Factors associated with inappropriate overdose response among people who use prescription opioids non-medically in rural Appalachia: A cross-sectional study

Background Opioid-related overdose deaths have accelerated in recent years. In response, overdose education and naloxone distribution (OEND) programs have been implemented across the United States, although many rural Appalachians continue to lack access. Despite the growing number of OEND programs, risk factors for inappropriate overdose response among persons who are training-naïve are currently unknown. Methods We used respondent-driven sampling to recruit and enroll 169 adults who use prescription opioids non-medically from three rural counties in West Virginia. Participants were interviewed to ascertain experience with witnessed overdose (lifetime and prior-year), characteristics of the most recent witnessed overdose, responses to the witnessed overdose, and OEND acceptability. Logistic regression was used to assess factors associated with inappropriate response to opioid-related overdose. Results Among the 73 (43% of the total sample) participants who witnessed an opioid-related overdose, the majority (n = 53, 73%) reported any inappropriate response. Participants were significantly more likely to report an inappropriate overdose response when the overdose victim was unresponsive (OR = 3.36; 95% CI = 1.07, 10.58). The most common appropriate responses were staying with the victim until recovery or help arrived (n = 66, 90%) and calling 911 (n = 63, 86%), while the most common inappropriate responses were hitting or slapping the victim (n = 37, 51%) and rubbing the victim with ice or placing them in a cold shower or bath (n = 14, 19%). While most (n = 60, 82%) had never heard of overdose prevention training, the vast majority (n = 69, 95%) were willing to participate in training, particularly those who had responded inappropriately (n = 52, 98%). Conclusions These findings underscore the urgent need for expanded access to OEND programs in at-risk rural communities that lacked coverage. Indeed, information generated by this study informed the development of a statewide naloxone distribution program in WV. These findings also indicate OEND programs are highly acceptable to training-naïve people who use opioids in rural Appalachia. Additional approaches to expand access to harm reduction services in the region, including mobile services and mail-based naloxone distribution should be aggressively pursued.

Russia and America confront terrorism, 1994–2004: a foundation of understanding

In the 1990s, Russia’s wars in Chechnya alientated the officials in the Clinton administration, for they deemed the response by the Yeltsin government to be an overreaction to the acts committed by Chechnyan terrorists. However, the Twin Towers attacks in 2001 created a certain common understanding between the two powers. In spite of the contrasting attitudes of the two towards bin Laden and al Qaeda during the Russian invasion of Afghanistan in the 1980s, responses to global terrorism put them on the same page in the new century. With the support of NATO’s Article 5, the American decision to invade Afghanstan and dislodge the Taliban met with allied approval and support. However, there was considerable controversy between Moscow and Washington over the Iraq war that America commenced with the Coalition of the Willing in 2003. Russian leaders condemned this invasion as an illustration of an American overreach as well as an inappropriate response to the 9/11 attacks. One commonality in the effort to contain terrorism was considerable administrative centralization within both political systems.

Toward a User-Centered Approach for Emergency Warning Distribution

There are many known problems with inappropriate response to emergency warnings. Recommended actions are not always properly followed, and sometimes emergency warnings are not taken seriously. A variety of psychological individual differences can influence the perception of emergency warnings. At present, warning distributors do not consider how these factors affect emergency warning response. We recommend that emergency warning distribution systems be developed that account for these differences to improve response. To this end, we propose four guidelines supported by psychological research and inspired by currently available technologies. These guidelines frame a user-centered approach to more appropriately tailor warning messages for each recipient.

How do we entertain ourselves with literary texts?

We argue that entertainment experiences as individual responses to literary texts have not been sufficiently studied in the past. Literary scholars have long regarded entertainment as an inappropriate response to literature. Likewise, psychologists and communications scholars have been hesitant to study entertainment as an effect of literary reading, arguably because those responses have been seen as too complex to fit into given explanations of entertainment. But entertainment theory has advanced recently and now tries to include more complex responses to media content. Those responses include affective states which are other than simply pleasure-driven.. The idea of entertainment as a response that can imply enjoyment, appreciation, or both allows and provides an explanation of readers’ responses to literary texts that goes beyond purely hedonistic motivations.