorrelation (LISA) tests were used to identify univariate and bivariate Census tract clusters of HIV positive IDUs in two time periods. We further compared three tract level characteristics (% poverty, % African Americans, and % unemployment) across areas of clustered and non-clustered tracts. We identified significant spatial clustering of high numbers of HIV positive IDUs in the early period (1987-1995) and late period (1996-2005). We found significant bivariate clusters of Census tracts where HIV positive IDUs and tract level poverty were above average compared to the surrounding areas. Our data suggest that poverty, rather than race, was an important neighborhood characteristic associated with the spatial distribution of HIV in SF and its spatial diffusion over time.
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Affiliation(s)
- Alexis N Martinez
- Department of Sociology and Sexuality Studies, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132, USA.
| | - Lee R Mobley
- GeoDa Center, School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ 85287, USA.
| | - Jennifer Lorvick
- Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA.
| | - Scott P Novak
- Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA.
| | - Andrea Lopez
- Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA.
| | - Alex H Kral
- Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA.
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Martinez AN, Lorvick J, Kral AH. Activity spaces among injection drug users in San Francisco. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:516-24. [PMID: 24374172 DOI: 10.1016/j.drugpo.2013.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Representations of activity spaces, defined as the local areas within which people move or travel in the course of their daily activities, are unexplored among injection drug users (IDUs). The purpose of this paper is to use an activity space framework to study place and drug user health. METHODS Data for this analysis is from an epidemiological study of street-recruited IDUs in San Francisco (N=1084). Study participants reported geographic intersections of where they most often slept at night, hung out during the day, and used drugs during a 6 month time period. We used GIS software to construct and map activity space routes of street-based network paths between these intersections. We further identified if syringe exchange program (SEP) locations intersected with, participant activity space routes. We used logistic regression to estimate associations between activity space variables and HIV serostatus, syringe sharing, and non-fatal overdose, after adjusting for individual and Census tract covariates. RESULTS Mean activity space distance for all participants was 1.5miles. 9.6% of participants had a SEP located along their activity space. An increase in activity space distance was associated with a decrease in odds of being HIV positive. An increase in residential transience, or the number of different locations slept in by participants in a 6 month time period, was associated with higher odds of syringe sharing. Activity space distance was not independently associated with overdose or syringe sharing. DISCUSSION Research that locates individuals in places of perceived importance is needed to inform placement and accessibility of HIV and overdose prevention programs. More attention needs to be given to the logistics of collecting sensitive geospatial data from vulnerable populations as well as how to maximize the use of GIS software for visualizing and understanding how IDUs interact with their environment.
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Affiliation(s)
- Alexis N Martinez
- Department of Sociology, San Francisco State University, United States.
| | - Jennifer Lorvick
- Urban Health Program, RTI International, San Francisco, CA, United States
| | - Alex H Kral
- Urban Health Program, RTI International, San Francisco, CA, United States
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