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DiGuiseppi GT, Prindle J, Rice ER, Davis JP. Longitudinal Associations between Homelessness and Substance Use: Investigating Demographic Differences for Young Adults in Treatment. Subst Use Misuse 2023; 59:243-253. [PMID: 37897085 PMCID: PMC10872782 DOI: 10.1080/10826084.2023.2267124] [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] [Indexed: 10/29/2023]
Abstract
Objective: To examine prospective, bidirectional associations between homelessness and substance use frequency among young adults receiving substance use treatment in the United States. We also investigated potential differences across demographic subgroups. Methods: Young adults (N = 3717, Mage = 20.1, 28% female, 7.3% sexual/gender minority, and 37% non-Hispanic White) receiving substance use treatment in the U.S. completed assessments at intake, 3 months, 6 months, and 12 months post-intake. Latent growth curve models with structured residuals (LGC-SR) were used to examine cross-lagged associations between homeless days and frequency of substance use and associated problems. Models were stratified by sex, race/ethnicity, and sexual and/or gender minority status. Results: Overall, days spent homeless (μ slope = -0.19, p = 0.046) and substance use frequency (μ slope 1 = -6.19, p < 0.001) significantly decreased during treatment, with no significant cross-lagged associations between homeless days and substance use frequency. However, results differed by race and ethnicity. For non-Hispanic White young adults, greater substance use at treatment entry was associated with steeper declines in homeless days between-persons (ϕ standardized = -0.14, p = 0.04). For African Americans, homeless days at treatment entry were associated with greater increases in substance use between-persons (ϕ standardized = 0.29, p = 0.04). No significant differences were found by sex or sexual/gender minority status. Conclusions: Despite overall declines in homelessness and substance use during treatment, these outcomes may unfold differently for non-Hispanic White and African American young adults. More support may be needed for African American young adults reporting homelessness at treatment entry.
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Affiliation(s)
- Graham T. DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
| | - Eric R. Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
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Mericle AA, Patterson D, Subbaraman MS, Howell J, Sheridan D, Borkman T, Burton J, Karriker-Jaffe KJ. Mapping COVID vulnerability in relation to drug and alcohol recovery residence availability across the United States. BMC Public Health 2023; 23:2266. [PMID: 37974152 PMCID: PMC10655292 DOI: 10.1186/s12889-023-17048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023] Open
Abstract
Recovery housing is an important resource for those in recovery from substance use disorders. Unfortunately, we know little about its relationship to key community health risk and protective factors, potentially limiting the role it could play as a broader health resource. Leveraging county-level data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR), this study used multilevel modeling to examine Community COVID Vulnerability Index (CCVI) scores as well as availability of COVID testing and vaccination sites in relation to recovery housing. CCVI composite scores were positively associated with recovery housing availability. Analyses using CCVI thematic sub-scores found that population density and number of churches were positively associated with recovery housing availability, while epidemiological factors and healthcare system factors were negatively associated with recovery housing availability. In counties with recovery housing, there also was a positive association between CCVI and both COVID testing and vaccination availability. Recovery residences tend to be located in areas of high COVID vulnerability, reflecting effective targeting in areas with higher population density, more housing risk factors, and other high-risk environments and signaling a key point of contact to address broader health issues among those in recovery from substance use disorders.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA.
| | - Deidre Patterson
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA
| | | | | | - Dave Sheridan
- National Alliance for Recovery Residences, St. Paul, MN, USA
| | | | - Jayla Burton
- Alcohol Research Group at the Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA, 94608, USA
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Subbaraman MS, Mahoney E, Witbrodt J, Karriker-Jaffe KJ, Mericle AA, Polcin DL. Multilevel Effects of Environmental and Neighborhood Factors on Sober Living House Resident 12-Month Outcomes. J Stud Alcohol Drugs 2023; 84:832-841. [PMID: 37449949 PMCID: PMC10765980 DOI: 10.15288/jsad.22-00307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 04/07/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Sober living houses (SLHs) are abstinence-based environments designed for individuals in recovery to live with others in recovery. Research shows that SLHs help some individuals maintain recovery and that certain SLH-related factors may be particularly protective. Here we assess how SLH housing and neighborhood characteristics are related to abstinence and psychiatric symptoms over time. METHOD Baseline, 6-month, and 12-month data were collected from 557 SLH residents. Multilevel mixed models tested associations between house and neighborhood characteristics and individual-level percent days abstinent (PDA) and the number of psychiatric symptoms (measured with the Psychiatric Diagnostic Screening Questionnaire [PDSQ]) as outcomes. Final models adjusted for sex, age, and race/ethnicity; ratings of house characteristics; and objective measurements of neighborhood-level exposures. RESULTS Both PDA and PDSQ improved significantly (ps ≤ .05) over time in both unadjusted and adjusted models. More self-help groups and fewer alcohol outlets within one mile were significantly protective for PDA, whereas walkability was significantly related to worse PDA and PDSQ (ps ≤ .05). For house-level factors, better ratings of house maintenance were related to significantly fewer psychiatric symptoms, whereas higher scores on SLH's safety measures and personal or residence identity were related to more psychiatric symptoms (ps ≤ .05). No house-level factor was significantly related to PDA. CONCLUSIONS Neighborhood-level factors such as increased availability of self-help groups and fewer nearby alcohol outlets may increase abstinence among individuals living in SLHs. House-level factors related to better maintenance may also facilitate improved mental health.
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Affiliation(s)
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Jane Witbrodt
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
- Alcohol Research Group, Emeryville, California
| | - Katherine J. Karriker-Jaffe
- Center on Behavioral Health Epidemiology, Implementation & Evaluation Research, RTI International, Berkeley, California
| | - Amy A. Mericle
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
- Alcohol Research Group, Emeryville, California
| | - Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
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Deutsch AR, Chau E, Motabar N, Jalali MS. Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States. SYSTEM DYNAMICS REVIEW 2023; 39:207-238. [PMID: 38107548 PMCID: PMC10723070 DOI: 10.1002/sdr.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/05/2023] [Indexed: 12/19/2023]
Abstract
The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute, Avera Health, Sioux Falls, SD, USA
- Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA
| | | | - Nikki Motabar
- University of California Santa Barbara, Santa Barbara, CA, USA
| | - Mohammad S Jalali
- University of California Santa Barbara, Santa Barbara, CA, USA
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA
- Sloan School of Management, Massachusetts, Institute of Technology, Cambridge, MA, USA
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Frew PM, Schamel JT, Randall LA, King AR, Spaulding AC, Wu E, Holloway IW. Vaccine confidence among people who use drugs: A cross-sectional survey. Hum Vaccin Immunother 2022; 18:2123201. [PMID: 36170655 DOI: 10.1080/21645515.2022.2123201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adult immunization coverage remains low in the US, particularly for people who use drugs (PWUD), a population that experiences a disproportionate burden of vaccine-preventable diseases. The extent of and characteristics associated with vaccine confidence (VC) held by PWUD is poorly understood. As VC strongly correlates with vaccine uptake, this cross-sectional study identifies mutable factors associated with VC and quantifies its relationship to immunization status within a highly vulnerable, underimmunized population of PWUD. Using a community-engaged research strategy with select partner organizations hosting syringe exchange programs in Atlanta, Los Angeles, and Las Vegas, USA, we surveyed participants ages 18-69 years served by these organizations from 2019 to 2020. Survey measures included sociodemographics, health behavior including immunization receipt, and vaccine confidence in adult vaccinations using a modified Emory Vaccine Confidence Index (EVCI). The findings reflect relatively low VC among the 1,127 recruited participants, with 56% expressing low VC (EVCI 0-12), 35% medium (EVCI 13-20) and 10% high (EVCI 21-24). EVCI varied by city, with lowest confidence in Atlanta and highest in Las Vegas. VC was associated with past receipt of specific vaccines, including hepatitis A, MMR, Tdap, and influenza. VC varied by specific sociodemographic correlates such as housing insecurity (reduced confidence) and receipt of public benefits or disability (increased confidence). This study identified correlates associated with VC based on site and sociodemographic characteristics for this priority population, highlighting the need for specific interventions to raise VC among PWUD, especially among those experiencing housing insecurity and without public benefits.
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Affiliation(s)
- Paula M Frew
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Jay T Schamel
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Laura A Randall
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Adrian R King
- Schools of Public Health, Medicine, and Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.,Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Anne C Spaulding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Wu
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,Southern California HIV/AIDS Policy Research Center, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA.,UCLA Hub for Health Intervention, Policy, and Practice, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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Identifying the availability of recovery housing in the U.S.: The NSTARR project. Drug Alcohol Depend 2022; 230:109188. [PMID: 34871978 PMCID: PMC8714706 DOI: 10.1016/j.drugalcdep.2021.109188] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Home is essential to recovery, and recovery housing can play an important role for individuals seeking a supportive environment. The National Study of Treatment and Addiction Recovery Residences (NSTARR) Project constitutes the largest and most diverse study of recovery housing to date. We describe the development of a national sampling frame to study recovery housing, as well as findings on availability and distribution of recovery housing across the U.S. METHODS Data from publicly available sources and lists maintained by entities tracking recovery housing were compiled. Residences for which locating information was available were geocoded and linked with U.S. Census data and drug and alcohol mortality data. We used hot spot analysis and multilevel models to describe the geographic distribution of recovery residences and assess whether residences are located in areas of high need. RESULTS The NSTARR database contains information on 10,358 residences operated by 3628 providers in all 50 states. Residences were more likely (p < 0.05) to be in urban areas and in counties with higher substance use mortality; they were less likely to be in economically disadvantaged areas. Recovery housing density also was greater in urban areas and areas with a greater proportion of non-White residents, but lower in economically disadvantaged areas. CONCLUSIONS Despite a wealth of research on some types of recovery housing, critical gaps in the field's understanding about the nature of recovery housing remain. The NSTARR Project represents an important first step to expand research on recovery housing across the country.
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