RESUMEN
The peer recovery workforce, including individuals in sustained recovery from substance use, has grown rapidly in the previous decades. Peer recovery coaches represent a scalable, resource-efficient, and acceptable approach to increasing service delivery, specifically among individuals receiving substance use services in low-resource communities. Despite the potential to improve access to care in traditionally underserved settings, there are a number of barriers to successfully integrating peer recovery coaches in existing recovery services. The current study presents results from two focus groups composed of peer recovery coaches. Findings suggest that peer recovery coaches report discordance between their perceived role and their daily responsibilities and experience both inter- and intrapersonal challenges that impact their own recovery processes. These results point to several promising policy and structural changes that may support and enhance this growing workforce.
Asunto(s)
Trastornos Relacionados con Sustancias , Humanos , Trastornos Relacionados con Sustancias/terapia , Grupo Paritario , Recursos Humanos , Grupos FocalesRESUMEN
BACKGROUND: Many people who inject drugs (PWID) lack access to a new sterile syringe each time they inject, with increased risk of injection-related harms, including spread of communicable diseases. In the United States (US), restricted access is largely due to state laws and policies regulating syringe access. Our aim in this US-focused study is to estimate variations in syringe acquisition behavior in relation to state-level syringe sale policies, drawing upon self-identified PWID in a nationally representative sample survey. METHODS: Estimates were obtained on the source of the last used syringe from participants of the National Survey on Drug Use and Health (NSDUH) years 2002-2011. States were classified as having restricted syringe policies if they had any restriction on the sale of syringes during the study period (e.g., required a prescription or limited the number being sold). RESULTS: In states with unrestricted syringe sale policies, PWID were more likely to have obtained their most recently used syringe from a safe source (Difference (%) = 9.8, 95% CI: 1.9, 17.7). This difference was largely driven by a larger percent of injectors obtaining syringes from a pharmacy in unrestricted states (Difference = 20.4, 95% CI: 12.2, 28.6) but was partially offset by fewer injectors obtaining syringes from syringe exchange programs (Difference = -10.7, 95% CI: -16.1, -5.3). CONCLUSION: These new findings, taken with other evidence, should help promote removal of policy barriers that now thwart syringe acquisition from a safe source. We hope this additional evidence will provoke policy discussions and may influence regulations that promote public health and reduce the spread of communicable diseases.
Asunto(s)
Infecciones por VIH , Abuso de Sustancias por Vía Intravenosa , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Programas de Intercambio de Agujas , Políticas , Abuso de Sustancias por Vía Intravenosa/epidemiología , Jeringas , Estados Unidos/epidemiologíaRESUMEN
Much research has focused on physical disorder in urban neighborhoods as evidence that the community does not maintain local norms and spaces. Little attention has been paid to the opposite: indicators of proactive investment in the neighborhood's upkeep. This manuscript presents a methodology that translates a database of approved building permits into an ecometric of investment by community members, establishing basic content, criteria for reliability, and construct validity. A database from Boston, MA contained 150,493 permits spanning 2.5 years, each record including the property to be modified, permit type, and date issued. Investment was operationalized as the proportion of properties in a census block group that underwent an addition or renovation, excluding larger developments involving the demolition or construction of a building. The reliability analysis found that robust measures could be generated every 6 months, and that longitudinal analysis could differentiate between trajectories across neighborhoods. The validity analysis supported two hypotheses: investment was best predicted by homeownership and median income; and maintained an independent relationship with measures of physical disorder despite controlling for demographics, implying that it captures the other end of a spectrum of neighborhood maintenance. Possible uses for the measure in research and policy are discussed.