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Worku F, Ugas M, Wheeler S, Siddiqi A, Papadakos J. A Cross-Sectional Study of COVID-19 Knowledge, Attitudes, and Practices Among Black Communities in the Greater Toronto Area. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02031-y. [PMID: 38902465 DOI: 10.1007/s40615-024-02031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/18/2024] [Accepted: 05/16/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION AND BACKGROUND COVID-19 preventative practices such as hand washing, social distancing, and mask wearing have been identified as ways to prevent the spread of COVID-19. However, social determinants can play a role in the ability of individuals and groups to adhere to recommended COVID-19 preventative practices. A cross-sectional study was undertaken to explore the COVID-19 knowledge, attitude, and practices (KAPs), and information sources used in the adult Black population within the Greater Toronto Area (GTA). METHODS An online questionnaire was completed by Black adults living in the GTA. Associations between KAPs, health literacy, and sociodemographic variables were assessed using descriptive tests. A multivariate logistic regression model was used to examine predictors of high preventative practices. RESULTS AND ANALYSIS Of the 169 respondents, most had high knowledge scores (80.5%), low attitudes (85.2%), and high COVID-19 preventative practices (82.2%). Hotspot status, working from home, and high health literacy were found to be independent predictors of high preventative practices. CONCLUSION AND IMPLICATIONS This study provides new knowledge that advances understanding of the COVID-19 KAPs of Black communities in a Canadian context. Our findings point to the inadequacy of current prevention strategies that focus narrowly on individual actions while overlooking the importance of systemic influences on health.
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Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mohamed Ugas
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Population Health and Value-Based Health Systems, Ontario Health, Toronto, ON, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Cancer Health Literacy Research Centre, Cancer Education, Princess Margaret Cancer Centre, 585 University Avenue, ELLICSR PMB B-130, Toronto, ON, M5G 2N2, Canada.
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada.
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Smith S, Beima-Sofie K, Naveed A, Bhatia N, Micheni M, Nguyen AT, Slaughter F, Wang L, Prabhu S, Wallace S, Simoni J, Graham SM. Impact of the COVID-19 Pandemic on Persons Living with HIV in Western Washington: Examining Lived Experiences of Social Distancing Stress, Personal Buffers, and Mental Health. AIDS Behav 2024; 28:1822-1833. [PMID: 38493281 PMCID: PMC11161538 DOI: 10.1007/s10461-024-04273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 03/18/2024]
Abstract
Pandemic-related stressors may disproportionately affect the mental health of people with HIV (PWH). Stratified, purposive sampling was used to recruit 24 PWH who participated in a quantitative survey on COVID-19 experiences for in-depth interviews (IDIs). IDIs were conducted by Zoom, audio recorded and transcribed. Thematic analysis was used to develop an adapted stress-coping model. Participants experienced acute stress following exposure events and symptoms compatible with COVID-19. Social isolation and job loss were longer-term stressors. While adaptive coping strategies helped promote mental health, participants who experienced multiple stressors simultaneously often felt overwhelmed and engaged in maladaptive coping behaviors. Healthcare providers were important sources of social support and provided continuity in care and referrals to mental health and social services. Understanding how PWH experienced stressors and coped during the COVID-19 pandemic can help healthcare providers connect with patients during future public health emergencies, address mental health needs and support adaptive coping strategies.
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Affiliation(s)
- Sarah Smith
- University of California, San Diego, CA, USA
| | | | | | | | | | | | | | | | - Sandeep Prabhu
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Stephaun Wallace
- University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Rivera BD, Friedman SR. What would it really take to solve the overdose epidemic in the United States? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104435. [PMID: 38729061 PMCID: PMC11220856 DOI: 10.1016/j.drugpo.2024.104435] [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: 01/27/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
The high overdose mortality rates in the United States poses several questions: Why have they been increasing exponentially since 1979? Why are they so high? And how can they be greatly reduced? Building on past research, the causes of the increase seem to be deeply rooted in US social and economic structures and processes, rather than due only to opioid prescription patterns or the advent of synthetic opioids. Given this, we consider what changes might be needed to reverse the exponentially-increasing overdose mortality. We use a path dependency argument to argue that the United States political, economic, and public health systems have helped create this crisis and, unfortunately, continue to heighten it. These same systems suggest that proposals to expand harm reduction and drug treatment capacity, to decriminalize or legalize drugs, or to re-industrialize the country sufficiently to reduce "communities of despair" will not be enacted at a scale sufficient to end the overdose crisis. We thus suggest that in the United States serious improvements in overdose rates and related policies and structures require massive social movements with a broad social change agenda.
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Affiliation(s)
- Bianca D Rivera
- SUNY Downstate Health Sciences University School of Public Health, Brooklyn, NY, USA
| | - Samuel R Friedman
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, USA.
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Seo B, Rioux W, Rider N, Teare A, Jones S, Taplay P, Ghosh SM. Bridging the Gap in Harm Reduction Using Mobile Overdose Response Services (MORS) in the Context of the COVID-19 Pandemic: A Qualitative Study. J Urban Health 2024; 101:252-261. [PMID: 38514599 PMCID: PMC11052954 DOI: 10.1007/s11524-024-00846-y] [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] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
The COVID-19 pandemic introduced additional health challenges for people who use substances (PWUS) amid the overdose crisis. Numerous harm reduction services, including supervised consumption sites (SCS) across Canada, faced shutdowns and reduced operating capacity in order to comply with public health measures. Mobile Overdose Response Services (MORS) are novel overdose prevention technologies that allow those who are unable to access alternative means of harm reduction to consume substances under the virtual supervision of a trained operator. Here, we examine the role of MORS in the context of the COVID-19 pandemic. A total of 59 semi-structured interviews were conducted with the following key interest groups: PWUS, healthcare providers, harm reduction workers, MORS operators, and the general public. Inductive thematic analysis informed by grounded theory was used to identify major themes pertaining to the perception of MORS. As the pandemic shifted the public focus away from harm reduction, many participants viewed MORS as an acceptable strategy to reduce the harms associated with solitary substance and alleviate the sense of isolation driven by social distancing measures. While the pandemic may have increased the utility of MORS, concerns surrounding personal privacy and confidentiality remained. Overall, MORS were perceived as a useful adjunct service to address the unmet needs PWUS during the pandemic and beyond.
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Affiliation(s)
- Boogyung Seo
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Nathan Rider
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adrian Teare
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Clingan SE, Cousins SJ, Lin C, Nguyen TE, Hser YI, Mooney LJ. Perceptions of COVID-19 risk during the pandemic: perspectives from people seeking medication for opioid use disorder. Ann Med 2023; 55:480-489. [PMID: 36692029 PMCID: PMC9879168 DOI: 10.1080/07853890.2023.2169342] [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: 07/09/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The Coronavirus Disease 2019 (COVID-19) pandemic has had devastating consequences for persons with opioid use disorder (OUD). Yet, little is known about how people seeking treatment for OUD perceive the risks of COVID-19 and how their perception interplays with their health behaviours. METHODS In-depth interviews were conducted from September 2021 to March 2022 with 32 patients seeking medication treatment for OUD (MOUD) in Southern California. All interviews were conducted virtually and lasted between one and two hours. Interviews were recorded and transcribed verbatim. Two qualitative researchers independently conducted a content analysis of the transcripts to identify themes. RESULTS Three primary themes were identified: (1) perceptions and beliefs about COVID-19 susceptibility and severity; (2) perceptions of COVID-19 risk compared to substance use behaviours; and (3) vaccine hesitancy. Participants were mixed in their beliefs of susceptibility to contracting COVID-19 and the severity of the disease if contracted. Some participants reported taking precautions to mitigate their chances of acquiring COVID-19, and other participants reported that COVID was not a big concern as substance use took priority. For many of the participants, COVID-19 concerns were overshadowed by the risk of overdosing on substances and other risky substance use behaviour. Most of the participants (n = 23; 72%) had received at least one COVID-19 vaccine by the time of the interview, but over half (n = 19; 59%) expressed vaccine hesitancy. Vaccine hesitancy was driven by concerns about the unknown long-term side effects and potential interactions of the vaccine with MOUD. CONCLUSIONS Our study provides insight into COVID-19 prevention measures as well as vaccination perceptions and hesitancy among people who received treatment for OUD.Key messagesParticipants expressed diverse perceptions of the seriousness of COVID-19, with some taking precautions to mitigate their chances of acquiring COVID-19 and others perceiving that the risk of contracting COVID-19 was less than the risk of overdosing.Substance use, social isolation, vaccine hesitancy and COVID-19 risk behaviours should be studied as co-occurring phenomena that have potentially overlapping relationships that can influence behaviours that impact health and well-being.
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Affiliation(s)
- Sarah E. Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sarah J. Cousins
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tram E. Nguyen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Community Health Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Larissa J. Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Edelman EJ, Rojas-Perez OF, Nich C, Corvino J, Frankforter T, Gordon D, Jordan A, Paris M, Weimer MB, Yates BT, Williams EC, Kiluk BD. Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population. Addict Sci Clin Pract 2023; 18:55. [PMID: 37726823 PMCID: PMC10510167 DOI: 10.1186/s13722-023-00407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach. METHODS We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost-benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use. CONCLUSIONS Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05338151.
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Affiliation(s)
- E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA.
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
- Department of Social and Behavioral Sciences, Yale School of Medicine, New Haven, CT, USA.
| | | | - Charla Nich
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Joanne Corvino
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Tami Frankforter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Derrick Gordon
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- The Consultation Center, New Haven, CT, USA
| | - Ayana Jordan
- Department of Psychiatry, NYU Langone Health, New York, NY, USA
| | - Manuel Paris
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Hispanic Clinic, Connecticut Mental Health Center, New Haven, CT, USA
| | - Melissa B Weimer
- Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, ES Harkness Memorial Hall, Suite 401, New Haven, CT, 06510, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Brian T Yates
- Department of Psychology, American University, Washington, DC, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Health Services Research and Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration (VA), Seattle, WA, USA
| | - Brian D Kiluk
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Harris RA, Long JA, Bao Y, Mandell DS. Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses. JAMA HEALTH FORUM 2023; 4:e231235. [PMID: 37294585 PMCID: PMC10257097 DOI: 10.1001/jamahealthforum.2023.1235] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
Importance In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. Objective To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Design, Setting, and Participants Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. Exposure On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Main Outcome Measures Monthly methadone-involved overdose deaths. Results From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). Conclusions and Relevance In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.
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Affiliation(s)
- Rebecca Arden Harris
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Corporal Michael J. Crescenz VA Medical Center, VA Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - David S. Mandell
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Frueh L, Collins AB, Newman R, Barnett NP, Rich JD, Clark MA, Marshall BDL, Macmadu A. Multi-level influences on increased overdose risk behaviors during the COVID-19 pandemic among people who use drugs in Rhode Island: a qualitative investigation. Harm Reduct J 2023; 20:14. [PMID: 36739417 PMCID: PMC9898862 DOI: 10.1186/s12954-023-00741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ongoing COVID-19 pandemic has disproportionately affected structurally vulnerable populations including people who use drugs (PWUD). Increased overdose risk behaviors among PWUD during the pandemic have been documented, with research underscoring the role of influencing factors such as isolation and job loss in these behaviors. Here, we use qualitative methods to examine the impact of the COVID-19 pandemic and pandemic-related response measures on drug use behaviors in a sample of PWUD in Rhode Island. Using a social-ecological framework, we highlight the nested, interactive levels of the pandemic's influence on increased overdose risk behaviors. METHODS From July to October 2021, semi-structured interviews were conducted with 18 PWUD who self-reported any increase in behaviors associated with overdose risk (e.g., increased use, change in drug type and/or more solitary drug use) relative to before the pandemic. Thematic analysis was conducted using a codebook with salient themes identified from interview guides and those that emerged through close reading of transcribed interviews. Guided by a social-ecological framework, themes were grouped into individual, network, institutional, and policy-level influences of the pandemic on drug use behaviors. RESULTS Individual-level influences on increased overdose risk behaviors included self-reported anxiety and depression, isolation and loneliness, and boredom. Network-level influences included changes in local drug supply and changes in social network composition specific to housing. At the institutional level, drug use patterns were influenced by reduced access to harm reduction or treatment services. At the policy level, increased overdose risk behaviors were related to financial changes, job loss, and business closures. All participants identified factors influencing overdose risk behaviors that corresponded to several nested social-ecological levels. CONCLUSIONS Participants identified multi-level influences of the COVID-19 pandemic and pandemic-related response measures on their drug use behavior patterns and overdose risk. These findings suggest that effective harm reduction during large-scale crises, such as the COVID-19 pandemic, must address several levels of influence concurrently.
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Affiliation(s)
- Lisa Frueh
- grid.166341.70000 0001 2181 3113Department of Environmental and Occupational Health, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA 19104 USA
| | - Alexandra B. Collins
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Roxxanne Newman
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Nancy P. Barnett
- grid.40263.330000 0004 1936 9094Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Josiah D. Rich
- grid.240267.50000 0004 0443 5079The Center for Health + Justice Transformation, The Miriam Hospital, 1125 North Main Street, Providence, RI USA
| | - Melissa A. Clark
- grid.40263.330000 0004 1936 9094Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI USA
| | - Brandon D. L. Marshall
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA
| | - Alexandria Macmadu
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI, 02912, USA.
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Factors Associated with COVID-19-Related Stress among Female Primary Caregivers in Vulnerable Families in South Africa. Eur J Investig Health Psychol Educ 2023; 13:377-390. [PMID: 36826212 PMCID: PMC9955265 DOI: 10.3390/ejihpe13020028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Inequality in South Africa is deeply rooted, and COVID-19 glaringly brought inequalities between families to the forefront. This study aimed to investigate factors associated with the above average stress levels of female primary caregivers in vulnerable families during the COVID-19 pandemic. A cross-sectional survey was undertaken among vulnerable families from October 2021 to February 2022. Above average scores were reported by approximately half of the respondents regarding stress from children/partners and stress related to financial issues. Fear of COVID-19, feeling depressed, COVID-19's impact on daily life, lower education levels, being in a relationship and living together, and perceiving an increase in domestic violence were statistically significantly associated with above average stress from children/partners. Age, impact of COVID-19 on daily life, being in a relationship and living with a husband/partner, and running out of food during the past 30 days were statistically significantly associated with above average stress concerning finances. These results provide new insights that can assist policy makers and practitioners in supporting low-income families during times of crisis. Support should not just focus on practical aspects, such as the provision of food, but equally importantly, on emotional support and protection for female primary caregivers and their families. Future research should delve more deeply into causes of COVID-19-related stress in vulnerable families.
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Carlisle VR, Maynard OM, Bagnall D, Hickman M, Shorrock J, Thomas K, Kesten J. Should I Stay or Should I Go? A Qualitative Exploration of Stigma and Other Factors Influencing Opioid Agonist Treatment Journeys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1526. [PMID: 36674280 PMCID: PMC9865602 DOI: 10.3390/ijerph20021526] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/15/2023]
Abstract
(1) The harm-reduction benefits of opioid agonist treatment (OAT) are well-established; however, the UK government's emphasis on "recovery" may be contributing to a high proportion of people leaving treatment and low retention rates. We wanted to develop a rich and nuanced understanding of the factors that might influence the treatment journeys of people who use OAT. (2) We explored factors at each level of the socioecological system and considered the ways these interact to influence treatment journeys in OAT. We carried out semi-structured interviews with people who use OAT (n = 12) and service providers (n = 13) and analysed data using reflexive thematic analysis. (3) We developed three themes representing participant perceptions of treatment journeys in OAT. These were: (1) The System is Broken; (2) Power Struggles; and (3) Filling the Void. (4) Conclusions: The data suggest that prioritisation of treatment retention is important to preserve the harm-reduction benefits of OAT. Stigma is a systemic issue which presents multiple barriers to people who use OAT living fulfilling lives. There is an urgent need to develop targeted interventions to address stigma towards people who use OAT.
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Affiliation(s)
- Victoria Rice Carlisle
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK
| | - Olivia M. Maynard
- School of Psychological Sciences, University of Bristol, Bristol BS8 1TU, UK
| | - Darren Bagnall
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Jon Shorrock
- Avon & Wiltshire NHS Mental Health Trust, Specialist Drug and Alcohol Services, Colston Fort, Montague Place, Bristol BS6 5UB, UK
| | - Kyla Thomas
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
| | - Joanna Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- The National Institute for Health and Care Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1TL, UK
- The National Institute for Health and Care Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol, Bristol BS8 1TL, UK
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Fernandez JR, Sherchan JS, Cho YJ, Nanaw J, Joseph NT, Forde AT. College students' underlying perceptions of COVID-19 threat, healthcare discrimination, and healthcare system inequities associated with self-rated health across racial/ethnic groups in the U.S. Front Public Health 2023; 10:1028344. [PMID: 36684993 PMCID: PMC9853174 DOI: 10.3389/fpubh.2022.1028344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background COVID-19-related health perceptions may differentially impact college students' stress, and in turn, their mental and physical health. This study examined racial/ethnic differences in college students' underlying perceptions of COVID-19 threat, healthcare discrimination, and U.S. healthcare system inequities and their associations with self-rated mental and physical health. Methods Four-hundred-thirty-two university students completed an online survey (December 2020-December 2021). Latent class analyses identified classes of perceived COVID-19 threat (i.e., severity, susceptibility), healthcare discrimination, and U.S. healthcare system inequities. Regression analyses examined whether class membership varied by race/ethnicity and was associated with self-rated mental and physical health. Results Class 1 members (27.3% of the sample) were more likely to identify as Hispanic or Latino, Non-Hispanic Asian, Non-Hispanic Black or African American, and Non-Hispanic Multiracial vs. Non-Hispanic White (vs. Class 4). Class 1 had high perceived COVID-19 threat, medium perceived healthcare discrimination, and high perceived U.S. healthcare system inequities, as well as higher odds of poorer mental and physical health (vs. Class 4). Conclusions College students' underlying perceptions of COVID-19 threat, healthcare discrimination, and U.S. healthcare system inequities were associated with poorer health. Given that students with these perceptions were more likely to belong to minoritized racial/ethnic groups, concerns over COVID-19 risk and healthcare may partially explain racial/ethnic disparities in college students' health. This study contributes to a limited body of evidence on college students' perceptions of the U.S. healthcare system and suggests important ways that structural inequalities and racial/ethnic disparities in COVID-19 risk, healthcare discrimination, and concerns over U.S. healthcare system inequity may affect college students' health.
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Affiliation(s)
- Jessica R. Fernandez
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Juliana S. Sherchan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Yong Ju Cho
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Judy Nanaw
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
| | - Nataria T. Joseph
- Division of Social Science, Seaver College, Pepperdine University, Malibu, CA, United States
| | - Allana T. Forde
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
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12
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Saunders EC, Satcher MF, Monico LB, McDonald RD, Springer SA, Farabee D, Gryczynski J, Nyaku A, Reeves D, Kunkel LE, Schultheis AM, Schwartz RP, Lee JD, Marsch LA, Waddell EN. The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study. HEALTH & JUSTICE 2022; 10:35. [PMID: 36529829 PMCID: PMC9760540 DOI: 10.1186/s40352-022-00199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January-March 2020) and post- (April-September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January-March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April-September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April-September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.
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Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA.
| | - Milan F Satcher
- Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Ryan D McDonald
- New York University Grossman School of Medicine, New York, NY, USA
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - David Farabee
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Amesika Nyaku
- Division of Infectious Diseases, Rutgers New Jersey Medical School, New Brunswick, NJ, USA
| | - Donald Reeves
- Rutgers University Correctional Health Care, Rutgers-Robert Wood Johnson Medical School, Trenton, NJ, USA
| | - Lynn E Kunkel
- Oregon Health and Science University -Portland State University School of Public Health and Addiction Medicine Section, Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Alysse M Schultheis
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | | | - Joshua D Lee
- New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 315, Lebanon, NH, 03766, USA
| | - Elizabeth Needham Waddell
- Oregon Health and Science University -Portland State University School of Public Health and Addiction Medicine Section, Division of General Internal Medicine & Geriatrics, Oregon Health and Science University, Portland, OR, USA
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13
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Krawczyk N, Rivera BD, Basaraba C, Corbeil T, Allen B, Schultebraucks K, Henry BF, Pincus HA, Levin FR, Martinez D. COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems. Addiction 2022; 118:857-869. [PMID: 36459420 PMCID: PMC9878119 DOI: 10.1111/add.16105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND AIMS Individuals with opioid use disorder (OUD) suffer disproportionately from COVID-19. To inform clinical management of OUD patients, research is needed to identify characteristics associated with COVID-19 progression and death among this population. We aimed to investigate the role of OUD and specific comorbidities on COVID-19 progression among hospitalized OUD patients. DESIGN Retrospective cohort study of merged electronic health records (EHR) from five large private health systems. SETTING New York City, New York, USA, 2011-21. PARTICIPANTS Adults with a COVID-19 encounter and OUD or opioid overdose diagnosis between March 2020 and February 2021. MEASUREMENTS Primary exposure included diagnosis of OUD/opioid overdose. Risk factors included age, sex, race/ethnicity and common medical, substance use and psychiatric comorbidities known to be associated with COVID-19 severity. Outcomes included COVID-19 hospitalization and subsequent intubation, acute kidney failure, severe sepsis and death. FINDINGS Of 110 917 COVID-19+ adults, 1.17% were ever diagnosed with OUD/opioid overdose. OUD patients had higher risk of COVID-19 hospitalization [adjusted risk ratio (aRR) = 1.40, 95% confidence interval (CI) = 1.33, 1.47], intubation [adjusted odds ratio (aOR) = 2.05, 95% CI = 1.74, 2.42], kidney failure (aRR = 1.51, 95% CI = 1.34, 1.70), sepsis (aRR = 2.30, 95% CI = 1.88, 2.81) and death (aRR = 2.10, 95% CI = 1.84, 2.40). Among hospitalized OUD patients, risks for worse COVID-19 outcomes included being male; older; of a race/ethnicity other than white, black or Hispanic; and having comorbid chronic kidney disease, diabetes, obesity or cancer. Protective factors included having asthma, hepatitis-C and chronic pain. CONCLUSIONS Opioid use disorder patients appear to have a substantial risk for COVID-19-associated morbidity and mortality, with particular comorbidities and treatments moderating this risk.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Bianca D Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Cale Basaraba
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Thomas Corbeil
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Brandy F Henry
- College of Education, The Pennsylvania State University, University Park, PA, USA
| | - Harold A Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Frances R Levin
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Diana Martinez
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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14
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Bradley H, Austin C, Allen ST, Asher A, Bartholomew TS, Board A, Borquez A, Buchacz K, Carter A, Cooper HLF, Feinberg J, Furukawa N, Genberg B, Gorbach PM, Hagan H, Huriaux E, Hurley H, Luisi N, Martin NK, Rosenberg ES, Strathdee SA, Jarlais DCD. A stakeholder-driven framework for measuring potential change in the health risks of people who inject drugs (PWID) during the COVID-19 pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103889. [PMID: 36343431 PMCID: PMC9574463 DOI: 10.1016/j.drugpo.2022.103889] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND People who inject drugs (PWID) have likely borne disproportionate health consequences of the COVID-19 pandemic. PWID experienced both interruptions and changes to drug supply and delivery modes of harm reduction, treatment, and other medical services, leading to potentially increased risks for HIV, hepatitis C virus (HCV), and overdose. Given surveillance and research disruptions, proximal, indirect indicators of infectious diseases and overdose should be developed for timely measurement of health effects of the pandemic on PWID. METHODS We used group concept mapping and a systems thinking approach to produce an expert stakeholder-generated, multi-level framework for monitoring changes in PWID health outcomes potentially attributable to COVID-19 in the U.S. This socio-ecological measurement framework elucidates proximal and distal contributors to infectious disease and overdose outcomes, many of which can be measured using existing data sources. RESULTS The framework includes multi-level components including policy considerations, drug supply/distribution systems, the service delivery landscape, network factors, and individual characteristics such as mental and general health status and service utilization. These components are generally mediated by substance use and sexual behavioral factors to cause changes in incidence of HIV, HCV, sexually transmitted infections, wound/skin infections, and overdose. CONCLUSION This measurement framework is intended to increase the quality and timeliness of research on the impacts of COVID-19 in the context of the current pandemic and future crises. Next steps include a ranking process to narrow the drivers of change in health risks to a concise set of indicators that adequately represent framework components, can be written as measurable indicators, and are quantifiable using existing data sources, as well as a publicly available web-based platform for summary data contributions.
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Affiliation(s)
- Heather Bradley
- Georgia State University School of Public Health, 140 Decatur Street SE, Atlanta, GA, 30303, USA.
| | - Chelsea Austin
- Georgia State University School of Public Health, 140 Decatur Street SE, Atlanta, GA, 30303, USA
| | - Sean T Allen
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Alice Asher
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Tyler S Bartholomew
- University of Miami Miller School of Medicine, 1600 NW 10(th) Avenue, #1140, Miami, FL, 33136, USA
| | - Amy Board
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Annick Borquez
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kate Buchacz
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Anastasia Carter
- Georgia State University School of Public Health, 140 Decatur Street SE, Atlanta, GA, 30303, USA
| | - Hannah L F Cooper
- Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Judith Feinberg
- West Virginia University Health Sciences, 1 Medical Center Drive, #1000, Morgantown, WV, 26506, USA
| | - Nathan Furukawa
- Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, USA
| | - Becky Genberg
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Pamina M Gorbach
- University of California Los Angeles, Fielding School of Public Health
| | - Holly Hagan
- NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Emalie Huriaux
- Washington State Department of Health, 101 Israel Road SE, Tumwater, WA, 98501, USA
| | | | - Nicole Luisi
- Emory University Rollins School of Public Health, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Natasha K Martin
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Eli S Rosenberg
- University at Albany School of Public Health, SUNY, 1 University Place, Rensselaer, NY, 12144, USA; Office of Public Health, New York State Department of Public Health, Corning Tower, State Street, Albany, NY, 12203, USA
| | - Steffanie A Strathdee
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Don C Des Jarlais
- NYU School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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15
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Lin L(A, Zhang L, Kim HM, Frost MC. Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder. Am J Psychiatry 2022; 179:740-747. [PMID: 35899380 PMCID: PMC9529783 DOI: 10.1176/appi.ajp.21111141] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the impact of COVID-19-related policies reducing barriers to telehealth delivery of buprenorphine treatment for opioid use disorder (OUD) on buprenorphine treatment across different modalities (telephone, video, and in-person visits). METHODS This was a national retrospective cohort study with interrupted time-series analyses to examine the impact of policy changes in March 2020 on buprenorphine treatment for OUD in the Veterans Health Administration, during the year before the start of the COVID-19 pandemic (March 2019 to February 2020) and during the first year of the pandemic (March 2020 to February 2021). The authors also examined trends in the use of telephone, video, and in-person visits for buprenorphine treatment and compared patient demographic characteristics and retention in buprenorphine treatment across the two periods. RESULTS The number of patients receiving buprenorphine increased from 13,415 in March 2019 to 15,339 in February 2021. By February 2021, telephone visits were used by the most patients (50.2%; 4,456 visits), followed by video visits (32.4%; 2,870 visits) and in-person visits (17.4%; 1,544 visits). During the pre-pandemic period, the number of patients receiving buprenorphine increased significantly by 103 patients per month. After the COVID-19 policy changes, there was an immediate increase of 265 patients in the first month, and the number continued to increase significantly, at a rate of 47 patients per month. The demographic characteristics of patients receiving buprenorphine during the pandemic period were similar to those during the pre-pandemic period, but the proportion of patients reaching 90-day retention on buprenorphine treatment decreased significantly from 49.6% to 47.7%, while days on buprenorphine increased significantly from 203.8 to 208.7. CONCLUSIONS The number of patients receiving buprenorphine continued to increase after the COVID-19 policy changes, but the delivery of care shifted to telehealth visits, suggesting that any reversal of COVID-19 policies must be carefully considered.
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Affiliation(s)
- Lewei (Allison) Lin
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI
- University of Michigan Injury Prevention Center, Ann Arbor, MI
| | - Lan Zhang
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI
- Consulting for Statistics, Computing & Analytics Research (CSCAR), University of Michigan, Ann Arbor, MI
| | - Madeline C. Frost
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
- Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
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16
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Wu C. Racial concentration and dynamics of COVID-19 vaccination in the United States. SSM Popul Health 2022; 19:101198. [PMID: 35996681 PMCID: PMC9387067 DOI: 10.1016/j.ssmph.2022.101198] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/12/2022] [Accepted: 08/03/2022] [Indexed: 11/19/2022] Open
Abstract
This article considers how county-level concentrations of Asians, Blacks, Hispanics, and Whites are associated with COVID-19 vaccination differently. I argue that racially specific mechanisms-differential concentrations of social vulnerability and political ideology by race-are likely to create diverse associations between racial concentration and COVID-19 vaccination not only across racial groups but also within racial groups over time from early rollout to the time after COVID-19 vaccines became widely available. I test this argument by drawing on data from multiple sources that include county-level information on COVID-19 vaccination rates, racial population make-ups, and measures of political ideology and community vulnerability. Results show that the association between racial concentration and COVID-19 vaccination changes substantially across and within racial groups over time. Counties with higher percent of Asians and percent of Whites have higher vaccination rates at earlier time intervals whereas counties with higher percent of Latinos and percent of Blacks show lower vaccination rates. This trend flips at later dates for percent of Blacks, percent of Latinos, and percent of Whites. Results from multilevel regression models and mediation analysis controlling for vaccine hesitancy show that social vulnerability and political ideology are the underlying factors and their differential associations with diverse racial concentrations help create the racially specific and time-varying patterns. Racial concentration and COVID-19 vaccination are associated differently across race groups. Racial concentration and COVID-19 vaccination are associated differently within race groups over time . Social vulnerability and political dynamics are the underlying factors for the racially specific and time varying patterns.
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Affiliation(s)
- Cary Wu
- Department of Sociology, York University, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
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17
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Kelly EL, Reed MK, Schoenauer KM, Smith K, Scalia-Jackson K, Kay Hill S, Li E, Weinstein L. A Qualitative Exploration of the Functional, Social, and Emotional Impacts of the COVID-19 Pandemic on People Who Use Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9751. [PMID: 35955107 PMCID: PMC9367729 DOI: 10.3390/ijerph19159751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
Since 2020, people who use drugs (PWUD) experienced heightened risks related to drug supply disruptions, contamination, overdose, social isolation, and increased stress. This study explored how the lives of PWUD changed in Philadelphia over a one-year period. Using semi-structured interviews with 20 participants in a Housing First, low-barrier medication for opioid use (MOUD) program in Philadelphia, the effects of the first year of the COVID-19 pandemic on the daily lives, resources, functioning, substance use, and treatment of PWUD were explored. Interviews were analyzed using a combination of directed and conventional content analysis. Six overarching themes emerged during data analysis: (1) response to the pandemic; (2) access to MOUD and support services; (3) substance use; (4) impacts on mental health, physical health, and daily functioning; (5) social network impacts; and (6) fulfillment of basic needs. Participants reported disruptions in every domain of life, challenges meeting their basic needs, and elevated risk for adverse events. MOUD service providers offset some risks and provided material supports, treatment, social interaction, and emotional support. These results highlight how there were significant disruptions to the lives of PWUD during the first year of the COVID-19 pandemic and identified critical areas for future intervention and policies.
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Affiliation(s)
- Erin L. Kelly
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Center for Social Medicine and Humanities, Department of Psychiatry, Semel Institute, University of California, Los Angeles, CA 90024, USA
| | - Megan K. Reed
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Kathryn M. Schoenauer
- Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kelsey Smith
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | - Sequoia Kay Hill
- Project HOME Health Services, Pathways to Housing PA, Philadelphia, PA 19141, USA
| | - Erica Li
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Lara Weinstein
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
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18
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Kahn LS, Wozniak ML, Doscher T, Moore C, Vest BM. Treatment Experiences Among People Who Use Opioids: A Social Ecological Approach. QUALITATIVE HEALTH RESEARCH 2022; 32:1386-1398. [PMID: 35645402 DOI: 10.1177/10497323221104315] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The prevalence of opioid use disorder (OUD) and surge in overdose deaths remain key public health concerns. Despite evidence supporting the efficaciousness of medications for opioid use disorder, most people with OUD do not receive treatment. In this qualitative study, semi-structured interviews were conducted with 35 adults in a northeastern city to learn about their experiences with substance use treatment. Qualitative data were analyzed using an inductive thematic content analysis approach, and a social ecological model was applied to examine contextual factors affecting participants' experiences accessing and engaging in treatment. While we organized our findings following the individual, interpersonal, community, and society levels of the socio-ecological model, we also observed overlap and interconnectedness between and across these levels. Our findings suggest that retention in treatment often depends upon personal motivation, treatment availability, the match of the treatment modality to an individual's needs, and social support. A person-centered approach is needed to promote individualized care and tailor treatment components to the patient's needs.
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Affiliation(s)
- Linda S Kahn
- Department of Family Medicine, Primary Care Research Institute, 12291University at Buffalo, Buffalo, NY, USA
| | - Monika L Wozniak
- Department of Family Medicine, Primary Care Research Institute, 12291University at Buffalo, Buffalo, NY, USA
| | - Tildabeth Doscher
- Department of Family Medicine, Primary Care Research Institute, 12291University at Buffalo, Buffalo, NY, USA
| | - Cheryll Moore
- 160089Erie County Department of Health, Buffalo, NY, USA
| | - Bonnie M Vest
- Department of Family Medicine, Primary Care Research Institute, 12291University at Buffalo, Buffalo, NY, USA
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19
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Schaffler Y, Kuska M, Barke A, Doering BK, Gossmann K, Meier Z, Kascakova N, Tavel P, Humer E, Pieh C, Stippl P, Schimböck W, Haid B, Probst T. Psychotherapists' Reports regarding the Impact of the COVID-19 Pandemic on Their Patients: A Cross-National Descriptive Study Based on the Social-Ecological Model (SEM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6825. [PMID: 35682406 PMCID: PMC9180390 DOI: 10.3390/ijerph19116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 outbreak has raised questions about how vulnerable groups experience the pandemic. Research that focuses on the view of individuals with pre-existing mental health conditions is still limited, and so are cross-country comparative surveys. We gathered our sample of qualitative data during the first lockdown after governmental measures against the spread of the SARS-CoV-2 virus came into force in Austria, Czechia, Germany, and Slovakia. A total of n = 1690 psychotherapists from four middle European countries answered the question of how the COVID-19 pandemic was addressed in sessions by their patients during the early stage of unprecedented public health conditions. We employed a descriptive qualitative methodology to determine themes following levels of the social-ecological model (SEM) regarding how the COVID-19 pandemic affected patients. At the public policy level, stressful environmental conditions concerned the governmental mitigation efforts. At the level of community/society, reported key themes were employment, restricted access to educational and health facilities, socioeconomic consequences, and the pandemic itself. Key themes at the interpersonal level regarded forced proximity, the possibility of infection of loved ones, childcare, and homeschooling. Key themes at the individual level were the possibility of contracting COVID-19, having to stay at home/isolation, and a changing environment. Within the SEM framework, adaptive and maladaptive responses to these stressors were reported, with more similarities than differences between the countries. A quantification of word stems showed that the maladaptive reactions predominated.
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Affiliation(s)
- Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, Danube University Krems, 3500 Krems, Austria; (M.K.); (E.H.); (C.P.); (T.P.)
| | - Martin Kuska
- Department for Psychosomatic Medicine and Psychotherapy, Danube University Krems, 3500 Krems, Austria; (M.K.); (E.H.); (C.P.); (T.P.)
- College of Applied Psychology, 41155 Terezin, Czech Republic
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, 85072 Eichstätt, Germany; (A.B.); (K.G.)
| | - Bettina K. Doering
- Clinical Psychology and Psychotherapy, Brandenburg Medical School Theodor Fontane, 16861 Neuruppin, Germany;
| | - Katharina Gossmann
- Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, 85072 Eichstätt, Germany; (A.B.); (K.G.)
| | - Zdenek Meier
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
| | - Natalia Kascakova
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
- Psychiatric-Psychotherapeutic Outpatient Clinic, Pro Mente Sana, 81108 Bratislava, Slovakia
| | - Peter Tavel
- Olomouc University Social Health Institute (OUSHI), Palacky University Olomouc, 77111 Olomouc, Czech Republic; (Z.M.); (N.K.); (P.T.)
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, Danube University Krems, 3500 Krems, Austria; (M.K.); (E.H.); (C.P.); (T.P.)
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, Danube University Krems, 3500 Krems, Austria; (M.K.); (E.H.); (C.P.); (T.P.)
| | - Peter Stippl
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria; (P.S.); (W.S.); (B.H.)
| | - Wolfgang Schimböck
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria; (P.S.); (W.S.); (B.H.)
| | - Barbara Haid
- Austrian Federal Association for Psychotherapy, 1030 Vienna, Austria; (P.S.); (W.S.); (B.H.)
| | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, Danube University Krems, 3500 Krems, Austria; (M.K.); (E.H.); (C.P.); (T.P.)
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20
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Brothers TD, Leaman M, Bonn M, Lewer D, Atkinson J, Fraser J, Gillis A, Gniewek M, Hawker L, Hayman H, Jorna P, Martell D, O'Donnell T, Rivers-Bowerman H, Genge L. Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness. Drug Alcohol Depend 2022; 235:109440. [PMID: 35461084 PMCID: PMC8988445 DOI: 10.1016/j.drugalcdep.2022.109440] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND During a COVID-19 outbreak in the congregate shelter system in Halifax, Nova Scotia, Canada, a healthcare team provided an emergency "safe supply" of medications and alcohol to facilitate isolation in COVID-19 hotel shelters for residents who use drugs and/or alcohol. We aimed to evaluate (a) substances and dosages provided, and (b) outcomes of the program. METHODS We reviewed medical records of all COVID-19 isolation hotel shelter residents during May 2021. The primary outcome was successful completion of 14 days isolation, as directed by public health orders. Adverse events included (a) overdose; (b) intoxication; and (c) diversion, selling, or sharing of medications or alcohol. RESULTS Seventy-seven isolation hotel residents were assessed (mean age 42 ± 14 years; 24% women). Sixty-two (81%) residents were provided medications, alcohol, or cigarettes. Seventeen residents (22%) received opioid agonist treatment (methadone, buprenorphine, or slow-release oral morphine) and 27 (35%) received hydromorphone. Thirty-one (40%) residents received prescriptions stimulants. Six (8%) residents received benzodiazepines and forty-two (55%) received alcohol. Over 14 days, mean daily dosages increased of hydromorphone (45 ± 32 - 57 ± 42 mg), methylphenidate (51 ± 28 - 77 ± 37 mg), and alcohol (12.3 ± 7.6 - 13.0 ± 6.9 standard drinks). Six residents (8%) left isolation prematurely, but four returned. During 1059 person-days, there were zero overdoses. Documented concerns regarding intoxication occurred six times (0.005 events/person-day) and medication diversion/sharing three times (0.003 events/person-day). CONCLUSIONS COVID-19 isolation hotel residents participating in an emergency safe supply and managed alcohol program experienced high rates of successful completion of 14 days isolation and low rates of adverse events.
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Affiliation(s)
- Thomas D Brothers
- Department of Medicine (General Internal Medicine & Clinician-Investigator Program), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, UK.
| | - Malcolm Leaman
- North End Community Health Centre, Halifax, Nova Scotia, Canada
| | - Matthew Bonn
- Canadian Association of People who Use Drugs, Dartmouth, Nova Scotia, Canada
| | - Dan Lewer
- UCL Collaborative Centre for Inclusion Health, Institute of Epidemiology & Health Care, University College London, London, UK
| | | | - John Fraser
- North End Community Health Centre, Halifax, Nova Scotia, Canada; Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Anesthesia, Pain Management & Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amy Gillis
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Gniewek
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
| | - Leisha Hawker
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
| | - Heather Hayman
- North End Community Health Centre, Halifax, Nova Scotia, Canada
| | | | - David Martell
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
| | | | | | - Leah Genge
- North End Community Health Centre, Halifax, Nova Scotia, Canada; Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Direction 180, Halifax, Nova Scotia, Canada
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21
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Walters SM, Bolinski RS, Almirol E, Grundy S, Fletcher S, Schneider J, Friedman SR, Ouellet LJ, Ompad DC, Jenkins W, Pho MT. Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis. Addict Sci Clin Pract 2022; 17:24. [PMID: 35468860 PMCID: PMC9037978 DOI: 10.1186/s13722-022-00303-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. METHODS The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. RESULTS Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. CONCLUSION The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.
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Affiliation(s)
- Suzan M Walters
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA.
- Center for Drug Use and HIV/HCV Research, New York, NY, USA.
| | - Rebecca S Bolinski
- Department of Sociology, Southern Illinois University, Carbondale, IL, USA
| | - Ellen Almirol
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Stacy Grundy
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | | | - John Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Samuel R Friedman
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Lawrence J Ouellet
- Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
| | - Danielle C Ompad
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, USA
- Center for Drug Use and HIV/HCV Research, New York, NY, USA
| | - Wiley Jenkins
- Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, USA
| | - Mai T Pho
- Department of Medicine, University of Chicago, Chicago, IL, USA
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22
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Technology-Based Mental Health Interventions for Domestic Violence Victims Amid COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074286. [PMID: 35409967 PMCID: PMC8998837 DOI: 10.3390/ijerph19074286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/11/2022]
Abstract
Introduction: Domestic violence is a threat to human dignity and public health. Mounting evidence shows that domestic violence erodes personal and public health, spawning issues such as lifelong mental health challenges. To further compound the situation, COVID-19 and societies’ poor response to the pandemic have not only worsened the domestic violence crisis but also disrupted mental health services for domestic violence victims. While technology-based health solutions can overcome physical constraints posed by the pandemic and offer timely support to address domestic violence victims’ mental health issues, there is a dearth of research in the literature. To bridge the research gap, in this study, we aim to examine technology-based mental health solutions for domestic violence victims amid COVID-19. Methods: A literature review was conducted to examine solutions that domestic violence victims can utilize to safeguard and improve their mental health amid COVID-19. Databases including PubMed, PsycINFO, and Scopus were utilized for the literature search. The search was focused on four themes: domestic violence, mental health, technology-based interventions, and COVID-19. A reverse search of pertinent references was conducted in Google Scholar. The social ecological model was utilized to systematically structure the review findings. Results: The findings show that a wide array of technology-based solutions has been proposed to address mental health challenges faced by domestic violence victims amid COVID-19. However, none of these proposals is based on empirical evidence amid COVID-19. In terms of social and ecological levels of influence, most of the interventions were developed on the individual level, as opposed to the community level or social level, effectively placing the healthcare responsibility on the victims rather than government and health officials. Furthermore, most of the articles failed to address risks associated with utilizing technology-based interventions (e.g., privacy issues) or navigating the online environment (e.g., cyberstalking). Conclusion: Overall, our findings highlight the need for greater research endeavors on the research topic. Although technology-based interventions have great potential in resolving domestic violence victims’ mental health issues, risks associated with these health solutions should be comprehensively acknowledged and addressed.
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23
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Saxon AJ, Edelman EJ. Introduction to the Special Series: National Drug Abuse Treatment Clinical Trials Network and the Opioid Use Disorder Care Continuum-20 years of research informing practice. Addict Sci Clin Pract 2022; 17:7. [PMID: 35109940 PMCID: PMC8809224 DOI: 10.1186/s13722-022-00291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, 1660 S. Columbian Wy., Seattle, WA, 98108, USA.
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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24
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Sullivan MC, Mistler C, Copenhaver MM, Wickersham JA, Ni Z, Kim RS, Shrestha R. Race, trust, and COVID-19 vaccine hesitancy in people with opioid use disorder. Health Psychol 2022; 41:115-120. [PMID: 34855415 PMCID: PMC9754617 DOI: 10.1037/hea0001120] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Vaccination against coronavirus disease 2019 (COVID-19) is a promising avenue for arresting the COVID-19 pandemic, yet suboptimal rates of vaccine uptake in at-risk groups may hinder efficacy and worsen existing health disparities. People with opioid use disorder (OUD) are likely to face increased vulnerability to COVID-19 due to a confluence of biological and social risk factors. We sought to assess factors associated with willingness to vaccinate against COVID-19 in people with OUD. METHOD Phone surveys were conducted from May to October 2020 with participants enrolled in an urban methadone maintenance program (MMP). Participants were adults who met DSM-5 criteria for OUD and reported injection drug use or sexual risk behavior. Participants were asked about their willingness to receive a highly or partially effective vaccine. Provider trust was assessed using the Trust in Physician scale. Multinomial regression was used to assess demographic and psychosocial factors related to vaccination willingness. RESULTS We surveyed 109 people with OUD enrolled in a MMP (M = 47 years; 56% women; 59% White, 23% Black/African American, 14.4% Hispanic/Latinx; 1.8% other). Participants who identified as Black or African American were significantly less likely to endorse willingness to use a partially effective COVID-19 vaccine (adjusted odds ratio [aOR] = .10; 95% confidence interval (CI) [.02, .61], p = .012), although not necessarily less willing to receive a highly effective vaccine (aOR = .40; 95% CI [.09, 1.73], p = .219; n.s.). Trust in physician was positively associated with willingness to use a partially effective vaccine (aOR = 1.12; 95% CI [1.02, 1.23], p = .017), but was not significantly associated with willingness to receive a highly effective vaccine (aOR = 1.07; 95% CI [.98, 1.16], p = .162, n.s) Conclusions: Proactive outreach from trustworthy sources will be needed to counter vaccine hesitancy in people with OUD, especially among Black Americans with OUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Matthew C Sullivan
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
| | - Colleen Mistler
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
| | - Michael M Copenhaver
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine
| | - Zhao Ni
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine
| | - Rayne S Kim
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine
| | - Roman Shrestha
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut
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25
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Krawczyk N, Fawole A, Yang J, Tofighi B. Early innovations in opioid use disorder treatment and harm reduction during the COVID-19 pandemic: a scoping review. Addict Sci Clin Pract 2021; 16:68. [PMID: 34774106 PMCID: PMC8590133 DOI: 10.1186/s13722-021-00275-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exerted a significant toll on the lives of people who use opioids (PWUOs). At the same time, more flexible regulations around provision of opioid use disorder (OUD) services have led to new opportunities for facilitating access to services for PWUOs. In the current scoping review, we describe new services and service modifications implemented by treatment and harm reduction programs serving PWUO, and discuss implications for policy and practice. METHODS Literature searches were conducted within PubMed, LitCovid, Embase, and PsycInfo for English-language studies published in 2020 that describe a particular program, service, or intervention aimed at facilitating access to OUD treatment and/or harm reduction services during the COVID-19 pandemic. Abstracts were independently screened by two reviewers. Relevant studies were reviewed in full and those that met inclusion criteria underwent final data extraction and synthesis (n = 25). We used a narrative synthesis approach to identify major themes around key service modifications and innovations implemented across programs serving PWUO. RESULTS Reviewed OUD treatment and harm reduction services spanned five continents and a range of settings from substance use treatment to street outreach programs. Innovative service modifications to adapt to COVID-19 circumstances primarily involved expanded use of telehealth services (e.g., telemedicine visits for buprenorphine, virtual individual or group therapy sessions, provision of donated or publicly available phones), increased take-home medication allowances for methadone and buprenorphine, expanded uptake of long-acting opioid medications (e.g. extended-release buprenorphine and naltrexone), home delivery of services (e.g. MOUD, naloxone and urine drug screening), outreach and makeshift services for delivering MOUD and naloxone, and provision of a safe supply of opioids. CONCLUSIONS The COVID-19 pandemic has posed multiple challenges for PWUOs, while simultaneously accelerating innovations in policies, care models, and technologies to lower thresholds for life-saving treatment and harm reduction services. Such innovations highlight novel patient-centered and feasible approaches to mitigating OUD related harms. Further studies are needed to assess the long-term impact of these approaches and inform policies that improve access to care for PWUOs.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, Room 4-12, New York, NY, USA.
| | - Adetayo Fawole
- New York University, School of Global Public Health, New York, NY, USA
| | - Jenny Yang
- NYU Grossman School of Medicine, New York, NY, USA
| | - Babak Tofighi
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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26
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Mohammad I, Berri D, Tutag Lehr V. Pharmacists and opioid use disorder care during COVID-19: Call for action. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021; 5:203-213. [PMID: 34909605 PMCID: PMC8661525 DOI: 10.1002/jac5.1556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Opioid use disorder (OUD) is a chronic relapsing condition characterized by problematic opioid use causing significant impairment in daily life. Medication for opioid use disorder using buprenorphine, methadone, and naltrexone with behavioral therapy reduces illicit opioid use and risk of overdose death. Despite evidence and decades of experience, barriers limit access to treatment and care for individuals with OUD. Barriers include a lack of treatment centers particularly in rural areas, regulations on buprenorphine prescribing, and stigma from the community and health care professionals. While many barriers are longstanding, the coronavirus disease 2019 (COVID‐19) pandemic‐forced isolation and associated stress has exacerbated challenges for individuals with mental health conditions such as OUD. Pharmacists are well‐positioned to bridge existing gaps in OUD care, particularly during the COVID‐19 pandemic. Roles for pharmacists include OUD risk identification and screening, referral of patients to treatment and support programs, ensuring medication access, expanding naloxone access, and advocacy initiatives. This review article identifies barriers to care for patients with OUD during the COVID‐19 pandemic and explores opportunities and resources for pharmacists to improve OUD care during the pandemic and beyond.
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Affiliation(s)
- Insaf Mohammad
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA.,Ambulatory Care Clinical Pharmacy Beaumont Hospital, Dearborn Dearborn Michigan USA
| | - Dena Berri
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA
| | - Victoria Tutag Lehr
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA
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27
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Alexander K, Pogorzelska-Maziarz M, Gerolamo A, Hassen N, Kelly EL, Rising KL. The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:60. [PMID: 34372900 PMCID: PMC8352141 DOI: 10.1186/s13011-021-00395-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 02/02/2023]
Abstract
Research objective The COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature. Methods This scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature. Results Of the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased. Conclusions In summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.
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Affiliation(s)
- Karen Alexander
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA.
| | - Monika Pogorzelska-Maziarz
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA
| | - Angela Gerolamo
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA
| | - Nadia Hassen
- Jefferson College of Nursing, Thomas Jefferson University, 901 Walnut St., Suite 800, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 40, Philadelphia, PA, 19107, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 1020 Sansom Street, Suite 239, Philadelphia, PA, 19107, USA
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28
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Friedman SR, Mateu-Gelabert P, Nikolopoulos GK, Cerdá M, Rossi D, Jordan AE, Townsend T, Khan MR, Perlman DC. Big Events theory and measures may help explain emerging long-term effects of current crises. Glob Public Health 2021; 16:1167-1186. [PMID: 33843462 PMCID: PMC8338763 DOI: 10.1080/17441692.2021.1903528] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/25/2021] [Indexed: 12/17/2022]
Abstract
Big Events are periods during which abnormal large-scale events like war, economic collapse, revolts, or pandemics disrupt daily life and expectations about the future. They can lead to rapid change in health-related norms, beliefs, social networks and behavioural practices. The world is undergoing such Big Events through the interaction of COVID-19, a large economic downturn, massive social unrest in many countries, and ever-worsening effects of global climate change. Previous research, mainly on HIV/AIDS, suggests that the health effects of Big Events can be profound, but are contingent: Sometimes Big Events led to enormous outbreaks of HIV and associated diseases and conditions such as injection drug use, sex trading, and tuberculosis, but in other circumstances, Big Events did not do so. This paper discusses and presents hypotheses about pathways through which the current Big Events might lead to better or worse short and long term outcomes for various health conditions and diseases; considers how pre-existing societal conditions and changing 'pathway' variables can influence the impact of Big Events; discusses how to measure these pathways; and suggests ways in which research and surveillance might be conducted to improve human capacity to prevent or mitigate the effects of Big Events on human health.
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Affiliation(s)
| | - Pedro Mateu-Gelabert
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | | | - Diana Rossi
- Intercambios Civil Association and University of Buenos Aires, Buenos Aires, Argentina
| | - Ashly E Jordan
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | - Maria R Khan
- NYU Grossman School of Medicine, New York, NY, USA
| | - David C Perlman
- Mount Sinai Beth Israel and Center for Drug Use and HIV Research, New York, NY, USA
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29
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Luigi M, Luo M, Maes EJP. Buprenorphine Opioid Treatment During the COVID-19 Pandemic. JAMA Intern Med 2021; 181:1135. [PMID: 33843962 DOI: 10.1001/jamainternmed.2021.0777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mimosa Luigi
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Michael Luo
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Etienne J P Maes
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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30
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Stormshak EA, Matulis JM, Nash W, Cheng Y. The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories. Front Psychol 2021; 12:695967. [PMID: 34305753 PMCID: PMC8294463 DOI: 10.3389/fpsyg.2021.695967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.
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Affiliation(s)
- Elizabeth A Stormshak
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Jordan M Matulis
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Whitney Nash
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
| | - Yijun Cheng
- Prevention Science Institute, University of Oregon, Eugene, OR, United States.,Department of Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
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Response to Routsolias and Mycyk Letter. J Emerg Nurs 2021; 47:527-529. [PMID: 33962800 DOI: 10.1016/j.jen.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/15/2022]
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