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Barriers to using new needles encountered by rural Appalachian people who inject drugs : Implications for needle exchange
(2019-04-02) Davis, Stephen M.; Kristjansson, Alfgeir L.; Davidov, Danielle; Zullig, Keith; Baus, Adam; Fisher, Melanie; Department of Psychology
Background: Using a new needle for every injection can reduce the spread of infectious disease among people who inject drugs (PWID). No previous study has examined new needle use barriers among PWIDs residing in the rural Appalachian part of the United States, an area currently in the midst of a heroin epidemic. Objective: Therefore, our primary aim was to explore self-reported barriers to using a new needle by PWID attending a needle exchange program (NEP). Methods: We conducted a cross-sectional survey of PWID attending two NEPs in rural West Virginia located in the heart of Central Appalachia. A convenience sample of PWID (n = 100) completed the Barriers to Using New Needles Questionnaire. Results: The median number of barriers reported was 5 (range 0-19). Fear of arrest by police (72% of PWID "agreed" or "strongly agreed") and difficulty with purchasing needles from a pharmacy (64% "agreed" or "strongly agreed") were the most frequently cited barriers. Conclusions/Importance: Congruent with previous findings from urban locations, in rural West Virginia, the ability of PWID to use a new needle obtained from a needle exchange for every injection may be compromised by fear of arrest. In addition, pharmacy sales of new needles to PWID may be blunted by an absence of explicit laws mandating nonprescription sales. Future studies should explore interventions that align the public health goals of NEPs with the occupational safety of law enforcement and health outreach goals of pharmacists.
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Qualitative case study of needle exchange programs in the Central Appalachian region of the United States
(2018-10) Davis, Stephen M.; Davidov, Danielle; Kristjansson, Alfgeir L.; Zullig, Keith; Baus, Adam; Fisher, Melanie; Department of Psychology
Background The Central Appalachian region of the United States is in the midst of a hepatitis C virus epidemic driven by injection of opioids, particularly heroin, with contaminated syringes. In response to this epidemic, several needle exchange programs (NEP) have opened to provide clean needles and other supplies and services to people who inject drugs (PWID). However, no studies have investigated the barriers and facilitators to implementing, operating, and expanding NEPs in less populous areas of the United States. Methods This qualitative case study consisted of interviews with program directors, police chiefs, law enforcement members, and PWID affiliated with two NEPs in the rural state of West Virginia. Interview transcripts were coded inductively and analyzed using qualitative data analysis software. Final common themes related to barriers and facilitators of past program openings, current program operations, and future program plans, were derived through a consensus of two data coders. Results Both NEPs struggled to find existing model programs, but benefited from broad community support that facilitated implementation. The largest operational barrier was the legal conundrum created by paraphernalia laws that criminalize syringe possession. However, both PWID and law enforcement appreciated the comprehensive services provided by these programs. Program location and transportation difficulties were additional noted barriers. Future program operations are threatened by funding shortages and bans, but necessitated by unexpected program demand. Conclusion Despite broad community support, program operations are threatened by growing participant volumes, funding shortages, and the federal government's prohibition on the use of funds to purchase needles. Paraphernalia laws create a legal conundrum in the form of criminal sanctions for the possession of needles, which may inadvertently promote needle sharing and disease transmission. Future studies should examine additional barriers to using clean needles provided by rural NEPs that may blunt the effectiveness of NEPs in preventing disease transmission.
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Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs : A systematic review with meta-analysis
(2017-05-17) Davis, Stephen M.; Daily, Shay; Kristjansson, Alfgeir L.; Kelley, George A.; Zullig, Keith; Baus, Adam; Davidov, Danielle; Fisher, Melanie; Department of Psychology
Background: Previous research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs. Methods: Study inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case-control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I 2 with alpha values for Q ≤ 0.10 considered statistically significant. Results: Of the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05-5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39-3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I 2 ≥ 66%) were observed for both models. Conclusions: The impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue.
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Energy drink consumption and substance use risk in middle school students
(2016-06-01) Mann, Michael J.; Smith, Megan L.s.; Kristjansson, Alfgeir L.; Department of Psychology
Objectives: Energy drink (ED) sales have increased greatly in recent years and ED is now a common topic in health behavior research. Most studies work with samples of college students and/or young adults and to a lesser degree with high school students. Research is lacking on ED consumption in younger users. The purpose of this study was to fill this gap and assess the prevalence of ED consumption in a sample of middle school students as well to analyze the relationships between ED use and illicit and licit drug use in girls and boys of this age. Method: We use cross-sectional school-survey data from 6-8th grade students in three US mid-Atlantic schools conducted in September to November 2014 (N = 1152, response rate: 82.4%). Results: Approximately 20% of participants had consumed ED and 10% had smoked cigarettes. Almost 14% had used alcohol at least once in their lifetime and 5.5% marijuana. Boys were more likely than girls to have used ED but no gender difference was observed in the prevalence of illicit substances. However, ED use was positively related to smoking and alcohol use among both genders, but also to several forms of illicit drug use among girls. Conclusion: ED consuming girls are particularly prone to also use illicit substances. This is the first survey-type study which reports a positive relationship between ED consumption with both licit and illicit drug use in middle school-aged girls and boys.
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Needs assessment of school and community physical activity opportunities in rural West Virginia : The McDowell CHOICES planning effort Health behavior, health promotion and society
(2015-04-03) Kristjansson, Alfgeir L.; Elliott, Eloise; Bulger, Sean; Jones, Emily; Taliaferro, Andrea R.; Neal, William; Department of Psychology
Background: McDowell CHOICES (Coordinated Health Opportunities Involving Communities, Environments, and Schools) Project is a county wide endeavor aimed at increasing opportunities for physical activity (PA) in McDowell County, West Virginia (WV). A comprehensive needs-assessment laid the foundation of the project. Methods: During the 6 month needs assessment, multiple sources of data were collected in two Town Hall Meetings (n∈=∈80); a student online PA interest survey (n∈=∈465); a PA and nutrition survey among 5th (10-11 years) and 8th graders (13-14 years) with questions adapted from the CDC's Youth Risk Behavior Surveillance Survey (n∈=∈442, response rate =∈82.2%); six semi-structured school and community focus groups (n∈=∈44); school site visits (n∈=∈11); and BMI screening (n∈=∈550, response rate∈=∈69.7%). Results: One third of children in McDowell County meet the national PA minimum of 60 minutes daily. At least 40% of 5th and 8th graders engage in electronic screen activity for 3 hours or more every day. The prevalence of obesity in 5th graders is higher in McDowell County than the rest of WV (∼55% vs. 47% respectively). SWOT analyses of focus group data suggest an overall interest in PA but also highlight a need for increase in structured PA opportunities. Focus group data also suggested that a central communication (e.g. internet-based) platform would be beneficial to advertise and boost participation both in current and future programs. Schools were commonly mentioned as potential facilities for public PA participation throughout the county, both with regards to access and convenience. School site visits suggest that schools need more equipment and resources for before, during, and after school programs. Conclusions: An overwhelming majority of participants in the McDowell CHOICES needs assessment were interested to participate in more PA programs throughout the county as well as to improve opportunities for the provision of such programs. Public schools were widely recognized as the hub of the communities and provide the best venue for PA promotion for both students and adult citizens, and can potentially serve as a platform for change in rural communities such as McDowell County.

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