Stigmatizing imagery for substance use disorders: a qualitative exploration.

BACKGROUND: Stigma is a significant barrier to the treatment of individuals with substance use disorders. While prior efforts have been made to change stigmatizing language to refer to individuals with substance use disorders (SUD), little is known about the effects of stigmatizing imagery. There is a need for complementary qualitative research to identify both stigmatizing and non-stigmatizing imagery in the field of SUD. METHODS: This study used qualitative methods to identify stigmatizing and non-stigmatizing imagery for SUD and explore the reactions of people with lived experience with SUD to SUD-related imagery. We conducted focus groups and brief semi-structured qualitative interviews with 14 individuals in recovery from a range of SUD. RESULTS: Participants identified images of substance use and criminal justice contact that are negative or stigmatizing, along with alternative images that were endorsed for use. The unanticipated concept of imagery-induced triggering and cue reactivity emerged in the interviews, along with an emphasis on diversity in race/ethnicity, gender, and age for representations of both patients and clinicians in all imagery. CONCLUSIONS: The findings can be helpful in informing imagery that can depict addiction, individuals with SUD, and individuals involved in the justice system for various fields from research to media, public health, and community-based programming. Based on qualitative feedback from patients on triggering effects and reactivity to visual cues, it is never appropriate to use drug use and drug paraphernalia imagery to depict substance use or misuse or pictures of people in cages.

The adoption and sustainability of digital therapeutics in justice systems: A pilot feasibility study.

BACKGROUND: This study explored whether participants with substance use disorder (SUD) would adopt and use a smart-phone app with a cognitive behavioral therapy program, weekly Brief Addiction Monitor (BAM) assessments, daily check-ins, tools to track sobriety and treatment, and other patient-centered resources. In addition, participants with SUD could access a social worker and peer support specialists. METHODS: The study sought participants from two groups: those referred by a justice-related agency and participants who responded to outreach from the Addiction Policy Forum (APF). The Connections smart-phone app was offered to both groups. The study examined use of the app and social worker/peer recovery support services by participants who downloaded and used the app; those referred by a justice-related agency and those who self-referred through APF. The app provided primary data, including socio-demographics, referral status, dates of use, activities completed, and BAM scores. RESULTS: The app was offered to 1973 participants, 40% of whom downloaded it. Three groups emerged from among the 350 who used the app: those who used only the cognitive behavioral aspects of the app, those who used only the recovery support services offered, and those who used both the app and recovery support services. Looking at the two referral groups, the justice-referred group preferred telehealth recovery support services with the social worker; the self-referred group used the app and the app plus the recovery support services equally. Scores on the BAM improved across time. Justice-referred participants' protective behaviors improved more than those of the self-referred participants while self-referred participants' risk behaviors improved more than those of justice-referred participants. Older participants were more likely to use the app, and to report fewer risky behaviors, as measured by the BAM. CONCLUSIONS: Use of a digital therapeutic appears to support recovery of participants with SUD although many clients need and want the integration of social worker-driven recovery support services. Basically, the app can be an extension to personal services, but many people with SUD (particularly during COVID-19) crave human interaction. It also appears that those who seek assistance on their own, rather than being referred by a justice-related agency, may be more likely to benefit from digital therapeutics such as the Connections app.

Understanding Impacts of SNAP Fruit and Vegetable Incentive Program at Farmers' Markets: Findings from a 13 State RCT.

Disparities in healthy food access and consumption are a major public health concern. This study reports the findings from a two-year randomized control trial conducted at 77 farmers' markets (FMs) in 13 states and the District of Columbia that sought to understand the impact of fruit and vegetable (FV) incentive vouchers, randomly issued at varied incentive levels to Supplemental Nutrition Assistance Program (SNAP) recipients, for use at FMs. Measures included FV and overall household food purchasing; FV consumption; food insecurity; health status; market expenditure; and demographics. A repeated-measures mixed-effects analysis and the Complier Average Causal Effect (CACE) were used to examine outcomes. Despite 82% reporting food insecurity in the prior year, the findings showed that financial incentives at FMs had statistically significant, positive effects on FV consumption; market expenditures increased with added incentives. SNAP recipients receiving an incentive of USD 0.40 for every USD 1.00 in SNAP spent an average of USD 19.03 per transaction, while those receiving USD 2 for every USD 1 (2:1) spent an average of USD 36.28 per transaction. The data showed that the incentive program at the highest level (2:1) maximally increased SNAP FM expenditure and FV consumption, increasing the latter by 0.31 daily cups among those who used their incentive (CACE model).

Between- and within-Group Differences in Fruit and Vegetable Purchases, Consumption, and BMI among Hispanic Farmers' Market Shoppers Who Use SNAP.

(1) Background: Despite considerable efforts to increase farmers' market access (FM) and improve household fruit and vegetable (FV) purchasing in low-income communities, little is known about the FV purchasing and consumption characteristics of low-income Hispanic farmers' market shoppers. (2) Methods: A secondary analysis of baseline data from a farmers' market study conducted between 2015 and 2017 (n = 2825) was performed. Participants who also received supplemental nutrition assistance program (SNAP) completed a 31-item online survey assessing demographics, health characteristics, and FV purchasing and consumption habits. Descriptive statistics and bivariate analyses were used to assess between- and within-group differences amongst Hispanic and non-Hispanic households. Regression analyses were used to examine associations among BMI, FV purchasing and consumption, and household size for Hispanic and non-Hispanic households as well as for Hispanic subgroups. (3) Results: The sample included 515 Hispanic and 2310 non-Hispanic SNAP-using FM shoppers in 13 states. Despite experiencing significantly higher food insecurity (89% vs. 81%, non-Hispanic), Hispanic shoppers consumed similar amounts of FV (3.04 cups/day) and spent less doing so. Significant subgroup differences were identified for FV purchasing. (4) Conclusions: Findings emphasize the importance of food insecurity and household size in FV interventions and underscore the capacity of Hispanic families to maintain FV consumption.

Impact of Animal Characters at a Zoo Concession Stand on Healthy Food Sales.

OBJECTIVE: The primary objectives of the study were to examine: 1) how increased availability of healthier items at a zoo concession stand affects sales and 2) how animal character marketing on zoo menu boards affects sales revenue. METHODS: An intervention was conducted over an 8-week period. On alternating weeks, zoo animal characters were systematically paired with and removed from healthy food items on a zoo concession menu board. Sales and revenue data were analyzed using frequencies, a Poisson regression model, and a negative binomial regression model, respectively. RESULTS: Newly introduced healthy items represented 8.2% of sales and 4.9% of revenue. Healthy item unit sales were significantly higher (P = .006) during the weeks animal cartoon characters were displayed, although there was no impact on revenue. CONCLUSIONS AND IMPLICATIONS: Findings suggest nonbranded character marketing is a viable strategy for promoting healthy products in family-friendly venues where concessions are sold.