The present study drew from the publicly available Amerispeak survey (n = 6,515) and examined public stigma towards different substances, the relationship between preferences for abstinence-based recovery and stigma toward each substance, and whether perceived dangerousness of substances moderates the relationship between preferences for abstinence-based recovery and public stigma. The results indicate that the general public has greater stigmatizing attitudes towards methamphetamine use disorder than cocaine use disorder, opioid use disorder, and alcohol use disorder. Furthermore, a preference for abstinence-based recovery was associated with greater stigmatizing attitudes toward all SUDs. The perceived dangerousness of a substance did not moderate the relationship between preference for abstinence-based recovery and stigmatizing attitudes towards SUDs but was related to public stigma in several models. Results have implications for creating stigma interventions for the general public, which can be adapted for abstinence-based settings, like healthcare organizations and treatment centers.

BACKGROUND: People experiencing homelessness (PEH) commonly experience “tri-morbidity,” whereby the effects of physical illness, mental illness, and substance use disorder combine to produce complex healthcare needs. Tiny home villages, or communities comprised of dwellings that are 400-square feet or smaller, have emerged in the U.S. as one option to bridge the gap between living on the street and temporary or permanent shelter. However, whether these communities have been successful in connecting PEH to health services has not been well explored. House of Hope Community Development Corporation sought recommendations for health care services organization and delivery at ECHO Village, a temporary tiny home village in Rhode Island, to meet the health care needs of its clients. AIMS: (1) To characterize barriers and opportunities to engage PEH in care from the perspective of health care providers using the CDC’s 6 Guiding Principles to a Trauma Informed Approach; (2) to assess the health care priorities and barriers and facilitators to care from the perspective of PEH using the Behavioral Model for Vulnerable Populations, and (3) to inform recommendations for health services delivery for ECHO Village and for similar homelessness service settings more broadly. METHODS: Literature was reviewed on evidence-based practices for providing health care to PEH, tiny home villages for PEH, and emergency, temporary housing. A matrix was developed to collect and organize descriptive data to select a comparison tiny home village. In Aim 1, 18 in-depth interviews were conducted with health care providers and other key informants in Rhode Island and at Avivo Village, a tiny home village for PEH in Minneapolis, Minnesota, to characterize barriers and opportunities to engage PEH in health care. In Aim 2, 10 in-depth interviews with Avivo Village residents were conducted to identify health care priorities, barriers, and facilitators to care. The 6 Guiding Principles to a Trauma-Informed Approach and the Behavioral Model were used to create initial coding frameworks for provider and resident interviews, respectively. Through an iterative process, codes were refined to aggregate data into patterns of meaning, emerging themes were revealed, and similarities and differences were identified through consensus coding for interpretation purposes. The Behavioral Model was used to assess the role of predisposing, enabling, and needs factors in health services utilization through a structured survey of 93 adults aged ≥18 experiencing homelessness in Rhode Island. Associations between subsistence difficulty and five health utilization outcomes using bivariate tests of survey data were evaluated. Binomial logistic regressions were run to explore the effects of predictor variables on these outcomes. RESULTS: Thematic analysis revealed that the tiny home village setting could facilitate the care of PEH by (1) overcoming many of the common barriers to receiving care for people who had been excluded from traditional shelters and other critical services, (2) affording a sense of safety and security for PEH, and (3) allowing PEH time and space to gain stability to focus on self-identified goals at their own pace. The importance of patient empowerment, peer support, mixed communities in which people in various stages of recovery live together, and non-judgmental providers also emerged as facilitators of care. Quantitative results showed that subsistence difficulty predicted going without needed care for the past 12 months at p <.05. Adjustment for potential confounders did not change our inferences. CONCLUSION: Several promising practices exist for health service organization and delivery in the tiny home village setting that can be replicated, scaled, and sustained regardless of model or service mix. Given the significant barriers to accessing healthcare faced by PEH, the tiny home village setting can serve as an effective engagement point for PEH, particularly for those averse to traditional shelters or care settings. / 2024-07-05T00:00:00Z

This dissertation explores the criminalization of hypodermic syringes as drug paraphernalia specifically in relation to the extent to which criminalization may impact individual’s connection with harm reduction services, implementation of harm reduction strategies, and healthcare. I utilize a critical criminological perspective to identify and explore the ways in which criminalization works to perpetuate and reinforce the marginalized status of and control and constrain the lives of people who inject drugs. I conducted secondary data analysis of interviews with twenty-five people who inject drugs in rural southern Illinois to explore the extent to which criminalization impacts accessibility and engagement with needed harm reduction and health services and identify the mechanisms through which this impact is enacted. Participants were asked to describe their knowledge of state laws and polices related to drug paraphernalia and calling emergency services in the event of witnessing an overdose. Lastly, this dissertation examined how people who inject drugs cope with their experiences with law enforcement. Findings illustrate that criminalization constricts accessibility and engagement with harm reduction and healthcare services among rural people who inject drugs through frequent violent encounters with law enforcement in which participants are routinely degraded, harassed, and abused. These encounters, coupled with pervasive community stigma, lock participants into a hyper-stigmatized master status further interrupting access and engagement with harm reduction and health services and diminishing networks of social support. Additionally, participants reported a lack of confidence in their understanding of state laws and policies related to paraphernalia and calling emergency services during overdose events; and, those who were most knowledgeable indicated that due to previous abusive encounters, they lacked trust in local law enforcement to uphold these protections. The local harm reduction agency served as a site of hope for participants as they leveraged services to restore a sense of control over their lives and drug use. Engagement with such services make it possible for participants to implement numerous harm reduction strategies in their daily lives and provided them with social support that was otherwise unavailable. Drug use associated stigma and violent encounters with police create significant barriers to accessing harm reduction services for rural people who inject drugs. As such, reducing drug use associated stigma is necessary to ensure that people who inject drugs can safely access needed harm reduction, health care, and treatment services.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.

No description available.