"We do it ourselves": strengths and opportunities for improving the practice of harm reduction.

BACKGROUND: Unprecedented increases in substance-related overdose fatalities have been observed in Texas and the U.S. since the onset of the COVID-19 pandemic and have made clear there is considerable need to reduce harms associated with drug use. At the federal level, initiatives have called for widespread dissemination and implementation of evidence-based harm reduction practices to reduce overdose deaths. Implementation of harm reduction strategies is challenging in Texas. There is a paucity of literature on understanding current harm reduction practices in Texas. As such, this qualitative study aims to understand harm reduction practices among people who use drugs (PWUD), harm reductionists, and emergency responders across four counties in Texas. This work would inform future efforts to scale and spread harm reduction in Texas. METHODS: Semi-structured qualitative interviews were conducted with N = 69 key stakeholders (25 harm reductionists; 24 PWUD; 20 emergency responders). Interviews were transcribed verbatim, coded for emergent themes, and analyzed using Applied Thematic Analysis with Nvivo 12. A community advisory board defined the research questions, reviewed the emergent themes, and assisted with interpretation of the data. RESULTS: Emergent themes highlighted barriers to harm reduction at micro and macro levels, from the individual experience of PWUD and harm reductionists to systemic issues in healthcare and the emergency medical response system. Specifically, (1) Texas has existing strengths in overdose prevention and response efforts on which to build, (2) PWUD are fearful of interacting with healthcare and 911 systems, (3) harm reductionists are in increasing need of support for reaching all PWUD communities, and (4) state-level policies may hinder widespread implementation and adoption of evidence-based harm reduction practices. CONCLUSIONS: Perspectives from harm reduction stakeholders highlighted existing strengths, avenues for improvement, and specific barriers that currently exist to harm reduction practices in Texas.

The Challenges of Public Health Leadership

There he led the merger of Meharry's Hubbard Hospital with the city of Nashville's public general hospital.1 In 1993, after serving as an advisor during the development of President Bill Clinton's health plan, Satcher became the first African American to head the Centers for Disease Control and Prevention (CDC). Published in the New England Journal of Medicine, the study showed that having a gun in the home was associated with a substantially higher risk of homicide by a family member or intimate partner.2 Ultimately, Congress reduced funding for the CDC's injury prevention center and prohibited it from spending money to "advocate or promote gun control. "3 During the administration of President George W. Bush, Satcher found himself out of favor after issuing a report on sexual health that criticized abstinence-only educational programs and acknowledged that safe sex could occur outside of a marriage.4 CONCLUSION Satcher's book might have been made more powerful with a thorough discussion of the obstacles he faced during the 1990s and early 2000s, an era in which growing party polarization shaped the implementation of public health policies in important ways.

Public perceptions of the role of government and nonstate actors in responding to COVID-19.

In this article, we examine public perceptions of the importance of different levels of government and of nongovernmental entities in responding to the COVID-19 pandemic. By analyzing the case of COVID-19, we illuminate patterns that may be helpful for understanding public perceptions of the response to a broader range of crises, including the impacts of hurricanes, tornadoes, earthquakes, wildfires, and other hazards. We contribute to the public policy literature on public perceptions of government response to crises and expand it to include consideration of the role of nonstate actors. Drawing on a representative survey of 1200 registered voters in Texas, we find that individuals are more likely to view government as extremely important to respond to the pandemic than nonstate actors. We find that perceptions of the role of state and nonstate actors are shaped by risk perception, political ideology and religion, gender, and race/ethnicity. We do not find evidence that direct impacts from the COVID-19 pandemic consistently shape perceptions of the role of state and nonstate actors.

En este artículo, examinamos la percepción pública sobre la importancia de los diferentes niveles de gobierno y de las entidades no gubernamentales en la respuesta a la pandemia de COVID­19. Al analizar el caso de COVID­19, esperamos resaltar patrones que podrían ser útiles para comprender las percepciones públicas de la respuesta a una gama más amplia de crisis, incluidos los impactos de huracanes, tornados, terremotos, incendios forestales y otros peligros. Contribuimos a la literatura de políticas públicas sobre las percepciones públicas de la respuesta del gobierno a las crisis y la ampliamos para incluir la consideración del papel de los actores no estatales. Basándonos en una encuesta representativa de 1,200 votantes registrados en Texas, encontramos que es más probable que las personas vean al gobierno como algo extremadamente importante para responder a la pandemia que los actores no estatales. Encontramos que las percepciones del papel de los actores estatales y no estatales están determinadas por la percepción del riesgo, la ideología política y la religión, el género y la raza / etnia. No encontramos evidencia de que los impactos directos de la pandemia de COVID­19 moldeen consistentemente las percepciones del rol de los actores estatales y no estatales.

The challenges of modeling and forecasting the spread of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has placed epidemic modeling at the forefront of worldwide public policy making. Nonetheless, modeling and forecasting the spread of COVID-19 remains a challenge. Here, we detail three regional-scale models for forecasting and assessing the course of the pandemic. This work demonstrates the utility of parsimonious models for early-time data and provides an accessible framework for generating policy-relevant insights into its course. We show how these models can be connected to each other and to time series data for a particular region. Capable of measuring and forecasting the impacts of social distancing, these models highlight the dangers of relaxing nonpharmaceutical public health interventions in the absence of a vaccine or antiviral therapies.

Impact of social distancing during COVID-19 pandemic on crime in Los Angeles and Indianapolis.

Governments have implemented social distancing measures to address the ongoing COVID-19 pandemic. The measures include instructions that individuals maintain social distance when in public, school closures, limitations on gatherings and business operations, and instructions to remain at home. Social distancing may have an impact on the volume and distribution of crime. Crimes such as residential burglary may decrease as a byproduct of increased guardianship over personal space and property. Crimes such as domestic violence may increase because of extended periods of contact between potential offenders and victims. Understanding the impact of social distancing on crime is critical for ensuring the safety of police and government capacity to deal with the evolving crisis. Understanding how social distancing policies impact crime may also provide insights into whether people are complying with public health measures. Examination of the most recently available data from both Los Angeles, CA, and Indianapolis, IN, shows that social distancing has had a statistically significant impact on a few specific crime types. However, the overall effect is notably less than might be expected given the scale of the disruption to social and economic life.