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This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.

There are three main components of peer-based approaches regardless of type: education, social support, and social norms. The purpose of this scoping review was to examine evidence in the literature among peer-based interventions and programs of components and behavioral mechanisms utilized to improve HIV care cascade outcomes.Of 522 articles found, 40 studies were included for data abstraction. The study outcomes represented the entire HIV care cascade from HIV testing to viral suppression. Most were patient navigator models and 8 of the studies included all three components. Social support was the most prevalent component. Role modeling of behaviors was less commonly described. This review highlighted the peer behavioral mechanisms that operate in various types of peer approaches to improve HIV care and outcomes in numerous settings and among diverse populations. The peer-based approach is flexible and commonly used, particularly in resource-poor settings.

Minoritized older adults face multiple health inequities and disparities, but are less likely to benefit from evidence-based health care interventions. With the increasing diversity of the U.S. aging population, there is a great promise for gerontology researchers to partner with racial/ethnic minority organizations and underrepresented communities to develop and implement evidence-based health interventions. Community-Based Participatory Research and Implementation Science offer guidance and strategies for researchers to develop and sustain community partnerships. However, researchers partnering with community organizations continue to face challenges in these collaborations, study outcomes, and sustainability. This may be especially true for those junior in their career trajectory or new to community-engaged research. The purpose of this forum article is to detail critical challenges that can affect gerontology researcher–community partnerships and relationships from the perspective of researchers. Seven challenges (pre- or mid-intervention design, implementation, and postimplementation phases) described within the Equity-focused Implementation Research for health programs framework are identified and discussed. Potential solutions are also presented. Planning for potential obstacles of the researcher–community partnerships can inform innovative solutions that will facilitate successful partnerships, thereby promoting the advancement of collaborative research between academic institutions and community organizations to improve older adult health outcomes.

Introduction Limited research has explored sex differences in the relationship between partner support and smoking cessation among minority low-income population. Further, scarce attention has been given to the influence of partners who are not married. The purpose of this study is to examine the relationship between negative and positive social support provided by partners and smoking cessation among men and women smokers. Methods Data were collected as part of the Tobacco Use in Drug Environment (TIDE) study, a cross-sectional study conducted in Baltimore, Maryland, from September 2013 to May 2015. Interviews were administered with current smokers. The sample size for the current analysis was 134 men and 86 women. Results Approximately 33% of male participants (n=45) reported currently trying to quit smoking cigarettes and 29% of women were currently trying to quit. Having a sex partner who did not mind the participant’s smoking was associated with decreased odds of trying to quit among men (AOR=0.35; 95% CI: 0.13–0.91, p=0.03). Having a sex partner who expressed concern about the participant’s smoking (AOR=12.9; 95% CI: 3.49–47.0, p

It is known that social inequities result in health disparities in outcomes, highlighted in the coronavirus disease 2019 (COVID-19) pandemic. This commentary discusses the actionable initiatives that have been implemented to address social inequities in healthcare in the United States. The publicly available social needs screening tools and International Classification of Disease Systems-10 Z codes for social determinants of health are introduced. In this context, policies, health system strategies and the larger role of implementation science in recognizing and alleviating the social needs are discussed.

The goal of this study was to assess awareness of, interest in, and sources of knowledge about pre-exposure prophylaxis (PrEP) among 1,464 HIV-uninfected patients from public STD clinics in Baltimore. Logistic regression analyses were conducted to examine factors associated with PrEP awareness and interest. Results suggest PrEP awareness and interest in knowing more about PrEP was highest among men who reported sex with men or with both men and women. White patients were more likely to be aware of PrEP than African American patients, and those reporting consistent condom use were more likely to have heard about PrEP than those who never used condoms. The major source of knowledge about PrEP was health care providers. Findings can inform future prioritization of locally targeted PrEP programs to enhance access to and uptake of PrEP among those most at risk for HIV transmission.

Vaccinating children against COVID-19 protects children's health and can mitigate the spread of the virus to other community members.The primary objective of this study was to use a socio-ecological perspective to identify multi-level factors associated with US parents' intention to vaccinate their children.This study used a longitudinal online cohort. Multinomial logistic regression models assessed socio-ecological predictors of negative and uncertain child COVID-19 vaccination intentions compared to positive intentions.In June 2021, 297 parents were surveyed and 44% reported that they intended to vaccinate their children while 25% expressed uncertainty and 31% did not intend to vaccinate their children. The likelihood of reporting uncertain or negative intention, compared to positive intention to vaccinate their children was higher among parents who had not received a COVID-19 vaccination and those who did not have trusted information sources. Parents who talked to others at least weekly about the COVID-19 vaccine were less likely to endorse uncertain compared to positive vaccine intentions (aRRR: 0.44; 95% CI: 0.20-0.93). A sub-analysis identified that parents had significantly higher odds of intending to vaccinate older children compared to younger children (children ages 16-17 years v. 0-4 years OR: 2.01, 95% CI: 1.05-3.84). An additional sub-analysis assessed the stability of parents' intention to vaccinate their children between March 2021 and June 2021 (N=166). There was transition within each intention group between the study periods; however, symmetry and marginal homogeneity test results indicated that the shift was not statistically significant. Parents expressing uncertainty in March 2021 were the most likely to change their intention, with 24% transitioning to positive intention and 23% to negative intention in June 2021.Study findings suggest that programs to promote vaccination uptake should be dyadic and work to promote child and parent vaccination. Peer diffusion strategies may be particularly effective at promoting child vaccination uptake among parents expressing uncertainty.

High-quality implementation of evidence-based interventions is important for program effectiveness and is influenced by training and quality assurance (QA). However, gaps in the literature contribute to a lack of guidance on training and supervision in practice settings, particularly when significant adaptations in programs occur. We examine training and QA in relationship to program fidelity among organizations delivering a widely disseminated HIV counseling and testing EBI in which significant adaptations occurred due to new testing technology. Using a maximum variation case study approach, we examined training and QA in organizations delivering the program with high- and low-fidelity (agencies: 3 = high; 3 = low). We identified themes that distinguished high- and low-fidelity agencies. For example, high-fidelity agencies more often employed a team approach to training; demonstrated use of effective QA strategies; leveraged training and QA to identify and adjust for fit problems, including challenges related to adaptations; and understood the distinctions between RESPECT and other testing programs. The associations between QA and fidelity were strong and straightforward, whereas the relationship between training and fidelity was more complex. Public health needs high-quality training and QA approaches that can address program fit and program adaptations. The study findings reinforced the value of using effective QA strategies. Future work should address methods of increasing program fit through training and QA, identify a set of QA strategies that maximize program fidelity and is feasible to implement, and identify low-cost supplemental training options.

Background: Declines in smoking prevalence among low-income adults lag behind national samples. Understanding the influence of social context factors such as gender, and normative influence on smoking attitudes and behaviors, can inform smoking cessation interventions. Objective: This study explored how gender, smoking dependence, and cessation norms influenced the likelihood of current quit attempts among urban-dwelling, predominately African American adults. Methods: Participants answered questions about their current quit attempts, smoking dependence (heaviness of smoking index [HSI]), and cessation norms (descriptive: having friends who quit smoking; injunctive: friends disapproving of smoking) as a part of a parent study exploring social and environmental factors in tobacco use. Logistic regression stratifying by gender and adjusting for demographics examined main and interaction effects of norms and HSI on odds of having a current quit attempt. Results: Among men, having a higher smoking dependence was associated with a reduced likelihood of trying to quit (AOR = 0.30 [0.15-0.59]), but this effect was moderated by having friends who had quit smoking (AOR = 2.40 [1.20-4.78]). When accounting for the effect of friends quitting smoking, men were not influenced by friends disapproving of smoking. Among women, currently attempting to quit was predicted by neither smoking dependence nor norms. Conclusions/Importance: Cessation norms and smoking dependence influenced the likelihood of quit attempts for men, but not women, in this study. This highlights the importance of conducting gender stratification in smoking cessation research so as to better understand how social and environmental factors differently impact cessation outcomes for men and women.

Pre-exposure prophylaxis (PrEP) could have a substantial impact on the HIV epidemic within the US. However, the implementation of PrEP interventions outside of clinical trials has been slow and faces considerable barriers. The aim of the current study was to qualitatively explore PrEP-related patient-reported outcomes (PRO) among MSM patients who enrolled in a PrEP program at two public STD clinics in Baltimore. We conducted in-depth interviews with 18 PrEP patients who self-identified as MSM at two Baltimore City Health Department STD clinics between March and November, 2017. A codebook was developed using an iterative process. During analysis, the study team identified various biomedical and psychosocial PrEP-related PRO among MSM PrEP patients. In addition to HIV prevention, PrEP-related PRO included greater peace of mind, better continuity in care and awareness about health and well-being, relationship solidarity with serodiscordant partners, and access to social services. These findings on PrEP-related PRO can potentially contribute to improving patient-provider communication, leading to increased engagement in care and uptake of PrEP by MSM.

AIMS This study sought to examine the prevalence and correlates of grit in a sample of Black men who have sex with men (BMSM) in Baltimore, Maryland. METHODS A trained research assistant administered the Short-Grit and Center for Epidemiological Studies Depression (CES-D) scales and surveyed participants of a community-based behavioral health intervention for demographic, health, and sexual behaviors. RESULTS Of 239 participants, two-thirds scored in the high grit category. A greater proportion of men with high grit demonstrated higher educational attainment, were employed in the prior 6 months, reported very good/excellent health, were human immunodeficiency virus-positive, scored

Background: Fentanyl-related mortality has skyrocketed among people who use opioids (PWUO) in North America. The current study of PWUO aims to examine the perceived fentanyl risk and training needs...

This study examined the relationship between maternal social stability and household residency among youth in vulnerable families. Data on the household residency of biological children (under 18 years of age) was collected from 259 mothers in Baltimore, Maryland. Only half (50%) of the mothers lived with at least one of their biological children. Multivariate logistic regression analyses were conducted to determine which maternal characteristics and stability factors predicting the likelihood of a child not living with their biological mother. A history of mental health diagnoses as well as economic and housing instability were the strongest predictors of children not living with their biological mothers. Social stability factors such as incarceration history, and receipt of food stamps were not associated with an increased likelihood that children were not living with their biological mother. Maternal economic and housing instability may be the basis on which vulnerability begins for youth. These findings serve as the foundation for future researchers interested in identifying factors that may moderate or mediate the complex relationship between maternal stability and childhood outcomes.

Background Relationships between academic faculty and decision makers have been documented as an important factor in the evidence-to-policy process. However, knowledge about the breadth, depth and dynamic quality of these relationships often remains unknown therefore rendering the potential for influence untapped, uncoordinated, redundant or inefficient. Methods We mapped the relationships between faculty at the Johns Hopkins Bloomberg School of Public Health and decision makers at the city, state, federal and global levels. In 2016, 211 of 627 eligible full-time faculty participated in a sociometric survey. Common metrics for social network analysis were modified to provide reliable indicators of network characteristics. UCINet was used for network visualisation. ‘Highly connected’ individuals included: faculty with ≥5 contacts at any one government level; those appearing in the top 10% in total across all four levels; decision makers appearing in the top 2% of frequently mentioned people. Results Results revealed faculty relationships spanning >100 government departments, ~700 decision makers, and 45 country governments. The majority of respondents (72%) mentioned at least one decision maker; 49 faculty and 24 decision makers appeared as ‘highly connected’. While the School of Public Health (SPH) demonstrates a diversity of relationships within and across government agencies, there were also identifiable gaps. Conclusion This study provides further support for using Network Analysis to explore size, reach, diversity and density of relationships between academic faculty and decision makers, with network maps serving as a proxy for potential influence. Academic institutions and government agencies should nurture a variety of relationships in order to enhance engaged scholarship and further informed decision making.

Background: There has been a dramatic increase in drug overdose deaths in the United States. In the current study, the authors examined factors associated with witnessing a drug overdose. Methods: A sample of 450 substance users in Baltimore, Maryland, were recruited for a behavioral intervention and were administered a survey. Multinomial logistic regression models were used to compare participants who never witnessed a drug overdose with those who witnessed one in the prior 6 months and those who witnessed an overdose over 6 months ago. Results: Most (58%) participants were male, 40% experienced homelessness in the prior 6 months, 63% reported a history of heroin injecting, 84% had snorted heroin, 75% reported witnessing a drug overdose, and 38% experienced an overdose. In multinomial logistic regression models, witnessing an overdose in the past 6 months was associated with number of different types of places where drugs were used (adjusted odds ratio [aOR] = 1.34), history of experiencing an overdose (aOR = 1.80), injecting heroin and/or speedball (aOR = 1.78), and snorting heroin (aOR = 1.54). Witnessing an overdose more than 6 months ago was associated with number of different places where drugs were used (aOR = 1.25), history of experiencing an overdose (aOR = 1.61), snorting heroin (aOR = 1.42), and injecting heroin or speedball (aOR = 1.47). Conclusions: These data suggest that people who engage in more public and frequent drug use, and hence are more likely to witness an overdose, should be targeted for interventions to prevent and treat drug overdose.

Background Post-traumatic stress disorder (PTSD) prevalence is high, but not well-understood, among women living in urban, impoverished areas. Although previous studies have established social support as an important factor in PTSD development and maintenance, little is known about how perceptions of neighborhood are linked to PTSD. This study examined the relationship between PTSD and social network and neighborhood factors among women with a low socioeconomic status. Methods We analyzed cross-sectional data collected from a human immunodeficiency virus/sexually transmitted infection peer network study in Baltimore, Maryland (n = 438). We used bivariate analyses to examine the associations between PTSD and social network characteristics and time in neighborhood and satisfaction. We then constructed multivariable regression models that controlled for the following with PTSD: homelessness, cocaine/heroin use, and unemployment. Main Findings Overall, 30% of women had PTSD symptom severity consistent with a clinical diagnosis. In the multivariable model, dissatisfaction with neighborhood block (odds ratio [OR], 1.80; p = .03) and living in one's neighborhood for more than 5 years (OR, 1.69; p = .03) were associated with PTSD. Social network factors that were significantly associated with PTSD included a higher number of network members in conflict with the participant (OR, 1.28; p = .02), presence of a network member who would let the participant stay with them (OR, 0.4; p = .004), and the number of network members with whom the participant socialized (OR, 0.6; p = .04). Conclusions In this sample of impoverished urban women with a high prevalence of PTSD, duration of residency, satisfaction with neighborhood, and network characteristics were found to be strongly associated with PTSD symptom severity.

Background Social desirability response bias may lead to inaccurate self-reports and erroneous study conclusions. The present study examined the relationship between social desirability response bias and self-reports of mental health, substance use, and social network factors among a community sample of inner-city substance users. Methods The study was conducted in a sample of 591 opiate and cocaine users in Baltimore, Maryland from 2009 to 2013. Modified items from the Marlowe-Crowne Social Desirability Scale were included in the survey, which was conducted face-to-face and using Audio Computer Self Administering Interview (ACASI) methods. Results There were highly statistically significant differences in levels of social desirability response bias by levels of depressive symptoms, drug use stigma, physical health status, recent opiate and cocaine use, Alcohol Use Disorders Identification Test (AUDIT) scores, and size of social networks. There were no associations between health service utilization measures and social desirability bias. In multiple logistic regression models, even after including the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomology, social desirability bias was associated with recent drug use and drug user stigma. Social desirability bias was not associated with enrollment in prior research studies. Conclusions These findings suggest that social desirability bias is associated with key health measures and that the associations are not primarily due to depressive symptoms. Methods are needed to reduce social desirability bias. Such methods may include the wording and prefacing of questions, clearly defining the role of “study participant,” and assessing and addressing motivations for socially desirable responses.

People who inject drugs have a greater risk of infectious disease and mortality than other substance abusers and nondrug users. Variation in risk behavior among people who inject drugs is likely associated with comorbid mental health disorders.Examine the association between a history of mood disorder and recent risk behavior among people who inject drugs.With baseline data from a behavioral HIV prevention clinical trial in a population of people who inject drugs, we used logistic regression models to compare the risk behaviors of people who report a past diagnosis of bipolar disorder (n = 113) or depression (n = 237) to a comparison group with no history of diagnosed mental illness (n = 446). We also assessed differences between groups before and after adjusting for demographic characteristics and current depressive symptoms.While there were no differences between groups in frequency of drug use, people who inject drugs who report a history of mood disorders reported more injection risk behaviors, drug overdoses, sex exchanges, and multiple partners than those with no history of mental illness. Adjusting the comparison for demographic characteristics and current depressive symptoms had little impact on these findings. Variation in risk between depression and bipolar disorder groups was minimal. Conclusions/Importance: People who inject drugs and have mood disorders have unique and significant social, clinical, and risk reduction needs. Despite the limited validity of self-reported mental health history, simply asking about a history of mood disorder may be effective for identifying a particularly vulnerable population of people who inject drugs.

Context Relationships between researchers and decision-makers have demonstrated positive potential to influence research, policy and practice. Over time, interest in better understanding the relationships between the two parties has grown as demonstrated by a plethora of studies globally. However, what remains elusive is the evolution of these vital relationships and what can be learned from them with respect to advancing evidence-informed decision-making. We therefore explored the nuances around the initiation, maintenance and dissolution of academic–government relationships. Methods We conducted in-depth interviews with 52 faculty at one school of public health and 24 government decision-makers at city, state, federal and global levels. Interviews were transcribed and coded deductively and inductively using Atlas.Ti. Responses across codes and respondents were extracted into an Excel matrix and compared in order to identify key themes. Findings Eight key drivers to engagement were identified, namely (1) decision-maker research needs, (2) learning, (3) access to resources, (4) student opportunities, (5) capacity strengthening, (6) strategic positioning, (7) institutional conditionalities, and (8) funder conditionalities. There were several elements that enabled initiation of relationships, including the role of faculty members in the decision-making process, individual attributes and reputation, institutional reputation, social capital, and the role of funders. Maintenance of partnerships was dependent on factors such as synergistic collaboration (i.e. both benefit), mutual trust, contractual issues and funding. Dissolution of relationships resulted from champions changing/leaving positions, engagement in transactional relationships, or limited mutual trust and respect. Conclusions As universities and government agencies establish relationships and utilise opportunities to share ideas, envision change together, and leverage their collaborations to use evidence to inform decision-making, a new modus operandi becomes possible. Embracing the individual, institutional, networked and systems dynamics of relationships can lead to new practices, alternate approaches and transformative change. Government agencies, schools of public health and higher education institutions more broadly, should pay deliberate attention to identifying and managing the various drivers, enablers and disablers for relationship initiation and resilience in order to promote more evidence-informed decision-making.

BackgroundFatal opioid overdose is a pressing public health concern in the United States. Addressing barriers and augmenting facilitators to take-home naloxone (THN) access and administration could expand program reach in preventing fatal overdoses.MethodsTHN access (i.e., being prescribed or receiving THN) was assessed in a Baltimore, Maryland-based sample of 577 people who use opioids (PWUO) and had a history of injecting drugs. A sub-analysis examined correlates of THN administration among those with THN access and who witnessed an overdose (N = 345). Logistic generalized estimating equations with robust standard errors were used to identify facilitators and barriers to accessing and using THN.ResultsThe majority of PWUO (66%) reported THN access. In the multivariable model, decreased THN access was associated with the fear that a person may become aggressive after being revived with THN (aOR: 0.55, 95% CI: 0.35-0.85), police threaten people at an overdose event (aOR: 0.68, 95% CI: 0.36-1.00), and insufficient overdose training (aOR: 0.43, 95% CI: 0.28-0.68). Enrollment in medication-assisted treatment, personally experiencing an overdose, and graduating from high school were associated with higher access. About half (49%) of PWUO with THN access and who had witnessed an overdose reported having administered THN. THN use was positively associated with "often" or "always" carrying THN (aOR: 3.47, 95% CI: 1.99-6.06), witnessing more overdoses (aOR:5.18, 95% CI: 2.22-12.07), experiencing recent homelessness, and injecting in the past year. THN use was reduced among participants who did not feel that they had sufficient overdose training (aOR: 0.56, 95% CI: 0.32-0.96).ConclusionTHN programs must bolster confidence in administering THN and address barriers to use, such as fear of a THN recipient becoming aggressive. Normative change around carrying THN is an important component in an overdose prevention strategy.

Background Evaluations of overdose response programs suggest effectiveness in preventing overdose-related death and individual willingness to respond to an overdose. However, knowledge of and confidence in performing response behaviors is necessary for individuals to intervene. This study assessed overdose responding self-efficacy among adults who reported lifetime opioid use. Methods Data come from a cross-sectional survey, part of a randomized controlled trial designed for adults living with hepatitis C. Participants were 18 years old or older, and reported lifetime opioid use. Overdose responding self-efficacy was assessed by perceived knowledge and/or need for additional training to have confidence responding to an overdose. Univariate statistics were calculated for overdose responding self-efficacy, and individual characteristics and experiences. Adjusted logistic regression was used to identify variables associated with low overdose responding self-efficacy. Results Of the 424 participants, 67.2% reported low overdose responding self-efficacy. Sixty percent witnessed and 30.4% experienced an overdose in the past year. Witnessing an overdose in the past year, experience with naloxone training, and receiving and using naloxone were associated with high overdose responding self-efficacy. While, apprehension with particular response behaviors (e.g. rescue breathing) was associated with low overdose responding self-efficacy. Conclusions A large proportion of adults who reported lifetime opioid use did not feel confident or knowledgeable responding to an overdose. This could be influenced by overdose exposure, specific response behaviors, and response trainings.

Background Little is known about trends in overdose behaviors. This study explored non-fatal overdose and engagement in overdose prevention behaviors and compared these trends to city-wide overdose fatality rates from 2017 to 2019 in Baltimore, MD. Methods The analysis included people who used opioids (PWUO; N = 502) recruited through a community-based study. Enrollment date was used to categorize participants into annual quarters. Logistic regression models examined change in overdose experiences and prevention behaviors with time. Baltimore’s fatal overdoses were also mapped over the study period to assess overlaps in trends. Results The majority of the sample were male(68 %), Black(61 %), reported past 6 months homelessness(56 %), and were on average 45 years old. Most had witnessed(61 %), and 28 % had personally experienced an overdose in the past 6 months. Witnessing overdose marginally increased(aβ = 0.182;p = 0.058) while experiencing overdose did not significantly change by enrollment quarter. Most participants had or had been prescribed naloxone(72 %), and one fifth(22 %) regularly carried naloxone, with both access to(aβ = 0,408;p = 0.002) and carrying naloxone(aβ = 0.302;p = 0.006) increasing over time. Overdose communication remained stable, with 63 % of participants reporting discussing overdose sometimes/often. Among participants who injected (n = 376), regularly injecting alone decreased(aβ=-0.207;p = 0.055), and reporting others often/always having naloxone with them when injecting increased over time(aβ = 0.573;p Conclusions Witnessed overdose marginally increased from 2017 to 2019, aligning with city trends of fatal overdose. Overdose prevention behaviors significantly increased over time. Despite reporting having naloxone or a naloxone prescription, most PWUO did not regularly carry naloxone, and many used alone. Social network diffusion interventions may be a strategy to promote normative overdose prevention behaviors.

Scarce research has explored how sex partners and their provision of social support impact depression among women. The purpose of this study is to examine the role of social support (overall and specific types of support) provided by a sex partner on depressive symptoms among a sample of women (n=295). We assessed depression using the Centers for Epidemiological Studies Depression Scale (CES-D) and used a social network inventory to evaluate partner characteristics and types of support provided. Overall 76% (n=225) of the sample experienced depressive symptoms in the past 90 days. Approximately one-third of the sample had a partner who provided emotional support (33.9%), financial support (36.6%), or socialization support (40.0%). About 41% of women said their partner offered no support while 16.3% had a partner who gave all three types of support. These findings demonstrate that partners and the level and types of support provided should not be discounted in mental health assessments.

Objective: The aim of the study was to examine alcohol use in African American women’s social networks.Design: This was a longitudinal study of African American women and their social networks in Baltimore, MD. Data were collected through face-to-face interviews at a community-based research clinic. Alcohol consumption frequency was assessed by a single question ‘How often do you drink alcohol?’ with a four-point ordinal rating scale ‘never,’ ‘monthly or less,’ ‘2–4 times a month’ and ‘>2 times a week.’ A longitudinal ordinal logistic model was conducted to use 317 African American women’s alcohol consumption frequency as a predictor of their social networks’ alcohol consumption frequency.Results: Results show that African American women’s alcohol consumption frequency was a statistically significant predictor of their social network members’ alcohol consumption frequency.Conclusion: Findings suggest the merit of social network-based approaches to address alcohol use among urban minority populations.

Studies on associations between body weight status and specific substance use have provided conflicting findings.This paper investigated the association between substance use and body weight status among African American women.We analyzed the data from 328 African American women who were enrolled in a HIV prevention intervention in Baltimore, MD, USA, in order to investigate the association between substance use and their body weight status. Participants' anthropometry was measured by trained research staff. Substance use information was collected via self-administered and interviewer-administered questionnaires.About 33.4% were classified as normal/underweight, 24.2% overweight, and 42.4% obese. Compared to overweight (38.5%) and obese (29.2%) participants, the normal/underweight women had significantly higher prevalence of drug use (52.8%) (χ(2)= 14.11, p0.05). BMI was significantly negatively associated with current heroin use (t = -2.21, p0.05). The risk of being overweight and obesity was lower among active marijuana (z = -2.05, p0.05) and heroin users (z = -1.91, p0.10) than among non-marijuana/non-heroin users. Heroin smokers had lower body weight (t = -3.02, p0.05) and BMI (t = -2.47, p0.05) than non-heroin smokers. The decrease in BMI appeared to be greater among more frequent (≥once/day) heroin users (t = -2.39, p0.05) as compared to the less frequent heroin users (once/day) (t = -1.71, p0.10), but this difference was not statistically significant.The results are comparable to existing findings. Active marijuana and heroin users were less likely to be overweight and obese compared to their counterparts. The impact of substance use on body weight status differed by the frequency and route of administration.

BACKGROUND: Research demonstrates the positive impact of opioid overdose education and community naloxone distribution (OEND) programs in reducing opioid related overdose deaths. Despite these promising findings opiate overdose continues to be a major cause of mortality. The “cascade of care” is a useful tool for identifying specific steps involved in achieving optimal health outcomes. We applied the cascade concept to identify gaps uptake and use of naloxone: awareness, access, training, possession and use. METHODS: Data came from a cross-sectional survey of 353 individuals aged 18 and older who self-reported lifetime history of heroin use who were recruited using street-based outreach methods. RESULTS: The sample was majority male (65%) and reported use of crack (64%), heroin (74%) and injection (57%) in the past 6 months. Ninety percent had ever witnessed an overdose and of these 59% were in the prior year. Awareness of naloxone (90%) was high. Over two-thirds reported having ever received (e.g. access) (69%) and/or been trained to use naloxone (60%). Over one-third of the sample reported never (37%) or rarely/sometimes carrying naloxone (38%), while 25% reported always carrying. One-third had ever used it (33%). Possession of naloxone often/always compared to never was associated with increased relative odds of being female (RRR=2.77, 95%CI=1.28) and ever use Naloxone (RRR=4.33, 95%CI=1.88–9.99) controlling for other variables. CONCLUSIONS: This study identifies that consistent possession is a gap in the naloxone cascade. Future research is needed to understand reasons for not always carrying naloxone.

Background Schools of public health (SPHs) are increasingly being recognised as important contributors of human, social and intellectual capital relevant to health policy and decision-making. Few studies within the implementation science literature have systematically examined knowledge exchange experiences within this specific organisational context. The purpose of this study was therefore to elicit whether documented facilitators and barriers to engaging with government decision-makers resonates within an academic SPH context. We sought to understand the variations in such experiences at four different levels of government decision-making. Furthermore, we sought to elicit intervention priorities as identified by faculty. Methods Between May and December 2016, 211 (34%) of 627 eligible full-time faculty across one SPH in the United States of America participated in a survey on engagement with decision-makers at the city, state, federal and global government levels. Surveys were administered face-to-face or via Skype. Descriptive data as well as tests of association and logistic regression analyses were conducted using STATA. Results Over three-quarters of respondents identified colleagues with ties to decision-makers, institutional affiliation and conducting policy-relevant research as the highest facilitators. Several identified time constraints, academic incentives and financial support as important contributors to engagement. Faculty characteristics, such as research areas of expertise, career track and faculty rank, were found to be statistically significantly associated with facilitators. The top three intervention priorities that emerged were (1) creating incentives for engagement, (2) providing funding for engagement and (3) inculcating an institutional culture around engagement. Conclusions The data suggest that five principal categories of factors – individual characteristics, institutional environment, relational dynamics, research focus and funder policies – affect the willingness and ability of academic faculty to engage with government decision-makers. This study suggests that SPHs could enhance the relevance of their role in health policy decision-making by (1) periodically measuring engagement with decision-makers; (2) enhancing individual capacity in knowledge translation and communication, taking faculty characteristics into account; (3) institutionalising a culture that supports policies and practices for engagement in decision-making processes; and (4) creating a strategy to expand and nurture trusted, relevant networks and relationships with decision-makers.

Data from a social network-based human immunodeficiency virus (HIV)/sexually transmitted infection (STI) prevention study with a total of 330 men and women at high risk for HIV/STIs were used to examine the relationships between substance use, depressive symptoms, general health, cardiovascular disease risk factors, sociodemographic characteristics, and systolic/diastolic blood pressure (SBP/DBP). Approximately 60% of the participants had prehypertension to stage 2 hypertension. In the base model, older patients (P

The prevalence of depression among drug users is high. It has been recognized that drug use behaviors can be influenced and spread through social networks.We investigated the directional relationship between social network factors and depressive symptoms among a sample of inner-city residents in Baltimore, MD.We performed a longitudinal study of four-wave data collected from a network-based HIV/STI prevention intervention for women and network members, consisting of both men and women. Our primary outcome and exposure were depression using CESD scale and social network characteristics, respectively. Linear-mixed model with clustering adjustment was used to account for both repeated measurement and network design.Of the 746 participants, those who had high levels of depression tended to be female, less educated, homeless, smokers, and did not have a main partner. In the univariate longitudinal model, larger size of drug network was significantly associated with depression (OR = 1.38, p.001). This relationship held after controlling for age, gender, homeless in the past 6 months, college education, having a main partner, cigarette smoking, perceived health, and social support network (aOR = 1.19, p = .001). In the univariate mixed model using depression to predict size of drug network, the data suggested that depression was associated with larger size of drug network (coef. = 1.23, p.001) and the same relation held in multivariate model (adjusted coef. = 1.08, p = .001).The results suggest that larger size of drug network is a risk factor for depression, and vice versa. Further intervention strategies to reduce depression should address social networks factors.

A large literature suggests that social norms contribute to HIV and substance use related behaviors. Less attention has been given to neighborhood factors that may contribute to the development of norms about risky behaviors. We examined the cross-sectional associations between perceptions of one’s neighborhood and norms of perceived prevalence of, and peer support for sex exchange and risky injection behaviors. The sample consisted of 719 people who reported injecting heroin and cocaine and did not move in the past 6 months in Baltimore, MD. Living in a neighborhood with disorder was associated with believing that others exchanged sex, practiced risky injection behaviors (descriptive norms) and approved of risky injection behavior (injunctive norms).

Impoverished urban neighborhoods tend to have higher rates of smoking and higher rates of exposure to secondhand smoke as compared to more affluent neighborhoods. Contextual factors of neighborhood disorder and social network and household composition may have an impact on indoor smoking behaviors. The TIDE study examined psychosocial factors associated with smoking behaviors among impoverished inner-city smokers in Baltimore, Maryland. Among a community-recruited sample of 413 smokers who lived with others, most (73%) reported that they or others smoked in their residence. Cohabitation with children, elderly, and those with asthma and other respiratory condition was not associated with indoor smoking. Neighborhood disorder, the proportion of social network members who smoked with the study participant, and the proportion of household members who smoked were all independently associated with smoking indoors. The study findings suggest the importance of addressing neighborhood and social network factors when developing programs for promoting indoor smoking bans as well as cessation and prevention programs.

The role of social desirability bias (SDB) in self-reported HIV risk behaviors continues to be problematic. This study examined whether SDB was associated with self-reported, via audio computer assisted self-interviewing (ACASI), sexual risk behaviors among people who use drugs. The present study was conducted among 559 participants who reported having a recent sexual partner at their 6-month visit of a longitudinal study. Robust Poisson regression was used to model the association between SDB and five risk behaviors. Analyses were stratified by gender and partner type. Higher scores of SDB were associated with decreased reporting of selling sex and having more than one sexual partner. Higher SDB scores were associated with increased reporting of always using condoms during oral, vaginal, and anal sex. Gender-specific differences were observed. The inclusion of a measure of SDB in data collection, along with other strategies, can be used to both identify and reduce self-report biases.

Food insecurity has been linked to poor physical and mental health as well as HIV risk behaviors. While prior research has shown that drug users are prone to food insecurity it is unclear if drug use exacerbates the physical and psychosocial consequences. A sample of women who used drugs (DU) (specifically heroin and cocaine) and women who did not use drugs (NDU) were examined to determine if the relationship between food insecurity and depression varied by drug use status. Approximately 29% (n=128) of the total sample experienced food insecurity. DU women were more likely to be food insecure. There were no differences in receiving food stamps. After controlling for demographics and receiving food stamps, a significant association between food insecurity and depression existed for both DU and NDU women. The strength of this association was approximately double for NDU women. The study results suggest that it is critical to integrate mental health, food assistance, and other services.

Through the current analysis, we aimed to better understand the relationship between congregational support and HIV prevention behaviors among a sample of high risk, HIV negative Black women. Participants were 434 Black women who were at high risk for contracting HIV through heterosexual sex. They were recruited from a city in the Mid Atlantic Region. Data were collected through face-to-face interviews and Audio-Computer-Assisted Self-Interviews (ACASI). Results revealed three congregational characteristics were important for Black women's comfort level discussing HIV and their likelihood of returning for their HIV test results: feeling loved by their congregation, having ministries that helped people with their problems and feeling listened to by their congregation. Thus, religious congregational support was a significant correlate of Black women's comfort discussing HIV prevention and treatment as well as their motivation to return to get their HIV test results.

Background Research has indicated associations between risky alcohol consumption and sexual risk behavior, which may in turn present risk of HIV acquisition or transmission. Little is known about social determinants of problematic alcohol use among African American MSM (AA MSM), a risk group disproportionately affected by HIV. The present study sought to explore associations between risky alcohol use and perceived peer norms of alcohol use among a sample of urban African American men who have sex with men (AA MSM). Methods A cross-sectional survey was administered to 142 AA MSM in Baltimore, Maryland, recruited using active and passive methods. Risky and hazardous alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT) and participants self-reported descriptive and injunctive peer norms regarding frequency and quantity of alcohol consumption. Results Nearly half reported hazardous or high risk consumption of alcohol. Perceived peer alcohol norms, both descriptive and injunctive, were associated with alcohol use, including hazardous use. Conclusions The findings highlight the role of social factors on problematic alcohol use among AA MSM. Results indicate that AA MSM's use of alcohol is associated with their perceptions of peer alcohol use. Potential interventions could include norms-based campaigns that seek to reduce risky alcohol consumption among AA MSM as well as programs to screen and identify individuals with problematic alcohol use.

The association between housing and HIV has been widely demonstrated, although inquiry into HIV testing has been largely limited to the homeless. This study examines correlates of HIV testing within the past 6 months with housing stability and residential transience (moving two or more times in the past 6 months) among 620 low-income urban African Americans. Unstably housed and transient participants were more likely to participate in high-risk sex behaviors than stably housed participants and non-transient participants, respectively. In multivariate analyses, residential transience was positively associated with recent HIV testing; however, persons unstably housed were not more likely to have recently been tested for HIV despite their increased vulnerability and risk. While structural interventions are necessary to address the HIV disparities related to housing, increased community-based and mobile testing centers may be able to improve access to HIV testing among unstably housed.

Depression and depressive symptoms mediate the association between drug use and HIV risk. Yet, there are few interventions that target depressive symptoms and HIV risk for people who use drugs (PWUD). This study was a randomized controlled trial of an integrated cognitive behavioral therapy and HIV prevention intervention to reduce depressive symptoms, injection risk behaviors and increase condom use in a sample of urban people who used heroin or cocaine in the prior 6 months. A total of 315 individuals aged 18-55, who self-reported at least one HIV drug and sex risk behavior and scored ≥16 and

Background Social network characteristics have been found to be associated with a variety of risky behaviors, including alcohol consumption. This study assessed the relationships between the characteristics of drinking buddies and alcohol dependence symptoms among a sample of African American men and women. Methods This is a cross-sectional study using baseline data from 721 impoverished African American men and women participating in an HIV prevention study in Baltimore, MD. Alcohol dependence symptoms were assessed through the Alcohol Use Disorders Identification Test (AUDIT) and was defined as AUDIT score ≥ 13 for females and AUDIT score ≥ 15 for males. Logistic regression models with generalized estimating equations (GEE) using network member as the unit of analysis were conducted to assess the associations between the gender or relationship (i.e., kin, non-kin or sex partner) of the drinking buddies and the participants’ alcohol dependence symptoms. Results Approximately 22% of the participants had alcohol dependence symptoms. Among male participants, alcohol dependence symptoms were associated with having drinking buddies who were sex partners (AOR: 2.41; 95%CI: 1.32, 4.39) or who were female (AOR: 2.29; 95%CI: 1.29, 4.05). Among female participants, association between the presence of drinking buddy and alcohol dependence symptoms did not depend on the types of relationship or the gender of the drinking buddy. Conclusions Social network characteristics with respect to alcohol dependence symptoms vary according to the type of relationship or the gender of the drinking buddies, especially among men. Gender-specific norm-based interventions may be a useful strategy to decrease drink problems.

Aims Social norms are a key source of influence on health behaviors. This study examined changes in social norms and relationships between HIV injection risk behaviors and social norms among injection drug users (IDUs) involved in an experimental intervention. Design Randomized clinical trial. Setting An HIV Prevention Trials Network study, Philadelphia, USA. Participants IDUs, called indexes, and their social network members, who were drug or sex partners, were recruited for an HIV prevention intervention and followed for up to 30 months (n = 652). Indexes were randomized into a peer education intervention or control condition. Measurements Outcomes of injection-related HIV risk behaviors (sharing needles, sharing cookers, sharing cotton, front-/back-loading) were measured every 6 months and the social norms of these four risk behaviors were assessed every 12 months. Findings There was a statistically significant intervention effect on all four social norms of injection behaviors, with participants in the intervention reporting less risky social norms compared with controls (changes in mean score: needles, −0.24, P = 0.007; cookers, −0.33, P = .004; cottons, −0.28, P = .0165; front-/back-loading, −0.23, P = .002). There was also a statistically significant bidirectional association with social norms predicting injection risk behaviors at the next assessment and risk behaviors predicting social norms at the subsequent visit. Conclusions Through social network interventions it is feasible to change both injection risk behaviors and associated social norms. However, it is critical that social network interventions focus on publically highlighting behavior changes, as changing social norms without awareness of behaviors change may lead to relapse of risk behaviors.

The transdisciplinary approach for teaching implementation research and practice (IR&P) in public health seeks to present related concepts on IR&P from multiple perspectives without paying an exclusive service to a specific home discipline. It is a response to the demand for a pedagogical approach to teaching that promotes a unity of knowledge around a subject that extends beyond the disciplinary boundaries within public health. Based on the experience of establishing a flagship course in IR&P at a graduate school of public health, we draw from existing theories and offer practical steps for developing and delivering content for IR&P from a transdisciplinary perspective. The potential of this teaching approach is its ability to demonstrate the pervasiveness and easy transfer of relevant concepts in IR&P across multiple disciplines and settings. This teaching approach has relevance for influencing the overall technique to graduate-level instruction in the health professions where multiple disciplines intersect.

Baltimore, Maryland consistently ranks highest nationally in rates of sexually transmitted diseases and HIV infection. Prior studies have identified geographic areas where STI and HIV infection in the city is most prevalent. It is well established that sex exchange behavior is associated with HIV and STIs, yet it is not well understood how sex exchangers are spatially distributed within the high-risk areas. We sought to examine the spatial distribution of individuals who report sex exchange compared to those who do not exchange. Additionally we examined the spatial context of perceived norms about sex exchange. Data for the study came from a baseline sample of predominately injection drug users (n=842). Of these, 21% reported sex exchange in the prior 90 days. All valid baseline residential addresses of participants living within Baltimore city boundaries were geocoded. The Multi-Distance Spatial Cluster Analysis (Ripley’s K-function) was used to separately calculate the K-functions for the addresses of participants reporting sex exchange or non-sex exchange, relative to the recruited population. Evidence of spatial clustering of sex exchangers was observed and norms aligned with these clusters. Of particular interest was the high density of sex exchangers in one specific housing complex of East Baltimore, which happens to be the oldest in Baltimore. These findings can inform targeted efforts for screening and testing for HIV and STIs and placement of both individual and structural level interventions that focus on increasing access to risk reduction materials and changing norms about risk behaviors.

There is growing awareness of the role of stigma and discrimination in HIV prevention, testing, and medical care. Yet, few studies have examined the stigma associated with using illicit drugs. In the present study, we examined the relationship between social network characteristics, drug user stigma, and depression. Study participants were comprised of 340 individuals who reported cocaine, crack, and/or heroin use in the prior 6 months and were involved in an HIV prevention study. They were recruited through street outreach, referrals, and word of mouth in inner-city Baltimore, MD, USA. The stigma scale was comprised of eight items, such as "how much do you feel ashamed of using drugs?" Depression was assessed with the Center for Epidemiological Studies Depression Scale, using cutoffs of 16 and 20 or greater. In the bivariate analyses, gender, homelessness in the past 6 months, drug user stigma, larger size of drug network, and current use of heroin, cocaine, and crack were all significantly associated with high levels of depression, whereas in the multivariate analyses, only drug user stigma remained significantly associated with depression. The results of this study suggest that drug treatment providers and other professionals who provide services to drug users should consider developing trainings to address drug user stigma. These programs should focus on the attitudes and behaviors of health and service providers toward drug users, among drug users themselves, and among family members and others who provide social support to drug users.

Social networks can either negatively or positively influence a variety of behaviors, including alcohol use. This study examined social network characteristics that are risk factors for and protective factors against heavy episodic drinking among a sample of women at risk for HIV/sexually transmitted infections.This was a cross-sectional study using baseline data from 567 impoverished women participating in an HIV prevention study in Baltimore, MD. Data were collected through face-to-face interviews at a community-based research clinic. Heavy episodic drinking was defined as six or more drinks per drinking episode on at least a weekly basis. We examined network characteristics, including structure and function and their association with heavy episodic drinking. Multivariate logistic regression was used, adjusting for individual-level factors, such as drug use, demographics, and depression.Approximately 21% of the sample engaged in heavy episodic drinking at least weekly. Controlling for individual-level factors, women who engaged in heavy episodic drinking had fewer social network members (a) who were in drug treatment, adjusted odds ratio (AOR) = 0.65, 95% CI [0.49, 0.88]; (b) who were employed, AOR = 0.89, 95% CI [0.79, 0.99]; and (c) with whom the participant socialized, AOR = 0.74, 95% CI [0.63, 0.96]. Women who engaged in heavy episodic drinking had a significantly higher number of social network members with whom they drank alcohol, AOR = 1.71, 95% CI [1.43, 2.03].Social network characteristics are both protective and risk factors for heavy episodic drinking among women. Interpersonal interventions, such as peer education, may be a useful strategy to decrease heavy episodic drinking and its subsequent outcomes among women.

Social networks, including sexual networks, have increasingly been considered in research addressing HIV disparities in the United States. The goal of this study is to examine correlates of concurrent involvement in multiple sexual partnerships with social (i.e. non-sexual) and sexual network characteristics among a sample of 337 low-income urban African American women reporting main sexual partnerships longer than six months in duration. In the multivariate analyses, women who had larger non-sexual social networks, more family members in that network, and reported high levels of trust in their partner(s) were less likely to be in concurrent partnerships. Women who had one or more sexual partner who used drugs in the past six months were more likely to be in concurrent partnerships. Our results provide further evidence of the important association of drug use and concurrent sexual partnerships, but suggest that family members, immediate and extended, may be an important area of focus in addition to structural interventions that address the root causes of poverty and drug abuse.

To determine correlates of concurrent sexual partnerships among high-risk low-income urban African American women, survey responses of 337 women who had main sexual partners for over six months and reported high-risk behaviors were analyzed; 142 of these women also reported other sexual partnerships within the past 90 days. Unadjusted analyses showed that concurrency was significantly associated with relationship status, sexual debut, forced sex, incarceration of self and partners, depression, drug use, known or suspected partner nonmonogamy, and partner drug use. Age of sexual debut, relationship status, and indicators of problem drug use remained significantly associated with concurrency when controlling for individual factors, and only indicators of problem drug use and known or suspected partner nonmonogamy remained significantly associated with concurrency when also controlling for partner characteristics. Our results suggest the presence of extensive sexual networks within this population and document the need for interventions that address drug abuse and partnership instability. Moreover, the strong association between concurrency and perceptions of partners’ nonmonogamy suggest the need for intervention to target men and women in this core group.