Acceptability and Perceived Utility of Virtual Reality Among People Who Are Incarcerated Who Use Drugs.

People who are incarcerated are at heightened risk of overdose upon community reentry. Virtual reality (VR) may provide an innovative tool for overdose prevention intervention in corrections facilities. This mixed methods study sought to understand incarcerated individuals' perspectives on VR for overdose prevention and explore physiological arousal associated with use of VR equipment. Study participants were 20 individuals, stratified by gender, with an opioid use disorder at a county jail. Qualitative interviews assessed acceptability and perceived utility of VR in the jail setting. Thematic analysis indicated high levels of acceptability and potential utility in the following areas: (a) mental health and substance use interventions, (b) community reentry skills training, and (c) communication and conflict resolution skills. Heart rate variability (HRV) data were collected continuously during the interview and during VR exposure to explore whether exposure to the VR environment provoked arousal. Physiological data analyses showed a significant decrease in heart rate (HR) [b = -3.14, t(18) = -3.85, p < .01] and no arousal as measured by root mean square of successive RR interval differences (RMSSD) [b = -0.06, t(18) = -1.06, p = .30] and high frequency-HRV (HF-HRV) [b = -0.21, t(18) = -1.71, p = .10]. This study demonstrated high acceptability and decreased HR response of VR among incarcerated people who use drugs.

Applications of Immersive Virtual Reality for Illicit Substance Use: A Systematic Review.

OBJECTIVE: This study aims to review applications of immersive, head-mounted display (HMD)-delivered virtual reality (VR) technology for the assessment and modification of clinically relevant factors (e.g., craving, electrophysiological reactions, brain activation) present in illicit substance use. METHOD: A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review was conducted and retrieved articles from four databases. Articles included were peer-reviewed, empirical studies and were screened on criteria pertaining to sample using (or with a history of using) substances and measurement of substance-related factors. RESULTS: Eighteen articles met inclusion criteria. Applications of immersive, HMD-delivered VR in assessment and modification were most prevalent among individuals using (or with a history of using) methamphetamine and targeted subjective craving, electrophysiological biomarkers (e.g., heart rate variability, skin conductance), and brain activity. Environments presented through VR involved substance-relevant cues (e.g., paraphernalia) and neuropsychological assessments. The majority of assessment studies elicited clinically relevant factor(s) present in illicit substance use through VR and all reviewed modification studies effectively reduced clinically relevant factors in methamphetamine and opioid use (e.g., craving, subjective pain). CONCLUSIONS: There is evidence to support the use of immersive, HMD-delivered VR in the assessment and modification of clinically relevant factors in methamphetamine use, as well as preliminary evidence to support its effectiveness for clinically relevant factors in opioid use. Future research should further examine the effectiveness of HMD-delivered VR in modifying illicit substance use and triangulate biomarkers measured in individuals using illicit substances.

An interpretable machine learning framework for opioid overdose surveillance from emergency medical services records.

The goal of this study is to develop and validate a lightweight, interpretable machine learning (ML) classifier to identify opioid overdoses in emergency medical services (EMS) records. We conducted a comparative assessment of three feature engineering approaches designed for use with unstructured narrative data. Opioid overdose annotations were provided by two harm reduction paramedics and two supporting annotators trained to reliably match expert annotations. Candidate feature engineering techniques included term frequency-inverse document frequency (TF-IDF), a highly performant approach to concept vectorization, and a custom approach based on the count of empirically-identified keywords. Each feature set was trained using four model architectures: generalized linear model (GLM), Naïve Bayes, neural network, and Extreme Gradient Boost (XGBoost). Ensembles of trained models were also evaluated. The custom feature models were also assessed for variable importance to aid interpretation. Models trained using TF-IDF feature engineering ranged from AUROC = 0.59 (95% CI: 0.53-0.66) for the Naïve Bayes to AUROC = 0.76 (95% CI: 0.71-0.81) for the neural network. Models trained using concept vectorization features ranged from AUROC = 0.83 (95% 0.78-0.88)for the Naïve Bayes to AUROC = 0.89 (95% CI: 0.85-0.94) for the ensemble. Models trained using custom features were the most performant, with benchmarks ranging from AUROC = 0.92 (95% CI: 0.88-0.95) with the GLM to 0.93 (95% CI: 0.90-0.96) for the ensemble. The custom features model achieved positive predictive values (PPV) ranging for 80 to 100%, which represent substantial improvements over previously published EMS encounter opioid overdose classifiers. The application of this approach to county EMS data can productively inform local and targeted harm reduction initiatives.

A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S.

Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.

Adverse Childhood Experiences, Substance Use, and Self-Reported Substance Use Problems Among Sexual and Gender Diverse Individuals: Moderation by History of Mental Illness.

Recent research has highlighted the alarmingly high rates at which sexual and gender diverse (SGD) individuals experience Adverse Childhood Experiences (ACE). ACE, in turn, are strongly related to mental illness-an important correlate of substance use. The present study explores whether mental illness moderates the relationship between ACE and substance use outcomes among SGD adults. As part of a larger community-based participatory research study, we assessed ACE, self-reported mental illness, and past-year substance use and misuse among a large and diverse sample of SGD community members in South Central Texas (n = 1,282). Multivariate logistic regression models were used to assess relationships between ACE, mental illness, substance use, and substance misuse (DAST > 3). Interaction terms between ACE and history of mental illness were created to assess moderation effects. Cumulative ACE scores were associated with a significantly higher odds of self-reported past year substance use (AOR = 1.43, 95% CI = 1.34-1.54) and substance misuse (AOR = 1.21, 95% CI = 1.11-1.32). History of mental illness was associated with an increased odds of self-reported substance misuse (AOR = 2.07, 95% CI = 1.20-3.55), but not past year substance use. There was a significant interaction of ACE and history of mental illness on the odds of past year substance use (AOR = 0.78, 95% CI = 0.69-0.89), but not for substance misuse. These results provide support for theoretical models linking ACE, mental illness, and substance use among SGD adults. Longitudinal research designs are needed to address temporality of outcomes and test mediation models of trauma, mental illness, and substance use. Future directions for prevention and intervention are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-023-00560-y.

Housing Insecurity and Other Syndemic Factors Experienced by Black and Latina Cisgender Women in Austin, Texas: A Qualitative Study.

Austin, Texas emerged as one of the fastest-growing cities in the U.S. over the past decade. Urban transformation has exacerbated inequities and reduced ethnic/racial diversity among communities. This qualitative study focused on housing insecurity and other syndemic factors among Black and Latina cisgender women (BLCW). Data collection from 18 BLCW using in-depth interviews guided by syndemic theory was conducted three times over three months between 2018 and 2019. Four housing insecurity categories emerged: (a) very unstable, (b) unstable, (c) stable substandard, and (d) stable costly. Participants who experienced more stable housing, particularly more stable housing across interviews, reported fewer instances of intimate partner violence (IPV), less substance use, and a reduced risk of acquiring HIV. Results identified the importance of exploring housing insecurity with other syndemic factors among BLCW along with determining structural- and multi-level interventions to improve housing circumstances and other syndemic factors. Future research should explore these factors in other geographic locations, among other intersectional communities, and among larger sample sizes and consider using a mixed methods approach.

"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.

"If It Didn't Get Reported, It Didn't Happen": Current Nonfatal Overdose Reporting Practices among Nontraditional Reporters in Texas.

Background: Drug overdose deaths in Texas have been accelerating in recent years with an increase of 33% in the 12 months leading up to December 2020. Accurate counts of nonfatal overdoses - including associated aspects of overdose, such as substances involved, demographic information, and reversal agents administered is critical to increase timely and adequate response to individuals and communities in need. Methods: Twenty semi-structured interviews were conducted with harm reduction workers across four Texas counties to understand existing methods of reporting overdoses, naloxone dissemination/administration, and recommendations for improving overdose surveillance. Interviews were transcribed and emergent themes were identified based on the a priori research goals. Results: Findings highlighted a variety of overdose data collection methods and tools among harm reduction organizations including Excel spreadsheet, web-based TONI application, notes on personal cell phones, and paper notes. Types of overdose data collected varied widely. Participants noted existing methods are suboptimal and that there is a need for a unified, statewide reporting system to improve overdose data capture. Participants also highlighted that overdose surveillance should include "hidden populations" of people who use drugs that are not currently counted in surveillance methods as a result of not interacting with the healthcare system. Conclusions: Texas lacks a unified overdose reporting system to capture critical data to inform overdose response and prevention efforts. Nontraditional reporters may be critical toward improving overdose syndromic efforts and capturing data among hard-to-reach populations. Harm reduction organizations are uniquely positioned to facilitate reporting among community gatekeepers and people who use drugs.

Longitudinal Correlates of Suicide Ideation in People who use Drugs during the COVID-19 Pandemic.

Some individuals may be more vulnerable to increased suicide-related thoughts and behavior in response to the COVID-19 pandemic but few studies have investigated risk factors that may be more predictive/specific to particular populations that are established to have a high risk for suicide, including gender differences in risk factors. We conducted a longitudinal study investigating risk factors for suicide ideation during the COVID-19 pandemic in adults who use alcohol and other drugs. Participants completed up to three surveys over a six-month follow-up period. Trait differences in substance use, COVID exposure/worry, trauma exposure, mood and post-traumatic stress disorder symptoms were investigated between individuals who presented with suicide ideation during course of study, compared to those that did not. Interactions with gender was investigated. State-related changes that relate to fluctuations in suicide ideation were also investigated (within subject design). A total of 214 participants were enrolled (61% women, agemean= 33 years, 45% presenting with suicide ideation during the course of the study). Greater frequency of vaping and using tobacco, opiates, and other substances, greater depression, anxiety, and PTSD symptoms, and greater COVID exposure and COVID-related worry were observed in individuals who presented with suicide ideation, compared to those that did not (p ≤ .0042). Increases in suicide ideation (within subject) was associated with increases in the frequency of alcohol and vaping, COVID-related worry, and PTSD symptoms (p ≤ .05). Gender-related differences in factors that relate to suicide ideation was observed. Within women, increases in frequency of alcohol use and PTSD symptoms and greater perceived early life trauma related to suicide ideation; while in men increases in vaping and COVID-related worry related to suicide ideation. This study further emphasizes the importance of investigating and identifying risk/resiliency factors for suicide-related thoughts and behavior in people who use drugs, including gender differences.

Cross-training needs among community-based clinicians in HIV and substance use.

BACKGROUND: People with double burden of HIV and substance use have poorer treatment engagement and worse treatment outcomes. Cross-training of HIV and substance use disorder clinicians can potentially enhance the scale up and quality of integrated care. Research is needed on clinicians' areas of greatest training need in order to inform training development. METHODS: Data from semi-structured individual interviews with 16 HIV and 13 substance use disorder clinicians (N = 29) examining clinician perspectives on their training needs were analyzed using thematic analysis focused on both a priori and emergent subthemes. RESULTS: Several key emergent subthemes were identified across the a priori themes of: 1) past training experiences; 2) gaps in training; and 3) training and supervision format/structure. Both HIV and substance use clinicians reported they had received minimal formal cross-training and had mostly been trained "on the job." Clinicians also emphasized gaps in training regarding sensitivity and anti-stigma, the latest medications for opioid use disorder, and HIV prevention/treatment and referral resources. Regarding training and supervision format, clinicians cited didactic workshops and ongoing supervision as appealing strategies. CONCLUSIONS: Results show that lack of formal and updated training for clinicians is an important gap in providing integrated HIV and substance use treatment. Didactic workshops and ongoing support strategies that address stigma, medications for HIV and substance use disorder, and referral resources are likely to be particularly valuable.

Impact of COVID-19 among people who use drugs: A qualitative study with harm reduction workers and people who use drugs.

BACKGROUND: Fatal drug overdoses in the USA hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. METHODS: Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. RESULTS: Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. CONCLUSIONS: Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.

Comparing Two Databases to Identify Access to Buprenorphine Treatment for Opioid Use Disorder.

OBJECTIVE: The objective of this study is to assess the differences in buprenorphine prescribers from a county level in the state of Texas by comparing the Substance Abuse and Mental Health Services Administration (SAMHSA) Buprenorphine Practitioner Locator to the Drug Enforcement Administration's (DEA) Controlled Substance Act (CSA) database. METHODS: County-level counts of buprenorphine prescribers were calculated from both the publicly available SAMHSA buprenorphine practitioner locator list and the DEA CSA database. These were then used to estimate the number of providers per 100,000 residents in each county. Regional variation in access to buprenorphine was compared descriptively across the state using poverty data from the US Census and county-level demography from the Texas Demographic Center. RESULTS: This study found 68.8% more X-waivered providers on the DEA CSA database (n = 2,622) with at least one provider reported in 125 of 144 counties in the state (49.2%) compared to the SAMHSA Buprenorphine Practitioner Locator (n = 1,553) with at least one provider reported in 103 counties (40.5%). CONCLUSIONS: The lack of a complete public registry of buprenorphine prescribers can inhibit the ability of patients to identify a convenient treatment. More work is needed to quantify the gap between treatment capacity and treatment need.

Ethical by Design: Engaging the Community to Co-design a Digital Health Ecosystem to Improve Overdose Prevention Efforts Among Highly Vulnerable People Who Use Drugs.

Introduction: The COVID-19 pandemic highlighted significant structural barriers that exacerbated health inequities among people at-risk for overdose. Digital health technologies have the potential to overcome some of these barriers; however, development of these technologies often fails to include people who use drugs and community key stakeholders in the development and dissemination process. Consequently, this may exacerbate health inequities and the digital divide among underserved, highly vulnerable people who use drugs. Methods: The current study employed community-engaged research methods to develop and implement a digital platform to improve overdose surveillance among harm reductionists in Texas. We used a co-design process with four community advisory boards (CABs) and conducted qualitative interviews among N = 74 key stakeholders (n = 24 people who use drugs; n = 20 first responders, n = 20 harm reductionists, n = 10 overdose prevention and response experts) to inform initial design and development. Results: Several key themes emerged through the qualitative data pertaining to technical features and human factors applications. In regards to technical features, participants highlighted the importance of developing a unified system of overdose reporting and data sharing among community organizations within a county or region to better inform overdose surveillance and community outreach efforts. This system should include flexible data entry methods, have offline usage capability, be user friendly, and allow for tracking of overdose-related supply distribution. Key human factor themes included the need to use person-centered language, to preserve the established trust of the community organizations among people who use drugs, to be tailored to specific target user groups (e.g., harm reduction workers, people who use drugs, first responders), and maintain transparency of data usage. Further, participants noted the importance of developing a platform that will facilitate client conversations about overdose when doing outreach in the field. These themes were reviewed by our CABs, academic, and industry partners to design an overdose digital platform uniquely tailored to community-based organizations providing harm reduction and overdose response efforts. Discussion: Community engagement throughout the development process is critical toward developing digital health tools for underserved people who use drugs. Dismantling the power structure among academic and industry partners is critical toward creating equity in engagement of community-based partners, particularly among persons with lived experience in addiction, a history of incarceration, or financial challenges. Our study highlights a multisectoral co-design process across community-academic-industry partners to develop a digital health tool tailored to the unique needs of community-based harm reduction organizations serving highly vulnerable people who use drugs. These partnerships are essential toward creating impact and reducing health disparities among highly vulnerable people who use drugs.

Development of a digital platform to improve community response to overdose and prevention among harm reduction organizations.

The overdose crisis in the USA remains a growing and urgent public health concern. Over 108,000 people died due to overdose during 2021. Fatal and non-fatal overdoses are under-reported in the USA due to current surveillance methods. Systemic gaps in overdose data limit the opportunity for data-driven prevention efforts and resource allocation. This study aims to improve overdose surveillance and community response through developing a digital platform for overdose reporting and response among harm reduction organizations. We used a community-engaged, user-center design research approach. We conducted qualitative interviews with N = 44 overdose stakeholders including people who use drugs and harm reductionists. Results highlighted the need for a unified, multilingual reporting system uniquely tailored for harm reduction organizations. Anonymity, data transparency, protection from legal repercussions, data accuracy, and community-branded marketing emerged as key themes for the overdose platform. Emergent themes included the need for real-time data in a dashboard designed for community response and tailored to first responders and harm reduction organizations. This formative study provides the groundwork for improving overdose surveillance and data-driven response through the development of an innovative overdose digital platform.

Impact of COVID-19 Among People Who Use Drugs: A Qualitative Study With Harm Reduction Workers and People Who Use Drugs.

Background: Fatal drug overdoses in the United States hit historical records during the COVID-19 pandemic. Throughout the pandemic, people who used drugs had greater odds of contracting COVID-19, increased drug use due to COVID-related stress, and heightened levels of anxiety and depression. This exploratory qualitative study examined the specific ways the pandemic negatively impacted people who use drugs. Methods: Qualitative interviews with 24 people who use drugs and 20 substance use harm reduction workers were conducted. Data from the qualitative interviews were analyzed using applied thematic analysis to identify emergent themes based on the a priori research goals. Results: Thematic analysis identified several common experiences during the pandemic among people who use drugs. These included mental distress due to financial strain and social isolation; increased drug use; increased risky drug-seeking and use behaviors due to changes in the drug markets; and reduced access to harm reduction, treatment, and recovery support services. Conclusions: Our study highlighted critical systemic failures that contributed to the rise in overdose deaths during the COVID-19 pandemic. Addressing these challenges through policy reform and improved funding models will ensure the sustainability of harm reduction services and increase access to substance use treatment among highly vulnerable people who use drugs.

Improving linkage and retention in treatment among people living with HIV and comorbid substance use.

HIV and substance use interact synergistically to exacerbate disease progression and contribute to poorer engagement in treatment. There is a lack of qualitative research exploring the complexity of systems that impact HIV patients' linkage to and retention in both substance use and HIV care. Data from qualitative individual interviews with 16 HIV and 13 substance use providers were analyzed using applied thematic analysis. Four themes emerged as barriers to linkage to care providers limited knowledge with appropriate referrals; limited access to treatment options within the community; difficult admission criteria to substance use facilities; and communication challenges across providers including power differential. Emergent themes as barriers to treatment retention were: unstable life of people who use drugs; providers' negative attitude and stigma towards patients; and transportation challenges. Interventions are needed to increase provider cross-training in HIV and substance use disorders, reduce barriers to accessing treatment, and improve communication across providers are needed.

Patient and Clinician Perceptions about Remote Video Visits for Musculoskeletal Problems: A Qualitative Study.

BACKGROUND: An understanding of patient and clinician opinions about remote video musculoskeletal consultations might help determine how to increase appeal and utilization. The purpose of this study was to evaluate perceptions of remote video musculoskeletal consultations. Our research questions was what are patient and clinician facilitators and barriers for the use of remote video consultations? METHODS: Prior to the COVID-19 pandemic 27 English speaking adult patients seeking ambulatory care for a musculoskeletal problem, and 10 English-speaking musculoskeletal clinicians were interviewed using a guide. Interviews were audio-recorded, transcribed, and coded using applied thematic analysis. RESULTS: Patient and clinician incentives for remote video consultations included increased convenience, lower costs, less waiting time, and a better experience. Patient and clinician barriers to remote video consultations included concerns about familiarity with technology, lack of personal interaction and physical examination, inability to perform procedures, difficulties with reimbursement (clinicians), as well as technical, logistical, and privacy issues. CONCLUSION: This qualitative study performed prior to the pandemic found that adoption of remote video consultation for musculoskeletal problems may improve with seamless, efficient, and effective care, at an affordable price, particularly if the human connection is similar to what occurs in person.

Parenting in the Midst of Adversity: Tailoring a Culturally Adapted Parent Training Intervention According to the Parenting Experiences of Mexican-Origin Caregivers.

Although parent training (PT) interventions are considered the gold standard for preventing externalizing behaviors in children and youth, their dissemination in low-income Latina/o immigrant communities continues to be scarce throughout the United States (US). An alternative to address this gap in service delivery consists of implementing culturally adapted PT interventions characterized by cultural and contextual relevance. Thus, the main objective of this qualitative study was to document salient immigration-related experiences, as well as parenting needs and challenges, as reported by 30 low-income Mexican-origin immigrant caregivers residing in an urban setting in the Southern United States. The research methodology was guided by the tenets of the Thematic Analysis approach, which involved collecting data through a series of focus group interviews. Qualitative research findings highlight the importance of culturally and contextually tailoring adapted PT prevention interventions, prior to their delivery in contexts that differ from those in which interventions were originally adapted. Specifically, parents in the current investigation provided detailed accounts of immigration-related stressors that are highly relevant to inform recruitment procedures, intervention curriculum, and intervention delivery activities.

Aunque las intervenciones de capacitaciones para padres se consideran la norma de oro para prevenir los comportamientos de externalización en los niños y los jóvenes, su difusión en las comunidades de inmigrantes latinos de bajos recursos continúa siendo escasa en todo Estados Unidos. Una alternativa para minimizar esta brecha en la prestación del servicio consiste en implementar intervenciones de capacitación para padres adaptadas culturalmente que se caractericen por la relevancia cultural y contextual. Por lo tanto, el objetivo principal de este estudio cualitativo fue documentar las experiencias destacadas relacionadas con la inmigración, así como las necesidades y las dificultades de la crianza, según lo informado por 30 cuidadores inmigrantes de origen mexicano y de bajos recursos que viven en un entorno urbano en el sur de EE. UU. La metodología de investigación estuvo guiada por los principios del método del análisis temático, que consistió en recopilar datos mediante una serie de entrevistas a grupos de análisis. Los resultados de la investigación cualitativa destacan la importancia de amoldar culturalmente y contextualmente las intervenciones preventivas y adaptadas de capacitación para padres antes de su implementación en contextos distintos a aquellos a los que fueron adaptadas originalmente. Específicamente, los padres de la investigación actual explicaron detalladamente los factores de estrés relacionados con la inmigración que son sumamente relevantes para preparar los procedimientos de captación, el currículo de intervención y las actividades de implementación de la intervención.

Exploring patterns of substance use among highly vulnerable Black women at-risk for HIV through a syndemics framework: A qualitative study.

Black women who use alcohol, marijuana, and other drugs are disproportionately affected by health disparities. Black women's HIV diagnosis rates are 15 times higher than White women, and is among the leading causes of death among Black women in the US. Previous studies support the association between substance use and HIV risk, yet it is essential to better understand the specific factors experienced within the context of substance misuse and recovery among vulnerable Black women at-risk for substance misuse, HIV, and adverse life experiences. We conducted qualitative interviews with 31 black women (age M = 32.13, range 18-57) four times over six months. Eligible participants were 18+ years, identified as a Black/African-American woman, had unprotected vaginal or anal sex with a man in the past 30 days, and spoke fluent English. All transcripts were transcribed verbatim and were analyzed used thematic content analysis. Two groups of participants emerged: 1) those in recovery from their drug of choice (n = 11, 7 of whom misused alcohol or marijuana during the study), and 2) those who misused their drug of choice during the study (active use group; n = 20). Four themes emerged in the context of substance use: cultural factors, structural factors (i.e., housing and employment), past and present adverse life experiences, and individual factors (i.e., substance use to cope with stress, self-medicating with substances for mental health symptoms, intimate partner violence, and sex exchange). While participants in both groups used substances to cope with regard to these factors, the recovery group tended to use substances at lower frequencies and did not relapse with their drug of choice during the study. The active use group reported more substance use with regard to structural factors and recent adverse life events, had more difficulty regarding employment, and less instances of intimate partner violence (IPV) but were more likely to cope using substances. Substance use interventions tailored to vulnerable Black women should consider including trauma-informed interventions and support groups that address the structural, social, and individual factors to better serve their needs.

Patient and clinician incentives and barriers for opioid use for musculoskeletal disorders a qualitative study on opioid use in musculoskeletal setting.

INTRODUCTION: Strategies for pain alleviation have relied heavily on opioids in the recent decades. One consequence is a crisis of opioid misuse, overdose, and overdose related death. This study sought patient and clinician incentives and barriers to the use of opioids in musculoskeletal illness. METHODS: In this qualitative study, twenty-eight patients and eight clinicians participated in a semi-structured interview seeking incentives and barriers for opioid use and prescription in musculoskeletal illness. Interviews were conducted by a trained qualitative interviewer. The interview data were transcribed and analyzed using a thematic analysis framework. RESULTS: Patient incentives for opioid use included doctor's orders, opioids being the only effective way to alleviate pain, alleviating symptoms of depression and anxiety, being able to keep a job, and lower cost of opioids relative to alternative treatment options. Patient barriers included associated risks (side effects, addiction) and wanting to control pain intensity. Clinician incentives for prescribing opioids included adequate pain alleviation, patient satisfaction, relatively inexpensive costs of opioids, convenience and doing what was taught by the clinician's superior. Lacking time and resources to adequately inform patients on appropriate opioid use and alternative treatments, likely results in more opioid prescribing than arguably necessary. Barriers for opioid prescribing included specific patient characteristics (psychiatric background, history of opioid misuse) and illness characteristics (nature of the injury, medical contra-indications). CONCLUSION: Patients feel that opioids should be used with caution. Clinicians in this study reported a tendency to default to opioids out of habit and convenience. Both patients and clinicians were aware that opioids are often misused to treat emotional pain.