Perceptions of neighborhood social environment and drug dependence among incarcerated women and men: a cross-sectional analysis

Health Outcomes by Neighborhood (HON): Effects of Neighborhood, Social Instability, and Health Factors on 12-Month Trajectories of Substance-Use Disorder Symptoms

BACKGROUND

Previous studies have shown that environment and health can influence drug use trajectories and the effects of substance use disorder (SUD) treatments. We hypothesized that trajectories of drug use-related problems, based on changes in DSM-5 symptoms, would vary by type(s) of drugs used, health factors, and neighborhood characteristics.

METHODS

We assessed mental and physical health, stress, social instability, neighborhood characteristics (disorderliness and home value), and DSM-5 symptom counts at two study visits, 12 months apart, in a community sample (baseline N = 735) in Baltimore, MD. Three prominent categories of drug-use trajectory were identified with K-means cluster analysis of symptom counts: Persistent (4 or more symptoms at both visits or at Visit 2), Improved (decrease from 4 or more symptoms at Visit 1 to 3 or fewer symptoms at Visit 2), and Low-Stable (3 or fewer symptoms at both visits). Baseline health and neighborhood measures were tested as predictors of trajectory in mediation and moderation models.

RESULTS

Among people with current opioid- and/or stimulant-use, odds of an Improved trajectory were (1) decreased with neighborhood disorder and social instability, or (2) increased with home value and social instability. Odds of a Low-Stable trajectory were decreased by social instability and stress but increased in those who were older or self-identified as white.

CONCLUSIONS

Trajectories of drug use-related problems are influenced by sociodemographic variables, neighborhood factors, and health. Assessing DSM-5 symptom counts as an outcome measure may be valuable in monitoring or predicting long-term trajectories and treatment effectiveness.

Adverse experiences, mental health, and substance use disorders as social determinants of incarceration

This study describes how incarcerated people understand: (a) Adverse experiences, mental health, and substance use disorders as determinants of incarceration, (b) the role of gender in impacting this understanding, and (c) strategies to prevent incarceration. Ecosocial theory provides a theoretical framework. Open-ended interviews were conducted (December 2016-January 2017) with recently incarcerated adults in Massachusetts state prisons. Participants described determinants of incarceration and incarceration prevention strategies. Interviews were coded thematically using inductive and deductive approaches. Thirty participants, evenly split by gender, reported themes across four levels: Society (lacking basic needs, discrimination), community (neighborhood factors), interpersonal (trauma), and individual (social isolation, mental health, substance use). However, there were variations in themes by gender. Proposed prevention strategies included early access to quality individualized cross-system services. In conclusion, findings highlight how investing in social and community building services could prevent incarceration. Policies can support these services by redirecting funding.

Acute Changes in Community Violence and Increases in Hospital Visits and Deaths From Stress-responsive Diseases

BACKGROUND

Community violence may affect a broad range of health outcomes through physiologic stress responses and changes in health behaviors among residents. However, existing research on the health impacts of community violence suffers from problems with bias.

METHODS

We examined the relations of acute changes in community violence with hospital visits and deaths due to stress-responsive diseases (mental, respiratory, and cardiac conditions) in statewide data from California 2005-2013. The community violence exposure was measured as both binary spikes and continuous acute changes. We applied a combined fixed-effects and time-series design that separates the effects of violence from those of community- and individual-level confounders more effectively than past research. Temporal patterning was removed from community violence rates and disease rates in each place using a Kalman smoother, resulting in residual rates. We used linear regression with place fixed-effects to examine within-place associations of acute changes in community violence with residual rates of each outcome, controlling for local time-varying covariates.

RESULTS

We found acute increases in hospital visits and deaths due to anxiety disorders (0.31 per 100,000; 95% confidence interval [CI] = 0.02, 0.59), substance use (0.47 per 100,000; 95% CI = 0.14, 0.80), asthma (0.56 per 100,000; 95% CI = 0.16, 0.95), and fatal acute myocardial infarction (0.09 per 100,000; 95% CI = 0.00, 0.18) co-occurring with violence spikes. The pattern of findings was similar for the exposure of continuous acute violence changes.

CONCLUSIONS

Although the associations were small, the identified increases in stress-responsive conditions suggest the possibility of health impacts of acute changes in community violence.

Associations of the Neighborhood Environment With Substance Use: A Cross-sectional Investigation Among Patients in Compulsory Drug Detention Centers in Thailand

Objectives

To identify the associations of characteristics of the neighborhood environment with substance abuse among clients receiving treatment for drug abuse in Thailand.

Methods

A cross-sectional study was conducted of 1128 drug addicts from 28 neighborhoods who were receiving treatment at all 7 compulsory drug detention centers in Thailand. A trained interviewer conducted structured interviews with the subjects about substance use and the perceived neighborhood environment in their community. A multilevel logistic regression model was applied to estimate the effects of the neighborhood environment on substance use.

Results

The majority of participants, 53.8% only used methamphetamine pills, 31.3% used other illicit drugs as well as methamphetamine pills, and 14.9% used an illicit drug other than methamphetamine. Three neighborhood characteristics were associated with substance use. A 1-unit increase in the perceived neighborhood cohesion score was associated with a 15% reduction in methamphetamine pill use and an 11% reduction of the use of both methamphetamine pills and another illicit drug. Conversely, a 1-unit increase in perceived neighborhood crime predicted 19 and 14% increases in the use of methamphetamine pills and the use of both methamphetamine pills and another illicit drug, respectively. In addition, a 1-unit increase in the scores for stigma surrounding addiction corresponded to a 25% increase of the use of methamphetamine pills and a 12% increase in the use of both methamphetamine pills and another illicit drug.

Conclusions

Substance use among drug addicts was influenced by characteristics of the neighborhood environment. Therefore, prevention and intervention strategies should be designed based on a consideration of the impact of neighborhood context on substance use behaviors.

Change processes questionnaire for treatment of drug dependents based on transtheoretical model: Psychometric properties in Iran 2016

BACKGROUND

Drug abuse is a serious subject that can lead to social, economic, cultural and health problems. The routine approaches in treatment of drug abuse are either medication or non-medication methods. Non-medication approach is focused on mental and social health. Non-drug treatment requires appropriate tools.

OBJECTIVE

To determine the validity, reliability, and structure of the Processes of Change Questionnaire.

METHODS

In this cross-sectional study, which was conducted in 2016, three hundred sixty-two drug dependents in Sabzevar Substance Abuse Treatment Centers (Iran) were enrolled in the study. Samples were selected through the multi-stage sampling method. They completed the 40-item Processes of Change Questionnaire (drug version). In this study, Backward-Forward method, confirmatory factor analysis (CFA), test-retest, Cronbach's alpha, content validity ratio (CVR) and content validity index (CVI) were used, using AMOS 5.0 and SPSS version 11.5.

RESULTS

Findings of the CFA showed the questionnaire has a good fit. The fit index of the CFA was calculated as 0.75. Cronbach's alpha was 0.93 for the whole questionnaire, and ranged from 0.51 to 0.88 for its different domains. Also, intraclass correlation coefficient (ICC) and content validity were satisfactory.

CONCLUSION

Based on the findings of this study, the processes of change 40-item questionnaire: drug version was a credible, reliable and valid tool to identify effective factors in the treatment drug abuse among the population of the Sabzevar, Iran.

Violent Crime in the Lives of Homeless Female Ex-Offenders

The cyclical pattern of violence in the lives of homeless female ex-offenders may precipitate ongoing substance use and recidivism; all of which have shown to be mounting public health issues affecting successful reentry. This paper, which analyzed baseline data from a longitudinal study of 126 female ex-offenders in Los Angeles and Pomona, California, highlighted the factors found to be associated with violent crime among homeless female ex-offenders. A multiple logistic regression model for whether or not the last conviction was for a violent offense indicated that poor housing (p = .011) and self-reported anger or hostility (p < .001) were significant correlates. An ordinal regression model for the number of violent offenses also indicated that affectionate support was associated with committing fewer number of violent crimes (p = .001), while positive social interactions (p = .007), and anger/hostility (p = .015) were associated with greater number of violent crimes. Implications for developing a comprehensive array of strategies that can mitigate the pattern of violence often seen in the lives of homeless female who have recently exited jails and prisons is discussed.

Neighborhoods and HIV: a social ecological approach to prevention and care

Neighborhood factors have been linked to HIV risk behaviors, HIV counseling and testing, and HIV medical care. However, the social-psychological mechanisms that connect neighborhood factors to HIV-related behaviors have not been fully determined. In this article we review the research on neighborhood factors and HIV-related behaviors, approaches to measuring neighborhoods, and mechanisms that may help to explain how the physical and social environment within neighborhoods may lead to HIV-related behaviors. We then discuss organizational, geographic, and social network approaches to intervening in neighborhoods to reduce HIV transmission and facilitate HIV medical care with the goal of reducing morbidity and mortality and increasing social and psychological well-being.