Voluntary Smoke-Free Measures Among Oklahoma Nightlife Owners: Barriers and Facilitators.

Smoke-free policies prevent exposure to secondhand smoke and encourage tobacco cessation. Local smoke-free policies that are more comprehensive than statewide policies are not allowed in states with preemption, including Oklahoma, which has the sixth highest smoking prevalence in the United States. In states with preemption, voluntary smoke-free measures are encouraged, but little research exists on venue owners' and managers' views of such measures, particularly in nightlife businesses such as bars and nightclubs. This article draws from semistructured interviews with 23 Oklahoma bar owners and managers, examining perceived risks and benefits of adopting voluntary smoke-free measures in their venues. No respondents expressed awareness of preemption. Many reported that smoke-free bars and nightclubs were an inevitable societal trend, particularly as younger customers increasingly expected smoke-free venues. Business benefits such as decreased operating and cleaning costs, improved atmosphere, and employee efficiency were more convincing than improved employee health. Concerns that voluntary measures created an uneven playing field among venues competing for customers formed a substantial barrier to voluntary measures. Other barriers included concerns about lost revenue and fear of disloyalty to customers, particularly older smokers. Addressing business benefits and a level playing field may increase support for voluntary smoke-free nightlife measures.

Transition to a 1-year deferral for male blood donors who report sexual contact with men: staff perspectives at one blood collection organization.

BACKGROUND: Front-line staff at blood collection organizations (BCOs) play important roles in keeping the blood supply safe, yet research on their professional practice and perspectives on training needs is sparse. This qualitative study explored these topics with regard to the then-impending change in donor eligibility for men reporting sex with another man (MSM). STUDY DESIGN AND METHODS: Semistructured, individual interviews with BCO staff (n = 13) in Northern California covered experiences of and opinions on indefinite deferral, the revised 1-year deferral, and anticipated potential challenges arising from the new policy. Transcripts were thematically coded, using deductive and inductive approaches. Analysis identified recurrent and divergent themes. RESULTS: Interviewees reported strong values of professionalism and respect for donors and supported the change to a 1-year deferral for MSM donors. Nonetheless, nearly all voiced the need for more in-depth training to maximize the likelihood of successful implementation. Specific recommendations included the use of role-play, provision of science-based talking points or FAQs, and empathy for donors and staff. CONCLUSION: More than the usual training may be required to help BCO staff feel prepared to educate the public about changes to MSM-related deferrals and communicate effectively with donors about potentially deferrable behavior. Overall, these findings suggest that before future policy changes, BCO staff's opinions about and role in implementing new donor eligibility screening procedures merit consideration.

Paramedic Perspectives on Barriers to Prehospital Acute Stroke Recognition.

BACKGROUND: Emergency Medical Service (EMS) providers are tasked with rapid evaluation, stabilization, recognition, and transport of acute stroke patients. Although prehospital stroke scales were developed to assist with stroke recognition, unrecognized challenges exist in the prehospital setting that hinder accurate assessment of stroke. The goal of this qualitative study was to systematically understand the challenges and barriers faced by paramedics in recognizing stroke presentations in the field. METHODS: Paramedics from 12 EMS agencies serving a mix of rural, suburban, and urban communities in the State of California participated in five focus group discussions. Group size ranged from 3-8, with a total of 28 participants. Demographics of the participants were collected and focus group recordings were transcribed verbatim. Transcripts were subjected to deductive and inductive coding, which identified recurrent and divergent themes. RESULTS: Strong consensus existed around constraints to prehospital stroke recognition; participants cited the diversity of stroke presentations, linguistic diversity, and exam confounded by alcohol and or drug use as barriers to initial evaluation. Also, lack of educational feedback from hospital staff and physicians and continuing medical education on stroke were reported as major deterrents to enhancing their diagnostic acumen. Across groups, participants reported attempting to foster relationships with hospital personnel to augment their educational needs, but this was easier for rural than urban providers. CONCLUSIONS: While challenges to stroke recognition in the field were slightly different for rural and urban EMS, participants concurred that timely, systematic feedback on individual patients and case-based training would strengthen early stroke recognition skills.

Saving lives, maintaining safety, and science-based policy: qualitative interview findings from the Blood Donation Rules Opinion Study (Blood DROPS).

BACKGROUND: Indefinite deferral from donation for any man who discloses having had sex with another man even once since 1977 (MSM77) is the US FDA's standing policy. This qualitative component of the Blood Donation Rules and Opinion Study was designed to provide insight into the perceptions and practices of current or previous donors with MSM history. STUDY DESIGN AND METHODS: Forty human immunodeficiency virus (HIV)-negative MSM completed an online survey, indicating that they had donated blood and were willing to be interviewed. Semistructured, individual interviews with these key informants covered donation experience and motivations, perceptions of MSM77, policy change preferences, and possible impact of a change to a time-limited deferral. Transcripts were coded deductively and inductively, following a modified Grounded Theory approach. Analysis identified recurrent and divergent themes. RESULTS: Ninety-five percent of participants endorsed modifying MSM77. Preferred deferral length ranged from none to 5 years; a common opinion was that a science-based deferral period would be less than 1 year. Other policy change recommendations included incorporating questions about specific HIV risk behaviors to the donor questionnaire for all potential donors. Interviewees recognized HIV infection rates are higher in MSM than the general US population, but participants considered themselves low-risk for HIV, donated blood "to save lives," and justified their recommendations as being more effective ways to identify donors at risk for HIV. CONCLUSION: Results suggest that MSM donors are concerned with blood safety; they can be appealed to as such. Communications about a new deferral policy should include scientific explanations and acknowledge altruistic motivations of potential donors.

Blood donor deferral for men who have sex with men: the Blood Donation Rules Opinion Study (Blood DROPS).

BACKGROUND: In the United States, any man who discloses having had sex with another man (MSM) even once since 1977 is currently deferred from donating blood. A study was conducted to assess noncompliance with the policy at four geographically dispersed blood centers. STUDY DESIGN AND METHODS: Male donors 18+ years of age with e-mail addresses were randomly selected and invited to complete a confidential online survey between August and October 2013. No additional recruitment e-mails were sent. Survey content included demographics, sexual history, donation history, compliance with the policy, and opinions about current and modified policies. RESULTS: Response rate was 11.5% but varied by center (6.3% to 21.7%). Of 3183 completed surveys, 2.6% of respondents (95% confidence interval, 2.1%-3.2%) reported donation after male-male sex. Noncompliance was not statistically different among the centers (p = 0.1), but was related to age with 5.7, 4.6, 2.5, and 1.0% of donors 18 to 24, 25 to 34, 35 to 54, and 50+ years of age, respectively, reporting noncompliance (p < 0.001). Of all respondents, 6.8% reported at least six female and 0.3% reported at least six male sex partners in the past 5 years. Opinions about the current MSM policy were mixed with noncomplying donors more supportive of change than complying donors. Approximatey half of noncompliers indicated they would adhere to a 1-year deferral. CONCLUSION: Noncompliance with the MSM policy is evident and may be increasing compared to earlier data. Any change from the current policy will require close monitoring to determine whether it affects residual risk of HIV in the US blood supply.

Dynamics of parent-adolescent communication on sexual health and HIV/AIDS in Tanzania.

Communication between parents and their adolescent children has been identified as one of the potential protective factors for adolescent sexual health. Qualitative exploration of sexual health communication with adolescents aged 12-15 (N = 114) and a sub-group of the parents (N = 20) was carried out. Four major themes emerged: reasons for parent-adolescent communications, or lack thereof; the focus of parental messages; the moral of the message; and the barriers to communication between parents and adolescents. Findings revealed similarities and discrepancies in views and perceptions between parents and adolescents. Adolescents and parents suggested that some sexual health communication was happening. Parents were reportedly likely to use fear to ensure that their children do not engage in risky sexual activities, while adolescents reported that conversations with their parents were mostly ambiguous and filled with warnings about the dangers of HIV/AIDS. Several communication barriers were reported by parents and adolescents. Parents of adolescents would benefit from HIV/AIDS specific communication skills.

Double disclosure bind: complexities of communicating an HIV diagnosis in the context of unintended pregnancy in Durban, South Africa.

Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.

A qualitative study of smokers' responses to messages discouraging dual tobacco product use.

Cigarette companies increasingly promote novel smokeless tobacco products to smokers, encouraging them to use smokeless tobacco in smoke-free environments. New messages may counteract this promotion. We developed 12 initial anti-smokeless message ideas and tested them in eight online focus groups with 75 US smokers. Those smokers who never tried smokeless tobacco were unaware of health risks of novel smokeless tobacco products, perceived scary messages as effective and acknowledged the addictive nature of nicotine. Smokers who had tried smokeless tobacco shared their personal (mainly negative) experiences with smokeless tobacco, were aware of health risks of novel smokeless tobacco products, but denied personal addiction, and misinterpreted or disregarded more threatening messages. Portraying women as smokeless tobacco users was perceived as unbelievable, and emphasizing the lack of appeal of novel smokeless tobacco products was perceived as encouraging continued smoking. Future ads should educate smokers about risks of novel smokeless tobacco products, but past users and never users may require different message strategies.

Is snus the same as dip? Smokers' perceptions of new smokeless tobacco advertising.

BACKGROUND: Since 2006, leading US cigarette companies have been promoting new snus products as line extensions of popular cigarette brands. These promotional efforts include direct mail marketing to consumers on cigarette company mailing lists. This study examines smokers' reactions to this advertising and perceptions of the new snus products. METHODS: Eight focus groups (n=65 participants) were conducted in San Francisco and Los Angeles in 2010 with smokers who received tobacco direct mail advertising. The focus group discussions assessed smokers' perceptions of the new snus products. Focus group videos were transcribed and coded using Transana software to identify common themes. RESULTS: Most participants were aware of snus advertising and many had tried free samples. Most were aware that snus was supposed to be 'different' from traditional chewing tobacco but consistently did not know why. Participants willing to try snus still identified strongly as smokers, and for some participants, trying snus reinforced their preference for smoking. Snus' major benefits were use in smoke-free environments and avoiding social stigma related to secondhand smoke. Participants were sceptical of the idea that snus was safer than cigarettes and did not see it as an acceptable substitute for cigarettes or as a cessation aid. CONCLUSIONS: Smokers repeated some messages featured in early snus advertising. Snus was not seen as an acceptable substitute for smoking or way to quit cigarettes. Current smoker responses to snus advertising are not consistent with harm reduction.

Policing drug users in Russia: risk, fear, and structural violence.

We undertook qualitative interviews with 209 injecting drug users (IDUs) (primarily heroin) in three Russian cities: Moscow, Barnaul, and Volgograd. We explored IDU's accounts of HIV and health risk. Policing practices and how these violate health and self, emerged as a primary theme. Findings show that policing practices violate health and rights directly, but also indirectly, through the reproduction of social suffering. Extrajudicial policing practices produce fear and terror in the day-to-day lives of drug injectors, and ranged from the mundane (arrest without legal justification; the planting of evidence to expedite arrest or detainment; and the extortion of money or drugs for police gain) to the extreme (physical violence as a means of facilitating "confession" and as an act of "moral" punishment without legal cause or rationale; the use of methods of "torture"; and rape). We identify the concept of police bespredel-living with the sense that there are "no limits" to police power-as a key to perpetuating fear and terror, internalized stigma, and a sense of fatalist risk acceptance. Police besprediel is analyzed as a form of structural violence, contributing to "oppression illness." Yet, we also identify cases of resistance to such oppression, characterized by strategies to preserve dignity and hope. We identify hope for change as a resource of risk reduction as well as escape, if only temporarily, from the pervasiveness of social suffering. Future drug use(r)-related policies, and the state responses they sponsor, should set out to promote public health while protecting human rights, hope, and dignity.

Sero-skeptics: discussions between test counselors and their clients about sexual partner HIV status disclosure.

Despite the current emphasis in the US on HIV testing and serostatus disclosure as HIV-prevention strategies, little is known about men who have sex with men's (MSM) perceptions of serostatus disclosure by sexual partners. This study used conversation analysis to examine recordings of HIV-test counseling sessions in order to understand how counselors and clients conceptualize and discuss sex partners' disclosure of HIV status. Of 50 test sessions audio-recorded in four publicly funded sites in Northern California, 47 sessions included a discussion about sexual partners' serostatus disclosure, in the vast majority of these (91.5%), counselors and clients avoided directly asserting their knowledge of partners' serostatus. Throughout the discussions, counselors and clients co-constructed the sense of distrust, uncertainty and unknowability of partners' serostatus. The implications of our findings for evaluating the effectiveness of HIV status disclosure as a prevention strategy are discussed.

Responsibility and risk: accounts of reasons for seeking an HIV test.

Using data from recordings of HIV test counselling sessions in publicly funded sites in Northern California, US, this paper examines the discussion of clients' reasons for testing as a site for self-presentation. While counsellors attempt to use the reason for testing discussion as a lead-in to a discussion of risk behaviour, clients often describe their testing as part of a routine, not in response to a specific risk. Clients use three practices to present themselves as reasonable and responsible people who are in control of their HIV status. First, clients present the normal and routine nature of testing, thereby portraying their reasonableness in seeking an HIV test. Secondly, clients deny or downgrade their risk when counsellors seek to identify a specific risk. Thirdly, when introducing a particular risk, clients package it within mitigating contexts that emphasise their knowledge about and control over the risk. These practices can make it difficult for counsellors to focus the counselling session on a specific risk incident. One of the counsellors in our dataset provides an alternative approach that manages to elicit risk and legitimates routine testing as a reason for testing.

Body/Selves and Beyond: Men's Narratives of Sexual Behavior on PrEP.

Although pre-exposure prophylaxis (PrEP) has dramatically impacted HIV prevention, deep engagement with PrEP-takers' own accounts of their sexual behavior is still rare. We report findings from semi-structured interviews with male participants of the US PrEP Demonstration Project. In their narratives, interviewees variously foregrounded their individual selves, interactions with sexual partners, and the biopolitical and historical context of their lives. PrEP served to discursively integrate the multiple selves populating these stories. We argue that medical anthropological notions can help make sense of men's accounts, and PrEP's role in them, advancing a holistic conception of personhood that includes but transcends concern with HIV.

Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: implications for health education and research.

AIMS: To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. DESIGN: Semi-structured qualitative interviews. SETTING: Denver, CO, USA. PARTICIPANTS: Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. MEASUREMENTS: Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. FINDINGS: Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. CONCLUSIONS: Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading.

The Use of Mobile Health Applications Among Youth and Young Adults Living with HIV: Focus Group Findings.

The objective of this study was to conduct focus groups with youth (18-29 years old) living with HIV (YLWH) to better understand preferences for mobile applications in general and to inform the design of a mobile health application aimed at improving retention and engagement in healthcare and adherence to antiretroviral therapy. We conducted four focus groups with YLWH to elicit the names and characteristics of applications that they commonly used, reasons they deleted applications, and the features of an ideal mobile health application. A diverse sample of youth (N = 17) with a mean age of 25 years, 88.2% male, and 29.4% African American participated in four focus groups. Positive attributes of applications included informative, simple, allowing for networking, timely updates, little overlap with other applications, unlimited access to entertainment, and with ongoing advancement. Participants identified several reasons for deleting applications, including engaging in excessive behaviors (e.g., spending money), for hook ups only, too many notifications or restrictions, occupied too much space on device, or required wireless connectivity or frequent updates. Participants suggested that a mobile health application that they would find useful should have the ability to connect to a community of other YLWH, readily access healthcare providers, track personal data and information (such as laboratory data), and obtain health news and education. Privacy was a key factor in a mobile health application for all participants. Researchers can use the information provided by focus group participants in creating mobile health applications for YLWH.

Positive and instructive anti-smoking messages speak to older smokers: a focus group study.

BACKGROUND: Smokers over the age of 45 are the only group with an increase in smoking prevalence, are the least likely to quit smoking, and bear most of the burden of tobacco-related disease. Research characterizing older adult perceptions of warning labels and anti-tobacco messages has not been reported in the literature. The purpose of this study was to describe whether older smokers perceived warning labels and anti-tobacco messages as effective for the promotion of smoking cessation. A secondary aim was to explore what types of messages and message delivery formats are most relevant to older adult smokers. METHODS: This focus group study is part of a larger study to characterize older smokers' perceptions of the risks and benefits associated with conventional and emerging tobacco products and determine the extent to which these perceptions relate to exposure to pro- and anti-tobacco messages. From April 2013 to August 2014 we conducted eight focus groups with 51 current and former smokers a focus group study in urban and suburban California. A semi-structured format about current use of conventional and emerging tobacco products was used. Participants were asked to recall and comment on examples of warning labels and anti-tobacco messages. Data were transcribed and thematically coded. RESULTS: Warning labels and anti-smoking messages were seen as ineffective for smoking cessation motivation among older California smokers. Positive framed anti-tobacco messages were identified as most effective. Text-only warnings were seen as ineffective due to desensitizing effects of repeated exposure. Negative messages were described as easy to ignore, and some trigger urges to smoke. Older adults are knowledgeable about the risks and health effects of smoking. However, they tend to be less knowledgeable about the benefits of cessation and may underestimate their ability to quit. CONCLUSION: These findings suggest that messages with a positive frame that outline immediate and long-term benefits of cessation would be an effective approach for long-term smokers. Current anti-tobacco messaging was generally not seen as effective for smoking cessation among long-term smokers.

E-cigarette marketing and older smokers: road to renormalization.

OBJECTIVES: To describe older smokers' perceptions of risks and use of e-cigarettes, and their responses to marketing and knowledge of, and opinions about, regulation of e-cigarettes. METHODS: Eight 90-minute focus groups with 8 to 9 participants met in urban and suburban California to discuss topics related to cigarettes and alternative tobacco products. RESULTS: Older adults are using e-cigarettes for cessation and as a way to circumvent no-smoking policies; they have false perceptions about the effectiveness and safety of e-cigarettes. They perceive e-cigarette marketing as a way to renormalize smoking. CONCLUSIONS: To stem the current epidemic of nicotine addiction, the FDA must take immediate action because e-cigarette advertising promotes dual use and may contribute to the renormalization of smoking.

Ambivalent tales of HIV disclosure in San Francisco.

In light of rising levels of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in San Francisco, we sought to understand disclosure practices, the calculus of risk and attitudes about HIV seroconversion. In 2000, 150 MSM participated in interviews pivoting around a detailed narrative of a recent incident of UAI. In order to understand the relationship between individual and community norms, we analyzed the narratives as accounts situated within the respondents' experience of the HIV epidemic and the gay community in San Francisco. In justifying their risky sexual practices, MSM cited a community-wide shift toward non-disclosure and barebacking since the advent of highly active anti-retroviral therapy (HAART). Fearing rejection by HIV-positive partners who refuse to use condoms, HIV-negative men saw little advantage in disclosing to casual partners whom they perceived as overwhelmingly HIV-positive. By contrast, HIV-positive men appeared eager to disclose their positive status to release themselves from responsibility for transmission and facilitate "bareback" or unprotected sex. Disavowal of individual responsibility for safer sex in deference to community norms may contribute to the recent spiraling of risk behavior and HIV incidence. Implications for prevention policy are discussed.

Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study.

Achieving 'universal access' to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: 'labyrinthine bureaucracy' governing access to ART; a 'system Catch 22' created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and 'system verticalization', where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform.