OBJECTIVE: Substance use disorders (SUD) affect approximately 19.3 million adults in the United States. Of adults with SUDs, only 5% perceive the need for SUD treatment and 10% utilize specialty SUD treatment. The literature evidences racial disparities in utilization of SUD treatment yet presents mixed outcomes regarding race/ethnicity (i.e., White, Latinx, and Black/African-American) and gender (i.e., male, female) differences in perceived need for SUD treatment, specialty SUD treatment utilization, and barriers to SUD treatment. In addition, interaction with healthcare systems for chronic medical conditions like diabetes or hypertension may facilitate connection to SUD treatments for individuals with co-occurring SUD and chronic medical conditions, but little research exists that explores this potential facilitator. This dissertation addresses the following questions, with a focus on race/ethnicity and gender, and their interaction: 1.) What characteristics are associated with perceiving a need for SUD treatment among adults with SUD? 2.) What are the characteristics of adults who do not engage in specialty SUD treatment among those who perceived a need for SUD treatment? What were the most commonly reported barriers to specialty SUD treatment? and 3.) Is receipt of a chronic medical condition diagnosis among individuals with SUD associated with a greater likelihood of specialty SUD treatment utilization? METHODS: This study uses data from the National Survey on Drug Use and Health (NSDUH) from years 2005 through 2017. Simple and multivariate logistic regressions were conducted and interactions were tested using multiplicative terms with race/ethnicity and gender. Analyses adjusted for weights to account for the survey’s complex sampling design. RESULTS: No significant racial/ethnic or gender differences were found in association with perceived need for SUD treatment. Among adults who perceived the need for SUD treatment, less than 20% in any racial/ethnic category utilized specialty SUD treatment services. Black/African-American adults, compared to White, were more likely to utilize specialty SUD treatment and less likely to name stigma as a barrier to treatment. Black/African-American adults with co-occurring chronic medical conditions and SUD were more likely to perceive a need for SUD treatment, but similarly likely to utilize specialty SUD treatment in comparison to White adults. Women and men did not significantly differ on perceived need for SUD treatment, utilization, or barriers. CONCLUSIONS: Differences in SUD treatment utilization patterns exist in association with race/ethnicity, though not with gender. Study findings suggest the presence of specialty SUD treatment utilization disparities, with stigma contributing to lower utilization for Whites compared to Blacks/African-Americans. Higher rates of treatment utilization among Blacks/African-Americans may reflect the presence of strengths uniquely attributed to this group.

Syftet var att, utifrån ett urval av människor med erfarenhet av problematisk narkotikakonsumtion, generera kunskap och förståelse om hur familjefaktorer samt reaktioner och agerande från samhällskontakter kan fungera som riskfaktorer för att människor blir problematiska narkotikakonsumenter. Fem semistrukturerade intervjuer med människor med erfarenhet av problematisk narkotikakonsumtion genomfördes. De teoretiska utgångspunkterna som användes för analysarbetet var Goldberg (2010):s stämplingsteoretiska modell och Nakken (1999):s missbrukarprocessteori. Resultatet visade att de riskfaktorer som kan härledas ur familjefaktorer var att bli utsatt för fysiskt våld, att vara familjens syndabock samt att ha fysiskt eller emotionellt frånvarande föräldrar. Samhällsfaktorer som visade sig vara riskfaktorer var att vara förskolan/skolans syndabock, att bli flyttad till specialklass samt att bli placerad utanför hemmet av socialtjänsten. Studien visade även på ett samband mellan problematiska familjeförhållanden och problematiska samhällskontakter. Studien visade att problematiska familjeförhållanden upplevdes som mest betydande för utvecklandet av en problematisk narkotikakonsumtion. / The main purpose with this study was to generate knowledge and understanding of how family factors and the reaction and behaviour of social contacts may serve as risk factors for people becoming drug comsumers. Five semi- structrured intervjues with people with problematic drug use was conducted. Theoretical starting points that was used for the analysis was Goldberg (2010)'s stamping theoretical model and Nakken (1999)'s abusing process theory. The result showed that the risk faktors that can be derived from family factors where being subjected to physical violence, to be the family scape goat or having phycisal or emotional absent parents. Social factors that were found to be risk factors was to be preschool/schools scapegoat, to be tranferred to the special class and to be placed outside the home by social services. The study also showed a correlation between problematic family relations and problematic social contacts.  The study shows that problematic family factors perceived as most significant for the development of problematic drug use.

No description available.

No description available.

The problem of this study was to compare and evaluate two methods of teaching medication compliance to an elderly population with a variety of medical problems, cultural backgrounds, and educational levels. Eighty patients over 65 years old who were attending clinic at a county health care facility participated in the study and were randomly placed into two groups. The Medication Knowledge and Compliance Scale was used to assess the patients' medication knowledge and self—reported compliance. Group I (control) received only verbal teaching. Group II (experimental) received verbal teaching as well as a Picture Schedule designed to tailor the patients' medication schedule to their daily activities. Each patient was re—evaluated two to three weeks later. Medications were also counted at each visit and prescription refill records were examined. Knowledge and compliance did increase significantly among all 80 participants. Patients in Group II demonstrated a significantly greater increase in compliance than Group I but did not show a greater increase in knowledge. Patients in Group II also improved compliance as evidenced by their prescription refill records. This study demonstrates that even though significant barriers to learning exist, knowledge and compliance can be significantly improved when proper teaching techniques are utilized.

Several studies showed adolescents living in temporary housing face multiple risks. The Floating Hospital (TFH), a non-profit organization serving homeless families in New York City, created the Camp Rise Up intervention as a six-day overnight camp to address these risks via a 14-lesson curriculum on the following topics: 1) communication; 2) self-esteem/body image; 3) anatomy; 4) alcohol and drugs; 5) puberty; 6) peer pressure; 7) pregnancy; 8) contraception; 9) gender and sexuality; 10) healthy relationships; 11) consent; 12) STIs/HIV; 13) media literacy; 14) managing emotions and conflict negotiation. Evaluation of Camp Rise Up compared pre-camp to post-camp mean scores for stage of change, self-efficacy, knowledge and social support for five behaviors of focus: saying “no” to sex, if pressured to have sex; talking about the need to use a condom every time, if you have sex; saying “no” to drugs, if pressured to use them; saying “no” to alcohol, if pressured to drink; and ending unhealthy relationships, if being abused. A secondary analysis of existing data collected by TFH on their August 2019 camp included a sample (n=24) that was 50.0% (n=11) Black, 36.4% (n= 8) Latinx, and 13.6% (n=3) mixed race with 13 girls (54.2%) and 11 boys (45.8%) with mean age of 13.26 (SD= 1.322, min=11, max=16). Results showed: a significant increase from pre-camp to post-camp for knowledge of how to say “no” to sex, if pressured (p=.002); self-rated knowledge for all 14 topics covered in the curriculum increased significantly from pre-lesson to post-lesson (p=.000); post-camp ratings for counselors, teachers, overall camp experience, and 14 lessons were all very good to excellent; and, majority of participants would recommend the camp to others, diffusing the innovation of Camp Rise Up. Emergent themes from qualitative data analysis were: camp was a fun positive experience, they made new friends, learned new things, and tried new things beyond their comfort zone, Findings may serve as preliminary studies data to justify grant funding to support a camp of longer duration with a larger sample size and long-term follow-up. The curriculum may find application in meeting needs of this vulnerable population for vital health education.

The present study demonstrates the effectiveness of combining medication packaging, verbal and graphical feedback, and pill count probes on increasing medication compliance. Eight chronic adult outpatients were randomly assigned to one of two conditions: (a) a regimen card medication packaging system, and (b) a 7- day baggie medication packaging system. A staggered group treatment design was used to ascertain whether either of the two special packaging systems was effective relative to baseline and reversal conditions (using the standard medication vial) in increasing medication compliance behavior among both over-and undercompliant outpatients. Results indicated that the use of the special packaging of medication in combination with the behavioral techniques of verbal and graphical feedback aided in improving compliance in 4 out of 8 noncompliant outpatients.

INTRODUCTION: Despite rising hepatitis C virus (HCV) incidence in the United States in recent years among young adults, little data describe HCV testing in youth. My objective was to characterize the HCV care cascade in adolescents and emerging adults in a large US sample and to describe the association between diagnosed substance use disorders (SUDs) and HCV testing. METHODS: In this retrospective cohort study, I describe HCV care cascade outcomes for youth 13–21 years old seen at least once from 1/2012–9/2017 at an OCHIN-participating federally qualified health center. Using electronic health record data, I analyzed odds of HCV testing by number of concurrent diagnosed SUDs associated with HCV risk (those associated with injection or intranasal use: opioids, amphetamines, and cocaine). RESULTS: Among 269,124 youth who met inclusion criteria, (54.7% female, 62.5% non-white, mean age [SD] at testing 18.5 [2.2] years), 6812 (2.5%) were tested for HCV antibody, 122/6812 (1.8%) of those tested were anti-HCV positive, and of anti-HCV positive youth, 75.4% had additional diagnostic testing. Only 1 had documented HCV treatment. Each additional HCV risk-associated SUD was associated with higher odds of HCV testing, particularly in younger (OR 9.12, 95% CI 6.78, 12.4 in 13–15 year-olds, and OR 8.37, 95% CI 7.48, 9.36 in 16–18 year-olds) compared with older youth (OR 3.9, 95% CI 3.59, 4.24 in 19–21 year-olds). CONCLUSION: This study highlights important gaps in recommended HCV testing during the current opioid crisis. As the first step in the care cascade, addressing missed testing opportunities is critical for reducing hepatitis C burden. / 2020-09-28T00:00:00Z

Self-medication impacts both negatively and positively the health of people, which has become evident during the COVID-19 pandemic. The study aimed to assess the prevalence of self-medicated drugs used for respiratory symptoms, as COVID-19 preventive, for its symptoms or once tested positive. To determine the perception of symptom relief and demographic variables that promote self-medication in Peru. We performed a cross-sectional, analytical, multicenter study in 3792 study respondents on the use, the reason for use, and perception of relief after the use of six drugs during the quarantine period. An online questionnaire was developed, pretested and submitted to the general public. Multivariable logistic regression was used to ascertain factors that influence an individual's desire to self-medicate, associations were considered significant at p < 0.05 and using region (coast, mountain and jungle) as cluster group. The majority of respondents self-medicated with acetaminophen for respiratory symptoms and mainly because they had a cold or flu. It was observed that all the surveyed drugs (acetaminophen, ibuprofen, azithromycin, penicillin, antiretrovirals and hydroxychloroquine) were consumed for various symptoms including: fever, fatigue, cough, sneezing, muscle pain, nasal congestion, sore throat, headache and breathing difficulty. Over 90% of respondents perceived relief of at least one symptom. Multivariable logistic regression showed that older people have a higher frequency of antiretroviral self-medication, respondents who currently have a job had a higher frequency of penicillin self-medication, and that respondents from the Andes consumed less acetaminophen, while the ones from the rainforest consumed it more. There were significant percentages of self-medication, including drugs without sufficient scientific evidence. Age, region where one lived and job status were variables associated with self-medication frequency. Continuous awareness and sensitization about the risks of self-medication are warranted. / Revisión por pares

Background: Rural people who inject drugs (PWID) have been disproportionately affected by the ongoing hepatitis C virus (HCV) epidemic. Methods: Using data from a cross-sectional study of PWID from rural New Hampshire, Vermont, and Massachusetts, we evaluated the potential for syringe services programs (SSPs) to lower the risk of HCV infection among rural PWID via their influence on the physical and social environment. The specific aims were to evaluate: 1) the association of spatial proximity to the nearest SSP with HCV seroprevalence and injection risk behaviors; 2) the association of indirect SSP use (secondary syringe exchange) with HCV seroprevalence and injection risk behaviors; and to 3) explore PWIDs’ perceptions and experiences with obtaining injection supplies, injection risk behaviors, and HCV. Results: Living farther from an SSP was associated with a higher prevalence of HCV seropositivity and injection risk behaviors. Indirect SSP use was weakly and imprecisely associated with lower prevalence of injection risk behaviors, while direct SSP and pharmacy use were both associated with a higher prevalence of HCV seropositivity and injection risk behaviors. Participants described sharing syringes in response to limited access to syringe sources. Syringe sharing behavior was influenced by perceptions of HCV risk, HCV status, and emotions of trust and intimacy. Conclusion: Spatial proximity to an SSP and direct use of an SSP may lower the risk of HCV infection among rural PWID. HCV prevention efforts in rural New England need to address syringe access and cultivate the perception that HCV is a serious but preventable risk.