Risk Environment Effects on Ontological Security Among People Who Use Drugs: An Ethnographic Study

风险环境对吸毒者本体安全的影响：一项人种学研究

• 批准号: 10520014
• 负责人: Jesse Lloyd Goldshear
• 金额: $ 3.15万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2023-06-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10520014
• 关键词: Area; COVID-19 pandemic; Clothing; Communities; Computer software; Conflict (Psychology); Cost Savings; County; Coupled; Data; Data Analyses; Drug Rehabilitation Centers; Drug usage; Drug user; Emotional; Environment; Environment and Public Health; Ethnography; Exclusion; Federal Government; Feeling; Food; Funding; Future; Generations; Goals; Government; HIV; HIV/HCV; Hand; Harm Reduction; Health; Health Services Accessibility; Hepatitis C Incidence; Hepatitis C virus; Homelessness; Hour; Housing; Individual; Infection; Injections; Interest Group; Interview; Life; Link; Literature; Local Government; Los Angeles; Medicine; Mental Health; Methodology; Methods; Modeling; Nature; Needle-Exchange Programs; Neighborhoods; Occupations; Ontology; Outcome; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pharmacotherapy; Police; Policies; Population; Property; Provider; Public Health; Public Housing; Research; Risk; Risk Behaviors; Role; Safety; Sampling; Sanitation; Security; Services; Shapes; Skin Tissue; Social Interaction; Soft Tissue Infections; State Government; Structure; Substance Use Disorder; Syringes; Techniques; Time; Treatment outcome; Trust; United States; United States Public Health Service; Victimization; Violence; Voice; Vulnerable Populations; War; Work; built environment; drug use behavior; health organization; housing instability; improved; interest; marginalized population; member; metropolitan; outreach; outreach program; participant observation; peer; physical conditioning; poor health outcome; programs; public health intervention; recruit; sobriety; social; social health determinants; substance use

PROJECT SUMMARY/ABSTRACT Amidst the ongoing COVID-19 pandemic Los Angeles county has seen a surge in the unhoused population. Among this group are people who use drugs (PWUD) – a community at dramatically increased risk for bloodborne infection such as HIV and Hepatitis C, skin and soft tissue infections, and other health vulnerabilities related to the daily violence of life on the street. Los Angeles County data from 2020 estimate that people with substance use disorders account for 32% of the total unhoused population. Unhoused PWUD are subject to frequent displacement and victimization at the hands of public safety and sanitation along with hostile housed residents. On the other hand, a wide array of public health services including syringe exchange programs, drug treatment centers, street medicine, housing outreach programs, and housing have been implemented in recent years, with dramatic expansion occurring due to the COVID-19 pandemic. These risk environment features, coupled with the uncertain and unpredictable nature of street life, may lead to decreased feelings of overall well- being and ontological security among this population. The overall goal of this effort is to document how these features (i.e. public safety/sanitation efforts, public health and housing efforts, and local interest groups) impact unhoused PWUD in Los Angeles, CA. The first aim of this study is to explore how interactions with public safety agencies and hostile neighborhood residents shape feelings of ontological security among this community, while the second aim will examine how interactions with public health agencies (i.e. homeless services, housing, syringe exchanges) and activists impacts these same outcomes. In order to elucidate these associations, this study will use complementary methodologies. First, in his role as an independent provider of harm reduction supplies and as a member of a local mutual aid organization, the PI will engage in ethnography using direct participant observation consistent with the Extended Case Method approach. Simultaneously, 30 unhoused PWUD will be recruited using snowball sampling to partake in hour- long semi-structured interviews. The utilization of both approaches is key – ongoing ethnography will highlight the present situation of unhoused PWUD and their relationship to public safety and public health organizations, while interviews will illuminate how these interactions impact feelings of security and well-being, to better understand social determinants of health. Analysis of both ethnographic data from fieldnotes and formal interview data will be conducted with guidance from a Community Advisory Board whose members will be drawn from the community and local stakeholder organizations. The inclusion of a CAB is consistent with the PI’s commitment to community-engaged participatory methods. Analysis of the data will be done using the ATLAS.ti 8 software package and will feature both inductive and deductive qualitative techniques. Final results will form the core of the PI’s doctoral dissertation and will be presented to the CAB as well as community members and other stakeholders in order to inform their future work with this population.

项目摘要/摘要 在正在进行的共同199年大流行洛杉矶县中，人们的人口激增。 在这一组中，有使用毒品的人（PWUD） - 一个社区急剧增加了风险 血源性感染，例如艾滋病毒和丙型肝炎，皮肤和软组织感染以及其他健康脆弱性 与街上生命的日常暴力有关。洛杉矶县2020年的数据估计 物质使用障碍占没有不受欢迎的人口的32％。未受调查的pw over 在公共安全和卫生的手中，经常流离失所和胜利以及敌对的housingd 居民。另一方面，包括注射器交换计划，毒品在内的各种各样的公共卫生服务 最近已经实施了治疗中心，街头医学，住房外展计划和住房 多年来，由于19号大流行，发生了巨大的扩张。这些风险环境特征， 再加上街头生活的不确定和不可预测的本质，可能会导致整体良好的感觉下降 该人群中的存在和本体安全。这项工作的总体目标是记录这些 功能（即公共安全/卫生工作，公共卫生和住房工作以及当地利益集团）影响 加利福尼亚州洛杉矶的未受调查的PWUD。这项研究的第一个目的是探索如何与公众互动 安全机构和敌对的社区居民塑造了本体论的感觉 社区，而第二个目标将研究与公共卫生机构的互动方式（即无家可归者 服务，住房，注射器交流）和激进主义者会影响这些相同的结果。 为了阐明这些关联，本研究将使用完整的方法。首先，他的角色 PI的独立减少损害供应供应商和当地共同援助组织的成员 将使用与扩展案例方法一致的直接参与观察进行民族志 方法。同时，将使用雪球抽样招募30个不受欢迎的PWUD来参加小时 - 长期半结构化访谈。两种方法的利用都是关键 - 正在进行的人种志将突出显示 不受欢迎的PWUD及其与公共安全和公共卫生组织的关系， 虽然访谈将阐明这些互动如何影响安全和福祉的感觉，以更好地 了解健康的社会决定者。对现场注释和正式访谈的人种志数据的分析 数据将在社区顾问委员会的指导下进行，其成员将从 社区和地方利益相关者组织。包含出租车与PI的承诺一致 到社区参与的参与方法。数据分析将使用Atlas.ti 8软件进行 包装，并将采用电感和演绎定性技术。最终结果将构成 PI的博士学位论文，并将介绍给出租车以及社区成员和其他 利益相关者为了告知他们未来与该人群的工作。