People who inject drugs (PWIDs) are the most stigmatized and marginalized people in the general population (Ahern, Stuber, & Galea, 2007; Birtel, Wood, & Kempa, 2017). This group is not easily accessed by typical means of patient outreach and is one of the most underserved populations for primary care, mental health services, and care for chronic infectious diseases associated with injection drug use including HIV and HCV (Ahern et al., 2007; Dean et al., 2000; Livingston, Milne, Fang, & Amari, 2012; Zeremski et al., 2013). Syringe Service Programs (SSPs) can give public health and social support organizations and agencies access to an otherwise underserved population and give PWID potential access to a constellation of care to address multiple comorbidities associated with injection drug use (Barocas et al., 2014; Pollack, Khoshnood, Blankenship, & Altice, 2002; Zeremski et al., 2013). Additionally, the potential access to primary and secondary care that SSPs may connect PWID to, perceived social support is one of the strongest predictors of well-being and mental health among people with stigmatized conditions including HIV/AIDS, HCV, and PWID (Birtel et al., 2017). Wider adoption of SSPs and bridging of SSP clients to Medication Assisted Treatment providers is a potential tool in combating the current opioid epidemic in Tennessee. The Tennessee Poll by ETSU was conducted between March and April of 2017. The Tennessee Poll is an annual statewide public opinion poll conducted by the Applied Social Research Lab (ASRL). In the Tennessee Poll, questions were asked about attitudes and beliefs associated with SSPs and PWID in Tennessee. In a previous project, the research team, using generational demographic categories used in Pew surveys, looked at attitudes about both illicit and medical use of marijuana. In comparison of generations, Millennials were 15.62 times (95% CI 5.6, 43.56, p < .001) more likely to support recreational marijuana legalization versus the reference category (The Silent Generation or the generation before Baby boomers and sometimes called “The Greatest Generation”) and 3.7 times (95% CI 1.47, 9.3, p

Since 2010, the incidence of acute Hepatitis C Virus (HCV) infections in the U.S. has nearly quadrupled. Re-use and sharing of syringes among people who inject drugs (PWID) is a significant contributor to increased rates of HCV transmission and a risk factor for HIV infection. Community pharmacists are uniquely positioned to offer harm reduction services that lower the transmission of HCV/HIV by providing sterile syringes to PWID. However, legislation on non-prescription syringe dispensing varies by state and differences in individual pharmacists’ interpretation and attitudes regarding these laws may impact their willingness to participate in harm reduction services. Little is known about the impact of these factors on pharmacist engagement with harm reduction services in central Appalachia, a region particularly hard-hit by the opioid epidemic. The objective of this project is to qualitatively evaluate open-ended responses collected as part of a survey administered to community pharmacists in three central Appalachian states in order to determine: 1) pharmacists’ knowledge and attitudes regarding their state’s non-prescription syringe dispensing laws; and 2) the correlation of attitudes about state legislation to pharmacists’ intent to sell syringes to PWID. A telephonic community pharmacist survey on non-prescription syringe attitudes and behaviors was conducted between April and June 2018 in Northeast Tennessee, Western North Carolina, and Southwest Virginia. Survey responses were obtained from pharmacists practicing in 391 community pharmacies (51% response rate) in the study region. Transcribed responses to open-ended survey questions were extracted from the dataset and a qualitative analysis was completed using a generalized inductive approach. A single investigator coded all qualitative data and a second investigator coded data from a random selection of 10% of the respondents in order to develop themes through consensus. Descriptive analysis was conducted using SPSS version 25 to compare syringe law attitude thematic categories to respondents’ intent to sell syringes to PWID. Preliminary analysis identified discrepancies in pharmacists’ non-prescription syringe law knowledge, state-specific differences in pharmacists’ non-prescription syringe law attitudes, and underlying differences in willingness to sell syringes to PWID based on attitudes. The findings may encourage pharmacists to reflect on personal attitudes and interpretation of state-specific legislation as factors that may influence participation in an evidence-based harm reduction strategy for prevention of HCV/HIV transmission. This study offers preliminary results that will serve as a basis for larger studies and interventions aimed at reducing ambiguity in pharmacists’ interpretation of non-prescription syringe dispensing laws and encouraging pharmacists to counter the spread of HCV/HIV in an evidence-based manner.

1 Critical comparison of compensation schemes for non-pecuniary harm and incurred duplication Abstract The Diploma thesis deals with critical comparison of compensation schemes for non-pecuniary harm and incurred duplication. The aim is to describe how non-pecuniary harm is compensated in case of health-related harm, with particular regard to comparison of schemes according to Civil Code and Labour Code. This description and critical comparison of both schemes leads to reflection, that this incurred duplication is not in accordance with the constitutional values, and that, in the future, changes will be needed, so that this accordance would be achieved. The thesis is divided into six chapters. The first chapter defines basic terms, with whom it tis worked in the text - harm. What is that, when is it compensated, how is it laid down in Civil Code and Labour Code. The second chapter deals with the history and development of compensation for non-pecuniary harm in case of health-related harm. Next chapter describes key document for calculation of the amount of compensation - Supreme Court's methodology and the Government Regulation used for accidents at work. In this chapter there are mentioned two other legislations, Civil service employment Act and Professional soldiers' Act. Chapter "incurred duplication and...

INTRODUCTION: Drug overdose death is now the leading cause of mortality among homeless adults in Boston, with opioids implicated in a majority of those deaths. Harm reduction interventions help minimize the risks associated with substance use, and are critical in supporting individuals with substance use disorder. Medical monitoring programs are an effective harm reduction strategy that work to prevent fatal drug overdoses and keep people safe while still actively using. METHODS: Visit data from the Supportive Place for Observation and Treatment (SPOT) was compiled and analyzed. The two measures of interest were the count of referrals to substance use disorder treatment and the count of visits prior to the first referral to treatment. Chi-square tests of independence, odds ratios, and binary logistic regression models were used to describe the association between factors of interest and referrals to substance use disorder treatment. RESULTS: Gender and age did not show any significant association to a connection to treatment. Overdose history (Adjusted Odds Ratio 6.59), reported stimulant use (AOR 2.59), and documented health or harm reduction education (AOR 5.14) were all associated with increased odds of being referred to substance use disorder treatment. Heavy sedation (AOR 0.55) was associated with decreased odds of a treatment referral.When examining factors associated with rapid connection to treatment, male gender (OR 1.87) was associated with increased odds, while overdose history (AOR 0.42) was associated with decreased odds. DISCUSSION: The two most impactful factors associated with increased odds of connecting to substance use disorder treatment were reported overdose history and documented education. Both of these factors suggests that a strength of SPOT is its ability to form and maintain meaningful connections with participants. One way that SPOT could improve referral outcomes would be to increase its ability to engage participants, such as through the recruitment of more harm reduction specialists or peer recovery coaches.

Ett begrepp som på senare tid fått större utrymme inom behandling av beroendesjukdom är skadereduktion (Harm reduction). Skadereduktion är metoder och ambitioner syftar till att minska skadeverkningarna av ett beteende utan att nödvändigtvis minska beteendet. Skadereduktion är ett begrepp som under senare år har fått en ökad användning inom sjukvård och socialtjänst men också inom rättsväsende och policyarbete. Trots att det använts i olika kontexter sedan 90-talet så finns det ingen tydlig definition av vad det innebär och olika tolkningar av begreppet kan leda till svårigheter att implementera dessa vårdåtgärder. Syftet är att beskriva skadereduktion som begrepp inom beroendevård med hjälp av begreppsanalys. En begreppsanalys utifrån Segesten modell (2017) har genomförts. Resultatet utgörs av en lexikal del och en litterär del som leder till att definiera meningsbärande attribut som sedan sorterats in i framträdande attribut för skadereduktion. I den litterära analysen presenteras de framträdande attributen som är: Autonomi, delaktighet av personer som tar droger, fokus på skador, folkhälsa, mänskligt värde och praktiskt och pragmatiskt. Tre fallbeskrivningar utformades för att beskriva och förtydliga resultatet. Avslutningsvis diskuteras hur skadereduktion och dess attribut förhåller sig inom kontexten beroendevård. Skadereduktion är mer än bara specifika insatser utan också ett förhållningssätt och ett annat sätt att se på de som brukar droger. Skadereducerande insatser och förhållningssätt flyttar fokus från att bota till att fokusera på att minska skador för dem som brukar droger.

BACKGROUND. Skin cancer represents a significant health threat with over 1.3 million diagnoses, 8000 melanoma deaths, and more than $1 billion spent annually for skin cancer healthcare in the US. Despite findings from laboratory, case-control, and prospective studies that indicate a link between youthful indoor tanning (IT) and skin cancer, IT is increasing among US youth. Appearance-focused interventions represent a promising method to counteract these trends. METHODS. A total of 430 female indoor tanners were randomized into intervention or no intervention control conditions. Intervention participants received an appearance-focused booklet based on decision-theoretical models of health behavior. Outcome variables included self-reports of IT behavior and intentions, as well as measures of cognitive mediating variables. RESULTS. Normative increases in springtime IT rates were significantly lower (ie, over 35%) at 6-month follow-up in intervention versus control participants with similar reductions in future intentions. Mediation analyses revealed 6 cognitive variables (IT attitudes, fashion attitudes, perceived susceptibility to skin cancer and skin damage, subjective norms, and image norms) that significantly mediated change in IT behavior. CONCLUSIONS. The appearance-focused intervention demonstrated strong effects on IT behavior and intentions in young indoor tanners. Appearance-focused approaches to skin cancer prevention need to present alternative behaviors as well as alter IT attitudes. Mediational results provide guides for strengthening future appearance-focused interventions directed at behaviors that increase risk of skin cancer.

Based on the growing importance of community engagement and the recognition of its importance by the American Association of Colleges of Pharmacy (AACP), the committee offers several examples of community engagement activities for consideration and replication by our academy and beyond. These activities, including those of winning institutions of the Lawrence J. Weaver Transformational Community Engagement Award, can be mapped to the core components of community engagement presented in Table 1. The committee, using an implementation readiness framework, provides the reader with insight into the challenges that may impact successful community engagement and encourages our academy to continue its work to support faculty capacity in this area. Toward that end, the committee offers a policy statement that encourages schools and colleges of pharmacy to have an office or designate a faculty member whose focus is specifically on community engagement. The committee also offers a recommendation that the core components be included in the criteria for the Weaver Award.

Current research suggests clear correlation between People Who Inject Drugs (PWID) struggling with Substance Use Disorder (SUD) and increased prevalence of Human Immunodeficient virus (HIV) and Hepatitis C (HCV) when compared to the general population. Current research also suggests clear correlation between decreased rates of HIV and HCV in communities with well supported Harm Reduction Programs such as Syringe Service Programs (SSP). The regions of Northeast Tennessee and East Tennessee have been flagged by the CDC as potential regions for future HIV outbreaks due to disproportionately high HCV rates. Prior to 2021, the incidence in of HIV in PWID in East Tennessee Region held consistent with about 15 new diagnoses per year. In 2021 this region reported 86 new diagnoses of HIV among PWID’s as well as an increase from 19.6% to 59.0% of total percentage of HIV incidence in this region associated with PWID’s. This data suggests a potential rapid HIV transmission event could occur in this region and surrounding areas, especially among PWID, area such as that seen in Scott County Indiana in 2015 that first prompted the CDC review of counties at highest risk of a potential outbreak. While there has not yet been a reported increase in incidence in our region of Northeast Tennessee, there is a high likelihood of our region’s population and health system getting impacted by this event. To further investigate what factors may have contributed to this event we called registered Tennessee and neighboring counties SSP’s within 100 miles radius to survey what their program was seeing in terms of HIV/HCV testing, participation accessibly, and weekly availability including changes since the onset of COVID-19 pandemic. We then reviewed data collected from participants at the region’s one local SSP, Syringe Trade and Education Program of Tennessee (STEP TN), a service provided by a partnership between Cempa Community Care and ETSU Center of Excellence for HIV/AIDS. We askedreviewed participants’ experiences regarding changes in accessibility they encountered over the last year including those contributable to the COVID-19 pandemic, changes in current drug use, barriers to HCV/HIV testing, and accessibility to supplies and healthcare. The goal of this project was to determine associations with the increased HIV incidence in the surrounding regions in hopes of mitigating the impact it might have on our region of Northeast Tennessee’s health system; we are not investigating causation or implying correlation to SSP programs, particularly as there is evidence supporting increased incidence of transmission of infectious disease following SSP closures. We plan to use the results for of this project to reduce barriers to care and increase accessibility and testing among PWID’s in our area.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Social harm involves incidents resulting in physical, financial, and emotional hardships such as crime, drug overdoses and abuses, traffic accidents, and suicides. These incidents require various law-enforcement and emergency responding agencies to coordinate together for mitigating their impact on the society. With the advent of advanced networking and computing technologies together with data analytics, law-enforcement agencies and people in the community can work together to proactively reduce social harm. With the aim of effectively mitigating social harm events in communities, this thesis introduces a distributed web application, Community Data Analytic for Social Harm (CDASH). CDASH helps in collecting social harm data from heterogenous sources, analyzing the data for predicting social harm risks in the form of geographic hotspots and conveying the risks to law-enforcement agencies. Since various stakeholders including the police, community organizations and citizens can interact with CDASH, a need for a trust framework arises, to avoid fraudulent or mislabeled incidents from misleading CDASH. The enhanced system, called Trusted-CDASH (T-CDASH), superimposes a trust estimation framework on top of CDASH. This thesis discusses the importance and necessity of associating a degree of trust with each social harm incident reported to T-CDASH. It also describes the trust framework with different trust models that can be incorporated for assigning trust while examining their impact on prediction accuracy of future social harm events. The trust models are empirically validated by running simulations on historical social harm data of Indianapolis metro area.