scholarly journals Shifting the paradigm: physician-authorized, student-led efforts to provide harm reduction services amidst legislative opposition

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Timothy P. McMullen ◽  
Mahan Naeim ◽  
Carol Newark ◽  
Haden Oliphant ◽  
Jeffrey Suchard ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Harm Reduction ◽  
Orange County ◽  
Well Being ◽  
The United States ◽  
Needle Exchange Program ◽  
People Who Use Drugs ◽  
State Governments ◽  
Syringe Access ◽  
Increased Risk

Abstract Background For over 30 years, syringe services programs (SSPs) have served as an efficacious intervention for the prevention of HIV and Hepatitis C transmission among persons who use drugs. Despite a strong body of evidence for the effectiveness of SSPs as a preventative public health measure, numerous local and state governments in the United States continue to resist the establishment of new SSPs and aggressively pursue the closure of those already in operation. Commentary In Orange County, California, local officials have repeatedly mobilized in opposition of the establishment of syringe access – thereby hindering access to healthcare for thousands of predominantly unhoused individuals. The county was previously served by the Orange County Needle Exchange Program from 2016 until 2018 when a civil suit brought by the Orange County Board of Supervisors resulted in the closure of the program. For more than 2 years, persons who inject drugs in Orange County lacked reliable access to clean syringes, placing them at increased risk for contracting HIV and Hepatitis C. Here, we comment on the ongoing effort to restore syringe access in Orange County. This collaborative physician-directed endeavor has brought together students and community volunteers to provide vital harm reduction services to a remarkably underserved population. Since the reestablishment of syringe access in Orange County by the Harm Reduction Institute, new legal barriers have arisen including the passage of new municipal legislation banning the operation of syringe exchanges. We are well-equipped to overcome these obstacles. This work serves as an affirmation of assertions made by previous authors regarding the unique qualifications of medical & graduate students as effective harm reductionists. Conclusion Harm reduction services are vital to the health and well-being of people who use drugs. The provision of these services should not be impeded by legislative interference by municipal, county, or state governments.

scholarly journals Towards cross-Canada monitoring of the unregulated street drug supply

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily Biggar ◽  
Kristi Papamihali ◽  
Pascale Leclerc ◽  
Elaine Hyshka ◽  
Brittany Graham ◽  
...  
Keyword(s):  
Harm Reduction ◽  
Monitoring System ◽  
Well Being ◽  
People Who Use Drugs ◽  
Drug Supply ◽  
Knowledge Mobilization ◽  
Survey Tool ◽  
Urine Toxicology ◽  
Early Results ◽  
Crack Use

Abstract Background The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions. Methods The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018–March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use. Results The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal. Conclusions This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.

scholarly journals Kinship Care and Child Protection in High-Income Countries: A Scoping Review

2021 ◽  
pp. 152483802110360
Author(s):  
Nutmeg Hallett ◽  
Joanna Garstang ◽  
Julie Taylor
Keyword(s):  
Home Care ◽  
Scoping Review ◽  
Child Protection ◽  
Kinship Care ◽  
Well Being ◽  
The United States ◽  
High Income ◽  
Out Of Home Care ◽  
Increased Risk ◽  
Abuse And Neglect

Kinship care is a global phenomenon with a long history, which in high-income countries (HICs) at least, is being increasingly formalized through legislation and policy. There are many benefits to kinship care, including improved child mental health and well-being when compared to other types of out-of-home care. Despite this, kinship care is not without its risks with a lack of support and training for kinship carers putting children at an increased risk of abuse and neglect. This scoping review was conducted across 11 databases to explore the breadth and depth of the literature about abuse and neglect within kinship care in HICs and to provide initial indications about the relationship between kinship care and abuse. Of the 2,308 studies initially identified, 26 met the inclusion criteria. A majority of studies were from the United States, and most used case review methods. From the included studies, rates of re-abuse, and particularly rates of physical and sexual abuse, appear to be lower in kinship care settings when compared to other out-of-home care settings, but rates of neglect are often higher. This review has demonstrated that a small but significant number of children living in kinship care experience neglect or abuse.

Trends in Childhood Obesity Research: A Brief Analysis of NIH-Supported Efforts

2007 ◽  
Vol 35 (1) ◽  
pp. 148-153 ◽  
Author(s):  
Terry T-K Huang ◽  
Mary N. Horlick
Keyword(s):  
Childhood Obesity ◽  
Behavioral Change ◽  
Population Level ◽  
Well Being ◽  
The United States ◽  
Obesity Epidemic ◽  
Obesity Research ◽  
Increased Risk ◽  
Economic Well Being

Childhood obesity continues to rise in the United States, with now over 17% of children and adolescents considered overweight. Childhood obesity predisposes an entire generation to increased risk of chronic diseases and disabilities and is a severe threat to the economic well-being of the nation. At first thought, the solution to the obesity epidemic may seem simple: encourage people to eat less and exercise more. However, the reality is that behavioral change is difficult to achieve without also considering the interplay of genetics, biological processes, and social and environmental mechanisms. As such, investment in obesity research has been considered an important tool to combat obesity and obesity-related diseases. Childhood obesity research, in particular, has drawn considerable attention, given the lower cost of prevention relative to treatment and the high potential for long-term benefits at a population level.

scholarly journals Social Isolation Among Older Military Veterans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 540-540
Author(s):  
Kirsten Laha-Walsh ◽  
Zainab Suntai
Keyword(s):  
Social Isolation ◽  
Military Service ◽  
Military Veterans ◽  
Well Being ◽  
Critical Issue ◽  
The United States ◽  
Civilian Life ◽  
Explanatory Variables ◽  
Increased Risk ◽  
Socially Isolated

Abstract Social isolation is an increasingly critical issue among older adults and has been found to affect several domains of well-being, including physical, psychological, and cognitive health. Research has found that military veterans often experience hardships in the transition back to civilian life including emotional trauma, depression, substance misuse and pain from combat-related injuries, which have been shown to persist well into older adulthood. As such, this study aimed to examine the prevalence of social isolation among older military veterans and determine which veterans are most at-risk of experiencing social isolation, using the Berkman-Syme Social Network Index as a framework. Data were derived from Round 1 of the National Health and Aging Trends Study (NHATS), an annual longitudinal panel survey of adults aged 65 and older living in the United States. Results showed that about 4.5% of veterans in the NHATS are severely socially isolated while another 20.9% are socially isolated. After controlling for other explanatory variables, being White, being 85 and older, having lower educational attainment, being unmarried/unpartnered and having lower income were associated with an increased risk of experiencing social isolation. Interventions aiming to improve the well-being of older veterans should consider employing both preventative and amendatory measures. These may include the creation and administration of a standardized social isolation scale during visits to veterans’ affairs (VA) medical centers and a general effort to address stressors from military service by destigmatizing and improving access to mental health services.

scholarly journals 316. Hepatitis C and Engagement in Health Care Among Persons Who Inject Drugs and Persons Who Use Non-Injection Drugs, Philadelphia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S167-S168
Author(s):  
Eman Addish ◽  
Hannah Zellman ◽  
Jay Kostman ◽  
Kendra Viner ◽  
Danica Kuncio ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Use ◽  
Harm Reduction ◽  
Sexual Behaviors ◽  
The United States ◽  
Persons Who Inject Drugs ◽  
Hcv Transmission ◽  
Reduction Methods ◽  
Associated Risk Factors ◽  
Unsafe Injection

Abstract Background The growing opioid epidemic is driving increasing rates of hepatitis C virus (HCV) infections in the United States. HCV transmission is most frequently attributed to unsafe injection behaviors, but can occur via other unsafe drug use and sexual behaviors. Differences in demographics, HCV rates and associated risk factors in non-injecting PWUD (NIPWUD), compared with people who inject drugs (PWID) must be understood in order to target elimination strategies. Methods Change is Philadelphia’s program to eliminate HCV among PWUD and enrollment includes HCV testing, linkage services, and an interviewer-administered survey including risk behaviors and healthcare engagement. This interim analysis includes the first 835 enrollees that identified as PWUD. For this analysis, PWID are enrollees who indicated ever injecting drugs and those who had not are NIPWUD. Results Among enrollees, 76% (N = 637) reported ever injecting drugs. PWIDs were younger and non-Hispanic (NH) white while NIPWUD were older and NH Black (age: P = 0.003; race/ethnicity: P < 0.0001). NIPWUDs had a high seropositivity rate though significantly lower than PWIDs (24% vs. 85%, respectively; P < 0.0001). Among PWID enrollees, 94% (N = 596) ever snorted. Of enrollees, 63% (N = 124) of NIPWUD and 56% (N = 356) of PWID identified having a PCP (P =0.07). PWIDs are more likely than NIPWUD to have overdosed (OD) (40% vs. 9%; P < 0.0001) though high rates of both groups ever witnessed an OD (84% vs. 67%, respectively). While 80% (N = 105) of NIPWUDs know how to use Narcan, 60% (N = 79) carry it, {94% (N = 503) and 71%(N = 381) in PWID, respectively}. NIPWUDs are more likely to be interested in drug treatment (P < 0.0001) and to have received it in the last 12 months (P = 0.0008). Conclusion Notable HCV infection exists among non-injecting PWUD reinforcing the need for harm reduction counseling and access to drug use equipment used for smoking and snorting. NIPWUD may be able to access drug and HCV treatment through PCPs and fatal ODs may be prevented by ensuring NIPWUDs have access to Narcan. In addition, PWID are likely to snort as well and should be counseled on non-injecting harm reduction methods. To succeed in micro elimination among PWUD, a focus on NIPWUDs as well as PWIDs is necessary to mitigate transmission of HCV. Disclosures All authors: No reported disclosures.

A Collaborative Evaluation of a Needle Exchange Program for Youth

1999 ◽  
Vol 26 (2) ◽  
pp. 213-224 ◽  
Author(s):  
Rebecca L. Weiker ◽  
Renee Edgington ◽  
Michele D. Kipke
Keyword(s):  
Harm Reduction ◽  
Quantitative Methods ◽  
Needle Exchange ◽  
The United States ◽  
Injection Drug ◽  
Needle Exchange Program ◽  
Multimethod Research ◽  
Needle Exchange Programs ◽  
Research Activities ◽  
Collaborative Evaluation

Limited research has been conducted to examine the effectiveness of existing HIV prevention and harm reduction interventions targeted to injection drug-using youth. Moreover, although there are a growing number of needle exchange programs being developed for youth throughout the United States, the effects of these services have yet to be systematically evaluated. This article describes a collaborative evaluation conducted by the Division of Adolescent Medicine, Childrens Hospital Los Angeles, and Clean Needles Now, a needle exchange serving young injection drug users. The evaluation employed a multimethod research design that included both qualitative and quantitative methods. Findings are presented about how a community-based agency’s service delivery philosophy can affect the design and implementation of an evaluation. Lessons learned from this collaborative evaluation are presented, including the potential benefits of incorporating harm reduction principles into research activities.

Same-Sex Binational Families

2018 ◽  
pp. 87-108
Author(s):  
Daniela G. Domínguez ◽  
Jacqueline Coppock ◽  
marcela polanco
Keyword(s):  
United States ◽  
Social Institutions ◽  
Well Being ◽  
The United States ◽  
Sexual Prejudice ◽  
Same Sex ◽  
Increased Risk ◽  
Residency Status ◽  
Binational Families ◽  
Legal Interventions

This chapter addresses challenges that can surface for some same-sex binational couples in the United States. Vulnerable to both immigration enforcement and social institutions seeking to deny the validity of their relationship, same-sex binational couples may be at increased risk for emotional hardship, relationship instability, conflict, and dissolution. The ramifications of divorce in binational relationships may include jeopardizing the residency status or lengthening the naturalization timeline; separation from children if removed from the United States; and potential removal to a country where one or both members in the partnership may be exposed to sexual prejudice. The chapter discusses the unique challenges that increase the risk of binational same-sex relationships ending in dissolution or divorce, highlighting the limited research on LGBTQ dissolution or divorce and the need for further research on clinical and legal interventions that could enhance the well-being of same-sex binational couples during and after relationship dissolution or divorce.

scholarly journals The Cedar Project: exploring the role of colonial harms and childhood maltreatment on HIV and hepatitis C infection in a cohort study involving young Indigenous people who use drugs in two Canadian cities

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e042545
Author(s):  
Margo E Pearce ◽  
Kate Jongbloed ◽  
Sherri Pooyak ◽  
Wenecwtsin M Christian ◽  
Maaxswxw Gibuu (White Wolf) Mary Teegee ◽  
...  
Keyword(s):  
Sexual Abuse ◽  
Substance Use ◽  
Hepatitis C ◽  
Indigenous People ◽  
Childhood Maltreatment ◽  
Well Being ◽  
Hcv Infection ◽  
Secondary Outcome ◽  
People Who Use Drugs ◽  
Physical Neglect

ObjectivesThis study examined associations between childhood maltreatment, colonial harms and sex/drug-related risks for HIV and hepatitis C virus (HCV) infection among young Indigenous people who use drugs.DesignThe Cedar Project is a cohort involving young Indigenous people who use drugs in British Columbia (BC), Canada. Indigenous collaborators, collectively known as the Cedar Project Partnership, govern the entire research process.SettingVancouver is a large city on the traditional territory of the Coast Salish peoples. Prince George is a mid-sized city, on the traditional territory of Lheidli T’enneh First Nation.Participants420 participants completed the Childhood Trauma Questionnaire and returned for follow-up from 2003 to 2016.Primary/secondary outcome measuresPrimary outcomes were HIV and HCV infection over the study period. Secondary outcomes included sex and substance use-related risks.ResultsPrevalence of childhood maltreatment was 92.6% experienced any maltreatment; 73.4% experienced emotional abuse; 62.6% experienced physical abuse; 60.3% experienced sexual abuse; 69.5% experienced emotional neglect and 79.1% experienced physical neglect. We observed significant associations between childhood maltreatment and apprehensions into residential schools and foster care. All maltreatment types were associated with higher odds of sex/substance use-related risks; sexual abuse was associated with higher odds of HCV infection (adjusted OR: 1.67; 95% CI 1.05 to 2.66; p=0.031).ConclusionsFindings reflect high prevalence of childhood maltreatment and their associations with HIV/HCV risk and HCV infection. Public health prevention and treatment initiatives must be trauma informed and culturally safe to support healing, health, and well-being.

scholarly journals Smoking and COVID-19: A Literature Review of Cohort Studies in Non-Chinese Population Settings

2021 ◽  
Vol 14 ◽  
pp. 1179173X2098867
Author(s):  
Aoife Rodgers ◽  
Manasi Nadkarni ◽  
Emilie Kruke Indreberg ◽  
Lenah Alfallaj ◽  
Zubair Kabir
Keyword(s):  
Literature Review ◽  
Cohort Studies ◽  
Chinese Population ◽  
Well Being ◽  
The United States ◽  
Smoking History ◽  
Eligibility Criteria ◽  
Potential Association ◽  
Increased Risk ◽  
The Uk

Background: Smoking history and its potential association with COVID-19 has attracted many researchers and the lay public alike. However, the studies published to date have several methodological limitations and are mainly from China. We set out to synthesize evidence on smoking and COVID-19 relationship drawn on cohort studies only which are published in non-Chinese population settings. Method: A systematic literature search was undertaken drawn on predefined eligibility criteria and a comprehensive search strategy following the PRISMA guideline between January 2020 and August 2020, excluding preprints and gray literature. Three specific outcomes were examined: smoking history, SARS-CoV2 infection, and COVID-19 severity. Results: Of an eligible 40 full-text studies, 7 cohort studies outside of China were finally included in this literature review through independent reviewing. Four studies were from the UK, 2 from the United States, and 1 from Turkey. The sample size ranged from 200 to more than 5000 participants. The findings broadly point to 1 direction, a higher smoking prevalence and an increased risk of smoking history on both SARS-CoV2 infection and on COVID-19 severity. Conclusion: A smoking history (either current or past) seems to negatively impact both SARS-CoV2 infection and COVID-19 severity. However, such an observation strengthens the argument to continue smoking cessation efforts both for individuals and for the general population health and well-being.

scholarly journals Chronic Hepatitis C as a Risk Factor for Colonic Neoplasia in a Community Setting

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Poulos JE ◽  
◽  
Ingram B ◽  
Milanov V ◽  
Conti M ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Community Setting ◽  
Developed Countries ◽  
The United States ◽  
Increased Risk ◽  
Colonic Neoplasia

An estimated 3.5 million people have Chronic Hepatitis C (CHC) in the United States [1]. With the current opioid epidemic, the number of people who are injecting drugs in the US. Has substantially increased the incidence of CHC virus [2]. With an apparent second wave of CHC, it will be important to manage the sequelae of these chronically infected patients and recognize associated comorbidities. CHC has been shown to increase the risk of hepatocellular carcinoma and has been linked to such malignancies as Non-Hodgkin lymphoma, cholangiocarcinoma, breast, pancreatic, renal, skin/oral, thyroid, and colon cancer [3-6]. Colon cancer is the second leading cause of cancer-related death in men in developed countries and the third most prevalent cause of death from cancer for women [7]. Colorectal Cancer (CRC) screening has been shown to reduce the risk for the development of CRC and prevent the development of more advanced disease [8,9]. The risks for developing colorectal cancer are associated with increasing age, family history, history of adenomas or Inflammatory Bowel Diseases (IBD) and ethnicity. Other possible risk factors include a high fat, low-fiber diet, obesity, smoking, and excessive alcohol use. A possible link between colon cancer and CHC has not been extensively studied. However, previous studies have suggested that patients with CHC have a higher risk of colonic adenomas and more advanced lesions. Thus, the goal of this study was to determine if patients with CHC undergoing screening or surveillance colonoscopies in a community setting have an increased risk of colonic neoplasia.

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