Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (Helping End Addiction Long-Term®) communities study.

BACKGROUND: Scaling up overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD) is needed to reduce opioid overdose deaths, but barriers are pervasive. This study examines whether the Communities That HEAL (CTH) intervention reduced perceived barriers to expanding OEND and MOUD in healthcare/behavioral health, criminal-legal, and other/non-traditional venues. METHODS: The HEALing (Helping End Addiction Long-Term®) Communities Study is a parallel, wait-list, cluster randomized trial testing the CTH intervention in 67 communities in the United States. Surveys administered to coalition members and key stakeholders measured the magnitude of perceived barriers to scaling up OEND and MOUD in November 2019-January 2020, May-June 2021, and May-June 2022. Multilevel linear mixed models compared Wave 1 (intervention) and Wave 2 (wait-list control) respondents. Interactions by rural/urban status and research site were tested. RESULTS: Wave 1 respondents reported significantly greater reductions in mean scores for three outcomes: perceived barriers to scaling up OEND in Healthcare/Behavioral Health Venues (-0.26, 95% confidence interval, CI: -0.48, -0.05, p = 0.015), OEND in Other/Non-traditional Venues (-0.53, 95% CI: - 0.84, -0.22, p = 0.001) and MOUD in Other/Non-traditional Venues (-0.34, 95% CI: -0.62, -0.05, p = 0.020). There were significant interactions by research site for perceived barriers to scaling up OEND and MOUD in Criminal-Legal Venues. There were no significant interactions by rural/urban status. DISCUSSION: The CTH Intervention reduced perceived barriers to scaling up OEND and MOUD in certain venues, with no difference in effectiveness between rural and urban communities. More research is needed to understand facilitators and barriers in different venues.

Associations Between Sexual Minority Status, Hazardous Drinking, and Discrimination Experiences Among Criminal Legal-Involved Adults in the Southern PrEP Cohort (SPECS) Study.

OBJECTIVE: Separately, individuals with criminal legal involvement (CLI) and those who identify as a sexual minority are at heightened risk for experiencing discrimination and engaging in hazardous alcohol use; however, little is known about the prevalence of these experiences and behaviors among sexual minority individuals who also have a history of CLI. METHOD: We examined experiences of discrimination and hazardous alcohol use reported by individuals with CLI and compared prevalence between those who identify as a sexual minority and those who do not. Baseline, cross-sectional data of cisgender sexual minority individuals from a multisite, prospective cohort study examining pre-exposure prophylaxis acceptability and uptake among criminal legal-involved adults were analyzed (N = 362, 14% sexual minority). RESULTS: Hazardous alcohol consumption was nearly twice as prevalent among participants who identified as a sexual minority compared to heterosexual participants, and a sexual minority identity was associated with higher discrimination scores. Additionally, hazardous drinking was more prevalent among those with higher discrimination scores. CONCLUSIONS: This study suggests that sexual minority individuals with a history of CLI are an especially high-risk group given the elevated rates of discrimination and hazardous alcohol use observed. More research is needed to further investigate the risk behaviors of this population and to develop interventions to intervene on their physical and mental health.

Scales for participant Alliance with Recovery Coach (SPARC): initial development and pilot test.

Recovery coaches are individuals with lived experience with recovery from substance use disorder who typically engender a greater sense of trust than found with other types of healthcare providers. However, there currently are no validated tools that measure the connection between recovery coaches and their participants. The purpose of this study was to describe the initial development of the Scales for Participant Alliance with Recovery Coach (SPARC) to measure recovery coach connection or alliance, including initial psychometric analyses. Measurement development began with five scales of the Client Evaluation of Self Treatment (treatment participation, treatment satisfaction, rapport, peer support, and social support). Adapted items were pre-tested with focus groups (n = 8) to ensure they were meaningful and accurately reflected the domains (Study 1). After modifications, the SPARC has six scales (engagement, satisfaction, rapport, motivation and encouragement, role model and community linkage). The survey was piloted with 100 individuals (Study 2) age 18 or over who had met with a recovery coach within the last six months. Most study participants were male (60%) and white (87%) with less than two years in recovery. After removing two low performing items, the items for five of the domains had acceptable internal consistency. The items for the engagement domain had a slightly lower reliability. Findings suggest that items cover relevant recovery coach roles, are internally consistent within domains, and can be easily administered to individuals engaging in recovery coaching services. Additional research is needed with a larger, more heterogenous sample to further refine items.

Cultural Predictors of Self-Esteem Among Black Women With Criminal Justice Involvement and Herpes Simplex Virus.

Black women have disproportionately alarming HSV-2 infection rates yet receive little attention in sexual health literature. Using a strengths-based resilience framework, this study sought to determine culturally relevant protective predictors of self-esteem for Black women who are justice-involved and have HSV-2. The authors conducted secondary data analysis on data from the "Black Women in the Study of Epidemics (B-WISE) Project," a longitudinal prospective study investigating health disparities and health services utilization among Black women with justice involvement. At baseline, N = 151 Black women with HSV-2 who were incarcerated or on probation completed survey measures assessing self-esteem, ethnic identity affirmation and belonging, perceived social support, and John Henryism Active Coping. Hierarchical linear regression analyses revealed ethnic identity affirmation and belonging and John Henryism Active Coping were significant predictors of self-esteem at 6-month follow-up. Implications are provided for current health professionals.

Concordance between Self-Reported Drug Use and Urinalysis in a Sample of Black American Women.

BACKGROUND: Obtaining accurate drug use data is important in the field of substance use research. Urinalysis, considered gold standard, can be costly or infeasible, whereas self-report is quick and easy, but susceptible to imperfect recall or misrepresentation. It is important to determine the concordance between self-report and urinalysis, and better understand the contexts and participant characteristics that influence self-report accuracy. The current study aims to assess this concordance for marijuana and cocaine in a sample of Black American women, some with criminal justice exposure, and to investigate predictors of non-concordance. METHODS: In this longitudinal study, a sample of Black American women were recruited from community, prison, and probation settings. Self-report drug use and urine drug screens were obtained at 6-, 12-, and 18-month follow-ups, allowing for the calculation of concordance. Generalized linear mixed models were used to assess participant characteristics that predicted non-concordance (both false positives and false negatives). RESULTS: In general, there was agreement between self-report and urinalysis results for both marijuana and cocaine. Baseline drug use status was the most consistent predictor of non-concordance. Individuals recruited while on probation were more likely to have false negative results and less likely to have false positive results. Additionally, concordance rates for marijuana increased over the follow-up period. CONCLUSIONS: Self-reported marijuana and cocaine use are accurate measures of actual drug consumption in a sample of Black American women with a variety of criminal justice interactions.

A preliminary examination of substance use risk among metropolitan and non-metropolitan girls involved in the juvenile justice system.

Research is limited on geographic differences in substance use risk factors among juvenile justice-involved girls. This secondary data analysis from one state juvenile justice system, collected as part of the NIH/NIDA funded JJTRIALS cooperative agreement, assessed criminogenic needs at intake for 160 girls from metropolitan and non-metropolitan counties. Although girls from different geographic areas did not differ significantly on key variables of interest, including substance use risk and related criminality variables, findings suggest that substance use risk is related to criminal history, substance-related offenses, and relationship problems among justice-involved girls. Implications include gender-specific juvenile justice programming and research.

African-American Women's Tobacco and Marijuana Use: The Effects of Social Context and Substance Use Perceptions.

BACKGROUND: Despite the status of tobacco and marijuana as two of the most commonly used substances in the U.S., both have detrimental health and social consequences for disfranchized African-Americans. Substance use may be shaped by social contextual influences from families and peers in African-American communities, and little research has examined perceptions of wrongfulness, harms, and dangers associated with daily tobacco and marijuana use among African-American women. OBJECTIVES: This study explores the effects of African-American women's social context and substance use perceptions (wrongfulness/harmfulness/dangerousness) on daily tobacco and marijuana use. METHODS: Survey data was collected in-person from 521 African-American women. Multivariate logistic models identified the significant correlates of women's daily use of tobacco and marijuana in the past six months. RESULTS: 52.59% of participants reported daily tobacco use and 10.56% used marijuana daily. Multivariate models indicated that women were more likely to be daily tobacco users if they had a family member with a substance use problem or perceived tobacco use to be wrong, harmful, or more dangerous than marijuana. In the models with marijuana as the dependent variable, women who lived with a person who used drugs were more likely to use marijuana daily. Perceiving marijuana use as wrong or harmful to one's health was protective against daily marijuana use. CONCLUSIONS: Findings stress the need for prevention and intervention efforts for African-American women that highlight social context influences and promote greater awareness of the health risks associated with daily tobacco and marijuana use.

The Role of Stressful Life Events and Cultural Factors on Criminal Thinking among African American Women Involved in the Criminal Justice System.

African American women are positioned at the intersection of multiple disadvantaged statuses and disproportionately impacted by criminal justice policies, as evinced by their increased likelihood of incarceration. Yet, they continue to be overlooked in mainstream criminological research. Using data from 418 African American women in the B-WISE (Black Women in a Study of Epidemics) project, the current study investigates the relationship between several prominent stressors occurring in five social contexts and criminal thinking as a coping strategy. Findings indicate that criminal thinking may be one maladaptive coping mechanism to manage stressors, such as gendered racism, financial stress, and network loss, that occur across these multiple social contexts for African American women in prison and on probation. Spirituality, on the other hand, seems to operate as a buffer. Implications for practice include promoting programs that strengthen a sense of collective identity in the community, as well as hiring more African American women who could provide additional culturally-competent behavioral health services in criminal justice professions.

African American women and sexually transmitted infections: The contextual influence of unbalanced sex ratios and individual risk behaviors.

This study uses data from 564 African American women to examine the correlates of lifetime prevalence of a sexually transmitted infection (STI). Specifically, we test the effects of perceptions about the availability of African American males, five partner characteristics, and drug history. At the bivariate-level, women with an STI diagnosis were significantly more likely to have dated a man who was married, older, had sex with another man, involved in concurrent partnerships, and had been incarcerated. About half of the participants stated it was difficult to find an eligible African American male and attributed the limited pool of same-race partners to drug trafficking, a lack of monogamy, and high rates of incarceration. Multivariate analyses revealed having dated a man who had concurrent sexual partnerships or had been incarcerated, as well as drug use during sex were positively associated with ever having an STI. Individual and contextual implications are addressed.

Factors associated with two types of child custody loss among a sample of African American mothers: A novel approach.

African American families are overrepresented in the Child Welfare System; however, extant research on this phenomenon has (1) focused mostly on Caucasian or mixed-race samples and (2) has not examined informal custody arrangements alongside official child custody loss. This research addresses these gaps in the literature by examining factors associated with both official and informal child custody loss among a sample of African American mothers. Multinomial regression results show that having ever been incarcerated following a conviction increases the odds of experiencing both types of custody loss relative to no loss. Additionally, mother's experiences of childhood victimization increase the likelihood of informal custody loss relative to no loss, while being older, past year homelessness, number of minor children, being lesbian or bisexual, crack/cocaine use, and more family social support increase the odds of official loss versus no loss. Finally, increases in social support from friends decrease the odds of official loss. Implications are discussed.

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women.

This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.

Ebony and Ivory? Interracial dating intentions and behaviors of disadvantaged African American women in Kentucky.

Using data from 595 predominantly disadvantaged African American women in Kentucky, this study examines perceptions about racial/ethnic partner availability, cultural mistrust, and racism as correlates of interracial dating intentions and behaviors with both white and Hispanic men. Participants reported levels of dating intentions and behaviors were significantly higher with whites than Hispanics. The multivariate models indicate less cultural mistrust and believing it is easier to find a man of that racial/ethnic category were associated with higher interracial dating intentions. Women were more likely to have dated a white man if they believed it was easier to find a white man and had interracial dating intentions; however, interracial dating intentions was the only significant correlate of having dated a Hispanic man. Findings suggest a shrinking social distance between racial groups, broadening the MMPI for African American women; yet, the low levels of interracial relationships are likely driven by preferences of men.

Reducing risky relationships: a multisite randomized trial of a prison-based intervention for reducing HIV sexual risk behaviors among women with a history of drug use.

Women involved in the criminal justice system, particularly those with a history of drug use, are at elevated risk of HIV infection, yet few HIV prevention interventions have been tailored for delivery to incarcerated women. Drawing on the Relational Model, the Reducing Risky Relationships for HIV (RRR-HIV) intervention was developed and evaluated in a multisite randomized clinical trial. Women with weekly drug use prior to incarceration (n = 444) who were incarcerated within correctional institutions in four states were randomized to (1) the RRR-HIV intervention consisting of an HIV educational video, five group sessions, and one postrelease booster session or (2) a control condition consisting of the HIV educational video. The RRR-HIV intervention combined didactic and interactive content regarding seven "thinking myths" about intimate relationships that may result in decisions to engage in risky sexual behaviors. Data were collected while women were still incarcerated and approximately 90 days following release from prison by trained interviewers. A negative binomial regression (NBR) model of unprotected sexual behaviors at the 90-day follow-up indicated that RRR-HIV participants reported fewer unprotected sexual behaviors than women in the control condition once the analysis was adjusted for study site. Future studies should examine the sustainability of the RRR-HIV intervention's effect on risk reduction. Implementation research is needed to determine whether delivery of this intervention by correctional staff or peers, rather than research staff, yields similar reductions in unprotected sexual behaviors.

Examining the associations of racism, sexism, and stressful life events on psychological distress among African-American women.

African-American women may be susceptible to stressful events and adverse health outcomes as a result of their distinct social location at the intersection of gender and race. Here, racism and sexism are examined concurrently using survey data from 204 African-American women residing in a southeastern U.S. urban city. Associations among racism, sexism, and stressful events across social roles and contexts (i.e., social network loss, motherhood and childbirth, employment and finances, personal illness and injury, and victimization) are investigated. Then, the relationships among these stressors on psychological distress are compared, and a moderation model is explored. Findings suggest that racism and sexism are a significant source of stress in the lives of African-American women and are correlated with one another and with other stressful events. Implications for future research and clinical considerations are discussed.

A scoping review: Forced/coerced sterilization as a socio-cultural risk factor for sexually transmitted HIV for older Black women.

Understanding socio-cultural factors that influence older (age 50 and up) Black women's risk for sexually transmitted HIV has often been absent from policies and programs. This scoping review asked: What does academic literature reveal about forced/coerced sterilization as a risk factor for older Black women who are disproportionately affected by sexually transmitted HIV? Using the Arksey and O'Malley scoping review methodology, the authors identified academic and gray literature published between 2000 and 2023. Of the 407 sources identified and screened, three articles met the criteria for inclusion. One study focused on birth control conspiracy beliefs, another focused on racial differences in Norplant use, and the third focused on the intergenerational transmission of mistrust of medical care that influences HIV prevention among Black Americans. The study findings suggest that because the link has not been made between socio-cultural factors that impact older Black women's reproductive health practices, further investigation is warranted.

The influence of familial networks and stigma on prison-based medication initiation for individuals with opioid use disorder: Clinicians' perceptions.

INTRODUCTION: Individuals with criminal legal system (CLS) involvement experience opioid use disorder (OUD) at elevated rates when compared to their non-justice involved counterparts. Medications for opioid use disorder (MOUD) are efficacious but underutilized within this population. Interpersonal relationships and stigma play salient roles in the outcomes of OUD treatment. This study examines prison-based treatment staff perspectives on how familial networks and stigma interact to impact one's decision of whether to initiate MOUD while in prison in Kentucky. METHODS: A coding team analyzed qualitative interviews with prison-based clinicians (n = 23) and administrators (n = 9) collected from the Geographic variation in Addiction Treatment Experiences (GATE) study using NVivo software. The study analyzed excerpts associated with the primary codes of "stigma" and "social networks" and the secondary code of "family" in order to assess the relationship between familial stigma and MOUD initiation from treatment staff viewpoints. RESULTS: Arising themes suggest that clients' families' lack of MOUD knowledge plays a crucial role in perpetuating related stigma, that this stigma often materializes as a belief that MOUD is a continuation of illicit substance use and that stigma levels vary across MOUD forms (e.g., more stigma towards agonists than antagonists). CONCLUSIONS: These findings carry implications for better understanding how intervention stigma within one's familial network impacts prison-based medication initiation decisions. Resulting themes suggest support for continued expansion of efforts by Kentucky Department of Corrections to involve participant families in education and treatment initiatives to reduce intervention stigma and increase treatment utilization.

Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach.

BACKGROUND: The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS: As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS: Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS: This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.

Get It in Writing: How to Make Medications for Opioid Use Disorder Available During Incarceration.

In a case example from the Kentucky HEALing Communities Study, extensive resources were deployed to address structural barriers and facilitate the provision of medication for opioid use disorder (OUD) in an urban county jail. However, implementation was unsuccessful, and this case example emphasizes the importance of including evidence-based medication for OUD (MOUD) treatment in the scope of work of jails' contracted medical providers. The privatization of correctional health care services allows local governments with opioid abatement funds to incorporate requirements into medical provider contracts to screen all people entering jails for OUD and to offer MOUD at intake, throughout incarceration, and upon release to everyone for whom it is clinically indicated. We provide sample contractual language that can be added to requests for medical provider proposals to help drive the private correctional health care market toward integrating MOUD treatment into their standard of care. This approach also could expedite efforts to scale up broad MOUD access across U.S. jails through sharing of workflows and best practices among the small group of national correctional health care companies contracted with jails in states with broad mandates, such as Massachusetts. Clinical Trial Registration: NCT04111939.

Rural and urban clinician views on COVID-19's impact on substance use treatment for individuals on community supervision in Kentucky.

BACKGROUND: The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians' perspectives of COVID-19 on SUD treatment delivery for people on community supervision. METHODS: Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky's Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods. RESULTS: Clinicians were predominantly white (92%) and female (88%) with an average of over 9 years working in the SUD treatment field and 4.6 years in their current job. Four COVID-19 themes were identified by both rural and urban clinicians including: (1) telehealth increases the modes of communication, but (2) also creates paperwork and technological challenges, (3) telehealth requires more effort for inter/intra-agency collaboration, and (4) it limits client information (e.g., no urine drug screens). Two additional rural-specific themes emerged related to COVID-19: (5) increasing telehealth options removes SUD treatment transportation barriers and (6) requires flexibility with programmatic requirements for rural clients. CONCLUSIONS: Findings indicate the need for community-based SUD treatment providers approved or contracted by DOC to support and train clients to access technology and improve information-sharing with community supervision officers. A positive lesson learned from COVID-19 transitions was a reduction in costly travel for rural clients, allowing for greater engagement and treatment adherence. Telehealth should continue to be included within the SUD continuum of care, especially to promote equitable services for individuals from rural areas.

Equity of overdose education and naloxone distribution provided in the Kentucky HEALing Communities Study.

Background: Opioid overdoses differentially affect demographic groups. Strategies to reduce overdose deaths, specifically overdose education and naloxone distribution (OEND), are not consistently delivered equitably. Methods: The HEALing Communities StudySM (HCS) is a cluster-randomized trial designed to implement evidence-based practices, including OEND, to reduce overdose deaths across communities. Individuals receiving OEND in eight Kentucky counties between January 2020 and June 2022 provided demographics and overdose history. Recipient characteristics were compared to opioid overdose decedent characteristics to evaluate whether OEND was equitably delivered to the target population. Recipient characteristics were also analyzed based on whether OEND was delivered in criminal justice, behavioral health, or health care facilities. Results: A total of 26,273 demographic records were analyzed from 137 partner agencies. Most agencies were in behavioral health (85.6 %) or criminal justice sectors (10.4 %). About half of OEND recipients were male (50.6 %), which was significantly lower than the 70.3 % of overdose decedents who were male, (p<0.001). OEND recipients tended to be younger than overdose decedents, but there were not significant differences in race/ethnicity between OEND recipients and overdose decedents. Over 40 % of OEND recipients had overdosed, and 68.9 % had witnessed a prior overdose. There were notable differences across facility types, as males and Black individuals accounted for fewer OEND recipients in addiction treatment facilities compared to jails. Conclusion: Although OEND recipients' demographics resembled those of decedents, specific attention should be paid to ensuring equitable OEND access. Variation in OEND uptake by facility type may reflect biases and barriers to care.