Rural risk environments for hepatitis c among young adults in appalachian kentucky
Rural risk environments for hepatitis c among young adults in appalachian kentucky
复制标题
DOI：
10.1016/j.drugpo.2019.05.006
复制
发表时间：
2019-10-01
影响因子：
4.4
通讯作者：
Cooper, Hannah L. F.
中科院分区：
文献类型：
--
作者：
Cloud, David H.;Ibragimov, Umedjon;Cooper, Hannah L. F.
背景：肯塔基州农村地区是丙型肝炎 (HCV) 的中心，特别是在注射吸毒的年轻人中。虽然风险环境框架 (REF) 已被广泛用于研究和解决注射吸毒者 (PWID) 中传染病的社会生态决定因素，但它几乎完全应用于城市环境。将 REF 应用于农村环境可以增强我们对这些重灾区 HCV 流行的驱动因素的了解，并为在当地背景下制定和实施减少伤害干预措施提供信息。 方法：2017 年 3 月至 8 月期间通过基于社区的外展方法（例如野餐、传单）和同行推荐招募参与者。符合资格标准的个人（年龄 18-35 岁，最近使用处方阿片类药物和/或海洛因来获得兴奋感，居住在 5 个目标县之一）参加了深入的半结构化访谈。访谈指南由 REF 提供，涵盖了与 HCV 相关的风险行为以及导致参与这些行为的脆弱性的环境特征。使用建构主义扎根理论方法对访谈进行转录和分析。结果：参与者（N = 19）描述了多种交叉的风险环境特征，这些特征塑造了 HCV 传播的脆弱性。经济衰退导致代际贫困、就业前景黯淡以及社会丰富机会减少，这些共同导致了药物滥用和危险的注射行为。地理隔离、缺乏对 HCV 传播风险的集体知识、缺乏减害服务、家庭贫困以及对执法的恐惧相互作用，增加了人们在“陷阱屋”（类似于射击场）或僻静区域（他们在这些地方匆忙注射并共用注射设备）注射的可能性。普遍存在的耻辱是采用、扩大和使用减少危害服务的结构性障碍。结论：这项探索性研究确定了可能导致阿巴拉契亚肯塔基州重大丙肝病毒负担的农村风险环境特征。研究结果表明，扩大针对农村环境的行之有效的减少伤害战略和反耻辱干预措施的重要性。
Background: Rural Kentucky is an epicenter of hepatitis C(HCV), especially among young adults who inject drugs. While the Risk Environment Framework (REF) has been used widely to study and address socio-ecological determinants of infectious disease among people who inject drugs (PWID), it has been almost exclusively applied to urban environments. Applying REF to rural environments can enhance our understanding of the drivers of HCV epidemics in these hard-hit areas, and inform the creation and implementation of harm reduction interventions in this local context.Methods: Participants were recruited between March and August 2017 via community-based outreach methods (e.g., cookouts, flyers) and peer referral. Individuals who met eligibility criteria (aged 18-35, recently used prescription opioids and/or heroin to get high, lived in one of the 5 target counties) participated indepth, semi-structured interviews. The interview guide was informed by the REF, and covered HCV-related risk behaviors and environmental features that shaped vulnerability to engaging in these behaviors. Interviews were transcribed and analyzed using constructivist grounded-theory methods.Results: Participants (N =19) described multiple intersecting risk environment features that shaped vulnerability to HCV transmission. Economic decline generated intergenerational poverty, dwindling employment prospects, and diminished social enrichment opportunities that collectively contributed to substance misuse and risky injection practices. Geographic isolation, lack of collective knowledge about HCV transmission risks, scarce harm reduction services, familial poverty, and fear of law enforcement interacted to increase the odds of people injecting in "trap houses" (akin to shooting galleries) or secluded areas, spaces in which they rushed to inject and shared injection equipment. Pervasive stigma was a structural barrier to adopting, expanding, and using harm reduction services.Conclusion: This exploratory study identified features of rural risk environments that may contribute to significant HCV burdens in Appalachian Kentucky. Findings signal the importance of expanding proven harm reduction strategies and anti-stigma interventions tailored to rural contexts.