Effects of COVID-19 on Overdose Risk Behaviors Among People Who Inject Drugs in Wisconsin.

BACKGROUND: The United States is currently experiencing the worst epidemic of drug overdose in the country's history. We sought to understand whether changes in drug use behavior and access to prevention services during the COVID-19 pandemic may have contributed to increased drug overdose. METHODS: We recruited adults with a history of injection drug use to complete an online survey during March through June 2021 to assess whether overdose experiences, drug use behaviors, and access to prevention services changed due to the pandemic. RESULTS: Diminished social support during the pandemic was correlated with reporting disrupted access to harm reduction services (P = 0.006) and experiencing an overdose (P = 0.005). Disrupted access to harm reduction services also was correlated with being female (P = 0.03) and reporting feeling pressure to share drugs or equipment (P = 0.01), worrying about withdrawal (P = 0.03), and changes to how and where individuals got their drugs, drug price and availability, with whom and where drugs were used, and the quantity or properties of drugs purchased (all P < 0.01). DISCUSSION: The cumulative impact of COVID-19-related disruptions may have resulted in heightened risk for overdose, as these findings suggest that, in many cases, experiencing one risk factor was suggestive of experiencing several risk factors.

Retrenchment of Wisconsin's Well Woman Program and changes in insurance coverage around the Affordable Care Act.

Since before the Affordable Care Act (ACA), states have partnered with the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to support access to cancer screening and treatment for uninsured/underinsured women. The Wisconsin Well Woman Program (WWWP) was one such program, supporting low-income women across the state. With ACA introduction, Wisconsin substantially downsized/restructured the WWWP, expecting the reduction in services to be offset by the rise in ACA-provided insurance coverage. This study assesses whether retrenchment in the WWWP following the ACA indeed prompted a differential rise in insurance coverage among the program's target population. We use a difference-in-differences (DID) design to contrast changes in county-level, target-population insurance rates, over 2008-2018, in Wisconsin counties previously most served by the WWWP vs those least served, adjusting for systematic differences across counties, including pre-policy trends. Pre-ACA (2011-2013), most-served counties had lower insurance rates by 2.5 percentage points (pp) than least-served counties; WWWP services likely compensated for some of that gap. In 2014-2015, along with WWWP's steep contraction, insurance rates rose sharply across all counties. Our primary DID analysis and event study suggest that WWWP contraction might have differentially driven more insurance take-up in most-served counties, by 1.88 pp [95 % Confidence Interval: 0.23,3.54], thus narrowing the pre-ACA gap. Sensitivity analyses suggest much smaller gains. Notwithstanding such potential insurance gains following program contraction, continued support for care navigation and coordination remain necessary to truly meet the needs of the vulnerable women previously served by the WWWP and similar programs across states.

Improving Health Promotion Through the Integration of Technology, Crowdsourcing, and Social Media.

As Internet accessibility and technological innovations continue to increase communication, new opportunities have emerged to leverage these tools to improve health promotion practice. Advances and utilization of collaborative Internet communication, or social media, have provided global connectivity on an unprecedented scale. Using these innovations to leverage the collective intellect of online communities for specific goals, crowdsourcing is an approach that has the potential to solve complex public health problems. Due to the novelty of crowdsourcing implementations and the relative infancy of its application within public health, it is necessary to examine examples to facilitate practitioner conceptualization and application. This article details the development and application of a crowdsourced effort leveraging social media and technology to assist in relief efforts during Hurricane Harvey. Furthermore, the article presents examples corresponding to a typology of crowdsourcing for public health, including Knowledge Discovery and Management, Distributed Human Intelligence Tasking, Broadcast Search, and Peer-Vetted Creative Production problems. Leveraging these innovative applications has positive implications for health promotion practice, including improved intervention development and evaluation, increased multidisciplinary collaboration, and enhanced facilitation of communication, information exchange, and support.

Advocacy and Public Policy Perceptions and Involvement of College Health Promotion Students.

Understanding the advocacy and public policy training needs of our future health promotion workforce is crucial if we are to prepare them to meet their professional responsibilities. The purpose of this study was to examine health promotion students' advocacy/public policy involvement, training, and perceptions. Electronic surveys were disseminated nationwide to college students in health education and closely related programs. Of 477 student respondents, the most frequently indicated advocacy/public policy activity engaged in was voting (56%). The greatest benefit to advocacy was indicated as creating public awareness, while the most prevalent barrier reported was lack of familiarity with the legislation process. Less than one third of students reported receiving any training; however, training and the number of training sources were associated with greater involvement (p < .05). Comparisons by academic classification indicated that graduate students participated in more advocacy activities and reported significantly more benefits, barriers, knowledge, and self-efficacy compared with undergraduates. Regression analysis indicated that knowledge, self-efficacy, perceived benefits, and total number of training sources were significant predictors of advocacy involvement in both graduate and undergraduate student models, with age also contributing significantly to the graduate student model. Findings emphasize the need for increased training at earlier education levels to increase knowledge, self-efficacy, and advocacy/public policy involvement.