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Tolou-Shams M, Ramaiya M, Lara Salas J, Ezimora I, Shumway M, Duerr Berrick J, Aguilera A, Borsari B, Dauria E, Friedling N, Holmes C, Grandi A. A Family-Based Mental Health Navigator Intervention for Youth in the Child Welfare System: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49999. [PMID: 37698896 PMCID: PMC10523219 DOI: 10.2196/49999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Youth in the child welfare system (child welfare-involved [CWI] youth) have high documented rates of mental health symptoms and experience significant disparities in mental health care services access and engagement. Adolescence is a developmental stage that confers increased likelihood of experiencing mental health symptoms and the emergence of disorders that can persist into adulthood. Despite a high documented need for evidence-based mental health services for CWI youth, coordination between child welfare and mental health service systems to increase access to care remains inadequate, and engagement in mental health services is low. Navigator models developed in the health care field to address challenges of service access, fragmentation, and continuity that affect the quality of care provide a promising approach to increase linkage to, and engagement in, mental health services for CWI youth. However, at present, there is no empirically supported mental health navigator model to address the unique and complex mental health needs of CWI youth and their families. OBJECTIVE Using a randomized controlled trial, this study aims to develop and test a foster care family navigator (FCFN) model to improve mental health service outcomes for CWI adolescents (aged 12-17 years). METHODS The navigator model leverages an in-person navigator and use of adjunctive digital health technology to engage with, and improve, care coordination, tracking, and monitoring of mental health service needs for CWI youth and families. In total, 80 caregiver-youth dyads will be randomized to receive either the FCFN intervention or standard of care (clinical case management services): 40 (50%) to FCFN and 40 (50%) to control. Qualitative exit interviews will inform the feasibility and acceptability of the services received during the 6-month period. The primary trial outcomes are mental health treatment initiation and engagement. Other pre- and postservice outcomes, such as proportion screened and time to screening, will also be evaluated. We hypothesize that youth receiving the FCFN intervention will have higher rates of mental health treatment initiation and engagement than youth receiving standard of care. RESULTS We propose enrollment of 80 dyads by March 2024, final data collection by September 2024, and the publication of main findings in March 2025. After final data analysis and writing of the results, the resulting manuscripts will be submitted to journals for dissemination. CONCLUSIONS This study will be the first to produce empirically driven conclusions and recommendations for implementing a family mental health navigation model for CWI youth with long-standing and unaddressed disparities in behavioral health services access. The study findings have potential to have large-scale trial applicability and be feasible and acceptable for eventual system implementation and adoption. TRIAL REGISTRATION ClinicalTrials.gov NCT04506437; https://www.clinicaltrials.gov/study/NCT04506437. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49999.
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Affiliation(s)
- Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Megan Ramaiya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jannet Lara Salas
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Ifunanya Ezimora
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jill Duerr Berrick
- Berkeley Social Welfare, University of California at Berkeley, Berkeley, CA, United States
| | - Adrian Aguilera
- Berkeley Social Welfare, University of California at Berkeley, Berkeley, CA, United States
| | - Brian Borsari
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- San Francisco Veteran Affairs Medical Center, San Francisco, CA, United States
| | - Emily Dauria
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Naomi Friedling
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Crystal Holmes
- Foster Care Mental Health, San Francisco, CA, United States
| | - Adam Grandi
- Foster Care Mental Health, San Francisco, CA, United States
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Dauria E, Rodriguez C, Bauerle Bass S, Tolou-Shams M, Christopoulos K. Implementation strategies to screen, refer and link women involved in the carceral system to PrEP for HIV prevention. Int J Prison Health 2023; 19:10.1108/IJPH-06-2022-0037. [PMID: 37113046 PMCID: PMC11058187 DOI: 10.1108/ijph-06-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE Women involved in the carceral system (CS) experience several conditions that increase their risk for HIV (e.g. high rates of substance use, psychiatric disorders, histories of victimization). The purpose of this study is to explore perspectives on potential strategies to connect women in the CS to pre-exposure prophylaxis (PrEP) services. DESIGN/METHODOLOGY/APPROACH This study conducted in-depth interviews with 27 women involved in the CS eligible for PrEP. Using vignettes, interviews explored attitudes, barriers and facilitators toward PrEP screening, referral and linkage facilitated via a CS stakeholder, an mHealth application or providing PrEP service referrals during detention via a navigator. FINDINGS Most women were, on average, 41.3 years, from racial and ethnic minority groups (56% black/African American; 19% Latinx). Inductive thematic analysis revealed CS involved women expressed mostly positive attitudes toward CS-based PrEP implementation. Younger women were more accepting of and interested in mHealth interventions. Implementation facilitators included leveraging relationships with trusted allies (e.g. "peers") and existing systems collaborations. Recommended implementation strategies included providing HIV and PrEP-specific education and training for system stakeholders and addressing issues related to privacy, system mistrust and stigma. ORIGINALITY/VALUE Results provide a critical foundation for the implementation of interventions to improve PrEP access for women involved in the CS and have important implications for implementation strategies for all adults involved in the CS. Improving access to PrEP among this population may also support progress toward addressing national disparities in PrEP uptake, where women, black and Latinx populations have substantial unmet need.
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Affiliation(s)
- Emily Dauria
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Katerina Christopoulos
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Dauria E, Skipalska H, Gopalakrishnan L, Savenko O, Sabadash L, Tolou-Shams M, Flanigan T, Navario P, Castillo TP. Exploratory qualitative study examining acceptability of strategies to improve access to substance use treatment and HIV prevention services for young adults on probation in Ukraine. BMJ Open 2022; 12:e061909. [PMID: 36418138 PMCID: PMC9685251 DOI: 10.1136/bmjopen-2022-061909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Adults <30 years' of age experience elevated HIV-rates in Ukraine. Young adults (YA) involved in the criminal justice system (CJS) are at an increased HIV-risk given elevated rates of substance use, engagement in high-risk sexual behaviour and insufficient healthcare access. The objective of this exploratory study was to investigate the acceptability of strategies to refer and link CJS-involved YA to HIV-prevention and substance use treatment services from CJS settings. DESIGN We conducted qualitative individual interviews with CJS-involved YA (18-24 years), and CJS stakeholders. Interviews were guided by the Social Ecological Model. Interviews with YA explored substance use and sexual behaviour, and acceptability of strategies to link YA to HIV-prevention and substance use treatment services from CJS. Stakeholder interviews explored system practices addressing HIV-prevention and substance use and addiction. Data were analysed using Inductive Thematic Analysis. SETTING Data were collected in three locales, prior to the 2022 Russian-Ukrainian conflict. PARTICIPANTS Thirty YA and 20 stakeholders. RESULTS Most YA were men, reported recent injection drug use and were M age=23 years. YA were receptive to linkage to HIV-prevention services from CJS; this was shaped by self-perceived HIV-risk and lack of access to HIV-prevention services. YA were less receptive to being referred to substance use treatment services, citing a lack of self-perceived need and mistrust in treatment efficacy. Stakeholders identified multilevel contextual factors shaping acceptability of HIV-prevention and substance use treatment from CJS (eg, stigma). CONCLUSIONS Findings should be reviewed as a historical record of the pre-conflict context. In that context, we identified strategies that may have been used to help curtail the transmission of HIV in a population most-at-risk, including CJS-involved YA. This study demonstrates that improving access to substance use treatment and HIV-prevention services via CJS linkage were acceptable if provided in the right conditions (eg, low or no-cost, confidential).
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Affiliation(s)
- Emily Dauria
- Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Lakshmi Gopalakrishnan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | | | | | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Peter Navario
- School of Public Health, New York University, New York, New York, USA
- HealthRight International, New York, New York, USA
| | - Theresa P Castillo
- School of Public Health, New York University, New York, New York, USA
- HealthRight International, New York, New York, USA
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Rosen B, Dauria E, Shumway M, Smith JD, Koinis-Mitchell D, Tolou-Shams M. Association of pregnancy attitudes and intentions with sexual activity and psychiatric symptoms in justice-involved youth. Child Youth Serv Rev 2022; 138:106510. [PMID: 38107676 PMCID: PMC10723635 DOI: 10.1016/j.childyouth.2022.106510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Context With over one-third of detained girls experiencing teenage pregnancy, it is critical that the juvenile justice system better addresses the sexual and reproductive health (SRH) needs of youth. Although pregnancy attitudes and intentions (PAI) are associated with pregnancy outcomes among the general adolescent population, this relationship has not been examined among justice-involved youth. Methods Participants were drawn from a longitudinal study characterizing trajectories of behavioral and reproductive health and recidivism among newly justice-involved youth in a Northeast family court. Baseline and four-month follow-up data from 288 justice-involved youth (JIY) were analyzed to characterize PAI; examine associations between pregnancy intentions and unprotected sexual activity (i.e., no hormonal, intrauterine, or barrier protection against pregnancy); and explore the relationship between pregnancy intentions and psychiatric symptoms. Results At baseline, 39% of JIY youth were sexually active, 44% of these youth reported inconsistent condom use and 14% had not used birth control at last sexual intercourse. Nearly half of sexually active youth reported some intent around pregnancy and those with any pregnancy intentions were more likely to report depression, low self-esteem, substance use, and trauma history. Pregnancy intentions at baseline predicted higher rates of unprotected sexual activity at four months (OR: 16.9, CI = 2.48-115.7). Conclusions This study highlights the importance of developing and implementing more comprehensive SRH assessments and brief interventions for youth entering the justice system.
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Affiliation(s)
- Brooke Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States
| | - Emily Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Community and Behavioral Health Sciences, Graduate School of Public Health, University of Pittsburgh, United States
- Department of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110, United States
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA 94110, United States
| | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Rhode Island Hospital Department of Psychiatry, 1 Hoppin St. Coro West, 2nd Floor, Providence, RI 02903, United States
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110, United States
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Ramos LMC, Delgadillo J, Vélez S, Dauria E, Salas J, Tolou-Shams M. Collecting Social Media Information in a Substance Use Intervention Trial With Adolescent Girls With Lifetime Substance Use History: Observational Study. JMIR Form Res 2021; 5:e25405. [PMID: 34505833 PMCID: PMC8463944 DOI: 10.2196/25405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 07/14/2021] [Accepted: 08/01/2021] [Indexed: 01/17/2023] Open
Abstract
Background Adolescents with juvenile legal system contact face numerous barriers to participation in behavioral health intervention research, including housing disruption, legal privacy concerns, and systems mistrust. Technology, such as social media, may be a novel and developmentally appropriate adolescent research study engagement and retention tool. Objective We examined data on social media information collected for study retention purposes from adolescents participating in a substance use intervention trial. Methods Data were collected as part of a randomized controlled trial determining efficacy of a group-based substance use intervention for girls and young women (12-24 years) with substance use histories referred from legal and school systems in the United States. Baseline demographic and social media information was analyzed from the subset of 114 adolescent girls (mean age 15.7 years; range 13-18 years), of whom 31.6% (36/114) were legally involved, 87.7% (100/114) belonged to minoritized racial/ethnic groups, and 32.5% (37/114) received public assistance. Results Most girls (74/114, 64.9%) provided at least one social media account (Instagram, 95% [70/74]; Facebook, 27% [20/74]; and Twitter, 11% [8/74]) during study enrollment. Legally involved girls were significantly less likely to provide social media information than school-referred girls (44% [16/36] versus 74% [58/78]; χ21 [N=114]=9.68, P=.002). Conclusions Obtaining social media information for study retention purposes from adolescent girls with lifetime substance use appears possible; however, particular subgroups (ie, legally involved girls) may be less likely to provide accounts. Factors shaping legally involved girls’ willingness to provide social media information, including mistrust and privacy concerns, and the impact of researcher’s access to social media information on study retention are critical directions for future research. Trial Registration ClinicalTrials.gov NCT02293057; https://clinicaltrials.gov/ct2/show/NCT02293057
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Affiliation(s)
- Lili M C Ramos
- Department of Psychology, John Jay College of Criminal Justice and the Graduate Center, City University of New York, New York, NY, United States
| | - Joseline Delgadillo
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Sarah Vélez
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Emily Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Jamie Salas
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Wurcel AG, Dauria E, Zaller N, Nijhawan A, Beckwith C, Nowotny K, Brinkley-Rubinstein L. Spotlight on Jails: COVID-19 Mitigation Policies Needed Now. Clin Infect Dis 2020; 71:891-892. [PMID: 32221515 PMCID: PMC7385748 DOI: 10.1093/cid/ciaa346] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alysse G Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Emily Dauria
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA.,Division of Infant Child and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Nicholas Zaller
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ank Nijhawan
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Curt Beckwith
- Division of Infectious Diseases, Department of Medicine, The Miriam Hospital and Rhode Island Hospital, Providence, Rhode Island, USA
| | - Kathryn Nowotny
- Department of Sociology, University of Miami, Coral Gables, Florida, USA
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Tolou-Shams M, Brown LK, Marshall BDL, Dauria E, Koinis-Mitchell D, Kemp K, Poindexter B. The Behavioral Health Needs of First-Time Offending Justice-Involved Youth: Substance Use, Sexual Risk and Mental Health. J Child Adolesc Subst Abuse 2020; 28:291-303. [PMID: 34220180 DOI: 10.1080/1067828x.2020.1774023] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examines substance use, emotional/behavioral symptoms and sexual risk among first-time offending, court-involved, non-incarcerated (FTO-CINI) youth. Youth and caregivers (N=423) completed tablet-based assessments. By time of first justice contact (average 14.5 years old), 49% used substances, 40% were sexually active and 33% reported both. Youth with co-occurring substance use and sexual risk had more emotional/behavioral symptoms; youth with delinquent offenses and females had greater co-occurring risk. Time of first offense is a critical period to intervene upon high rates of mental health need for those with co-occurring substance use and sexual risk to prevent poor health and legal outcomes.
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Affiliation(s)
- Marina Tolou-Shams
- University of California, San Francisco, Department of Psychiatry, Weill Institute for Neurosciences; 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry; 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Larry K Brown
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; 222 Richmond St, Providence, RI 02903, USA.,Department of Psychiatry, Rhode Island Hospital; 593 Eddy St, Providence, RI 02903, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health; 121 S Main St, Providence, RI 02903, USA
| | - Emily Dauria
- University of California, San Francisco, Department of Psychiatry, Weill Institute for Neurosciences; 1001 Potrero Ave, San Francisco, CA, 94110, USA.,Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry; 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; 222 Richmond St, Providence, RI 02903, USA.,Department of Psychiatry, Rhode Island Hospital; 593 Eddy St, Providence, RI 02903, USA
| | - Kathleen Kemp
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; 222 Richmond St, Providence, RI 02903, USA.,Department of Psychiatry, Rhode Island Hospital; 593 Eddy St, Providence, RI 02903, USA
| | - Brittney Poindexter
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; 222 Richmond St, Providence, RI 02903, USA.,Department of Psychiatry, Rhode Island Hospital; 593 Eddy St, Providence, RI 02903, USA
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Aibana O, Dauria E, Kiriazova T, Makarenko O, Bachmaha M, Rybak N, Flanigan TP, Petrenko V, Becker AE, Murray MB. Patients' perspectives of tuberculosis treatment challenges and barriers to treatment adherence in Ukraine: a qualitative study. BMJ Open 2020; 10:e032027. [PMID: 32014870 PMCID: PMC7044979 DOI: 10.1136/bmjopen-2019-032027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/18/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To understand the challenges faced by patients with tuberculosis (TB) and factors that influence TB treatment adherence in Ukraine. DESIGN Qualitative study. SETTING TB treatment facilities in Kyiv Oblast, Ukraine. PARTICIPANTS Sixty adults who had undergone treatment for drug-sensitive TB between June 2012 and August 2015. METHODS We conducted semistructured, in-depth, individual interviews among a purposively selected clinical sample of patients previously treated for drug-sensitive TB. Interview content encompassed WHO's framework for barriers to adherence to long-term therapies and included questions about patient preferences and motivators concerning treatment adherence. We examined treatment experience across strata defined by previously identified risk correlates of non-adherence. RESULTS Among 60 participants, 19 (32.8%) were HIV positive, 12 (20.3%) had substance use disorder and 9 (15.0%) had not completed TB treatment. Respondents discussed the psychological distress associated with hospital-based TB care, as well as perceived unsupportive, antagonistic interactions with TB providers as major challenges to treatment adherence. An additional barrier to successful treatment completion included the financial toll of lost income during TB treatment, which was exacerbated by the additional costs of ancillary medications and transportation to ambulatory TB clinics. The high pill burden of TB treatment also undermined adherence. These challenges were endorsed among participants with and without major risk factors for non-adherence. CONCLUSIONS Our findings highlight important barriers to TB treatment adherence in this study population and suggest specific interventions that may be beneficial in mitigating high rates of poor treatment outcomes for TB in Ukraine.
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Affiliation(s)
- Omowunmi Aibana
- Internal Medicine, McGovern Medical School at the University of Texas Health Science Center - Houston, Houston, Texas, USA
| | - Emily Dauria
- Psychiatry, University of California San Francisco, San Francisco, California, USA
| | | | | | | | - Natasha Rybak
- Infectious Diseases, The Miriam Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Timothy Palen Flanigan
- Infectious Diseases, The Miriam Hospital, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Vasyl Petrenko
- Phthisiology (Tuberculosis), Bogomolets National Medical University, Kyiv, Ukraine
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Brinkley-Rubinstein L, Dauria E, Tolou-Shams M, Christopoulos K, Chan PA, Beckwith CG, Parker S, Meyer J. The Path to Implementation of HIV Pre-exposure Prophylaxis for People Involved in Criminal Justice Systems. Curr HIV/AIDS Rep 2019. [PMID: 29516265 DOI: 10.1007/s11904-018-0389-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, USA.
- Center for Health Equity Research, University of North Carolina, Chapel Hill, USA.
| | - Emily Dauria
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, USA
| | | | - Philip A Chan
- Department of Medicine, Brown University, Providence, USA
| | | | - Sharon Parker
- Department of Social Work and Sociology, North Carolina Agricultural and Technical University, Greensboro, USA
| | - Jaimie Meyer
- AIDS Program, Yale School of Medicine, New Haven, USA
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Dauria E, Tolou-Shams M, Skipalska H, Bachmaha M, Hodgdon S. Outcomes of the "STEPS" HIV prevention training program for young males in the penitentiary institution, Ukraine. Int J Prison Health 2019; 14:101-108. [PMID: 29869581 DOI: 10.1108/ijph-02-2017-0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Ukraine has one of the fastest growing HIV epidemics globally. Due to their engagement in high-risk behaviors, adolescents and emerging adults involved with the penitentiary system are at a particularly high risk of HIV-acquisition. To address the epidemic, young males (aged 14 to 20 years) in penitentiary institutions across Ukraine participated in a ten-week, group-based HIV-prevention intervention (STEPS). The paper aims to discuss these issues. Design/methodology/approach The authors analyzed clinical and programmatic services data collected as part of an evaluation of the STEPS intervention. Paired t-tests and χ2 were used to examine pre- and post-intervention differences in HV knowledge, attitudes, and risk behaviors and alcohol and other drug use knowledge. Findings In total, 105 male youths participated in the ten-session STEPS intervention. At baseline, males reported high frequencies of risk behaviors (e.g. unprotected sexual activity, injection drug use), moderate levels of HIV-related knowledge, and negative attitudes toward HIV and people living with HIV. At follow-up (immediately following the last STEPS session), participants' HIV-related knowledge substantially improved and participants tended to have more favorable attitudes toward HIV. Research limitations/implications Outcomes suggest that knowledge and attitudes about HIV among Ukrainian incarcerated youth can improve as a result of group-based HIV-prevention intervention. Originality/value In Ukraine, individuals involved with the criminal justice system are one of the populations most-at-risk for HIV; criminal justice-involved adolescents and young adults are disproportionately affected by the HIV epidemic. Research among this sub-population is limited. This study aims to address this gap by evaluating an on-going group-based HIV-prevention program designed to reduce adolescent risk of HIV.
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Affiliation(s)
- Emily Dauria
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco , San Francisco, California, USA
| | - Marina Tolou-Shams
- Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco , San Francisco, California, USA
| | | | - Mariya Bachmaha
- School of Public Health, Brown University , Providence, Rhode Island, USA
| | - Sara Hodgdon
- HealthRight International, New York City, New York, USA
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Abstract
PURPOSE OF REVIEW This review discusses recent advances in research on the intersection of HIV prevention and substance use among youth involved with the justice system. We discuss current themes of recent findings and provide guidance for researchers, policymakers, and clinicians on the next steps in advancing work in this nascent area. RECENT FINDINGS Of the 46 studies that measured HIV risk and substance use among justice-involved youth, 56% were cross-sectional designs, 22% were intervention trials, and 22% were longitudinal designs. Cross-sectional studies suggested that substance use is highly associated with HIV risk behaviors. Longitudinal analyses underscored the importance of understanding contextual risk factors, such as trauma and violence. Intervention trials demonstrated improved scientific rigor of behavioral approaches. Despite recent advances, research in this field remains limited. Future directions include longer follow-up periods, consideration of biomedical HIV-prevention interventions, and a focus on dissemination and implementation science of efficacious interventions.
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Affiliation(s)
- Marina Tolou-Shams
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry, San Francisco, CA, USA.
| | - Anna Harrison
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Matthew E Hirschtritt
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Langley Porter Psychiatric Institute, 401 Parnassus Ave, 94143, San Francisco, CA, USA
| | - Emily Dauria
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry, San Francisco, CA, USA
| | - Jill Barr-Walker
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- ZSFG Library, University of California San Francisco, San Francisco, CA, USA
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Peterson M, Nowotny K, Dauria E, Arnold T, Brinkley-Rubinstein L. Institutional distrust among gay, bisexual, and other men who have sex with men as a barrier to accessing pre-exposure prophylaxis (PrEP). AIDS Care 2018; 31:364-369. [PMID: 30227719 DOI: 10.1080/09540121.2018.1524114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Populations at highest risk for acquiring HIV are more likely to pass through criminal justice (CJ) settings, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. The present study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men involved in the criminal justice system. Using semi-structured interviews, 26 participants who identified as MSM were asked about PrEP knowledge and interest, HIV risk, and incarceration experience. One theme that emerged across interviews was how institutional distrust in CJ settings may instill lack of trust in medical care after perceived mistreatment. Participants explained how lack of privacy fostered feelings that medical care was not confidential, care received was tied to status as an incarcerated person, and feelings of dehumanization led to distrust. Findings explore how distrust may hinder PrEP uptake and other HIV prevention efforts in CJ settings as well as after release. They highlight the need for greater privacy efforts and cultural humility, and explore how medical settings may function as spaces for people who are incarcerated to disclose HIV risk status. Few studies to our knowledge have examined the role of institutional distrust on men who have sex with men (MSM) in the context of pre-exposure prophylaxis (PrEP) interventions. The present study has implications for creating best practices to structure HIV prevention interventions in CJ settings.
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Affiliation(s)
- Meghan Peterson
- a School of Public Health , Brown University , Providence , RI , USA.,b Center for Prisoner Health and Human Rights , Miriam Hospital , Providence , RI , USA
| | - Kathryn Nowotny
- c Department of Sociology , University of Miami , Miami , FL , USA
| | - Emily Dauria
- d Department of Psychiatry , University of California , San Francisco , CA , USA
| | - Trisha Arnold
- e Department of Psychology , Rhode Island Hospital , Providence , RI , USA
| | - Lauren Brinkley-Rubinstein
- f Department of Social Medicine , University of North Carolina , Chapel Hill , NC , USA.,g Center for Health Equity Research , University of North Carolina , Chapel Hill , NC , USA
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Brinkley-Rubinstein L, McKenzie M, Macmadu A, Larney S, Zaller N, Dauria E, Rich J. Erratum to: A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release [Drug and Alcohol Dependence 184 (2018) 57-63]. Drug Alcohol Depend 2018; 186:9. [PMID: 29522882 PMCID: PMC10446121 DOI: 10.1016/j.drugalcdep.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Michelle McKenzie
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nickolas Zaller
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Emily Dauria
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Josiah Rich
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, United States
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Brinkley-Rubinstein L, McKenzie M, Macmadu A, Larney S, Zaller N, Dauria E, Rich J. A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: Findings at 12 months post-release. Drug Alcohol Depend 2018; 184:57-63. [PMID: 29402680 PMCID: PMC10445765 DOI: 10.1016/j.drugalcdep.2017.11.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
Recently, incarcerated individuals are at increased risk of opioid overdose. Methadone maintenance treatment (MMT) is an effective way to address opioid use disorder and prevent overdose; however, few jails and prisons in the United States initiate or continue people who are incarcerated on MMT. In the current study, the 12 month outcomes of a randomized control trial in which individuals were provided MMT while incarcerated at the Rhode Island Department of Corrections (RIDOC) are assessed. An as-treated analysis included a total of 179 participants-128 who were, and 51 who were not, dosed with methadone the day before they were released from the RIDOC. The results of this study demonstrate that 12 months post-release individuals who received continued access to MMT while incarcerated were less likely to report using heroin and engaging in injection drug use in the past 30 days. In addition, they reported fewer non-fatal overdoses and were more likely to be continuously engaged in treatment in the 12-month follow-up period compared to individuals who were not receiving methadone immediately prior to release. These findings indicate that providing incarcerated individuals continued access to MMT has a sustained, long-term impact on many opioid-related outcomes post-release.
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Affiliation(s)
| | - Michelle McKenzie
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Alexandria Macmadu
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, United States
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Nickolas Zaller
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Emily Dauria
- Department of Psychiatry, University of California, San Francisco, CA, United States
| | - Josiah Rich
- Division of Infectious Diseases, The Miriam Hospital, Providence, RI, United States
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Tolou-Shams M, Dauria E, Conrad SM, Kemp K, Johnson S, Brown LK. Outcomes of a family-based HIV prevention intervention for substance using juvenile offenders. J Subst Abuse Treat 2017; 77:115-125. [PMID: 28476263 DOI: 10.1016/j.jsat.2017.03.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 11/17/2022]
Abstract
Approximately 80% of all arrested youth are diverted from detention and supervised in the community through probation, specialty courts and other community-based diversion efforts. Justice-involved youth have greater psychiatric impairment, substance use and sexual risk behaviors than their non-justice-involved peers. Family-based interventions to address mental health, substance use and recidivism have been successful in improving these youth outcomes; but the lack of integration of HIV/STI prevention is notable given the co-occurrence of substance use, delinquency and sexual risk-taking behaviors among justice-involved youth. Moreover, emotion dysregulation may be an important and understudied underlying construct of these co-occurring risk behaviors for justice-involved youth. Study participants were 47 caregiver-youth dyads enrolled in a juvenile drug court program. As part of a pilot efficacy trial, dyads were randomized to a 5-session family-based integrated substance use and HIV/STI prevention intervention that relied on affect management strategies for risk reduction or an adolescent-only psychoeducation condition matched for time and attention. Data collected at baseline and 3months post-intervention suggest that a family-based integrated affect management substance use and HIV prevention pilot intervention may lead to justice-involved youths' enhanced motivation to change their marijuana use, decreased marijuana use and decreased risky sexual behavior over time. Future research is required to replicate these pilot trial findings and should also examine family-level mediators and moderators of treatment response, particularly with respect to HIV prevention efforts for these youth.
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Affiliation(s)
- Marina Tolou-Shams
- University of California, San Francisco, Department of Psychiatry, Weill Institute for Neurosciences, United States; Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry, United States.
| | - Emily Dauria
- University of California, San Francisco, Department of Psychiatry, Weill Institute for Neurosciences, United States; Zuckerberg San Francisco General Hospital, Division of Infant Child and Adolescent Psychiatry, United States
| | - Selby M Conrad
- Rhode Island Hospital, Department of Psychiatry, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
| | - Kathleen Kemp
- Rhode Island Hospital, Department of Psychiatry, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
| | - Sarah Johnson
- Northeastern University, Department of Counseling and Applied Educational Psychology, United States
| | - Larry K Brown
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States
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Kemp K, Tolou-Shams M, Conrad S, Dauria E, Neel K, Brown L. Suicidal ideation and attempts among court-involved, non-incarcerated youth. J Forensic Psychol Pract 2016; 16:169-181. [PMID: 29142507 DOI: 10.1080/15228932.2016.1172424] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Over the past decade, suicide remains one of the leading causes of death among adolescents and a public health priority. Court-involved non-incarcerated juvenile justice youth frequently present with risk factors for suicide. Among these court-involved youth, 14% (n=50) endorsed a lifetime history of suicide ideation and attempts. Three main factors were associated with increased risk: prior offense, substance use, and childhood sexual abuse histories. This study highlights the importance of understanding suicidal behavior among non-detained juvenile justice populations. Community-based court involvement provides a rare opportunity to coordinate screening and suicide prevention efforts for youth and their families.
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Affiliation(s)
- Kathleen Kemp
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin Street, Suite 204, Providence, RI 02903
| | - Marina Tolou-Shams
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin Street, Suite 204, Providence, RI 02903
| | - Selby Conrad
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin Street, Suite 204, Providence, RI 02903
| | - Emily Dauria
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin Street, Suite 204, Providence, RI 02903
| | - Kira Neel
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin Street, Suite 204, Providence, RI 02903
| | - Larry Brown
- Bradley/Hasbro Children's Research Center/Rhode Island Hospital and the Warren Alpert Medical School of Brown University, 1 Hoppin Street, Suite 204, Providence, RI 02903
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Cooper HLF, Caruso B, Barham T, Embry V, Dauria E, Clark CD, Comfort ML. Partner Incarceration and African-American Women's Sexual Relationships and Risk: A Longitudinal Qualitative Study. J Urban Health 2015; 92:527-47. [PMID: 25694224 PMCID: PMC4456473 DOI: 10.1007/s11524-015-9941-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Racialized mass incarceration is associated with racial/ethnic disparities in HIV and other sexually transmitted infections (STIs) in the US. The purpose of this longitudinal qualitative study was to learn about the processes through which partner incarceration affects African-American women's sexual risk. Four waves of in-depth qualitative interviews were conducted in 2010-2011 with 30 women in Atlanta, Georgia (US) who had recently incarcerated partners. Approximately half the sample misused substances at baseline. Transcripts were analyzed using grounded theory. For over half the sample (N = 19), partner incarceration resulted in destitution, and half of this group (N = 9) developed new partnerships to secure shelter or food; most misused substances. Other women (N = 9) initiated casual relationships to meet emotional or sexual needs. When considered with past research, these findings suggest that reducing incarceration rates among African-American men may reduce HIV/STIs among African-American women, particularly among substance-misusing women, as might rapidly linking women with recently incarcerated partners to housing and economic support and drug treatment.
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Kegler MC, Honeycutt S, Davis M, Dauria E, Berg C, Dove C, Gamble A, Hawkins J. Policy, Systems, and Environmental Change in the Mississippi Delta. Health Educ Behav 2015; 42:57S-66S. [DOI: 10.1177/1090198114568428] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community-level policy, systems, and environmental (PSE) change strategies may offer an economical and sustainable approach to chronic disease prevention. The rapidly growing number of untested but promising PSE strategies currently underway offers an exciting opportunity to establish practice-based evidence for this approach. This article presents lessons learned from an evaluation of a community-based PSE initiative targeting stroke and cardiovascular disease prevention in the Mississippi Delta. Its purpose is to describe one approach to evaluating this type of PSE initiative, to stimulate discussion about best practices for evaluating PSE strategies, and to inform future evaluation and research efforts to expand practice-based evidence. The evaluation used a descriptive mixed-methods design and focused on the second year of a multisectoral, multiyear initiative. Cross-sectional data were collected in the summer and fall of 2010 using four data collection instruments: a grantee interview guide ( n = 32), a health council member survey ( n = 256), an organizational survey ( n = 60), and a grantee progress report ( n = 26). Fifty-eight PSE changes were assessed across five sectors: health, faith, education, worksite, and community/city government. PSE strategies aligned with increased access to physical activity opportunities, healthy food and beverage options, quality health care, and reduced exposure to tobacco. Results showed that grantees were successful in completing a series of steps toward PSE change and that sector-specific initiatives resulted in a range of PSE changes that were completed or in progress. Considerations for designing evaluations of community-based PSE initiatives are discussed.
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Affiliation(s)
| | | | | | | | | | - Cassandra Dove
- Mississippi State Department of Health, Jackson, MS, USA
| | | | - Jackie Hawkins
- Mississippi State Department of Health, Jackson, MS, USA
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Malebranche DJ, Arriola KJ, Jenkins TR, Dauria E, Patel SN. Exploring the "bisexual bridge": a qualitative study of risk behavior and disclosure of same-sex behavior among black bisexual men. Am J Public Health 2010; 100:159-64. [PMID: 19910348 DOI: 10.2105/ajph.2008.158725] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We explored factors influencing sexual behavior, disclosure of same-sex behavior, and condom-use practices among Black bisexual men. METHODS We conducted semistructured interviews with 38 Black men in Atlanta, Georgia, who reported having had oral, vaginal, or anal sex with both men and women in the prior 6 months. RESULTS Participants described approaches to disclosure of same-sex behavior as part of a complex decisional balance influenced by both situational and individual factors and ranging from full disclosure to total secrecy. Influences on sexual behavior and condom-use practices included: (1) type of relationship, (2) gender-specific considerations, (3) perceptions of comfort or trust, and (4) fear of disease or pregnancy. CONCLUSIONS Disclosure of same-sex behavior was not a major influence on the sexual behavior and condom-use practices of the Black bisexual men in our study, who demonstrated heterogeneity in approaches to sexual behavior, disclosure of same-sex behavior, and condom-use practices. Additional research is needed to assess the social determinants of sexual risk for this population. Future HIV-prevention efforts should include initiatives to encourage accuracy in risk assessment and in taking sexual histories in clinical settings.
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Affiliation(s)
- David J Malebranche
- Emory University School of Medicine, Division of General Medicine, 49 Jesse Hill Jr. Drive, Suite 413, Atlanta, GA 30303, USA.
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Zuccotti G, Dauria E, Torcoletti M, Lodi F, Bernardo L, Riva E. Clinical and pro-host effects of cefaclor in prophylaxis of recurrent otitis media in HIV-infected children. J Int Med Res 2001; 29:349-54. [PMID: 11675909 DOI: 10.1177/147323000102900412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of cefaclor in the prophylaxis of recurrent acute otitis media (AOM) in human immunodeficiency virus (HIV)-infected children. The study was carried out in children born between 1 January 1986 and 31 December 1996 who had been vertically HIV infected Patients who had experienced recurrent AOM between October 1997 and March 1998 (period 1) were eligible for the trial. Recurrent AOM was defined as the occurrence in the same patient of three or more episodes of AOM within 6 months of the observation period. Patients recruited for this trial received cefaclor at a dose of 20 mg/kg once daily for 6 months between April and September 1998 (period 2). Clinical observation was carried out in periods 1 and 2 and for the first 6 months after prophylaxis, i.e. October 1998 - March 1999 (period 3). Natural killer-cell activity, phagocytosis and myeloperoxidase activity were determined before and at the end of the prophylactic period. For each period, CD4-cell count measurement and CD4-positive cell class were recorded. Seventeen children were recruited for this trial. No significant differences were observed in natural killer-cell activity between periods 1 and 2, nor were any significant differences observed in CD4-positive cell class or CD4-positive cell count between the three periods. However, cefaclor administration was associated with a reduction in the number of AOM episodes in 100% of cases and a mean increase in myeloperoxidase activity in 57% of cases. This suggests that cefaclor may be useful in the prophylaxis of recurrent AOM in HIV-infected children.
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Affiliation(s)
- G Zuccotti
- Department of Paediatrics, San Paolo Hospital, University of Milan, Italy.
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