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Sauer J, Stewart K. Geographic information science and the United States opioid overdose crisis: A scoping review of methods, scales, and application areas. Soc Sci Med 2023; 317:115525. [PMID: 36493502 DOI: 10.1016/j.socscimed.2022.115525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/23/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Opioid Overdose Crisis (OOC) continues to generate morbidity and mortality in the United States, outpacing other prominent accident-related reasons. Multiple disciplines have applied geographic information science (GIScience) to understand geographical patterns in opioid-related health measures. However, there are limited reviews that assess how GIScience has been used. OBJECTIVES This scoping review investigates how GIScience has been used to conduct research on the OOC. Specific sub-objectives involve identifying bibliometric trends, the location and scale of studies, the frequency of use of various GIScience methodologies, and what direction future research can take to address existing gaps. METHODS The review was pre-registered with the Open Science Framework ((https://osf.io/h3mfx/) and followed the PRISMA-ScR guidelines. Scholarly research was gathered from the Web of Science Core Collection, PubMed, IEEE Xplore, ACM Digital Library. Inclusion criteria was defined as having a publication date between January 1999 and August 2021, using GIScience as a central part of the research, and investigating an opioid-related health measure. RESULTS 231 studies met the inclusion criteria. Most studies were published from 2017 onward. While many (41.6%) of studies were conducted using nationwide data, the majority (58.4%) occurred at the sub-national level. California, New York, Ohio, and Appalachia were most frequently studied, while the Midwest, north Rocky Mountains, Alaska, and Hawaii lacked studies. The most common GIScience methodology used was descriptive mapping, and county-level data was the most common unit of analysis across methodologies. CONCLUSIONS Future research of GIScience on the OOC can address gaps by developing use cases for machine learning, conducting analyses at the sub-county level, and applying GIScience to questions involving illicit fentanyl. Research using GIScience is expected to continue to increase, and multidisciplinary research efforts amongst GIScientists, epidemiologists, and other medical professionals can improve the rigor of research.
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Affiliation(s)
- Jeffery Sauer
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
| | - Kathleen Stewart
- Department of Geographical Sciences, University of Maryland at College Park, 4600 River Road, Suite 300, Riverdale, MD, 20737, USA.
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Ballard AM, Cooper HLF, Young AM, Caruso BA. 'You feel how you look': Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use. PLOS WATER 2022; 1:e0000019. [PMID: 38742171 PMCID: PMC11090493 DOI: 10.1371/journal.pwat.0000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Existing literature attests to water, sanitation, and hygiene (WASH) inequities among people experiencing homelessness (PEH) in the United States, but there is a dearth of research on such issues in rural areas. Homelessness is an emerging public health concern in rural areas where homelessness is on the rise, infectious disease outbreaks are becoming increasingly common, and PEH face unique WASH-related challenges compared to their urban counterparts. We conducted an exploratory study to understand the impacts of unmet WASH needs among rural PEH and their intersection with drug use through in-depth interviews (n = 10). Eligible participants were 18 years or older, lived in one of five Central Appalachian counties, and had experienced homelessness in the previous six months. Using thematic analysis, we identified factors that inhibit WASH access, and adverse health and well-being outcomes that result from unmet WASH needs. We also explore how WASH experiences compare among rural PEH who self-reported drug use to those who did not. Our findings revealed that factors at multiple levels inhibited WASH access, including stigma and place-based characteristics, which contributed to the adverse physical, mental, and emotional health of PEH. Comparisons between PEH who used drugs to those that did not revealed the intricate relationship between WASH, homelessness, and substance use in communities impacted by the opioid epidemic. Expanded WASH facilities that are safe and available with no prerequisites can address inadequate access among rural PEH and collaboration with harm reduction services may be advantageous to reach those who inject drugs.
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Affiliation(s)
- April M. Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, United States of America
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Bethany A. Caruso
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
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Rudolph AE. Integrating a web-based survey application into Qualtrics to collect risk location data for HIV prevention research. AIDS Care 2022; 34:397-403. [PMID: 34839777 PMCID: PMC9016781 DOI: 10.1080/09540121.2021.2008860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aspects of the physical and social environment play an important role in shaping HIV-related risk/prevention behaviors and access to prevention and treatment services. Here, we describe the feasibility of integrating a web-based survey application to collect risk locations into Qualtrics and compare this approach with a JavaScript-based alternative. Between 2017 and 2018, we enrolled 29 persons living with HIV in Boston Massachusetts to complete an interviewer-administered questionnaire using Qualtrics. Surveys collected demographics; sex/drug use risk behaviors; locations where participants met sex partners, had condomless sex, attended group sex events, and shared a syringe or injection equipment with someone else (up to 10 locations each); and the locations where participants (a) had sex with each sex partner (past 6 months) and (b) used drugs with each drug use partner (past 6 months). Location data were collected using embedded links to an encrypted web-based survey application. Overall, participants provided valid coordinates 93% of the time; when an exact location was not provided, a neighborhood was provided instead, resulting in little missing data. Our findings suggest that this web-based data collection tool (alone or with embedded links in Qualtrics) is a feasible and secure option for collecting risk location data.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, USA
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Ballard AM, Haardöerfer R, Prood N, Mbagwu C, Cooper HLF, Young AM. Willingness to Participate in At-Home HIV Testing Among Young Adults Who Use Opioids in Rural Appalachia. AIDS Behav 2021; 25:699-708. [PMID: 32910353 PMCID: PMC7481760 DOI: 10.1007/s10461-020-03034-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
New HIV infections associated with injection drug use are of major concern in rural US communities. This study explores acceptability of, consent for, and uptake of free at-home HIV testing among people who use drugs (PWUD) in one of the nation’s epicenters for drug-related harms and HIV vulnerability: Rural Central Appalachia. Eligible participants were 18–35 years old, lived in Appalachian Kentucky, and reported using opioids to get high in the previous 30 days. A majority reported being likely (63.6%, 96/151) to take a free at-home HIV tests and 66.9% (101/151) consented to receive one. Among those who were randomly selected to receive a Home Access HIV-1 test kit (n = 37), 37.8% mailed in blood spots and 21.6% called to receive results. This study provides evidence that PWUD may be willing to take an at-home test, but other barriers may inhibit actual completion.
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Affiliation(s)
- April M Ballard
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30329, USA.
| | - Regine Haardöerfer
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nadya Prood
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Chukwudi Mbagwu
- Department of Preventive Medicine and Environmental Health, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Young AM, Ballard AM, Cooper HLF. Novel Recruitment Methods for Research Among Young Adults in Rural Areas Who Use Opioids: Cookouts, Coupons, and Community-Based Staff. Public Health Rep 2020; 135:746-755. [PMID: 32933438 DOI: 10.1177/0033354920954796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Rural communities in the United States are increasingly becoming epicenters of substance use and related harms. However, best practices for recruiting rural people who use drugs (PWUD) for epidemiologic research are unknown, because such strategies were developed in cities. This study explores the feasibility of web- and community-based strategies to recruit rural, young adult PWUD into epidemiologic research. MATERIALS AND METHODS We recruited PWUD from rural Kentucky to participate in a web-based survey about opioid use using web-based peer referral and community-based strategies, including cookouts, flyers, street outreach, and invitations to PWUD enrolled in a concurrent substance use study. Staff members labeled recruitment materials with unique codes to enable tracking. We assessed eligibility and fraud through online eligibility screening and a fraud detection algorithm, respectively. Eligibility criteria included being aged 18-35, recently using opioids to get high, and residing in the study area. RESULTS Recruitment yielded 410 complete screening entries, of which 234 were eligible and 151 provided complete, nonfraudulent surveys (ie, surveys that passed a fraud-detection algorithm designed to identify duplicate, nonlocal, and/or bot-generated entries). Cookouts and subsequent web-based peer referrals accounted for the highest proportion of screening entries (37.1%, n = 152), but only 29.6% (n = 45) of entries from cookouts and subsequent web-based peer referrals resulted in eligible, nonfraudulent surveys. Recruitment and subsequent web-based peer referral from the concurrent study yielded the second most screening entries (27.8%, n = 114), 77.2% (n = 88) of which resulted in valid surveys. Other recruitment strategies combined to yield 35.1% (n = 144) of screening entries and 11.9% (n = 18) of valid surveys. CONCLUSIONS Web-based methods need to be complemented by context-tailored, street-outreach activities to recruit rural PWUD.
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Affiliation(s)
- April M Young
- 4530 Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.,Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - April M Ballard
- 4530 Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA.,1371 Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Hannah L F Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Fadanelli M, Cloud DH, Ibragimov U, Ballard AM, Prood N, Young AM, Cooper HLF. People, places, and stigma: A qualitative study exploring the overdose risk environment in rural Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 85:102588. [PMID: 31753603 DOI: 10.1016/j.drugpo.2019.11.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/20/2019] [Accepted: 11/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Though overdose rates have been increasing in US rural areas for two decades, little is known about the rural risk environment for overdoses. This qualitative study explored the risk environment for overdoses among young adults in Eastern Kentucky, a rural epicenter of the US opioid epidemic. METHODS Participants were recruited via community-based outreach. Eligibility criteria included living in one of five rural Eastern Kentucky counties; being aged 18-35; and using opioids to get high in the past 30 days. Semi-structured interviews explored the rural risk environment, and strategies to prevent overdose and dying from an overdose. Interviews were transcribed verbatim and analyzed using constructivist grounded-theory methods. RESULTS In this sample (N = 19), participants reported using in a range of locations, including homes and outdoor settings; concerns about community stigma and law enforcement shaped the settings where participants used opioids and the strategies they deployed in these settings to prevent an overdose, and to survive an overdose. Almost half of participants reported using opioids in a "trap house" or other dealing locations, often to evade police after buying drugs, and reported that others present pressed them to use more than usual. If an overdose occurred in this setting, however, these same people might refuse to call EMS to protect themselves from arrest. Outdoor settings presented particular vulnerabilities to overdose and dying from an overdose. Most participants reported using opioids outdoors, where they skipped overdose prevention steps to reduce their risk of arrest; they worried that no one would find them if they overdosed, and that cell phone coverage would be too weak to summon EMS. CONCLUSION Findings suggest that initiatives to reduce overdoses in Eastern Kentucky would be strengthened by de-escalating the War on Drugs and engaging law enforcement in initiatives to protect the health of people who use opioids.
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Affiliation(s)
- Monica Fadanelli
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA.
| | - David H Cloud
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Umedjon Ibragimov
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - April M Ballard
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - Nadya Prood
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
| | - April M Young
- College of Public Health, University of Kentucky, 111 Washington Ave, Lexington, KY 40536, USA; Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Lexington, KY 40508, USA
| | - Hannah L F Cooper
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, USA
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Ballard AM, Cooper HL, Young AM. Web-Based Eligibility Quizzes to Verify Opioid Use and County Residence Among Rural Young Adults: Eligibility Screening Results from a Feasibility Study. JMIR Res Protoc 2019; 8:e12984. [PMID: 31215520 PMCID: PMC6604504 DOI: 10.2196/12984] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/15/2019] [Accepted: 05/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Web-based methods can be used to collect data from hidden populations, including people who use drugs (PWUD). These methods might be especially advantageous among PWUD in rural areas, where transportation barriers are prevalent, stigma may heighten concerns about confidentiality, and internet access is improving. However, Web-based research with PWUD can be challenging, especially in verifying eligibility. Administering quizzes to verify residential and substance use eligibility could prove valuable in online research among PWUD, yet the utility of this approach is currently unknown. Objective This study describes the implementation of online eligibility quizzes about the local community to verify residence in the target study area along with drug dose, appearance, and price to verify opioid misuse. Methods To be eligible, individuals had to live in 1 of 5 eastern Kentucky counties, report using opioids to get high in the past 30 days, and be 18 to 35 years old. Participants recruited from August 2017 to July 2018 were asked questions about their opioid use followed by a quiz about drug dose, appearance, and price to verify substance use eligibility. Residential eligibility was verified with 5-question quizzes assessing knowledge of the county where they reported living. Questions tested knowledge about towns, festivals, and landmarks; local school mascots and colors; and presence of certain retail stores, restaurants, and facilities (eg, jails). A subsample that reported using opioids in the past 24 hours was randomly selected to complete urine drug testing (UDT). Nonparametric tests were performed to explore differences across demographic subgroups. Results Of the 410 entries assessed for eligibility, 39.3% (161/410) were ineligible as they reported no substance use, being outside the age range, or living outside the study area. Of the remaining 249 who met the eligibility criteria based on age, residency, and opioid misuse, 94.0% (234/249) passed the eligibility quizzes. Among those who passed the heroin quiz, 99.4% (167/168) recognized the image of powdered heroin, 94.6% (159/168) answered the cap size (ie, the purchase unit) question correctly, and 97.0% (163/168) answered the street price question correctly. Among those who passed the drug quiz for prescription opioids, 95% (36/38) answered the dose question correctly, and 82% (31/38) selected the correct image. In a random sample of participants who completed UDT within 3 days of their online screening, 74% (25/34) tested positive for an opioid. Conclusions This study demonstrated the utility of using online eligibility screening quizzes to verify opioid misuse and residence. Participants accurately recognized heroin and prescription opioid doses, prices, and images and correctly answered questions about features of their county. Online quizzes to screen and enroll PWUD hold promise for future research as an alternative to more time- and resource-intensive approaches that could offset the advantages of Web-based methods.
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Affiliation(s)
- April M Ballard
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States.,Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Hannah Lf Cooper
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States.,Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, United States
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