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Davis A, Knudsen HK, Walker DM, Chassler D, Lunze K, Westgate PM, Oga E, Rodriguez S, Tan S, Holloway J, Walsh SL, Oser CB, Lefebvre RC, Fanucchi LC, Glasgow L, McAlearney AS, Surratt HL, Konstan MW, Huang TTK, LeBaron P, Nakayima J, Stein MD, Rudorf M, Nouvong M, Kinnard EN, El-Bassel N, Tilley J, Macoubray A, Savitzky C, Farmer A, Beers D, Salsberry P, Huerta TR. Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial. LANCET REGIONAL HEALTH. AMERICAS 2024; 32:100710. [PMID: 38510790 PMCID: PMC10950860 DOI: 10.1016/j.lana.2024.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Background Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). Methods We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). Findings Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18). Interpretation The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. Funding US National Institute on Drug Abuse.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Hannah K. Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Daniel M. Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA
| | - Deborah Chassler
- Boston University School of Social Work, 264-270 Bay State Road, Boston, MA, 02215, USA
| | - Karsten Lunze
- Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Department of Medicine, 801 Massachusetts Ave., Boston, MA, 02118, USA
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Emmanuel Oga
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sandra Rodriguez
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Sylvia Tan
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - JaNae Holloway
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Sharon L. Walsh
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Carrie B. Oser
- Department of Sociology, Center on Drug and Alcohol Research, Center for Health Equity Transformation, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA
| | - R. Craig Lefebvre
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Laura C. Fanucchi
- Department of Medicine, Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Lexington, KY, 40508, USA
| | - LaShawn Glasgow
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA
| | - Hilary L. Surratt
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Michael W. Konstan
- Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Terry T.-K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, Graduate School of Public Health & Health Policy, City University of New York, 55 W. 125 Street, Room 803, New York, NY, 10027, USA
| | - Patricia LeBaron
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Julie Nakayima
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY, 40508, USA
| | - Michael D. Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Maria Rudorf
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Monica Nouvong
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Elizabeth N. Kinnard
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Jess Tilley
- New England Drug Users Union, 36 Bedford Terrace, Suite 2, Northampton, MA, 01060, USA
| | - Aaron Macoubray
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Caroline Savitzky
- Boston Medical Center, Section of Infectious Diseases, 801 Massachusetts Ave., Boston, MA, 02118, USA
| | - Amy Farmer
- The Ohio State University College of Medicine, HEALing Communities Research, 530 W. Spring St., Suite 275, Columbus, OH, 43215, USA
| | - Donna Beers
- Boston Medical Center, Section of General Internal Medicine, 801 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Pamela Salsberry
- The Ohio State University College of Public Health, 1841 Neil Ave., Columbus, OH, 43210, USA
| | - Timothy R. Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 4000, Columbus, OH, 43202, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, 700 Ackerman Rd., Suite 5000, Columbus, OH, 43202, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH, 43210, USA
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Glick JL, Grieb SM, Harris SJ, Weir BW, Smith KC, Puryear T, Hamilton White R, Allen ST. Exploring the impact of the COVID-19 pandemic on syringe services programs in rural Kentucky. Harm Reduct J 2022; 19:47. [PMID: 35590373 PMCID: PMC9117854 DOI: 10.1186/s12954-022-00631-7] [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: 02/24/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The coronavirus pandemic (COVID-19) exacerbated risks for adverse health consequences among people who inject drugs by reducing access to sterile injection equipment, HIV testing, and syringe services programs (SSPs). Several decades of research demonstrate the public health benefits of SSP implementation; however, existing evidence primarily reflects studies conducted in metropolitan areas and before the COVID-19 pandemic. OBJECTIVES We aim to explore how the COVID-19 pandemic affected SSP operations in rural Kentucky counties. METHODS In late 2020, we conducted eighteen in-depth, semi-structured interviews with persons (10 women, 8 men) involved in SSP implementation in rural Kentucky counties. The interview guide broadly explored the barriers and facilitators to SSP implementation in rural communities; participants were also asked to describe how COVID-19 affected SSP operations. RESULTS Participants emphasized the need to continue providing SSP-related services throughout the pandemic. COVID-19 mitigation strategies (e.g., masking, social distancing, pre-packing sterile injection equipment) limited relationship building between staff and clients and, more broadly, the pandemic adversely affected overall program expansion, momentum building, and coalition building. However, participants offered multiple examples of innovative solutions to the myriad of obstacles the pandemic presented. CONCLUSION The COVID-19 pandemic impacted SSP operations throughout rural Kentucky. Despite challenges, participants reported that providing SSP services remained paramount. Diverse adaptative strategies were employed to ensure continuation of essential SSP services, demonstrating the commitment and ingenuity of program staff. Given that SSPs are essential for preventing adverse injection drug use-associated health consequences, further resources should be invested in SSP operations to ensure service delivery is not negatively affected by co-occurring crises.
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Affiliation(s)
- Jennifer L. Glick
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Suzanne M. Grieb
- grid.21107.350000 0001 2171 9311Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224 USA
| | - Samantha J. Harris
- grid.21107.350000 0001 2171 9311Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Brian W. Weir
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Katherine C. Smith
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Tyler Puryear
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Rebecca Hamilton White
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Sean T. Allen
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205 USA
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Parker MA, Zoh RS, Nelson EJ, Owora AH. Correlates of disparities in syringe return ratios: A cross-sectional study of a syringe services program in New York. J Subst Abuse Treat 2020; 121:108193. [PMID: 33357603 DOI: 10.1016/j.jsat.2020.108193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/07/2020] [Accepted: 11/01/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Predictors of syringe exchange behavior are critical to informing secondary prevention measures needed to attenuate risk of blood-borne infections among persons who inject drugs (PWID). METHODS Participants included PWIDs who attended a syringe services program in New York from 2015 to 2017 (n = 1777). We analyzed the syringe return ratio (receipts/returns) with two distinct but related methodological strategies-threshold logistic regression and quantile regression-to identify correlates of disparities in syringe return ratios. RESULTS The majority of participants were white males negative for HIV (90% white, 63% male, 76% HIV-). Logistic and quantile regression models showed that the correlates of disparate syringe return ratios (i.e., magnitude and directionality of differences) changed across different percentile groups and quantile levels, respectively. At the median threshold, being single, urbanicity, and older age were associated with higher return ratios. Syringe return ratio disparities were more pronounced among subgroups of nontypical PWIDs (with extremely low or high return ratios) especially by urbanicity, race, relationship status, and type of housing. CONCLUSIONS Irrespective of urbanicity classification, correlates of syringe return ratios such as older age, Black race, single relationship status, and unstable housing appear to be critical to informing targeted secondary prevention initiatives that promote harm reduction behavior.
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Affiliation(s)
- Maria A Parker
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Roger S Zoh
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Erik J Nelson
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Arthur H Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, United States.
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Thomas N, van de Ven K, Mulrooney KJD. The impact of rurality on opioid-related harms: A systematic review of qualitative research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 85:102607. [PMID: 31864787 DOI: 10.1016/j.drugpo.2019.11.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/02/2019] [Accepted: 11/10/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Over the past decade, there has been mounting recognition that opioid use and related mortality and morbidity is a significant public health problem in rural, non-urban areas across the globe. Taking what has been termed the 'opioid crisis' as a starting off point, this article aims to systematically review the qualitative literature on the ways in which rurality shapes the risk for opioid-related harm. METHODS A systematic review was undertaken using database searches and secondary reference list searches for qualitative literature on rural and non-urban opioid-related harms. A total of 32 qualitative studies met the inclusion criteria. Data extraction was performed in NVivo 12 using a codebook based on the 'risk environment' framework. RESULTS The findings explore how rurality shapes the risk environment for opioid-related harms through four environment influences: (1) economic conditions, including economic transition and deindustrialisation that has occurred in many rural areas, and the high levels of economic distress experienced by rural residents; (2) physical conditions, including a lack of infrastructure and recreation opportunities, larger geographic distances, and limited transportation; (3) social conditions, where social networks could be both protective but also amplify risk through a lack of knowledge about treatment and risk behaviours, a lack of anonymity and stigmatisation of people who use opioids in rural areas; and (4) policy conditions including limited coverage and availability of harm reduction and drug treatment services, and stigmatising service provider practices. CONCLUSIONS The impact of rurality on risk of opioid-related harm is multifaceted. We suggest that future research on rural opioid use would benefit from drawing on the theoretical toolkit of rural criminology to attend to the ways the 'rural crisis', and attendant insecurities, anxieties and strains, impacts upon rural communities and shapes risk, along with how socio-cultural characteristics of the rural 'organise' risks of drug use.
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Affiliation(s)
- Natalie Thomas
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia.
| | - Katinka van de Ven
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; Drug Policy Modelling Program, Social Policy Research Centre, UNSW, Sydney, NSW, Australia
| | - Kyle J D Mulrooney
- Centre for Rural Criminology, University of New England, Armidale, New South Wales, Australia; School of Humanities, Arts, and Social Sciences, University of New England, Armidale, New South Wales, Australia
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