Michelle Teti

Initiation into prescription opioid misuse amongst young injection drug users.

BACKGROUND Prescription opioids are the most frequently misused class of prescription drugs amongst young adults. Initiation into prescription opioid misuse is an important public health concern since opioids are increasingly associated with drug dependence and fatal overdose. Descriptive data about initiation into prescription opioid misuse amongst young injection drug users (IDUs) are scarce. METHODS An exploratory qualitative study was undertaken to describe patterns of initiation into prescription opioid misuse amongst IDUs aged 16-25 years. Those young IDUs who had misused a prescription drug at least three times in the past three months were recruited during 2008 and 2009 in Los Angeles (n=25) and New York (n=25). Informed by an ethno-epidemiological approach, descriptive data from a semi-structured interview guide were analysed both quantitatively and qualitatively. RESULTS Initiation into prescription opioid misuse was facilitated by easy access to opioids via participants own prescription, family, or friends, and occurred earlier than misuse of other illicit drugs, such as heroin. Nearly all transitioned into sniffing opioids, most injected opioids, and many initiated injection drug use with an opioid. Motives for transitions to sniffing and injecting opioids included obtaining a more potent high and/or substituting for heroin; access to multiple sources of opioids was common amongst those who progressed to sniffing and injecting opioids. CONCLUSION Prescription opioid misuse was a key feature of trajectories into injection drug use and/or heroin use amongst this sample of young IDUs. A new pattern of drug use may be emerging whereby IDUs initiate prescription opioid misuse before using heroin.

‘What does it take to be a man? What is a real man?’: ideologies of masculinity and HIV sexual risk among Black heterosexual men

Research documents the link between traditional ideologies of masculinity and sexual risk among multi-ethnic male adolescents and White male college students, but similar research with Black heterosexual men is scarce. This exploratory study addressed this gap through six focus groups with 41 Black, low- to middle-income heterosexual men aged 19 to 51 years in Philadelphia, PA. Analyses highlighted two explicit ideologies of masculinity: that Black men should have sex with multiple women, often concurrently, and that Black men should not be gay or bisexual. Analyses also identified two implicit masculinity ideologies: the perception that Black heterosexual men cannot decline sex, even risky sex, and that women should be responsible for condom use. The studys implications for HIV prevention with Black heterosexual men are discussed.

Photovoice as a community-based participatory research method among women living with HIV/AIDS: Ethical opportunities and challenges

Photovoice is a method in which participants use photography to identify, express, and disseminate their experiences. We conducted photovoice projects with women living with HIV/AIDS (N=21) to explore opportunities and challenges associated with the method. Photovoice provided a means to achieve two key principles of ethical public health practice: It gives participants opportunities to define their health priorities, and facilitates participant empowerment. Ethical challenges that were encountered related to exposing, through photographs, ones identity as living with HIV/AIDS, illicit activities, and other people. We discuss lessons learned for future practice to maximize the ethical opportunities and manage the challenges associated with using photovoice as an HIV-related CBPR strategy.

Racial discrimination, social support, and sexual HIV risk among Black heterosexual men

Numerous studies document the adverse impact of racial discrimination on African Americans’ health outcomes, but few have focused on HIV risk. We examined the relationship between racial discrimination and sexual risk in a sample of 526 Black heterosexual men and tested the hypothesis that social support would moderate this relationship. Participants in the predominantly low-income urban sample ranged in age from 18 to 45. High social support had a buffering impact on the relationship between racial discrimination and sexual risk. Among men reporting high racial discrimination, those with more social support reported less sexual risk than men with low social support. Men who reported high racial discrimination and low social support reported more sexual risk than men in any of the other groups. The study highlights social support as an important but understudied protective factor that may reduce sexual risk for Black heterosexual men who report high levels of racial discrimination.ResumenNumerosos estudios documentan los efectos negativos de la discriminación racial en la salud de los afroamericanos, pero pocos se han centrado en el riesgo de VIH. Examinamos la relación entre la discriminación racial y el riesgo sexual en una muestra de 526 hombres negros heterosexuales para probar la hipótesis que el apoyo social mitigaria esta relación. Los participantes en una muestra predominantemente urbana de bajos ingresos tenían edades comprendidas entre 18 a 45. Alto apoyo social tuvo un impacto amortiguador sobre la relación entre la discriminación racial y el riesgo sexual. Entre los hombres que reportaron una alta discriminación racial, aquellos con más apoyo social indicaron tener menos riesgos sexuales que los con bajo apoyo social. Hombres que reportaron una alta discriminación racial y bajo apoyo social reportaron más riesgos sexuales que aquellos en cualquiera de los otros grupos. El estudio pone de manifiesto el apoyo social como un factor de protección importante poco estudiado que puede reducir el riesgo sexual para hombres negros heterosexuales que reportan altos niveles de discriminación racial.

“I’m a Keep Rising. I’m a Keep Going Forward, Regardless”: Exploring Black Men’s Resilience Amid Sociostructural Challenges and Stressors

A growing number of health and social science research findings document Black men’s adversities, but far less is known about their strengths. The purpose of this study was to explore resilience among low-income, urban, Black men. Semistructured interviews produced rich narratives, which uncovered numerous sociostructural stressors in men’s lives, such as racism, incarceration, and unemployment. Most men were resilient despite these challenges, however, and described five main forms of resilience: (a) perseverance; (b) a commitment to learning from hardship; (c) reflecting and refocusing to address difficulties; (d) creating a supportive environment; and (e) drawing support from religion/spirituality. Analysis of men’s challenge and resilience narratives revealed the need to understand and promote low-income, urban, Black men’s resilience via a broader ecosocial perspective which acknowledges the importance of social and community-level protective factors to support individual men’s efforts to survive and thrive amid their adversities.

A mixed methods evaluation of the effect of the protect and respect intervention on the condom use and disclosure practices of women living with HIV/AIDS.

This mixed methods study evaluated the efficacy of an intervention to increase HIV status disclosure and condom use among 184 women living with HIV/AIDS (WLH/A). Participants were recruited from an HIV clinic and randomly assigned to: (1) a comparison group, who received brief messages from their health care providers (HCPs), or; (2) an intervention group, who received messages from HCPs, a group-level intervention, and peer-led support groups. Participants completed risk surveys at baseline, 6-, 12-, and 18-months. Quantitative analyses using hierarchical generalized linear models within a repeated measures framework indicated that intervention participants had significantly higher odds of reporting condom use with sexual partners in months 6 and 18. Grounded Theory-based qualitative analyses suggested that the opportunity to discuss the social context of their lives in addition to HIV/AIDS, including continued stigma and fear related to disclosure, are also essential components of a prevention strategy for WLH/A.

Taking pictures to take control: Photovoice as a tool to facilitate empowerment among poor and racial/ethnic minority women with HIV.

&NA; Poor and racial/ethnic minority women comprise the majority of women living with HIV (WLH) in the United States. Race, gender, class, and HIV‐based stigmas and inequities limit womens powers over their health and compromise their quality of life. To help WLH counter this powerlessness, we implemented a Photovoice project, called Picturing New Possibilities (PNP), and explored how women experienced empowerment through Photovoice. PNP participants (n = 30) photographed their life experiences, attended 3 group discussions and a community exhibit of their photos, and completed a follow‐up interview. We used strategies of Grounded Theory to identify key empowerment themes. Participants described empowerment through enhanced self‐esteem, self‐confidence, critical thinking skills, and control. Our findings suggest that Photovoice is an important tool for WLH. It offers women a way to access internal strengths and use these resources to improve their quality of life and health.

“You think it’s hard now … It gets much harder for our children”: Youth with autism and their caregiver’s perspectives of health care transition services

Adolescents with Autism Spectrum Disorder diagnosis often have complex comorbid physical and mental health conditions. These youth rely heavily on their medical providers and struggle through the often rocky transition out of pediatric care into adulthood and adult-centered care. This study is among the first to qualitatively examine the health care transition experiences of youth with Autism Spectrum Disorder and their caregivers. We conducted four focus groups with youth with Autism Spectrum Disorder (n = 13) and their caregivers (n = 19) and used thematic analysis strategies to identify key themes. Parents’ discussions emphasized (a) loss of relationship with provider and lack of support transitioning from pediatric to adult care, (b) providers’ lack of knowledge about Autism Spectrum Disorder, and (c) concerns about losing guardianship. Youth emphasized their confusion and anxiety around (a) medical providers’ role, especially in the transition to adulthood; and (b) managing their medical lives independently. Our findings are important because they not only improve our understanding of health care transition needs among youth with Autism Spectrum Disorder and their caregivers but demonstrate a sound methodological procedure to facilitate input from youth with Autism Spectrum Disorder.

Transitions Are Scary for Our Kids, and They're Scary for Us: Family Member and Youth Perspectives on the Challenges of Transitioning to Adulthood with Autism.

BACKGROUND Adolescents with autism spectrum disorder (ASD) face many challenges as they age into adulthood. Because little is known about the perspectives of caregivers and youth during this critical transition, this study explored their social, educational, and vocational needs and experiences. METHOD Two focus groups were conducted with youth with ASD (n = 13) and two focus groups were conducted with their caregivers (n = 19), where theme analysis strategies derived from Grounded Theory were utilized to identify themes. RESULTS Both groups experienced fear and anxiety about transitioning, unmet needs were also high, leaving caregivers struggling to fill gaps. Most caregivers and youth reported lacking individualized services. Caregivers faced difficulty in motivating youth and creating opportunities for education and employment. Although youth have future goals, they were unaware of steps needed to accomplish them and hesitant to talk to caregivers. CONCLUSIONS Findings indicate considerable unmet needs for caregivers and youth with ASD. Perspectives of both groups should be considered when developing programmes and educating providers.

‘Pain on Top of Pain, Hurtness on Top of Hurtness’: Social Discrimination, Psychological Well-Being, and Sexual Risk Among Women Living With HIV/AIDS

ABSTRACT This qualitative study explored how a subsample (n = 26) of participants in Protect and Respect (N = 184), a safer-sex intervention for women living with HIV/AIDS (WLH/A), discussed their experiences of social discrimination and the impact of discrimination on their lives, psychological well-being, and risk behaviors during group intervention sessions. The majority of participants was Black (83%), earned less than