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Abstract Background Examining support for substance use policies, including those for harm reduction, among the general public and policy influencers is a fundamental step to map the current policy landscape and leverage policy opportunities. Yet, this is a knowledge gap in Canada. Our paper identifies the level of support for substance use policies in two provinces in Canada and describes how the level of support is associated with intrusiveness and sociodemographic variables. Methods Data came from the 2019 Chronic Disease Prevention Survey. The representative sample included members of the general public (Alberta n = 1648, Manitoba n = 1770) as well as policy influencers (Alberta n = 204, Manitoba n = 98). We measured the level of support for 22 public policies concerning substance use through a 4-point Likert-scale. The Nuffield Council on Bioethics Intervention Ladder framework was applied to assess intrusiveness. We used cumulative link models to run ordinal regressions for identification of explanatory sociodemographic variables. Results Overall, there was generally strong support for the policies assessed. The general public in Manitoba was significantly more supportive of policies than its Alberta counterpart. Some differences were found between provinces and samples. For certain substance use policies, there was stronger support among women than men and among those with higher education than those with less education. Conclusions The results highlight areas where efforts are needed to increase support from both policy influencers and general public for adoption, implementation, and scaling of substance use policies. Socio-demographic variables related to support for substance use policies may be useful in informing strategies such as knowledge mobilization to advance the policy landscape in Western Canada.

Abstract Introduction Risky behaviours, including tobacco use, are highly prevalent among adolescents worldwide. Although these behaviours are largely influenced by various sociodemographic factors, including sex, there is a paucity of regionally representative literature on the sex-related inequalities in cigarette smoking among adolescents in Africa. This study examined the sex-based disparities in current cigarette smoking among adolescents aged 13–15 years in Africa. Methods The present study employed a secondary analysis of nationally representative data on 45 African countries obtained from the Global Youth Tobacco Survey, accessible through the World Health Organization (WHO) Global Health Observatory. We used the online version of the WHO Health Equity Assessment Toolkit (HEAT) to generate the results. Results The prevalence of current cigarette smoking among the adolescents surveyed ranged from 1.6% in Eritrea to 10.4% in Mali among the low-income countries, from 1.3% in Tanzania to 13.1% in Mauritania among the lower-middle-income countries, from 5.2% in Gabon to 15.3% in Mauritius among the upper-middle-income countries, and 14.7% in Seychelles, the only high-income country in the study. The absolute summary measure (D) showed diverse sex-related disparities in the burden of current cigarette smoking among adolescents across the sub-regions. In all countries surveyed, the prevalence of cigarette smoking was higher among male adolescents compared to females, except in Liberia and Mozambique, where female adolescents bore a more significant burden than their male counterparts. Furthermore, male adolescents were more burdened with high cigarette smoking prevalence than females in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia, where such disparities were most pronounced. Meanwhile, we found less disparity in the burden of cigarette smoking between male and female adolescents in most of the lower and upper-middle-income countries surveyed. Conclusion This study sheds light on the sex-based inequalities in the prevalence of current cigarette smoking among adolescents in Africa. In contrast to female adolescents, male adolescents bear a greater burden of current cigarette smoking. The burden of cigarette smoking is most pronounced in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia. Conversely, in most of the lower and upper-middle-income countries surveyed, the burdens of current cigarette smoking among male and female adolescents were found to be less disparate. Consequently, cigarette smoking prevention programmes and strategies must be implemented in all African nations. There is also the need to intensify interventions aimed at altering the smoking behaviour of male adolescents. Policymakers can develop and implement evidence-based interventions to address the burden of cigarette smoking among the adolescents. Finally, existing policies and programmes addressing adolescents' cigarette smoking should be re-assessed and strengthened to achieve their objectives.

Abstract An interdisciplinary approach has the potential not only to help solve conservation-centric problems but also to enrich and improve evidence-based scientific research. Crime science, an offshoot of criminology, provides a comprehensive, solution-oriented approach that transcends disciplinary boundaries and bridges science and practice for developing effective conservation interventions to real-life problems such as Human Elephant Conflict (HEC). This paper focuses on HEC as a conservation concern, but the resultant behaviors toward elephants, people, and their property are criminology’s concern. Using the Action Research paradigm, a rapid assessment of human–elephant conflict (HEC) in India was undertaken to identify contextual solutions. This study utilized problem-oriented field research methods that enabled the gathering of data on elephant habitat-landscape, villagers’ lifestyle (habitat) in the fringe areas, their current approaches in dealing with the conflict, the challenges forest officials face to mitigate HEC, and the assistance provided by district administrators to protect villagers and their corps and HEC-related deaths. The qualitative inquiry, including observation of village-forest fringe areas, focus group discussions with villagers, and interviews with forest officers and rangers, and district administrators/collectors who are handlers, guardians, and managers of the conflict space, provided rich data in identifying situational practical measures and underscored the role of crime science in providing a conceptual framework to gather evidence in addressing HEC in forest areas. The findings of the research suggest that human–animal convergence space is the source (or location) of conflict and criminology-driven situational crime prevention measures, including increasing effort, risks, reducing rewards and provocations, and removing excuses might mitigate the conflict, requiring coordinated efforts by villagers, forest and district administrators, and local law enforcers.

Abstract Crime prediction serves as a valuable tool for deriving insightful information that can inform policy decisions at both operational and strategic tiers. This information can be used to identify high-crime areas, and optimise resource allocation and personnel management for crime prevention. Traditionally, techniques such as the Poisson model and regression analysis have been widely used for crime prediction. However, recent statistical advancements have introduced Integrated Nested Laplace Approximations (INLA) as a promising alternative for spatial and temporal data analysis. This study focuses on crime prediction using the INLA model. Specifically, the first-order autoregressive model under the INLA modelling framework is employed on longitudinal data for crime predictions in different regions of the City of Johannesburg, South Africa. The model parameters and hyperparameters considering space and time are estimated through the INLA model. In this work, the suitability and performance of the INLA model for crime prediction is assessed, which effectively captures spatial and temporal patterns. This study contributes to research by first introducing a novel approach for South African crime prediction. Secondly, it develops a model using no demographic information other than clustering attributes as an exogenous variable. Thirdly, it quantifies prediction uncertainty. Finally, it addresses data scarcity through demonstrating how INLA can provide reliable crime predictions, where conventional methods are limited. Based on our findings, the INLA model ranked areas by crime levels, obtaining a 29.3% Mean Absolute Percentage Error (MAPE) and 0.8 $$R^2$$ R 2 value for crime predictions. These findings and contributions presents the potential of INLA in advancing evidence-based decision-making for crime prevention.

Abstract Background Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]). Methods Two-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition. Conclusion This protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade. ClinicalTrials.gov identifier NCT05503173.

Abstract Background Opioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study. Methods This is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement. Discussion Most ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality. Trial Registration ClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991 .

Abstract Background Unhealthy alcohol use is a common public health problem in HIV care settings in Africa and it affects the HIV continuum of care. In Uganda and other low-income countries, HIV care providers are a key resource in caring for young people (15–24 years) living with HIV (YPLH) with unhealthy alcohol use. Caring for YPLH largely depends on care providers’ perceptions of the problem. However, data that explores HIV care providers’ perceptions about caring for YPLH with unhealthy drinking are lacking in Uganda. We sought to describe the perceptions of HIV care providers regarding caring for YPLH with unhealthy drinking in the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in southwestern Uganda. Methods We used semi-structured in-depth interviews (IDIs) to qualitatively explore HIV care providers’ perceptions regarding caring for YPLH with unhealthy alcohol use. The study was conducted at the adolescent immunosuppression (ISS) clinic of Mbarara Regional Referral Hospital. Interviews were tape-recorded and transcribed verbatim. Using thematic content analysis, data from 10 interviews were analyzed. Results HIV care providers were concerned and intended to care for YPLH with unhealthy alcohol use. They understood that unhealthy drinking negatively impacts HIV care outcomes and used counseling, peer support, and referrals to routinely intervene. They however, did not apply other known interventions such as health education, medications and follow-up visits because these required family and institutional support which was largely lacking. Additional barriers that HCPs faced in caring for YPLH included; gaps in knowledge and skills required to address alcohol use in young patients, heavy workloads that hindered the provision of psychosocial interventions, late payment of and low remunerations, lack of improvement in some YPLH, and inadequate support from both their families and hospital management. Conclusion HIV care providers are important stakeholders in the identification and care of YPLH with unhealthy alcohol use in Southwestern Uganda. There is a need to train and skill HCPs in unhealthy alcohol use care. Such training ought to target the attitudes, subjective norms, and perceived control of the providers.

Criminological imagination requires that criminologists adopt multiple perspectives on their study subjects, shifting backwards and forwards between the personal and remote, the micro and the macro, or the theoretical and the empirical. Criminology should thus be ‘refractive’ (Frauley 2015: 21), harnessing the multi-perspectivism of social life to produce fuller, sharper analyses that reveal links between individual lives, social structures, and historical context. One such perspective is fa’a Sāmoa criminology. Not much is known about this worldview or its relationship with criminology, let alone its application as a credible epistemology. This article argues that Western criminology is not the only way to generate new knowledge and recommended solutions and that instead fa’a Sāmoa criminology offers an alternative way. Two qualitative case studies demonstrate how Sāmoan thinking and doing applies in the contexts of Sāmoan young people’s interaction with the youth justice system and hard-to-reach gang-involved Sāmoan peoples. Key implications are highlighted and recommended.

This article presents an interdisciplinary theory on the causes of crime in Samoa. The theory utilises a cultural practice of building the foundation - fa’avae - of a Samoan house, to explain the causes of crime and to articulate a crime prevention strategy from the nuances of the word fa’avae. The interdisciplinary nature of this theory considers two main aspects of the Samoan life of God and family (aiga) to describe both the causes of crime in Samoa, and a way forward to restore aiga and community fractured by crime. The theory calls upon the church through church ministers – faifeau – to become active in the public sphere. This entails speaking out about the causes of crime and working in collaboration with other stakeholders in devising culturally appropriate crime prevention approaches for Samoa, likely to also be familiar to other ‘South’ Pacific nations.

This article examines narratives and practices of post-conflict recovery in Bougainville and Solomon Islands respectively, with particular emphasis on the governance of justice and security. The original visions and pathways to recovery differed markedly in each case. Drawing on local strengths, including traditional leadership and customary practices of reconciliation, was integral to Bougainville’s aspirations for peacebuilding and the shaping of its post-conflict social and political order. Under the auspices of a major Australian-led regional intervention, Solomon Islands followed a more conventional state building approach that made few concessions to the significance of local non-state social institutions and actors in relation to justice and security. Despite these initial divergences, recent years have seen growing areas of convergence in both places, notably around acknowledging the importance of practical hybridity between state and non-state forms of justice and security governance.

The article discusses the application of mediation to conflict involving sorcery and sorcery-related violence in Papua New Guinea (PNG) villages and remote Australian Indigenous communities. The article proposes that a Hybrid Mediation Approach to managing this form of conflict can be effective. This approach re-imagines the stages of mediation not as fixed or rigid steps but as design parameters that empower the parties through incorporating local values and traditions into the dispute management process. The hybrid element of the approach refers to the incorporation of local values and traditions into the mediation design. The article makes reference to specific examples of sorcery-related conflict at the remote Australian community of Aurukun and a village in PNG to provide a background to this discussion of effective mediation techniques.

Using the plural policing and Global South policing frameworks, this article examines police officers' actions when handling domestic violence (DV) cases in Fiji. Drawing on an empirical survey of 365 police officers, it discusses what police do when dealing with DV reports. The findings show, firstly, that the majority of police officers are aware of the zero-tolerance policy for DV. Secondly, the majority of police officers assert they do not implement the zero-tolerance policy when handling DV cases. Thirdly, police officers take DV cases seriously. Fourthly, officers say they encourage people to use traditional customary and religious ways of settling cases and proceed with further investigation and possible prosecution only if the victim insists. Theoretically, the findings show that police practise a plural policing method of resolving DV. The article empirically and theoretically contributes to the literature on plural policing of DV in Pacific Island countries.

While domestic violence (DV) has been understood as a form of gendered violence linked to patriarchal power, postcolonial and indigenous feminist criminologies have underscored that DV needs to be understood also in relation to the interactions and entanglements between colonialism, class, race, nation, gender and religion. Moreover, such interventions require questioning Western and secular assumptions and reductions of culture, tradition and non-modern (read ‘non-Western’) epistemologies and faith as reserves of mainly patriarchal power. This paper reflects within three practitioner spaces on efforts against DV in Fiji and Tuvalu and how these critiques and interventions are mobilised in practice and with community interactions. We draw on the varied experiences of the three of us (educator, counsellor and police officer) to explore how we are embedded in various forms of translation and border-crossing work, especially in relation to assumptions, practices and knowledge linked to culture, religion and rights in relation to DV.

Tamasailau Suaalii-Sauni and Tuivalu Lauganiu present an Epilogue for this special issue on Pacific Criminology

Police reform is a critical component of peacekeeping, peacebuilding, and reintroducing stability in countries emerging from conflict. The assumption is that without a secure environment and a security system, sustained peace, political, economic, and cultural rebuilding is impossible. Ethnic conflict in the Solomon Islands between 1998–2003 resulted in reform of the Royal Solomon Islands Police Force (RSIPF), carried out by the Australian-led Regional Assistance Mission to the Solomon Islands (RAMSI). This institutional reconfiguration has been presented by the Solomon Islands government and RAMSI as a success and the gold standard for reforms in the Pacific. Despite this, internal stakeholder perspectives on the effectiveness and appropriateness of post-conflict institutional reform are absent. This work analyses and explores reflections and experiences of reform held by RSIPF officers at the mission’s culmination. It interrogates critical reflections on the changes during reform, examines key concerns and drawbacks, and advances literature on post-conflict scholarship.

The United States regularly deports individuals to Tonga due to criminal convictions, and these deportees often struggle to reintegrate into Tongan society. This phenomenological study explored the lived experiences of 12 such criminal deportees through semi-structured interviews to elicit participants’ personal stories of deportation and transition. Common themes of family, religion, and Tongan culture emerged in their responses. These results are discussed, as well as recommendations to aid deportees. The study emphasizes that successful deportee reintegration can be facilitated with the collaboration of government, religious groups, and families.

Pacific Island states face high levels of criminal deportations arriving from the United States, Australia and New Zealand—with the expectation that returnees will simply reintegrate. However, reintegration into a country that individuals often do not remember, or know the language or cutural protocols of, can be difficult. Returnees may face social stigma and/or subsequent surveillance and legal requirements on their return: the latter known in scholarly literature as ‘crimmigration creep’. In this article, we examine the case of Samoa, which has taken a unique culture-centric approach to reintegration through the establishment of the quasi-governmental Samoa Returnees Charitable Trust, rejecting external ‘one-size-fits-all’ approaches. We argue that this exertion of Samoa’s agency has led to a delay in crimmigration creep.

Abstract Background Veterans with substance use disorder (SUD) are at high risk for cognitive problems due to neurotoxic effects of chronic drug and alcohol use coupled in many cases with histories of traumatic brain injury (TBI). These problems may in turn result in proneness to SUD relapse and reduced adherence to medical self-care regimens and therefore reliance on health care systems. However, the direct relationship between cognitive function and utilization of Veterans Health Administration (VHA) SUD and other VHA health care services has not been evaluated. We sought initial evidence as to whether neurocognitive performance relates to repeated health care engagement in Veterans as indexed by estimated VHA care costs. Methods Neurocognitive performance in 76 Veterans being treated for SUD was assessed using CNS-Vital Signs, a commercial computerized cognitive testing battery, and related to histories of outpatient and inpatient/residential care costs as estimated by the VHA Health Economics Resource Center. Results After controlling for age, an aggregate metric of overall neurocognitive performance (Neurocognition Index) correlated negatively with total VHA health care costs, particularly with SUD-related outpatient care costs but also with non-mental health-related care costs. Barratt Impulsiveness Scale scores also correlated positively with total VHA care costs. Conclusions In Veterans receiving SUD care, higher impulsivity and lower cognitive performance were associated with greater health care utilization within the VHA system. This suggests that veterans with SUD who show lower neurocognitive performance are at greater risk for continued health problems that require healthcare engagement. Cognitive rehabilitation programs developed for brain injury and other neurological conditions could be tried in Veterans with SUD to improve their health outcomes.

Abstract At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

Abstract Background Diagnosis of alcohol use disorder (AUD) in primary care is critical for increasing access to alcohol treatment. However, AUD is underdiagnosed and may be inequitably diagnosed due to societal structures that determine access to resources (e.g., structural racism that limits opportunities for some groups and influences interpersonal interactions in and beyond health care). This study described patterns of provider-documented AUD in primary care across intersections of race, ethnicity, sex, and community-level socioeconomic status (SES). Methods This cross-sectional study used EHR data from a regional healthcare system with 35 primary care clinics that included adult patients who completed alcohol screenings between 3/1/2015 and 9/30/2020. The prevalence of provider-documented AUD in primary care based on International Classification of Diseases-9 (ICD-9) and ICD-10 diagnoses was compared across intersections of race, ethnicity, sex, and community-level SES. Results Among 439,375 patients, 6.6% were Latine, 11.0% Asian, 5.4% Black, 1.3% Native Hawaiian/Pacific Islander (NH/PI), 1.5% American Indian/Alaska Native (AI/AN), and 74.2% White, and 58.3% women. The overall prevalence of provider-documented AUD was 1.0% and varied across intersecting identities. Among women, the prevalence was highest for AI/AN women with middle SES, 1.5% (95% CI 1.0–2.3), and lowest for Asian women with middle SES, 0.1% (95% CI 0.1–0.2). Among men, the prevalence was highest for AI/AN men with high and middle SES, 2.0% (95% CI 1.1–3.4) and 2.0% (95% CI 1.2–3.2), respectively, and lowest for Asian men with high SES, 0.5% (95% CI 0.3–0.7). Black and Latine patients tended to have a lower prevalence of AUD than White patients, across all intersections of sex and SES except for Black women with high SES. There were no consistent patterns of the prevalence of AUD diagnosis that emerged across SES. Conclusion The prevalence of provider-documented AUD in primary care was highest in AI/AN men and women and lowest in Asian men and women. Findings of lower prevalence of provider-documented AUD in Black and Hispanic than White patients across most intersections of sex and SES differed from prior studies. Findings may suggest that differences in access to resources, which vary in effects across these identity characteristics and lived experiences, influence the diagnosis of AUD in clinical care.

Abstract Background Many people with opioid use disorder who stand to benefit from buprenorphine treatment are unwilling to initiate it due to experience with or fear of both spontaneous and buprenorphine-precipitated opioid withdrawal (BPOW). An effective means of minimizing withdrawal symptoms would reduce patient apprehensiveness, lowering the barrier to buprenorphine initiation. Ketamine, approved by the FDA as a dissociative anesthetic, completely resolved BPOW in case reports when infused at a sub-anesthetic dose range in which dissociative symptoms are common. However, most patients attempt buprenorphine initiation in the outpatient setting where altered mental status is undesirable. We explored the potential of short-term use of ketamine, self-administered sublingually at a lower, sub-dissociative dose to assist ambulatory patients undergoing transition to buprenorphine from fentanyl and methadone. Methods Patients prescribed ketamine were either (1) seeking transition to buprenorphine from illicit fentanyl and highly apprehensive of BPOW or (2) undergoing transition to buprenorphine from illicit fentanyl or methadone and experiencing BPOW. We prescribed 4–8 doses of sublingual ketamine 16 mg (each dose bioequivalent to 3–6% of an anesthetic dose), monitored patients daily or near-daily, and adjusted buprenorphine and ketamine dosing based on patient response and prescriber experience. Results Over a period of 14 months, 37 patients were prescribed ketamine. Buprenorphine initiation was completed by 16 patients, representing 43% of the 37 patients prescribed ketamine, and 67% of the 24 who reported trying it. Of the last 12 patients who completed buprenorphine initiation, 11 (92%) achieved 30-day retention in treatment. Most of the patients who tried ketamine reported reduction or elimination of spontaneous opioid withdrawal symptoms. Some patients reported avoidance of severe BPOW when used prophylactically or as treatment of established BPOW. We developed a ketamine protocol that allowed four of the last patients to complete buprenorphine initiation over four days reporting only mild withdrawal symptoms. Two patients described cognitive changes from ketamine at a dose that exceeded the effective dose range for the other patients. Conclusions Ketamine at a sub-dissociative dose allowed completion of buprenorphine initiation in the outpatient setting in the majority of patients who reported trying it. Further research is warranted to confirm these results and develop reliable protocols for a range of treatment settings.

Familiegjenforeining til flyktningar har vore kjenneteikna ved at mor eller far kom til landet først og resten av familien kom seinare. Det siste tiåret har foreldre og sysken i større grad fått gjenforeining med tidlegare einslege mindreårige flyktningar. Gjennom kvalitative intervju undersøkjer vi ti tidlegare einslege mindreårige flyktningar sine erfaringar med slik gjenforeining, og deira møte med hjelpeapparat og regelverk i den samanheng. Ved hjelp av institusjonell teori analyserer vi fram to motstridande institusjonelle logikkar i intervjua: dei unge sitt ansvar for familien si sak versus det offentlege sitt ansvar for familien si sak. Logikken om dei unge sitt ansvar dominerer i materialet. Gleda over etterlengta familieliv er for dei fleste av dei unge blanda med tungt ansvar for mottak og integrering av familiemedlemmane. Resultat frå studien viser at dei unge som tek eller vert pålagt eit stort ansvar for familien, ofte opplever alvorlege konsekvensar, blant anna i form av psykiske utfordringar og avbroten skulegang. Vi etterlyser endring av regelverk og ein praksis i det lokale hjelpeapparatet meir tilpassa dei unge sin situasjon.

I denne artikkelen oppsummerer og diskuterer vi nyere norsk forskning om brukernes erfaringer med digitale løsninger som tilbys av Nav. Gjennomgangen er organisert rundt tre sentrale temaer: (1) kontaktkanaler og digital ulikhet, (2) digitale dialogløsninger og brukerinvolvering og (3) opplæring i å håndtere digitale løsninger. Digitalisering gir nye muligheter for å innhente informasjon og komme i kontakt med etaten og muligheter for medvirkning i egne saker. Samtidig krever digitale løsninger arbeid og teknologisk og byråkratisk kompetanse, noe som mange brukere mangler. Digitalisering kan dermed både reprodusere sosial ulikhet og skape nye former for sosial ulikhet. I artikkelen oppsummerer vi det vi så langt vet om den digitale brukeren i velferdsbyråkratiet som ideal og praksis, og reiser aktuelle spørsmål for videre forskning.

Abstract This study introduces an algorithmic strategy for measuring dimensions of police presence at microgeographic units using GPS data from police patrol units. The proposed strategy builds upon the integrated theory of hot spots patrol strategy from Sherman et al. (Journal of Contemporary Criminal Justice 30:95–122, 2014), focusing on three key dimensions: the frequency, duration, and intermittency of police presence. This study provides pseudocodes for the algorithm, facilitating the pre-processing of GPS-derived data sequences to generate measures of these three central concepts. The measures presented in this article offer a framework for investigating the impact of police presence on crime and other relevant crime-related outcomes at microgeographic units, using GPS data. This algorithmic strategy may further contribute to the development of evidence-based strategies in place-based policing initiatives.

Abstract There is a vast literature evaluating the empirical association between stay-at-home policies and crime during the COVID-19 pandemic. However, these academic efforts have primarily focused on the effects within specific cities or regions rather than adopting a cross-national comparative approach. Moreover, this body of literature not only generally lacks causal estimates but also has overlooked possible heterogeneities across different levels of stringency in mobility restrictions. This paper exploits the spatial and temporal variation of government responses to the pandemic in 45 cities across five continents to identify the causal impact of strict lockdown policies on the number of offenses reported to local police. We find that cities that implemented strict lockdowns experienced larger declines in some crime types (robbery, burglary, vehicle theft) but not others (assault, theft, homicide). This decline in crime rates attributed to more stringent policy responses represents only a small proportion of the effects documented in the literature.

Abstract Purpose/Goal This research investigates the potential link between mobility and violent crimes in Tamil Nadu, India, using an empirical study centred on the COVID-19 pandemic waves (2020–2022). The goal is to understand how these events influenced crime, employing a counterfactual approach. Methods The study employs the XGBoost algorithm to forecast counterfactual events across different timeframes with varying levels of mobility. The mobility data sources include historical bus and passenger records spanning a decade, along with Google Community Mobility Reports added during the pandemic phases. The foundation for crime analysis is built upon the univariate time series of violent crimes reported as First Information Reports from 2010 to 2022. Findings Results indicate a significant correlation between mobility and violent crimes when mobility drops below a specific threshold. However, no such correlation is observed when mobility is above this threshold during the non-pandemic periods. The COVID-19 pandemic had a major impact on people’s and vehicular mobility, especially during the complete lockdown periods of the first two waves, and also affected crime rates. Conclusions The decrease in recorded incidents could also be attributed to fewer criminal opportunities. Additionally, this could be due to unfavourable situational factors, such as victims’ limited access to appropriate health and law enforcement agencies to report crimes. Furthermore, frontline services were busy with pandemic-related commitments, which could have contributed to a lack of crime registration even when crimes were committed.

Abstract The prevalence and influence of gangs on adolescents and young adults remain a concern in Western Cape, South Africa—particularly as they have one of the largest gang presence. While less attention has been focused on young women, there is a need to elucidate the relationship between gang exposure and health behaviors, such substance use, in addition to understanding whether becoming a caregiver impacts this relationship. This study uses baseline data from 496 participants enrolled in a NIDA-funded R01 trial that recruited young women aged 16 to 19 who were out of school and reported recent alcohol or other drug use and sexual risk behavior. At enrollment, a risk behavior survey was administered, and urine drug screening was conducted. Multivariable logistic regression analyses were conducted to examine baseline associations between childbirth, a gang exposure index based on eight items, and positive drug screens of the most prevalent drugs in the Western Cape (marijuana, methaqualone, and methamphetamine). At enrollment, approximately 39% of the sample had a positive urine screen for marijuana, 17% for methaqualone, and 11% for methamphetamine. Additionally, 28% had ever given birth. While only 6% reported ever being a member of a gang, most reported exposure to gangs through their physical and social environments. For all three drugs, gang exposure was associated with statistically significantly higher odds of a positive screen. Every one-point increase in the gang exposure index was associated with a 31% increase in the odds of a positive marijuana screen (p

Abstract Objective To identify faith-based leaders’ (FBLs’) knowledge, perceptions, and questions about syringe services programs (SSPs). Methods We conducted a one-time, national online survey of 461 Christian FBLs August–September 2022. Results 56% of FBLs agreed they support having SSPs in their communities; only 7% strongly disagreed. We identified 15 main questions FBLs have about SSPs. We found statistically significant differences based on FBL Protestant affiliations. Mainline FBLs are more knowledgeable about SSPs, likely to believe a larger number of SSP services would benefit their community, supportive of SSPs, interested in data related to SSPs, and likely to look to local public health officials to shape their opinions on SSPs compared with non-mainline FBLs. Conclusions SSP advocates can address questions that FBLs have about SSPs before beginning outreach. By understanding common Protestant denominational affiliations, advocates can focus initial engagement efforts on FBLs in their communities who are more likely to support SSPs. Our findings suggest that local public health officials can influence FBLs’ opinions about SSPs.

Abstract Introduction Engaging families in behavioral health services is a high priority for juvenile justice (JJ) systems and family advocacy groups. Family-driven care (FDC) enhances family engagement and decision-making power in youth behavioral health services, ultimately, improving youth and family mental health and substance abuse outcomes. Despite the benefits, there is limited guidance on how to integrate FDC into behavioral health care within the JJ system. Therefore, the goal of this study is to understand factors that promoted adoption of FDC the JJ context. Methods JJ staff and leadership across the state of Georgia participated in surveys and interviews to understand contextual implementation determinants related to the adoption of FDC. Between November 2021- July 2022, 140 JJ staff participated in the survey from 61 unique JJ organizations. In addition, 16 staff participated in follow-up key informant interviews to explain quantitative findings. Results Based on a mixed methods analysis, JJ agencies were more likely to implement FDC if they had the following characteristics: (1) presence of site leaders that were strongly committed to family engagement, (2) a shared understanding that family engagement was a top priority, (3) staff training related to family engagement, (4) external partnerships with organizations that serve families, (5) a workplace culture that was supportive of innovation, and (6) presence of family engagement programs that were easier (or more feasible) for staff to implement. Discussion This mixed methods study underscores the importance of strengthening these 6 inner and outer setting implementation determinants when preparing to integrate FDC into JJ systems. Findings are used to promote the adoption and delivery of this high priority intervention in a state-level JJ system.

Abstract Background Although clinical substance use disorder (SUD) care is multidisciplinary there are few opportunities to collaborate for quality improvement or systems change. In Oregon, the Project ECHO (Extension for Community Healthcare Outcomes) model was adapted to create a novel multidisciplinary SUD Leadership ECHO. The objective of this study was to understand the unique effects of the adapted ECHO model, determine if the SUD Leadership ECHO could promote systems change, and identify elements that enabled participant-leaders to make changes. Methods Four focus groups were conducted between August and September of 2022 with a purposive sample of participants from the second cohort of the Oregon ECHO Network’s SUD Leadership ECHO that ran January to June 2022. Focus group domains addressed the benefits of the adapted ECHO model, whether and why participants were able to make systems change following participation in the ECHO, and recommendations for improvement. Thematic analysis developed emergent themes. Results 16 of the 53 ECHO participants participated in the focus groups. We found that the SUD Leadership ECHO built a multi-disciplinary community of practice among leaders and reduced isolation and burnout. Three participants reported making organizational changes following participation in the ECHO. Those who successfully made changes heard best practices and how other organizations approached problems. Barriers to initiating practice and policy changes included lack of formal leadership authority, time constraints, and higher-level systemic issues. Participants desired for future iterations of the ECHO more focused presentations on a singular topic, and asked for a greater focus on solutions, advocacy, and next steps. Conclusions The adapted ECHO model was well received by focus group participants, with mixed reports on whether participation equipped them to initiate organizational or policy changes. Our findings suggest that the SUD Leadership ECHO model, with fine-tuning, is a promising avenue to support SUD leaders in promoting systems change and reducing isolation among SUD leaders.

Abstract Background Substance use disorders (SUDs) have been consistently shown to exhibit moderate intergenerational continuity (1–3). While much research has examined genetic and social influences on addiction, less attention has been paid to clients’ and lay persons’ perceptions of genetic influences on the heritability of SUD (4) and implications for treatment. Methods For this qualitative study, twenty-six structured Working Model of the Child Interviews (WMCI) were conducted with mothers receiving inpatient SUD treatment. These interviews were thematically analyzed for themes related to maternal perceptions around intergenerational transmission of substance use behaviours. Results Findings show that over half of the mothers in this sample were preoccupied with their children’s risk factors for addictions. Among this group, 29% spontaneously expressed concerns about their children’s genetic risk for addiction, 54% shared worries about their children’s propensity for addiction without mentioning the word gene or genetic. Additionally, 37% had challenges in even discussing their children’s future when prompted. These concerns mapped onto internal working models of attachment in unexpected ways, with parents who were coded with balanced working models being more likely to discuss intergenerational risk factors and parents with disengaged working models displaying difficulties in discussing their child’s future. Conclusion This research suggests that the dominant discourse around the brain-disease model of addictions, in its effort to reduce stigma and self-blame, may have unintended downstream consequences for parents’ mental models about their children’s risks for future addiction. Parents receiving SUD treatment, and the staff who deliver it, may benefit from psychoeducation about the intergenerational transmission of SUD as part of treatment.

Abstract Background Some people with substance use disorders (SUD) can experience multiple co-occurring social problems. Digital solutions have been developed to support effective and cost-effective social welfare and healthcare in addictions treatment. Given the varying severity of problems from alcohol and other drug use, digital service tools can save money and provide tailored care. Objective In this study we aimed to understand the perspectives of those who develop digital service tools on people with SUD and treatment encounters. As a case, we interviewed those who have been involved in the development of a digital client segmentation tool The Navigator. Methods Ten (N = 10) semi-structured interviews were conducted with professionals involved in digital client segmentation tool development and were analysed with inductive content analysis. Participants were asked about the development of the Navigator from the perspectives of their own role as developers, the clients, the effectiveness of the services, and decision-making processes. Findings Some people with SUD may face several obstacles when using digital services. Digital divide, feared or experienced stigma and biased attitudes, complex life situations, and difficulties in committing to treatment were identified as challenges. Nevertheless, digital solutions can offer the clients alternative ways of using the services that can better meet their individual needs. The anonymity and facelessness of digital solutions can reduce the fear of immediate judgement. Implementing digital solutions in substance use work poses challenges due to chronic staff shortages. Digitalisation often results in the creation of multiple simultaneously managed channels, potentially reducing time-consumption but increasing the perceived workload. There is a call for multi-professionalism, acknowledging inequalities between various disciplines within the field.

Abstract Background Low health literacy is costly and observed among justice-impacted adults (JIA), a group that often faces numerous barriers in accessing healthcare and a disproportionate burden of illness. Health literacy interventions for JIA are critically needed to improve healthcare access and related outcomes. Methods This manuscript describes the protocol for a longitudinal mixed-methods randomized clinical trial that assesses the effectiveness of a coach-guided health literacy intervention on JIA’s healthcare access. The intervention was previously piloted with justice impacted adults. We will recruit 300 JIA ages 18 + in San Diego, California. Participants will be randomized 1:1 to the Treatment Group (i.e., coach-guided intervention providing 12 sessions of individualized health coaching and service navigation over 6 months) or the Control Group (i.e., self-study of the health coaching program, and brief service navigation support). We will quantitatively assess JIA’s healthcare access defined as: use of healthcare, health insurance status, and regular source of care at 6-months as the primary outcomes. Participants will also be surveyed at 12-months. Statistical analyses will incorporate the intent-to-treat (ITT) principle and we will estimate mixed-effects logistic regression for the primary outcomes. We will also conduct qualitative interviews at 6 and 12-months with 40 purposively sampled participants, stratified by study arm, who reported healthcare access barriers at baseline. Interviews will explore participants’ satisfaction with the intervention, healthcare attitudes, self-efficacy for and barriers to healthcare access over time, perceived contribution of the intervention to health and well-being, and diffusion of intervention-related information within participants’ social networks. We will conduct deductive thematic analyses of qualitative data. Discussion Low health literacy among JIA is a foundational challenge requiring tailored intervention strategies. Findings from this trial may inform policies and the structure of service delivery models to build health literacy among JIA in institutional and community settings throughout the United States and elsewhere. Trial registration This study is registered with the United States’ ClinicalTrials.gov registry under protocol # 161,903.

Abstract Background The aim of the current study was to assess the accuracy of expert predictions, which were derived using a Delphi panel foresight study between 2009 and 2011, on a variety of drug-related topics in Finland in 2020. Methods The material used to evaluate the accuracy of the predictions consists of published reports on statistics, survey results, official register data, wastewater analyses and official documents. Whenever possible, we used multiple information sources to ascertain possible changes related to the predictions. Results Between 2009 and 2011, the majority – but not all – of the experts accurately predicted an increase in drug use. Indeed, more people experimented with or used drugs, and more drug residues were found in wastewater monitoring. The experts also correctly predicted an increase in population-level approval of drug use, but this development has been rather slow. Contrary to predictions, there was no marked increase in the use of new synthetic drugs. However, the misuse of buprenorphine increased during the 2010s. In the drug market, unit prices were surprisingly stable over the ten-year period. There were no changes in legislation related to the legal status of drugs, as was foreseen by the experts. However, enforcement moved in the direction foreseen by the experts: more lenient measures have been taken against users. Drug care system reforms favored a combination of mental health and addiction care units between 2009 and 2011, and 2020, as foreseen by the experts. Conclusions It seems to have been easier for the experts to foresee the continuation of existing trends, e.g., increasing use of drugs or widening approval of drugs, than to predict possible changes in the popularity of distinct groups of drugs such as new psychoactive substances (NPS). Even armed with the prediction that drug imports and wholesale would increasingly fall into the domain of organized crime, this undesirable development could not be stopped. Expert disagreement can also be seen as a valuable indication of uncertainty regarding the future. Foresight related to drug-related issues can produce relatively accurate and realistic views of the future at least up to ten years ahead.

Abstract In this article, we investigate situations involving firearm violence in Sweden. The spatiotemporal distribution of records is assessed in different contexts across the country and linked to land use, demographic, and socio-economic characteristics by area and by street segment. The findings emphasize the prevalence of evening shootings, particularly in economically disadvantaged areas where young people congregate in public places often in residential areas, in parks, in playgrounds, and in transit areas. Although two-thirds of shootings took place in larger urban municipalities, our study sheds light on the non-uniform distribution of gun violence along the rural–urban continuum. We conclude by offering suggestions for future research and practical interventions to address this pressing issue that negatively affects people and communities.

Abstract Background setting The presumption that family violence will repeat and escalate is embedded in practices including risk assessment and case management. However, there is limited evidence that further episodes are inevitable, or that subsequent episodes will increase in severity. Therefore, we need to better understand temporal patterns in aggressor behavior to inform how risk is conceptualized in practice. Methods For a sample of 2115 family violence aggressors who came to police attention in Integrated Safety Response catchment areas in Aotearoa New Zealand, we collected information New Zealand Police routinely recorded about reported harm between 2018 and 2020. We used a hidden Markov model to estimate the latent (i.e., unmeasurable) states behind the information reported to police, and modeled aggressors’ movement between those states over time. Results We identified three latent states. The first contained low or no reported harm, the second contained low probabilities of reported harm, and the third involved a high probability of reported verbal abuse and a moderate probability of reported physical violence. We identified four pathways through the latent states over the two-year follow-up period, which we called No reported harm, High reported harm, Low reported harm, and De-escalation. Conclusions The findings add to the body of research indicating that family violence aggressors do not inevitably repeat or escalate their harmful behavior, and that a small subset of cases account for a large proportion of reported harm. This study demonstrates how information that police routinely collect can be used to estimate aggressors’ latent behavioral states and model pathways communicating the probability that they will continue to come to police attention for family violence, contributing to improved risk assessment and practice.

Abstract Background Justice-involved youth have higher rates of substance use disorders (SUDs) than the general population. Many do not connect with or complete treatment, leading to recidivism. This qualitative study explores perceptions and barriers to treatment in this population. Results Justice-involved youth participating in a larger study focused on access to SUD treatment were interviewed about available treatment and justice system involvement. Twenty-one dyads (youth and a guardian) and 3 individual guardians (total N = 45) were interviewed by phone. Inclusion criteria were youth aged 14–17 involved in the justice system that screened positive for SUD. Youth sample was 43% male. Thematic analysis guided the process. The study was Indiana University Institutional Review Board approved (#1802346939). Data was interpreted within the ecological system theory. Youth barriers included willingness to engage in treatment, time constraints/scheduling conflicts, and low perceived usefulness of treatment. Major guardian themes included high cost of treatment, lack of communication by the justice system about treatment, youth unwillingness or disinterest to engage in treatment, and limited program availability. Conclusions The barriers to treatment for justice-involved youth are multifaceted and occur across the spectrum of levels of the ecological system, which include parents, peers, social systems, and cultural elements. Many youth and guardians suggested improvements for their interactions with the juvenile justice system. Further examination is needed of current policy implementation to address these concerns.

Abstract Background Despite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment. Method This preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2–19), and following (Study Days 20–21) residential treatment. Discussion This manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life. Trial registration: ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728 . Protocol Version 10 May 2023

Abstract Background In the U.S. there are significant racial and gender disparities in the uptake of pre-exposure prophylaxis (PrEP). Black Americans represented 14% of PrEP users in 2022, but accounted for 42% of new HIV diagnoses in 2021 and in the South, Black people represented 48% of new HIV diagnoses in 2021 but only 21% of PrEP users in 2022. Women who use drugs may be even less likely than women who do not use drugs have initiated PrEP. Moreover, women involved in community supervision programs (CSP) are less likely to initiate or use PrEP, More PrEP interventions that focus on Black women with recent history of drug use in CSPs are needed to reduce inequities in PrEP uptake. Methods We conducted a secondary analysis from a randomized clinical trial with a sub-sample (n = 336) of the total (N = 352) participants from the parent study (E-WORTH), who tested HIV negative at baseline were considered PrEP-eligible. Black women were recruited from CSPs in New York City (NYC), with recent substance use. Participants were randomized to either E-WORTH (n = 172) an HIV testing plus, receive a 5-session, culturally-tailored, group-based HIV prevention intervention, versus an HIV testing control group (n = 180). The 5 sessions included an introduction to PrEP and access. This paper reports outcomes on improved awareness of PrEP, willingness to use PrEP, and PrEP uptake over the 12-month follow-up period. HIV outcomes are reported in a previous paper. Results Compared to control participants, participants in this study assigned to E-WORTH had significantly greater odds of being aware of PrEP as a biomedical HIV prevention strategy (OR = 3.25, 95% CI = 1.64–6.46, p = 0.001), and indicated a greater willingness to use PrEP as an HIV prevention method (b = 0.19, 95% CI = 0.06–0.32, p = 0.004) over the entire 12-month follow-up period. Conclusions These findings underscore the effectiveness of a culturally-tailored intervention for Black women in CSP settings in increasing awareness, and intention to initiate PrEP. Low uptake of PrEP in both arms highlight the need for providing more robust PrEP-on-demand strategies that are integrated into other services such as substance abuse treatment. Trial Registration ClinicalTrials.gov Identifier: NCT02391233 .

Abstract Background The COVID-19 pandemic exacerbated existing mental health challenges and introduced new ones, particularly among vulnerable populations such as individuals within the criminal justice system, who disproportionately experienced employment, financial, and housing issues. As mandatory lockdowns and social distancing mandates were implemented, the United States saw unprecedented interruptions to treatment. Telemedicine emerged as a transformative tool in alleviating new and existing treatment barriers. Yet, limited empirical research has examined the impact and implications of telemedicine on mental health treatment in criminal justice populations. Methods The timing of this study’s data collection overlapped with the spread of COVID-19 in the United States and provided a unique opportunity to examine the impact of telemedicine as part of a natural experiment. Utilizing interviews with 61 community mental health center service providers, this study qualitatively examined service providers’ experiences in treating criminal justice-involved individuals with serious mental illness who were receiving mental health treatment through telemedicine. Results Service providers expressed satisfaction with telemedicine in addressing client transportation and childcare barriers while increasing engagement. Service providers voiced new concerns regarding clients’ confidentiality, digital literacy, and limitations to gathering non-verbal client information during virtual treatment. Conclusions Mental health treatment offered through telemedicine mitigates barriers to treatment that disproportionately affect criminal justice clients. Despite its benefits, challenges like access to reliable internet and to internet-enabled devices, confidentiality concerns, and information gathering must be addressed to achieve optimal and equitable mental health treatment through telemedicine. The findings support the continued use of telemedicine in mental health treatment delivery for this population.

Abstract While criminal legal involvement is a structural determinant of health, both administrative and national longitudinal cohort data are collected and made available in a way that prevents a full understanding of this relationship. Administrative data are both collected and overseen by the same entity and are incomplete, delayed, and/or uninterpretable. Cohort data often only ask these questions to the most vulnerable, and do not include all types of criminal legal involvement, when this involvement occurs in someone’s life, or family and community involvement. To achieve a more optimized data landscape and to facilitate population-level research on criminal legal involvement and health, (1) individual administrative level data must be made available and able to be linked across carceral systems, (2) a national data archive must be made to maintain and make criminal legal data available to researchers, and (3) a nationally representative, longitudinal study focused on those with criminal legal involvement is necessary. By beginning to critically think about how future data could be collated and collected, we can begin to provide more robust evidence around how the criminal legal system impacts the health of our society and, in turn, create policy reform.

Abstract Background Overdose deaths continue to rise within the United States, despite effective treatments such as buprenorphine and methadone for opioid use disorder (OUD). Mobile medical units with the ability to dispense buprenorphine have been developed to engage patients and eliminate barriers to accessing OUD treatment. This study reports survey responses of patients of a mobile medical unit dispensing buprenorphine in areas of Chicago, IL with high overdose rates. Methods All patients who were dispensed buprenorphine via the mobile medical unit were invited to participate in a 7-item anonymous survey between May 24, 2023, and August 25, 2023. The survey included 5-point satisfaction scale, multiple-choice, and open-ended questions. Outcomes included satisfaction with buprenorphine dispensing from the mobile medical unit, satisfaction with filling buprenorphine at a pharmacy in the past, barriers experienced at pharmacies when filling buprenorphine, and whether the client would have started treatment that day if the mobile medical unit had not been present. Satisfaction scale and multiple-choice question responses were assessed using descriptive statistics. Wilcoxon signed-rank test was used to compare median satisfaction levels between receiving buprenorphine from the mobile medical unit versus filling a buprenorphine prescription at a community pharmacy. Open-ended questions were analyzed qualitatively using inductive thematic analysis. Results 106 unique patients were dispensed buprenorphine from the mobile unit during the study period. Of these patients, 54 (51%) completed the survey. Respondents reported high satisfaction with the buprenorphine dispensing process as a part of a mobile medical unit. Of those who had previously filled buprenorphine at a pharmacy, 83% reported at least one barrier, with delays in prescription dispensing from a community pharmacy, lack of transportation to/from the pharmacy, and opioid withdrawal symptoms being the most common barriers. 87% reported they would not have started buprenorphine that same day if the mobile medical unit had not been present. Nearly half of survey participants reported having taken buprenorphine that was not prescribed to them. Qualitative analysis of open-ended survey responses noted the importance of convenient accessibility, comprehensive care, and a non-judgmental environment. Conclusions Mobile medical units that dispense buprenorphine are an innovative model to reach patients with OUD who have significant treatment access barriers. This study found that patients who experienced barriers to accessing buprenorphine from a pharmacy were highly satisfied with the mobile medical unit’s buprenorphine dispensing process. Programs seeking to develop mobile buprenorphine dispensing programs should consider patient priorities of accessibility, comprehensive care, and welcoming, non-judgmental environments.

Abstract We present the case of a 14-year-old who established care at our primary care clinic after hospitalization for unintentional fentanyl overdose. They were diagnosed with severe opioid use disorder (OUD) and stimulant use disorder (StUD) and initiated buprenorphine while inpatient. They were then transitioned to the only known outpatient primary care clinic in her county who was actively providing medications for opioid use disorder (MOUD) in adolescents. At the first visit, they reported a history of 20 overdoses, struggling with adherence to buprenorphine and continued opioid cravings. An overdose safety plan was reviewed with them and their parent including providing them naloxone kits, fentanyl test strips, and education handout sheets. Due to their significant overdose history and adherence challenges with sublingual buprenorphine, they were started on long-acting injectable buprenorphine (LAIB) with weekly provider visits and urine toxicology screening. In collaboration with the treatment team, they initiated behavioral treatment with contingency management (CM), with incentives for appointment completion, expected urine results, and successful medication administration. Over the next 19 months, and to date, they have increasingly engaged with care and have remained abstinent. LAIB may be an appealing alternative for adolescents with OUD to improve adherence and reduce risk of recurrent use and overdose. Adjunctive treatment with CM may improve retention in MOUD and have the benefit of treating StUD. There is a need for further research to explore innovative, community-based treatment for youth with OUD.

Abstract Background Evaluating the risk of relapse is a pivotal step in the treatment of patients with methamphetamine use disorder (MUD). The 30-item Stimulant Relapse Risk Scale (SRRS) was originally developed in Japan to meet the demand. This study examined the reliability, validity, and factor structure of the Chinese version of the SRRS for patients with MUD. Methods 247 patients with MUD self-rated the Chinese version of the SRRS. Cronbach’s alpha coefficients and inter-item correlation analysis were used to assess the internal consistency reliability. Construct validity was determined through confirmatory factor analysis (CFA), and concurrent validity was examined using the visual analogue scale (VAS) for drug craving and the severity of dependence scale (SDS). We followed the participants for 1 year and assessed the predictive validity based on the correlation of the scores of the Chinese version of the SRRS with the relapse rate within 3, 6, and 12 months of follow-up. Results CFA revealed satisfactory model fit estimates for the 22-item Chinese version of the SRRS that consisted of four subscales. The four-factored 22-item Chinese version of the SRRS had adequate internal consistency with Cronbach’s alphas ranging from 0.76 to 0.92. The 22-item Chinese version of the SRRS scores were significantly correlated with the VAS and SDS scores as well as the relapse rate within 3, 6, and 12 months, indicating good concurrent and predictive validity of this scale. The receiver operating characteristic curve revealed a cutoff score of 40 could discriminate between participants with (SDS score ≥ 4) and without (SDS score

Abstract Background Social reintegration relies on the support given to prisoners not only during their reentry into society but also throughout their imprisonment. Our goal was to analyze the expectations reported by cisgender and transgender women returning to society and of the justice and social welfare professionals from the Brazilian prison system. Methods A qualitative analysis using saturation sampling was conducted. The participants were selected through a non-probabilistic sampling technique. Data was collected through semi-structured interviews with professionals involved in the management of the prison system and female former inmates. Interviews were transcribed and analyzed using an open and focused coding process. Textual data was stored, organized, and coded using Atlas software according to emerging themes. Results The study involved 15 professionals and 13 female former inmates, five of them identified as transgender women. Among the professionals, the age range went from 38 to 65 years old; they reported a work history in their respective fields, from 10 to 35 years, with an equal distribution across genders. As for the female former inmates, their ages ranged from 24 to 42 years old, and the most reported crime was drug trafficking. Their incarceration time varied from 1 to 8 years. Female inmates were vulnerable to abuse and violence, including physical, sexual, and emotional violence. Women in situations of prior vulnerability faced additional challenges during their sentences. Transgender women were even more neglected and discriminated against by the system. Despite the professionals being aware and concerned about vulnerabilities and the need to improve the reintegration process, in general, they were not sensitive to the gender perspective. There were no specific policies able to support social integration for this public. Conclusions Data showed multifaceted challenges faced by female former inmates within the Brazilian prison system, highlighting the insufficient policies for both cisgender and transgender women. Additionally, the results revealed a lack of sensitivity among professionals regarding gender issues and their particularities in the prison system and social reintegration. These findings emphasize the need for a more comprehensive and intersectional approach that addresses the diverse socio-economic backgrounds of these individuals.

Abstract Background Hepatitis C virus (HCV) continues to cause significant morbidity and mortality within the US, and disproportionately impacts those involved with the criminal justice system. Despite this, knowledge and attitudes regarding HCV treatment among adults on probation have not been well studied. We conducted a cross-sectional survey of adults on probation accessing on-site HCV testing and linkage services at the adult probation department in Denver, Colorado. The survey assessed general knowledge of HCV and HCV treatment, as well as attitudes surrounding HCV treatment that might reflect medical mistrust. We used bivariate and multivariable logistic regression to identify factors associated with previous HCV testing, previous HCV treatment, and HCV antibody positivity at the time the survey was conducted. Results A total of 402 participants completed all or a portion of the survey. 69% of the participants were cis-gender men; 29% were white, 27% were Black, and 30% were Hispanic/Latinx. Fewer than half of participants correctly identified that HCV infection is commonly asymptomatic (46%), that there is currently no vaccine that prevents HCV (19%), and that reinfection after treatment is possible (47%). Very few participants felt that side-effects (9%) or cost of treatment (10%) were barriers to care. Many participants believed that racial disparities exist in the treatment of HCV (59%). The belief that people who use substances are treated inequitably by health care providers was also commonly reported (35% of participants). Self-reported injection drug use and higher HCV-related knowledge were positively associated with previous testing for HCV. Higher HCV-related knowledge was positively associated with HCV antibody positivity at the time of survey completion, though the magnitude of the association was small. Conclusion Interventions are needed to increase knowledge of HCV, to improve access to HCV testing and treatment, and to reduce bias associated with HCV and substance use within the probation population.

Abstract Background Cigarette smoking remains a leading cause of preventable illness and death, underscoring the need for effective evidence-based smoking cessation interventions. Nuumi, a novel smoking cessation program integrating a digital behavioral therapy and an electronic cigarette, may provide a solution. Objective To investigate the initial efficacy, acceptability and psychological outcomes of an evidence-based smoking cessation intervention comprised of a mobile phone app and an electronic cigarette among adults who smoke and who are motivated to quit. Methods A prospective 6-month single-arm mixed-methods pilot study will be conducted. Seventy adults who smoke and who are motivated to quit will be recruited via web-based advertisements and flyers. Participants receive access to an app and an electronic cigarette with pods containing nicotine for temporary use of at least 3 months. The electronic cigarette is coupled with the app via Bluetooth, allowing for tracking of patterns of use. The behavioral therapy leverages evidence-based content informed by cognitive behavioral therapy and mindfulness-informed principles. Web-based self-report surveys will be conducted at baseline, at 4 weeks, at 8 weeks, at 12 weeks, and at 24 weeks post-baseline. Semi-structured interviews will be conducted at baseline and at 12 weeks post-baseline. Primary outcomes will be self-reported 7-day point prevalence abstinence from smoking at 12 weeks and 24 weeks. Secondary outcomes will include other smoking cessation-related outcomes, psychological outcomes, and acceptability of the nuumi intervention. Descriptive analyses and within-group comparisons will be performed on the quantitative data, and content analyses will be performed on the qualitative data. Recruitment for this study started in October 2023. Discussion As tobacco smoking is a leading cause of preventable morbidity and mortality, this research addresses one of the largest health burdens of our time. The results will provide insights into the initial efficacy, acceptability, and psychological outcomes of a novel mobile health intervention for smoking cessation. If successful, this pilot may generate an effective intervention supporting adults who smoke to quit smoking. The results will inform feasibility of a future randomized controlled trial. Trial Registration German Clinical Trials Register DRKS00032652, registered 09/15/2023, https://drks.de/search/de/trial/DRKS00032652 .

The number of students with intellectual disabilities attending folk high schools has increased over the past few decades, but their participation and experiences remain understudied. The present study explored the experiences of six former folk high school students with Downs syndrome who were part of a Norwegian age cohort in a longitudinal study. The data was collected through individual interviews, and the findings were analysed through the lens of Etienne Wengerʼs social learning theory. The participants described the folk high school as a social, dynamic, safe, and inclusive community. They were expected to engage in both formal and informal activities, including taking on responsibilities while living at a boarding school. Social participation could be challenging, but it simultaneously motivated them to learn and practise new skills to better fit in. The learning experiences at the folk high school were deemed meaningful, particularly in terms of fostering independence and preparing for adulthood. The learning and formation processes at the folk high school closely align with the characteristics and domains of a community of practice as outlined in Wengerʼs social learning theory. When considering the folk high schoolʼs vision to be a «a school for life» in conjunction with the theory of community of practice and considering the experiences of former folk high school students, it suggests that the folk high school could be a viable post-secondary education option. For the students with Downs syndrome in this study, the folk high school served as a meaningful springboard into adult life.

Arbeidsinkludering og arbeid for alle er sentrale politiske mål i Norge. Det er få personer med utviklingshemming som deltar i ordinært arbeidsliv. Personer med utviklingshemming har i hovedsak varig tilrettelagt arbeid (VTA) på skjermet arbeidsplass eller dagtilbud. Forskning på dagtilbud viser at dets rolle og status som arbeidsrelatert tilbud er omdiskutert. I denne artikkelen blir det undersøkt om dagtilbudene bidrar til deltakelse på ordinære arbeidslivsarenaer for personer med utviklingshemming. Studien er basert på et kvantitativt datamateriale fra en elektronisk spørreundersøkelse blant ledere av dagtilbud til personer med utviklingshemming i Norge. Resultatene viser at dagtilbudene bidrar til at personer med utviklingshemming inkluderes på ordinære arbeidslivsarenaer. Studien viser også at elementer ved Supported Employment benyttes i dagtilbudene selv uten kjennskap til metoden. Studien slår fast at dagtilbudene bidrar til økt arbeidsinkludering for personer med utviklingshemming.