scholarly journals Designing a Graphic Novel: Engaging Community, Arts, and Culture Into Public Health Initiatives

2021 ◽  
Vol 22 (1_suppl) ◽  
pp. 35S-43S
Author(s):  
Sarah Febres-Cordero ◽  
Athena D. F. Sherman ◽  
Joseph Karg ◽  
Ursula Kelly ◽  
Lisa M. Thompson ◽  
...  
Keyword(s):  
Public Health ◽  
Service Industry ◽  
Community Setting ◽  
Graphic Novel ◽  
Community Advisory Board ◽  
Opioid Antagonist ◽  
Dissemination And Implementation ◽  
Opioid Overdose ◽  
Negative Stereotypes ◽  
Community Based Research

The opioid epidemic was declared a national public health emergency in 2017. In Georgia, standing orders for the opioid antagonist, naloxone, have been implemented to reduce mortality from opioid overdoses. Service industry workers in the Atlanta, Georgia, inner-city community of Little Five Points (L5P) have access to naloxone, potentially expanding overdose rescue efforts in the community setting. To explore the issues facing L5P, our research brings together qualitative descriptive inquiry, ethnography, community-based research, a community advisory board, and a local artist to maximize community dissemination of research findings through a graphic novel that describes encountering an opioid overdose. This format was chosen due to the ethical responsibility to disseminate in participants’ language and for its potential to empower and educate readers. This article describes the process of working on this study with the community and a local artist to create sample pages that will be tested for clarity of the message in a later phase. Working with an artist has revealed that while dissemination and implementation for collaboration begin before findings are ready, cross-collaboration with the artist requires early engagement, substantial funding, artist education in appropriate content, and member checking to establish community acceptability altering illustrations that reinforce negative stereotypes. By sharing the experiences of actions taken during an opioid overdose in L5P through a graphic novel, we can validate service industry workers’ experiences, acknowledge their efforts to contribute to harm reduction, and provide much-needed closure to those who encounter opioid overdoses in the community.

scholarly journals Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study

10.2196/22411 ◽  
2020 ◽  
Vol 4 (12) ◽  
pp. e22411
Author(s):  
Alex S Bennett ◽  
Robert Freeman ◽  
Don C Des Jarlais ◽  
Ian David Aronson
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
York City ◽  
Shared Responsibility ◽  
Opioid Antagonist ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Negative Consequences ◽  
Qualitative Interview Study

Background Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. Objective We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. Methods We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. Results Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants’ narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just “others” to be managed with stigmatizing practices and language. Conclusions It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation.

scholarly journals Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study (Preprint)

2020 ◽  
Author(s):  
Alex S Bennett ◽  
Robert Freeman ◽  
Don C Des Jarlais ◽  
Ian David Aronson
Keyword(s):  
Public Health ◽  
New York ◽  
New York City ◽  
York City ◽  
Shared Responsibility ◽  
Opioid Antagonist ◽  
People Who Use Drugs ◽  
Opioid Overdose ◽  
Negative Consequences ◽  
Qualitative Interview Study

BACKGROUND Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. OBJECTIVE We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. METHODS We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. RESULTS Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants’ narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just “others” to be managed with stigmatizing practices and language. CONCLUSIONS It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation.

scholarly journals eB4CAST: An Evidence-Based Tool to Promote Dissemination and Implementation in Community-Based, Public Health Research

2018 ◽  
Vol 15 (10) ◽  
pp. 2142 ◽  
Author(s):  
Melissa Olfert ◽  
Rebecca Hagedorn ◽  
Makenzie Barr ◽  
Oluremi Famodu ◽  
Jessica Rubino ◽  
...  
Keyword(s):  
Public Health ◽  
Future Application ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Program Sustainability ◽  
Community Based ◽  
Community Based Research ◽  
Community Factors ◽  
Program Impact ◽  
Direct Data

eB4CAST, evidence-Based forecast C-capture, A-assemble, S-sustain, T-timelessness (eB4CAST), framework was developed from existing dissemination and implementation (D & I) constructs as a dissemination tool to promote community-based program usability and future application in targeted populations. eB4CAST captures and transforms research findings into a dissemination report that shows program need and impact to endorse program continuation and expansion. This is achieved through direct and indirect data collection of community factors and program impact that can showcase the need for program sustainability and potential for future dissemination sites. Testimonials, individual feedback, and program process and outcomes contribute to the direct data while data collected from census, county, and state databases and reports allow for indirect information to be captured and analyzed. Capturing data in the two levels allow eB4CAST to forecast program need and highlight program impact through a footprint. eB4CAST framework for dissemination tool creation is organized into four sections: Capture, Assemble, Sustainability, and Timelessness. Capture encompasses the collection of indirect and direct data related to intervention goals. Assemble is the compilation of the data into a visually appealing and easily understood media. Sustainability encourages the use of dissemination tools to provide forecast of program need and footprint of program impact back to community participants, program leaders, and key stakeholders to endorse program sustainability. Lastly, timelessness encourages cyclic movement through these constructs to continue program monitoring and data sharing to ensure timeless program evaluation and conformation to change in needs. The eB4CAST framework provides a systematic method to capture justification of program need and impact of community-based research that can be modified to fit diverse public health interventions providing a necessary D & I tool.

Future Issues in Dissemination and Implementation Research

2017 ◽  
Author(s):  
Ross C. Brownson ◽  
Graham A. Colditz ◽  
Enola K. Proctor
Keyword(s):  
Public Health ◽  
Health Services ◽  
Implementation Research ◽  
Clinical Care ◽  
Dissemination And Implementation ◽  
Public Health Services ◽  
Middle Income ◽  
Middle Income Countries ◽  
Dissemination And Implementation Research ◽  
The Many

This chapter highlights just a sample of the many rich areas for dissemination and implementation research that will assist us in shortening the gap between discovery and practice, thus beginning to realize the benefits of research for patients, families, and communities. Greater emphasis on implementation in challenging settings, including lower and middle-income countries and underresourced communities in higher income countries will add to the lessons we must learn to fully reap the benefit of our advances in dissemination and implementation research methods. Moreover, collaboration and multidisciplinary approaches to dissemination and implementation research will help to make efforts more consistent and more effective moving forward. Thus, we will be better able to identify knowledge gaps that need to be addressed in future dissemination and implementation research, ultimately informing the practice and policies of clinical care and public health services.

Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

2017 ◽  
Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan
Keyword(s):  
Public Health ◽  
Treatment Strategies ◽  
Implementation Fidelity ◽  
Population Level ◽  
The United States ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Health Gains ◽  
Significant Public Health ◽  
Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

scholarly journals Take-Home Naloxone for the Emergency Interim Management of Opioid Overdose: The Public Health Application of an Emergency Medicine

Drugs ◽  
2019 ◽  
Vol 79 (13) ◽  
pp. 1395-1418 ◽  
Author(s):  
John Strang ◽  
Rebecca McDonald ◽  
Gabrielle Campbell ◽  
Louisa Degenhardt ◽  
Suzanne Nielsen ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Medicine ◽  
Opioid Overdose ◽  
The Public ◽  
Interim Management ◽  
Health Application

scholarly journals PUBLIC HEALTH APPROACH TO OPIOID OVERDOSE

2007 ◽  
Vol 97 (4) ◽  
pp. 587-588 ◽  
Author(s):  
Susan J. Klein ◽  
Daniel A. O’Connell ◽  
Alma R. Candelas ◽  
James G. Giglio ◽  
Guthrie S. Birkhead
Keyword(s):  
Public Health ◽  
Public Health Approach ◽  
Opioid Overdose

Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018–2019, From the HEALing Communities Study

2021 ◽  
pp. e1-e4
Author(s):  
Marc R. Larochelle ◽  
Svetla Slavova ◽  
Elisabeth D. Root ◽  
Daniel J. Feaster ◽  
Patrick J. Ward ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Public Health Approach ◽  
Opioid Overdose ◽  
Death Rates ◽  
Overdose Death ◽  
Race Ethnicity ◽  
State Death ◽  
Rate Ratios ◽  
Hispanic White

Objectives. To examine trends in opioid overdose deaths by race/ethnicity from 2018 to 2019 across 67 HEALing Communities Study (HCS) communities in Kentucky, New York, Massachusetts, and Ohio. Methods. We used state death certificate records to calculate opioid overdose death rates per 100 000 adult residents of the 67 HCS communities for 2018 and 2019. We used Poisson regression to calculate the ratio of 2019 to 2018 rates. We compared changes by race/ethnicity by calculating a ratio of rate ratios (RRR) for each racial/ethnic group compared with non-Hispanic White individuals. Results. Opioid overdose death rates were 38.3 and 39.5 per 100 000 for 2018 and 2019, respectively, without a significant change from 2018 to 2019 (rate ratio = 1.03; 95% confidence interval [CI] = 0.98, 1.08). We estimated a 40% increase in opioid overdose death rate for non-Hispanic Black individuals (RRR = 1.40; 95% CI = 1.22, 1.62) relative to non-Hispanic White individuals but no change among other race/ethnicities. Conclusions. Overall opioid overdose death rates have leveled off but have increased among non-Hispanic Black individuals. Public Health Implications. An antiracist public health approach is needed to address the crisis of opioid-related harms. (Am J Public Health. Published online ahead of print September 9, 2021:e1–e4. https://doi.org/10.2105/AJPH.2021.306431 )

The Effect of Overdose Education and Naloxone Distribution: An Umbrella Review of Systematic Reviews

2021 ◽  
pp. e1-e12
Author(s):  
Amir Razaghizad ◽  
Sarah B. Windle ◽  
Kristian B. Filion ◽  
Genevieve Gore ◽  
Irina Kudrina ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Reviews ◽  
Optimal Strategies ◽  
Risk Of Bias ◽  
Opioid Overdose ◽  
Umbrella Review ◽  
High Concentration ◽  
Exclusion Criteria ◽  
High Quality Research ◽  
Reported Data

Background. Opioids contribute tomore than 60 000 deaths annually in North America. While the expansion of overdose education and naloxone distribution (OEND) programs has been recommended in response to the opioid crisis, their effectiveness remains unclear. Objectives. To conduct an umbrella review of systematic reviews to provide a broad-based conceptual scheme of the effect and feasibility of OEND and to identify areas for possible optimization. Search Methods. We conducted the umbrella review of systematic reviews by searching PubMed, Embase, PsycINFO, Epistemonikos, the Cochrane Database of Systematic Reviews, and the reference lists of relevant articles. Briefly, an academic librarian used a 2-concept search, which included opioid subject headings and relevant keywords with a modified PubMed systematic review filter. Selection Criteria. Eligible systematic reviews described comprehensive search strategies and inclusion and exclusion criteria, evaluated the quality or risk of bias of included studies, were published in English or French, and reported data relevant to either the safety or effectiveness of OEND programs, or optimal strategies for the management of opioid overdose with naloxone in out-of-hospital settings. Data Collection and Analysis. Two reviewers independently extracted study characteristics and the quality of included reviews was assessed in duplicate with AMSTAR-2, a critical appraisal tool for systematic reviews. Review quality was rated critically low, low, moderate, or high based on 7 domains: protocol registration, literature search adequacy, exclusion criteria, risk of bias assessment, meta-analytical methods, result interpretation, and presence of publication bias. Summary tables were constructed, and confidence ratings were provided for each outcome by using a previously modified version of the Royal College of General Practitioners’ clinical guidelines. Main Results. Six systematic reviews containing 87 unique studies were included.We found that OEND programs produce long-term knowledge improvement regarding opioid overdose, improve participants’ attitudes toward naloxone, provide sufficient training for participants to safely and effectivelymanage overdoses, and effectively reduce opioid-relatedmortality. High-concentration intranasal naloxone (.2mg/mL) was as effective as intramuscular naloxone at the same dose, whereas lower-concentration intranasal naloxone was less effective. Evidence was limited for other naloxone formulations, as well as the need for hospital transport after overdose reversal. The preponderance of evidence pertained persons who use heroin. Author's Conclusions. Evidence suggests that OEND programs are effective for reducing opioid-related mortality; however, additional high-quality research is required to optimize program delivery. Public Health Implications. Community-based OEND programs should be implemented widely in high-risk populations. (Am J Public Health. Published online ahead of print July 2, 2021: e1–e12. https://doi.org/10.2105/AJPH.2021.306306 )

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