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1.
Harm Reduct J ; 21(1): 79, 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38589920

RESUMO

People who nonmedically use drugs (PWUD) face intricate social issues that suppress self-actualization, communal integration, and overall health and wellness. "Strengths-based" approaches, an under-used pedagogy and practice in addiction medicine, underscore the significance of identifying and recognizing the inherent and acquired skills, attributes, and capacities of PWUD. A strengths-based approach engenders client affirmation and improves their capacity to reduce drug use-related harms by leveraging existing capabilities. Exploring this paradigm, we conducted and analyzed interviews with 46 PWUD who were clients at syringe services programs in New York City and rural southern Illinois, two areas with elevated rates of opioid-related morbidity and mortality, to assess respondents' perceived strengths. We located two primary thematic modalities in which strengths-based ethos is expressed: individuals (1) being and advocate and resource for harm reduction knowledge and practices and (2) engaging in acts of continuous self-actualization. These dynamics demonstrate PWUD strengths populating and manifesting in complex ways that both affirm and challenge humanist and biomedical notions of individual agency, as PWUD refract enacted, anticipated, and perceived stigmas. In conclusion, programs that blend evidence-based, systems-level interventions on drug use stigma and disenfranchisement with meso and micro-level strengths-based interventions that affirm and leverage personal identity, decision-making capacity, and endemic knowledge may help disrupt health promotion cleavages among PWUD.


Assuntos
Usuários de Drogas , Transtornos Relacionados ao Uso de Substâncias , Humanos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Atitude , Redução do Dano
4.
J Addict Med ; 17(5): 500-502, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37788599

RESUMO

ABSTRACT: Ongoing assessments by climate scientists, including a recent report from the United Nations' Intergovernmental Panel on Climate Change, punctuate the pronounced effect that climate change is poised to have in the near future on the health and well-being of humans-particularly those with low socioeconomic status-throughout the world. To this end, to date, very limited scholarly attention has been placed on the effects that climate change may have on people who use drugs (PWUDs), in particular those with opioid use disorder, and assessed their structural and social determinants of climate change vulnerability. Since COVID-19, which has key lessons to offer on climate change's potential effects on PWUDs, the opioid epidemic has been rapidly accelerating in terms of its socioeconomic, racial, and geographic reach. The opioid epidemic has been further deepened by increasing fentanyl contamination and co-use with stimulants such as methamphetamine and (crack) cocaine, spurring a heavy increase in overdose deaths. These trends highlight a looming confrontation between the world's complex overdose crisis and its equally intensifying climate emergency. This piece contextualizes the specter of harms that climate change is likely to cultivate against PWUDs and offers strategies for mitigation.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Humanos , Analgésicos Opioides/efeitos adversos , Mudança Climática , Epidemia de Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Fentanila , Overdose de Drogas/epidemiologia
5.
Soc Sci Med ; : 116251, 2023 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-37865583

RESUMO

Research focused on health disparities-whether relating to one's race/ethnicity, gender expression, sexual orientation, citizenship status, income level, etc.-constitutes a large, generative, and highly profitable portion of scholarship in academic, clinical, and government settings. Health disparities research is expressed as a means of bringing greater attention to, and ultimately addressing via evidence-based implementation science, acts of devaluation and oppression that have continually contributed to these inequities. Philosophies underlying health disparities research's expansive and growing presence mirror the formal logic and ethos of the Military Industrial Complex and the Prison Industrial Complex. The "Health Disparities Research Industrial Complex," operationalized in this article, represents a novel mutation and extension of these complexes, primarily being enacted through these three mechanisms: 1) The construction and maintenance of beliefs, behaviors, and policies in healthcare, and society more broadly, that create and sustain disadvantages in minority health; 2) the creation and funding of research positions that inordinately provide non-minoritized people and those without relevant lived experiences the ability to study health disparities as "health equity tourists"; and 3) the production of health disparities research that, due to factors one and two, is incapable of fully addressing the disparities. In this piece, these and other core elements of the Health Disparities Research Industrial Complex, and the research bubble that it has produced, are discussed. Additionally, strategies for reducing the footprint and impact of the Health Disparities Research Industrial Complex and better facilitating opportunities for meaningful implementation in the field are presented.

8.
J Racial Ethn Health Disparities ; 10(1): 418-426, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35041153

RESUMO

BACKGROUND: There is little research on lead (Pb) screening behaviors and outcomes and possible health sequelae of children in Flint, Michigan in the years following the city's 2014 water crisis, which included widespread tap water contamination with elevated levels of heavy metals and other environmental contaminants. METHODS: Between June and November 2019, we collected and analyzed cross-sectional data on Flint children's demographics and self-report of screenings of blood lead levels (BLLs) and results and various potential water contamination-related health symptoms and outcomes. We calculated descriptive statistics to summarize the prevalence of health outcomes and screenings in children, and fit multivariable models using generalized estimating equations to characterize the association between baseline traits and health symptoms and outcomes in children. RESULTS: A total of 244 children (mean age 8.6 ± 4.8) were included in the analysis. Overall, 76.6% of the children were reported to have been screened for elevated BLLs after the water source switch. In total, after the water source switch, 25.0% of children were reported as having clinician-diagnosed elevated BLLs. Overall, 43.9% of children experienced hyperactivity, 39.3% had emotional agitation, 29.1% had comprehension issues/learning delays, while 38.9% of children had skin rashes and 10.7% experienced hair loss. A child having elevated BLLs also significantly increased the odds of experiencing adverse cognitive/behavioral outcomes (comprehension issues/learning delays OR = 4.0, hyperactivity OR = 6.6, emotional agitation OR = 3.5). CONCLUSION: Child BLL screening following the crisis initiation was moderate, and BLLs and potential water contamination-related morbidity outcomes appeared heightened. Further research is needed to contextualize epidemiologic factors contributing to BLL screening patterns and results and the potential water contamination-associated sequelae observed here.


Assuntos
Intoxicação por Chumbo , Chumbo , Humanos , Criança , Pré-Escolar , Adolescente , Água , Intoxicação por Chumbo/diagnóstico , Intoxicação por Chumbo/epidemiologia , Estudos Transversais , Avaliação de Resultados em Cuidados de Saúde
9.
J Gen Intern Med ; 38(1): 98-106, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35731368

RESUMO

BACKGROUND: Women who use drugs (WWUD) have low rates of contraceptive use and high rates of unintended pregnancy. Drug use is common among women in rural U.S. communities, with limited data on how they utilize reproductive, substance use disorder (SUD), and healthcare services. OBJECTIVE: We determined contraceptive use prevalence among WWUD in rural communities then compared estimates to women from similar rural areas. We investigated characteristics of those using contraceptives, and associations between contraceptive use and SUD treatment, healthcare utilization, and substance use. DESIGN: Rural Opioids Initiative (ROI) - cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020); National Survey on Family Growth (NSFG) - nationally-representative U.S. household reproductive health survey (2017-2019). PARTICIPANTS: Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use; fecundity determined by self-reported survey responses. MAIN MEASURES: Unweighted and RDS-weighted prevalence estimates of medical/procedural contraceptive use; chi-squared tests and multi-level linear regressions to test associations. KEY RESULTS: Of 855 women in the ROI, 36.8% (95% CI 33.7-40.1, unweighted) and 38.6% (95% CI 30.7-47.2, weighted) reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use (aOR 1.50 [95% CI 1.08-2.06]). There was a positive association between contraception use and recent medications for opioid use disorder (aOR 1.34 [95% CI 0.95-1.88]) and prior 6-month primary care utilization (aOR 1.32 [95% CI 0.96-1.82]) that did not meet the threshold for statistical significance. CONCLUSION: WWUD in rural areas reported low contraceptive use; those who recently received SUD treatment had greater odds of contraceptive use. Improvements are needed in expanding reproductive and preventive health within SUD treatment and primary care services in rural communities.


Assuntos
Anticoncepção , População Rural , Gravidez , Feminino , Humanos , Estudos Transversais , Anticoncepcionais/uso terapêutico , Aceitação pelo Paciente de Cuidados de Saúde
10.
Soc Sci Med ; 314: 115464, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36327635

RESUMO

The consequences of environmental disasters and other ecologic and communal crises are frequently worst in racially/ethnically minoritized and low-income populations relative to other groups. This disproportionality may create or deepen patterns of governmental distrust and stoke health promotion disengagement in these groups. To date, there has been limited contextualization of how historically disenfranchised populations utilize government-administered or facilitated resources following such disasters. Focusing on the water crisis in Flint, Michigan, we examine and theorize on the usage of neo public assistance, free risk reduction resources that are provided to disaster survivors as a liminal means of redressing ills created and/or insufficiently mitigated by the state. We surveyed 331 Flint residents, evaluating their usage of four neo public assistance resources following the FWC, finding low to moderate uptake: 131 residents (39.6%) indicated that they obtained blood lead level (BLL) screenings, 216 (65.3%) had their tap water tested for lead (Pb) and other contaminants, 137 (41.4%) had their home water infrastructure replaced, and 293 (88.5%) had acquired bottled water at community distribution sites. Unemployment, receiving public benefits, and lacking reliable transportation and stable housing were associated with lower uptake of some resources. Compared to White and "Other" race individuals, Black residents were generally more likely to acquire/utilize these resources, suggesting heightened concerns and health promotion proclivities even in the face of observed macro and individual-level challenges. Potential reasons and implications are discussed.


Assuntos
Desastres , Chumbo , Humanos , Assistência Pública , Comportamento de Redução do Risco , Água
11.
J Environ Manage ; 320: 115886, 2022 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-36056493

RESUMO

A Critical Race Theory of Environmental Disaster can aid researchers in better contextualizing racially disproportionate environmental disasters and their intricate social meanings to survivors. Such a theory, as proposed and operationalized here, incorporates interpretations of the causes and consequences of environmental disaster. In so doing, this theory weighs the racial and economic stratification often preceding environmental disaster and that which reflexively becomes more embedded in the aftermath. Focusing on the water crisis in the racially diverse, socioeconomically diminished city of Flint, Michigan, this article examines survey data from research conducted with city residents. The analysis considers residents' attitudes and beliefs around the crisis' scope and its intentionality and residents' health outcomes. Results suggest that various institutional and community-level mechanisms contribute to processes of meaning-making during crisis, or "crisis-making," finding consistent variation in residents' understanding of the nature and scope of the water crisis that is associated with specific cultural and health-related experiences. This construction substantiates that a Critical Race Theory of Environmental Disaster must consider not only race, but class in the context of race, as instrumental in developing social understandings of, and experiences with, environmental disaster.


Assuntos
Desastres , Água , Cidades , Percepção , Inquéritos e Questionários
12.
J Aging Stud ; 61: 101023, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35654549

RESUMO

As the overall U.S. population grows older and increasingly diverse, greater focus is needed on the various Home and Community-Based Services (HCBS), such as home health care, case management, meal delivery and preparation, and personal care, required to address the unique social and medical complexities of diverse older adults. Presently, however, there has been limited research on needs and broader dynamics associated with HCBS facilitation in this population. To address this gap, we sought to contextualize practices and barriers to care coordination for diverse homebound older adults, conducting semi-structured interviews with 41 providers of HCBS, including older adult care coordinators, in-home care workers, and physicians in greater Chicago, Illinois. Common care coordination practices included fluid processes related to engendering racial concordance in care, facilitating linguistic adaptations, and navigating relationships with clients' families. However, in certain circumstances, these practices are hindered. For example, broad client-level challenges included racialized dynamics of distrust and limited health literacy, and organizations cited ongoing obstacles recruiting and retaining diverse staff and finding HCBS providers to service low-income, minority communities often burdened by high crime rates. Continued efforts need to be made to better understand the HCBS needs of diverse homebound older adults and the associated challenges of providing culturally humble programming to this population.


Assuntos
Serviços de Saúde Comunitária , Serviços de Assistência Domiciliar , Idoso , Visita Domiciliar , Humanos , Grupos Raciais , Seguridade Social
14.
J Community Psychol ; 50(1): 385-408, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34115390

RESUMO

Stigma is a fundamental driver of adverse health outcomes. Although stigma is often studied at the individual level to focus on how stigma influences the mental and physical health of the stigmatized, considerable research has shown that stigma is multilevel and structural. This paper proposes a theoretical approach that synthesizes the literature on stigma with the literature on scapegoating and divide-and-rule as strategies that the wealthy and powerful use to maintain their power and wealth; the literatures on racial, gender, and other subordination; the literature on ideology and organization in sociopolitical systems; and the literature on resistance and rebellion against stigma, oppression and other forms of subordination. we develop a model of the "stigma system" as a dialectic of interacting and conflicting structures and processes. Understanding this system can help public health reorient stigma interventions to address the sources of stigma as well as the individual problems that stigma creates. On a broader level, this model can help those opposing stigma and its effects to develop alliances and strategies with which to oppose stigma and the processes that create it.


Assuntos
Transtornos Mentais , Saúde Pública , Humanos , Bode Expiatório , Estigma Social
15.
Res Aging ; 44(3-4): 323-333, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34291677

RESUMO

OBJECTIVE: Non-medical services care coordination for daily activities of living is crucial in improving older adults' health and enabling them to age in place, but little is known about specific practices and barriers in this space. METHODS: Semi-structured interviews were conducted with 41 professionals serving older adults in greater Chicago, Illinois-which consists of diverse urban, suburban, and semi-rural communities-to contextualize non-medical services needs and care coordination processes. RESULTS: In-home care, home-delivered meals, non-emergency transportation, and housing support were cited as the most commonly needed services, all requiring complex coordination support. Respondents noted a reliance on inefficient phone/fax usage for referral-making and cited major challenges in inter-professional communication, service funding/reimbursement, and HIPAA. CONCLUSIONS: Non-medical services delivery for older adults is severely impacted by general siloing throughout the care continuum. Interventions are needed to enhance communication pathways and improve the salience and interdisciplinarity of non-medical services coordination for this population.


Assuntos
Serviços de Assistência Domiciliar , Idoso , Habitação , Humanos , População Rural
16.
Health Place ; 69: 102578, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33964805

RESUMO

Research suggests that the built environment is associated with drug use. However, there is limited scholarship focusing on specific features of the built environment that influence drug use behaviors, experiences, and patterns and how risk factors for drug use are placed in distinctive urban and rural settings. Applying Neely and Samura's conceptual theory that describes space as contested, fluid and historical, interactional and relational, and defined by inequality and difference, we assessed data from semi-structured qualitative interviews conducted between 2019 and 2020 with consumers at syringe exchange programs (SEPs) in an urban location (New York City) and a rural location (southern Illinois). We aimed to contextualize how drug use manifests in each space. In total, 65 individuals, including 59 people who use drugs (PWUD) and six professionals who worked with PWUD, were interviewed. Findings illustrate that, in both the urban and rural setting, the built environment regulates the drug use milieu by mediating social reproduction, namely the degree of agency PWUD exert to acquire and use drugs where they desire. Processes of "stigma zoning," defined as socio-spatial policing of boundaries of behavior deemed undesirable or deviant, impacted PWUD's socio-geographic mobility, social conditions, and resource access, and modulated PWUD's broader capacity and self-efficacy. Similar patterns of drug use, according to social and economic inequities chiefly related to housing instability, were further observed in both settings.


Assuntos
Ambiente Construído , Preparações Farmacêuticas , Atitude Frente a Saúde , Humanos , População Rural , Estigma Social
17.
Lancet Planet Health ; 5(5): e309-e315, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33964240

RESUMO

COVID-19 is unique in the scope of its effects on morbidity and mortality. However, the factors contributing to its disparate racial, ethnic, and socioeconomic effects are part of an expansive and continuous history of oppressive social policy and marginalising geopolitics. This history is characterised by institutionally generated spatial inequalities forged through processes of residential segregation and neglectful urban planning. In the USA, aspects of COVID-19's manifestation closely mirror elements of the build-up and response to the Flint crisis, Michigan's racially and class-contoured water crisis that began in 2014, and to other prominent environmental injustice cases, such as the 1995 Chicago (IL, USA) heatwave that severely affected the city's south and west sides, predominantly inhabited by Black people. Each case shares common macrosocial and spatial characteristics and is instructive in showing how civic trust suffers in the aftermath of public health disasters, becoming especially degenerative among historically and spatially marginalised populations. Offering a commentary on the sociogeographical dynamics that gave rise to these crises and this institutional distrust, we discuss how COVID-19 has both inherited and augmented patterns of spatial inequality. We conclude by outlining particular steps that can be taken to prevent and reduce spatial inequalities generated by COVID-19, and by discussing the preliminary steps to restore trust between historically disenfranchised communities and the public officials and institutions tasked with responding to COVID-19.


Assuntos
Negro ou Afro-Americano , Desastres , Exposição Ambiental , Disparidades em Assistência à Saúde , Saúde Pública , Cidades , Humanos , Características de Residência , Determinantes Sociais da Saúde , Marginalização Social , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Populações Vulneráveis
18.
J Urban Health ; 98(5): 642-653, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33788147

RESUMO

Little is known about the physical and mental health outcomes of adults in the low-income, predominantly Black city of Flint, Michigan, following the city's water crisis which began in April 2014 after austerity policies led to the city switching its water source. We investigate these dynamics using data from a longitudinal community-based cohort in Flint. Between June and November 2019, surveys were administered at nine public sites across Flint. Nested models were employed to assess relationships between respondent demographics, including race/ethnicity, and self-report of clinician-diagnosed blood lead levels (BLLs) and various physical symptoms and mental health outcomes, including depression/anxiety (PHQ-4) and psychological trauma (PC-PTSD-5). Of the 331 respondents (mean age: 47.9 + 16.5), most were women (58.6%) and Black (57.7%). In total, 10.0% self-reported elevated BLLs, with borderline significantly higher reports among Blacks (p = 0.07). Skin rashes (58.1% vs. 33.9%, p < 0.01), hair loss (45.5% vs. 30.3%, p = 0.01), and nausea (35.6% vs. 20.2%, p = 0.1) were significantly higher among Blacks versus Whites. Additionally, 29.0% and 26.3% of respondents met trauma and depression/anxiety criteria, respectively. Increasing physical symptoms was associated with psychological trauma (OR 2.1, p < 0.01) and depression/anxiety (OR 1.9, p < 0.01). In closing, Flint adults, particularly Blacks, experienced deleterious physical and mental health outcomes following the city's water crisis that appear to represent a substantial burden of excess cases. Further research is needed on how austerity impacts community health in economically distressed urban cities and ways to generate capacity to identify and curb adverse consequences.


Assuntos
Chumbo , Água , Adulto , Feminino , Humanos , Michigan/epidemiologia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Autorrelato , Abastecimento de Água
19.
Ethn Health ; 26(6): 863-878, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-30870001

RESUMO

Objectives: There is a growing burden of HIV and sex-related diseases in South Asia and India. Sociological research illustrates that key axes of social stratification, such as race and ethnicity, affect social network structure which, in turn, impacts sexual health and wellbeing. Research on networks has increasingly begun to examine the ways in which networks drive or harness sexual behaviors, but has largely neglected the influence of culture and cultural markers in this continuum. Furthermore, much of the existing scholarship has been conducted in the U.S. or in Western contexts.Design: As part of an exploratory effort, we examined how skin color and body mass index (BMI) affected networks among 206 men who have with men (MSM) frequenting sex markets in Hyderabad, India. A novel phone-based network generation method of respondent-driven sampling was used for recruitment. In assessing how skin color and BMI drive these structures, we also compared how these factors contribute to networks relative to two more commonly referenced markers of social difference among Indians, caste and religion.Results: Our findings suggest that skin color and BMI contribute significantly more to network structure than do caste and religion.Conclusions: These findings tentatively illuminate the importance of individual-level heterogeneity in bodily attributes, factors which are seldom considered in conventional approaches to researching how social stratification and health inequalities are animated during the formation of networks.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Índice de Massa Corporal , Homossexualidade Masculina , Humanos , Masculino , Comportamento Sexual , Pigmentação da Pele , Rede Social , Apoio Social
20.
Trauma Violence Abuse ; 22(3): 571-587, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-31416406

RESUMO

Research conducted with violent offenders demonstrates an overwhelming tendency for individuals in this population to frame their violent acts as tuned responses to perceived slights ranging from verbal insults to ostensibly nonviolent physical actions. To date, no review has characterized and categorized specific situational cues that are associated with interpersonal violence/ideation. Here, literature addressing attitudes, attributions, and triggers around reactive forms of violence and perspectives on violence deservedness was thematically and narratively reviewed using a theoretical framework focused on shame and threatened social bonds. Of the 29 articles that met the inclusion criteria, 11 statistically assessed relationships between attributions, attitudes, or triggers and subsequent violence/ideation, with 10 (90.1%) demonstrating, in subgroup analysis, statistically greater attitudes endorsing violence when shame or a threat to a social bond manifested. Overall, three primary axes of attribution, attitudes, or triggers toward interpersonal violence emerged from the review: (1) generalized intrapersonal justifications, (2) environmental and social group triggers, and (3) jealousy and triggers in the context of romantic relationships. These dynamics, both inside and outside of the United States, are reviewed, and a conceptual intervention model is presented. Findings illustrate that behavioral interventions specifically targeting individual- and community-level pathways to shame manifestation and emotion regulation represent an underutilized yet auspicious approach to curbing violence ideation and perpetration.


Assuntos
Relações Interpessoais , Violência , Atitude , Humanos , Fatores de Risco , Estados Unidos , Violência/psicologia
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