High Risk Populations

high risk population definition

"group of people who share a characteristic that causes each member to be susceptible to a particular event"

- vulnerable population

examples of high risk populations

- immigrants

- youth

- low SES

- prisoners

- sex workers

- rural populations

High Risk Populations for Opioid Overdose

- People taking high doses of opioids

- People who "doctor shop"

- People using multiple abuseable substances like opioids, benzodiazepines, other CNS depressants, illicit drugs

- Low-income people and those living in rural areas

- Medicaid populations

- People with substance abuse or other mental health issue

vulnerable populations are defined by:

- Categorical Vulnerability Approach

- Contextual Vulnerability Approach

categorical vulnerability

Defines vulnerable populations as those groups in society whose members share features that might make them vulnerable.

◦ For example, the U.S. Code of Federal Regulations lists "children, prisoners, pregnant women, mentally disabled persons, [and] economically or educationally disadvantaged persons" as vulnerable groups.

contextual vulnerability

Highlights extent to which vulnerability is sensitive to context

National Bioethics Advisory Commission describes 6 types of vulnerability that could apply to research participants in different circumstances:

1. Cognitive or communicative vulnerability (language barriers)

2. Institutional vulnerability (formal relationships)

3. Deferential vulnerability (informal relationships)

4. Medical vulnerability (serious health condition w/ no cure *will try anything, lack of healthcare/ insurance)

5. Economic vulnerability (not being able to pay)

6. Social vulnerability (peers, people you interact with)

vulnerability in context (pregnant woman)

a pregnant woman may be vulnerable during active labor, but not in other stages of her pregnancy

Theories and Approaches

Health Belief Model

Theory of Planned Behavior

**focus on behavior and consequences

Harm Reduction Approach

Generative Approach

Harm Reduction Approach

- effective for HIV/AIDS transmission prevention and substance abuse

- meets people where they are

- Focuses more on reducing negative consequences of the risky behavior as

opposed to trying to stop the behavior altogether **output

*controversial: condoning risky behavior?

harm reduction approach examples

- Needle Exchange Programs

- Opioid Replacement Therapy

- Designated Driver programs

- Switching to "safer" tobacco products

- Dissemination of risk reduction kits (condoms, bleach) IVD users and sex workers

- Safer sex education

- STI screening among sex workers and IVD users

- Ecstasy testing

- Supervised injection sites

Needle Exchange Programs pros and cons

Pros:

reduce HIV transmission/ bacterial infections

connect people to physical, psychological and emotional treatment programs.

Cons:

may encourage drug use

shows "acceptance" of IV drug use

programs funded w/ taxpayer $$

effective?

community concerns- "not in my neighborhood"

*should be preventing drug use all together

harm reduction techniques use ideas from these theories:

◦Social network theory (using social networks to disseminate information/risk reduction kits)

◦ Social Cognitive Theory (Improving self-efficacy, observational learning of those who altered behavior)

◦ Value-expectancy theories (Improving attitudes, reducing barriers, increasing benefits, increasing perceived behavioral control)

◦ Transtheoretical models (assessing readiness to alter risky behaviors)

Generative Approach

focuses on behavior that's not conceptualized in terms of inputs/ outputs, but an organizing processes through which individuals generate behavior overtime

- why do we do what we do?

generative approach examples

Gender roles/ expectations

- Females who have unhealthy eating and exercise patterns to fit cultural gender expectation of being "skinny"

- Males who use steroids to fit cultural gender expectation of being strong/muscular

- Females who experience Female Genital Cutting/Mutilation as a sign of being a woman in their culture

Street/Drug Culture among Youth

- Selling drugs to fulfill role of having a job or having power/street credibility in social group

- Being part of a gang to be recognized in society

applications of generative approach

1) Identify key constructs that motivate behavior among a specific group, and the context in which those motivations are carried out via health risk behavior

2) Work toward adding less risky behaviors to an "inventory of behaviors" that satisfies overarching schema/cultural identity

- E.g., instead of using steroids to get strong, can focus on different lifting techniques, using

protein powder, etc.

- E.g., instead of working in risky job (e.g., drug sales) to make money for family, can focus on different options for job or making money

3) Disseminate and encourage adoption of those non-risky behaviors