Health services usage by Alaskan injection drug users

Service use and barriers to care among heroin users: results from a national survey

BACKGROUND

Heroin use is associated with many serious consequences.While effective treatments exist, barriers to services persist. Understanding service use and barriers to treatment can structure treatment practice and target interventions for those who are most at risk.

OBJECTIVES

To describe patterns and correlates of substance abuse service utilization and treatment barriers among a nationally representative sample of heroin users.

METHODS

Data for this study were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. This study focused on lifetime heroin users (N = 150).

RESULTS

Fifty-nine percent of heroin users reported receiving at least one treatment service. The most common services used were 12-step programs, detoxification, and rehabilitation. Approximately 44% reported at least one barrier to treatment. The most common were lack of motivation and beliefs that it could be managed alone. In a multivariate logistic regression, having a heroin use disorder was associated with a greater likelihood of receiving services (OR = 6.09) and experiencing a barrier (OR = 11.11) compared to those without a disorder.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

High rates of service use and barriers were observed for all levels of heroin involvement. These findings underscore the importance of improving access to services for this group, even when full criteria for a drug disorder is not met. Integration of motivational approaches is also needed within the most common services used. To our knowledge, this is the first study to describe patterns and correlates of service use using a nationally representative community sample of heroin users.

Developing a culturally competent and socially relevant sexual health survey with an urban Arctic community

OBJECTIVES

To develop a culturally competent and socially relevant sexual health survey for people living in Nuuk, Greenland, aged 15 years and older.

STUDY DESIGN

Qualitative study with interviews.

METHODS

Community and research informants (n=10) were interviewed informally to identify survey topics. A sexual health survey was constructed combining local knowledge from informants with a review of sexual health literature for the Arctic and other Indigenous locations. The draft survey was distributed to community partners for commentary and revision. After translation into Danish and Greenlandic, cognitive interviews were conducted with 11 Nuuk residents, identified through snowball sampling, to both pilot test the survey and exchange social and cultural knowledge relevant to sexual health in Nuuk. The utility of this process was evaluated against implementation of the final survey to Nuuk residents enrolled in Inuulluataarneq (n=149).

RESULTS

Theme saturation was reached by the ninth interview. STI risk and self-efficacy, co-occurrence of alcohol use and sex and STI knowledge were identified as most relevant. Questions about community efficacy, culture/community involvement and identity were most sensitive. Upon implementation of the final survey, 146 of 149 participants answered all survey questions. Two Elder participants refused to answer questions about sex. Some questions had low response variability but still added to our contextual understanding and helped to build rapport with participants.

CONCLUSIONS

Combining an iterative process with community-based participatory research principles and cognitive interview techniques was an effective method for developing a sexual health survey with Nuuk residents.