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.