CS. PHTH2053. CLASS 12. FALL 2024

Community & Public Health 2053 Fall Class 12

Dr. Claudia Santelices

Introduction to Substance Use Research and Qualitative Methods

Social & Behavioral Issues

• Overview of key social and behavioral issues related to substance use.

Types of Research Design

Qualitative vs Quantitative

• Qualitative Research:

  • Answers "Why?" questions.

  • Utilizes observation, symbols, words, etc.

  • Involves non-statistical analysis and interpretation of data.

• Quantitative Research:

  • Answers "How many?" or "How much?" questions.

  • Involves statistical analysis and numerical data.

Importance of Public Health Knowledge

• Mary Jane Schneider's quote emphasizing the need for public health awareness among citizens.

Substance Use Disorders

Definition and Characteristics

• Substance Use Disorder (SUD):

  • Symptoms include tolerance and withdrawal.

  • Behavioral changes due to biochemical changes in the brain.

  • Prioritization of substance use over personal and others' harm.

  • Classified now as the medical term for addiction by the APA, replacing "substance abuse" and "substance dependence."

The Triple Wave Epidemic

Three Waves of Opioid Mortality

1. First Wave:

   • Opioid pill overdoses began rising in 2000 and continued to 2016.

2. Second Wave:

   • Increase in heroin overdoses starting in 2007, surpassing opioid pills in 2015.

3. Third Wave:

   • Fentanyl and synthetic opioids emerge dramatically after 2013, now over 95% of opioid overdoses linked to fentanyl.

Drug Overdose Mortality Rates

• Rates tripled in the U.S. from 1999 to 2018 with synthetic opioids as main contributors.

• Fentanyl-related overdose rates increased 33-fold from 1999 to 2018.

Current Trends and Statistics

• Data from CDC in December 2020 indicates rising fatal drug overdoses during the COVID-19 pandemic.

• Massachusetts data: Opioid mortality quintupled from 2000 to 2019 with increased fentanyl presence.

Interconnected Issues

• SUDs linked with broader issues:

  • Rising healthcare costs, AIDS epidemic, racial disparities, and violent crime.

Syringe Access and Drug Use

Study Overview

• Focus on injection practices, syringe acquisition, and discard behaviors among Injecting Drug Users (IDUs).

Multidisciplinary Approach

• Integration of epidemiological, ethnographic, and bioassay methods to identify HIV-1 and hepatitis risk factors.

Quantitative Strategies

• Recruitment of IDUs through outreach, surveys, and statistical analysis of health trends.

Participant Sample

• Demographic breakdown of male and racial demographics across Hartford, New Haven, and Springfield.

Health Indicators

• Self-reported health conditions among IDUs in different cities detailing rates of HIV, hepatitis, TB, and mental illness.

Importance of Qualitative Research

• Exploring neighborhood variations and drug injection practices.

• Development of tailored prevention programs.

Qualitative Strategies

• In-depth ethnographic descriptions, focus groups, interviews, and mapping of drug use environments.

Neighborhood Descriptions

• Analyze how environment shapes drug use and associated risks.

Social Mapping Focus Groups

• Community mapping of drug-related locations to inform risk factors.

IDU Diaries

Goals and Structure

• Focus on daily interactions with drug use, capturing both patterns and emotional responses.

Strengths of Diaries

• Provide insights into HIV and hepatitis risks, allowing for real-time reflections on behaviors.

• Personal accounts can motivate change among users.

Results from Diaries

• Documenting crises and emotional turmoil associated with drug use.

IDU Day Visits

• Ethnographic observations focusing on IDU interactions and behaviors in their environment.

Observational Data Collection

• Guidelines for systematically observing drug injection practices to assess various risks.

Suggestions for Policy Improvement

• Emphasis on harm reduction strategies including syringe exchange programs and safe injection sites.

Study Challenges

• Addressing methodological, legal, and health-related challenges in conducting research in high-risk populations.

Recommendations for Future Research

• Enhance ethnographic methods for deeper understanding and intervention strategies.