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Open Access Publications from the University of California

Scholarly Works (26 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2020)
In 2017, there were large increases (260-500%) in overdose deaths among women in the United States across age groups (30-64 years and 55-64 years). In addition, U.S. women who inject drugs (WWID) are at increased risk for substance use-related disease transmission, bacterial infections, as well as sexual and physical violence compared to men who inject drugs. Relatedly, women face unique access barriers to substance use-related services, such as stigma and low coverage of gender-specific drug use-related services. Despite these heightened risks experienced by WWID, interventions specifically tailored to preventing women from transitioning into injection drug use have not been developed to date. As such, we advocate for the development of gender-responsive programs to prevent injection drug use initiation. This is critical to ensuring a comprehensive approach to preventing injection drug use initiation among those populations at highest risk of injection-related morbidity and mortality.
    Cover page: Preventing transitions into injection drug use: A call for gender-responsive upstream prevention
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2023)

    Purpose: Substance use is prevalent in U.S. criminal legal system (CLS) cases, yet court-ordered treatments rarely recommend effective treatments such as medications for addiction treatment (MAT). The stressful work coupled with lack of preparation among CLS professionals to support various pathways to recovery is theorized to drive and facilitate high rates of burnout, leading to stigma towards defendants with substance use disorder (DWSUD). This study aims to enhance our understanding of the connection between CLS occupational stress, substance use disorder (SUD) stigma, and to evaluate the impact of a tailored training on attitudes and practices concerning DWSUD within the CLS. Methodology: Using a mixed methods approach, we collected primary data. Qualitative data explored possible drivers, facilitators, and practices of substance use-related stigma among CLS professionals. We utilized various national trainings to collect pre-post-training survey data. Pre-training data assessed the relationship of burnout and attitudes towards DWSUD. Pre-post-training data assessed changes in behavioral intentions to refer to MAT for SUD-related cases, intentions to engage in self-care for managing occupational stress, and attitudes toward DWSUD. Findings: CLS professionals experience complex and intense occupational stress, leading to manifestations of emotional, mental, and physical symptoms; driving and facilitating SUD stigma. There was a significant relationship between 2 of the 3 occupational burnout dimensions and attitudes towards DWSUD. The adapted SHIELD training significantly improved attitudes and behavioral intentions related to SUD cases and promoting well-being behaviors among CLS professionals. Implications: These results highlight the urgent need for targeted interventions that provide resources increasing efficacy regarding SUD-related cases and addressing the demanding and stress-inducing nature of CLS professionals' work, as occupational stress contributes to SUD stigma. The adapted SHIELD training demonstrates the positive impact intervention has on attitudes and behavioral intentions, ultimately promoting well-being within the CLS profession. By identifying the nuanced relationships between burnout dimensions and attitudes, as well as the impact of an adapted training intervention, the study contributes valuable insights into improving the well-being of CLS professionals and promoting fair treatment for individuals with SUD. The study's findings advocate for enhanced curriculum, intervention strategies, and more resources to create a more empathetic and effective legal environment.

      • Article
      • Peer Reviewed
      UC San Diego Previously Published Works (2017)

      Background

      Little is known about ways network-level factors that may influence the adoption of combination prevention behaviors among injection networks, or how network-oriented interventions might moderate this behavior change process.

      Methods

      A total of 232 unique injection risk networks in Philadelphia, PA, were randomized to a peer educator network-oriented intervention or standard of care control arm. Network-level aggregates reflecting the injection networks' baseline substance use dynamics, social interactions, and the networks exposure to gender- and structural-related vulnerabilities were calculated and used to predict changes in the proportion of network members adopting safer injection practices at 6-month follow-up.

      Results

      At follow-up, safer injection practices were observed among 46.31% of a network's members on average. In contrast, 25.7% of networks observed no change. Controlling for the effects of the intervention, significant network-level factors influencing network-level behavior change reflected larger sized injection networks (b=2.20, p=0.013) with a greater proportion of members who shared needles (b=0.29, p<0.001) and engaged in poly drug use at baseline (b=6.65, p=0.021). Changes in a network's safer injection practices were also observed for networks with fewer new network members (b=-0.31, p=0.008), and for networks whose members were proportionally less likely to have experienced incarceration (b=-0.20, p=0.012) or more likely to have been exposed to drug treatment (b=0.17, p=0.034) in the 6-months prior to baseline. A significant interaction suggested the intervention uniquely facilitated change in safer injection practices among female-only networks (b=-0.32, p=0.046).

      Conclusions

      Network-level factors offer insights into ways injection networks might be leveraged to promote combination prevention efforts.
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2021)

        Background

        Mediated and moderated processes that lead to intervention efficacy may underlie results of trials ruled as nonefficacious. The overall purpose of this study was to examine such processes to explain the findings of one of the largest, rigorously conducted behavioral intervention randomized controlled trials, EXPLORE.

        Methods

        Four thousand two hundred ninety-five HIV-negative men who have sex with men (MSM) in the United States were randomized in a 2-armed trial. Participants completed follow-up and an HIV test every 6 months up to 48 months. We used multiple and causal mediation analyses to test 5 mediators, including safer sex self-efficacy and condomless receptive anal sex with HIV-positive or status-unknown partners on our primary outcome (HIV seroconversion). We also examined whether intervention effects on the mediators would be moderated by robust correlates of HIV among MSM, including stimulant use.

        Results

        There were significant effects of the intervention on all hypothesized mediators. Stimulant use moderated the effect on condomless receptive anal sex In stratified multiple mediation models, we found that among MSM with low stimulant use, the intervention significantly prevented HIV by reducing condomless receptive anal sex with HIV-positive or status-unknown partners. Among MSM with higher stimulant use, there were no indirect effects of the intervention on HIV through any of the hypothesized mediators.

        Conclusion

        The results suggest that the null effect found in the original EXPLORE trial might have occurred as a function of previously unexplored mediated and moderated processes. This study illustrates the value of testing mediated and moderated pathways in randomized trials, even in trials ruled out as nonefficacious.
          Cover page: Using Novel Approaches to Evaluate Behavioral Interventions: Overlooked Significant HIV Prevention Effects in the HPTN 015 Project EXPLORE
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2020)
          Since the introduction of antiretroviral therapy, the number of women living with HIV (WLHIV) continues to increase. Despite the decrease in HIV diagnosis among women in California, less than half of WLHIV are retained in HIV care. Structural barriers put women at increased risk for delayed HIV diagnosis, delayed entry into HIV care, and poorer treatment outcomes. The objective of this qualitative analysis is to identify how structural barriers negatively impact women's sustained engagement in HIV care in Southern California. WLHIV accessing local HIV support services participated in a qualitative study by completing a semi-structured interview and brief survey between January and April 2015 (n = 30). Poverty, unemployment, housing instability, and needs for transportation emerged as the dominant structural barriers for women when discussing their challenges with sustained engagement in HIV care. System-level interventions that decrease these noted barriers may help improve HIV care continuum for women living in Southern California.
            Cover page: Structural Barriers to Women’s Sustained Engagement in HIV Care in Southern California
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2018)
            Estimates show a 50% lifetime human immunodeficiency virus (HIV) risk among Black men who have sex with men (BMSM) in the United States(U.S.). Studying the dynamics of sexual positioning practices among BMSM could provide insights into the disparities observed among U.S. groups of men who have sex with men (MSM). This study explored sexual positioning dynamics among HIV-negative BMSM and how they aligned with a theoretical model of sexual positioning and HIV/sexually transmitted infection (STI) risk among MSM. In-depth qualitative interviews were conducted with 29 HIV-negative BMSM between ages 25 and 35 in Los Angeles. Comments related to sexual behaviors were reviewed for relevance regarding oral or anal sexual positioning practices. Data presented represent the range of themes related to decision making regarding sexual positioning. Personal preference, partner attraction, HIV avoidance, and feeling obligated to practice partner preferences influenced sexual positioning. Drug use also affected decision making and was sometimes preferred in order to practice receptive anal intercourse. These variables build on the conceptual model of sexual positioning practices and sexual risk, and add understanding to the relationship between preferences, practices, and risk management. Future research on risk among HIV-negative BMSM should quantify the relative impact of personal preferences, partner attraction, partner type, compromise, and substance use on sexual positioning practices and risk.
              Creative Commons 'BY-NC-SA' version 4.0 license
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2018)
              This study assesses effects of a community-based intervention across seven sites in the United States on HIV care utilization and study retention, among people living with HIV (PLWH). A two-armed study was conducted from 2013 to 2016 in each of seven community-based agencies across the United States. Each site conducted interventions involving community engagement approaches in the form of case management or patient navigation. Control conditions were standard of care involving referral to HIV clinical care. Participants (N = 583) were adults reporting erratic or no HIV care in the past 6 months. Longitudinal survey data on demographics, behavioral risks, and HIV care were collected from participants at baseline, before service delivery, and at 6-month follow-up. Unadjusted and adjusted generalized linear mixed models were used to assess the intervention effects on HIV care utilization and study retention. Participants were majority black (75.5%), cisgender male (55.1%), and heterosexual (55.4%). No significant intervention effect was observed on HIV care utilization, although both groups improved significantly over time [adjusted odds ratio (AOR): 2.09, 95% confidence interval (CI): 1.30-3.37]. Intervention participants were more likely to be retained in the study (AOR: 1.50, 95% CI: 1.03-2.20). Community intervention did not affect HIV care utilization more than standard of care, but intervention participants were more likely to be retained in the study, suggesting that such approaches support relationship building in ways that can facilitate follow-up of socially vulnerable PLWH. More research is needed to understand how such community efforts can support better HIV care utilization in these populations.
                Cover page: Multi-Site Evaluation of Community-Based Efforts to Improve Engagement in HIV Care Among Populations Disproportionately Affected by HIV in the United States
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2022)
                Exposure to trauma increases the risk of engaging in detrimental health behaviours such as tobacco and substance use. In response, the United States Substance Abuse and Mental Health Services Administration developed Trauma-Informed Care (TIC), an organisational framework for improving the provision of behavioural health care to account for the role exposure to trauma plays in patients' lives. We adapt TIC to introduce a novel theory of behaviour change, the Trauma-Informed Theory of Individual Health Behavior (TTB). TTB posits that individual capacity to undertake intentional health-promoting behaviour change is dependent on three factors: (1) the forms and severity of trauma they have been and are exposed to, (2) how this trauma physiologically manifests (i.e., the trauma response) and (3) resilience to undertake behaviour change despite this trauma response. We define each of these factors and their relationships to one another. We anticipate that the introduction of TTB will provide a foundation for developing theory-driven research, interventions, and policies that improve behavioural health outcomes in trauma-affected populations.
                  Cover page: Articulating the Trauma‐Informed Theory of Individual Health Behavior
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2018)

                  Objectives

                  To provide current national estimates of lesbian, gay, bisexual, and questioning (LGBQ) adolescents' (grades 9-12) substance use risks.

                  Methods

                  The 2015 national Youth Risk Behavior Survey included questions for 19 substance use outcomes covering 15 substances. LGBQ adolescents' substance use was described and their risk relative to heterosexual adolescents was estimated after controlling for sociodemographic confounders.

                  Results

                  In controlled analyses, we found that LGBQ adolescents were 1.12 (95% confidence interval [CI] = 1.06, 1.19) times as likely as heterosexual adolescents to report any lifetime and 1.27 (95% CI = 1.14, 1.41) times as likely to report past 30-day substance use. LGBQ adolescents were at significantly greater risk for all but 1 studied substance, including alcohol, cigarettes, cigars, cocaine, ecstasy, electronic vapor usage ("vaping"), hallucinogens, heroin, inhalants, marijuana, methamphetamine, prescription drugs (without physician direction), steroids, and synthetic marijuana.

                  Conclusions

                  LGBQ adolescents are at substantially greater risk for substance use. Public Health Implications. Policymakers should invest in prevention and early intervention resources to address substance use risks among LGBQ adolescents.
                    • Article
                    • Peer Reviewed
                    UC San Diego Previously Published Works (2020)
                    : This editorial review covers current trends in the epidemiology of HIV among people who inject drugs (PWID) in the United States, including four recent HIV outbreaks. We discuss gaps in the prevention and treatment cascades for HIV and medications for opioid disorder and propose lessons learned to prevent future HIV outbreaks. Over the last decade, North America has been in the throes of a major opioid epidemic, due in part to over-prescribing of prescription opiates, followed by increasing availability of cheap heroin, synthetic opioids (e.g. fentanyl), and stimulants (e.g. methamphetamine). Historically, HIV infection among PWID in the US had predominantly affected communities who were older, urban and Black. More recently, the majority of these infections are among younger, rural or suburban and Caucasian PWID. All four HIV outbreaks were characterized by a high proportion of women who inject drugs and underlying socioeconomic drivers such as homelessness and poverty. We contend that the US response to the HIV epidemic among PWID has been fractured. A crucial lesson is that when evidence-based responses to HIV prevention are undermined or abandoned because of moral objections, untold humanitarian and financial costs on public health will ensue. Restructuring a path forward requires that evidence-based interventions be integrated and brought to scale while simultaneously addressing underlying structural drivers of HIV and related syndemics. Failing to do so will mean that HIV outbreaks among PWID and the communities they live in will continue to occur in a tragic and relentless cycle.
                      Cover page: Preventing HIV outbreaks among people who inject drugs in the United States: plus ça change, plus ça même chose.
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