In Arizona, United States, long distances to services, diverse populations, and medical provider shortages impact substance use disorder (SUD) prevention and treatment for Indigenous and historically excluded populations. To address these issues, the Culturally-Centered Addictions Research Training Program (C-CART) is designed to engage doctoral students and future and practicing clinicians in culturally-centered, community-engaged, interdisciplinary team-based research. C-CART Scholars engage in team-based projects designed in collaboration with community partners and academic mentors, focusing on culturally-responsive interventions for SUD. Evaluation of the C-CART program indicates significant growth in Scholars’ research skills, cultural competency, and collaboration experiences. The C-CART Curriculum is designed with the goal of advancing health equity and improving SUD treatment outcomes in diverse healthcare settings. This paper describes the C-CART Curriculum with the hope that it will serve as a model for future initiatives that aim to train students in culturally-centered methodologies and further the interests of other diverse communities that are under or improperly served. C-CART’s model is a step toward connecting rural, community-based programs and clinics with university researchers, thereby building trust and improving practice through strong networks and culturally-centered clinical research training.

Background Racial disparities in child welfare systems have been well-documented over the past several decades. Despite programmatic efforts, little attention has been given to the impact of public policies on racial disproportionality in child welfare. While overrepresentation of Black children has been widely studied, there is notably less research on the overrepresentation of Native American children in foster care.Objective To explore the relationship between state policies and racial disproportionality in foster care entries for Black and Native American children.Participants and Setting Data from Guttmacher Policy Institute and State Child Abuse and Neglect Policies Database were used to determine state child welfare policies. Adoption and Foster Care Analysis Reporting System was used to obtain state foster care entry data.Methods Log-binomial regression and chi-square tests were employed to analyze state policies associated with racial disproportionality in foster care entries.Results Many policies were significantly associated with higher rates of disproportionality for both Black and Native American children. Policies concerning prenatal substance use and neglect were linked to increased racial disproportionality in foster care. Conversely, policies exempting child maltreatment allegations for prescribed medication during pregnancy, requiring mandated reporter training, and educational requirements for child welfare workers were associated with lower rates of racial disproportionality in foster care.Conclusions Many public policies are associated with racial disproportionality in child welfare systems. Findings emphasize the need for research-informed policymaking and highlight the importance of further public health law research in this area.

Purpose and Approach Women in recovery describe stigma, negative treatment, and limited support as barriers to achieving their health and parenting goals. Mobile health technologies carefully tailored to support the unique needs of recovery communities can provide less burdensome alternatives to in-person services for women transitioning out of substance use treatment. An iterative design process integrated women’s interests into the structure, content, and interaction flow of a mobile health (mHealth) app. Setting and Participants Participants included women in recovery from opioid, alcohol, and polysubstance use disorders in a comprehensive housing program in urban Arizona. Methods Five focus groups with 3–7 participants each (n = 27 total) informed creation of the mHealth app. Informed by theoretical models of usability and person-centered design, development involved an iterative series of focus groups in which we asked women to comment on interest in using each feature. This provided a qualitative priority framework for feature development. We then modified the app and repeated the process to gauge consensus and continually refine our prototype. Results Women were interested in access to resources, such as housing, counseling, and parenting advice in settings known to treat women in recovery with respect. They also asked for positive messages, chatting with peers, and access to expert answers. They were less interested in points-based learning modules and “scored” activities, leading us to develop a “daily challenges” concept that builds good habits, but does not feel like “classwork”. Women’s recommendations shaped an mHealth app tailored to maximize utility, access, and safety for this at-risk population. Conclusion Integration of user-centered design with applied ethnographic techniques guided the development of a custom-tailored mHealth app responsive to lived experiences and needs of women in recovery. Future research should evaluate the potential for user-centered apps to increase self-efficacy, perceived social support, and to reduce risk of relapse.

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Chrissina C. Burke, Aliyah Joy Balsiger, James Wilce, Donald A. Grushkin, Bonnie R. Marquez, Emery R. Eaves; Introduction: Leila Monaghan’s Contributions to Anthropology. Practicing Anthropology 1 September 2022; 44 (4): 2–4. doi: https://doi.org/10.17730/0888-4552.44.4.2 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest Search

In this paper, in honor of Leila Monaghan’s contributions to decolonizing and privileging varied forms of communication, I consider the complex position of graffiti and wall art in contemporary Coimbra, Portugal. Through exploration of three questions that emerged during my three months of ethnographic research on the decriminalization of drug use in Portugal, I consider how this form of artistic expression fits into the broader imaginary of a country that has been, in its turn, one of the great colonial powers, a highly restrictive dictatorial regime, and finally, one of the most economically depressed countries in Western Europe. In Portugal, I consider graffiti, as a form of art and communication and question how it fits into a complex process of de-colonizing and exploring power among diverse youth, even within a former colonial center of power.

Introduction: A nutrient-dense, plant-rich diet may be promising as a nutrition intervention for pregnant women for a number of factors. Factors include the possibility of a decreased risk for gestational diabetes, excess weight gain, and preeclampsia. Little is known about the experience of following this type of dietary pattern while pregnant and what barriers are present that should be addressed in a large-scale intervention. Methods: Qualitative interviews were used to understand the personal experience of women who aimed to eat a nutrient-dense plant-rich diet while pregnant. Semi-structured interviews were conducted from June to August 2020. Results: Three main themes regarding a nutrient-dense plant-rich diet emerged. First, family and social influence played an important role. Second, women who had a previous pregnancy felt they had fewer pregnancy symptoms on this diet. Last, the participants may have experienced a reduced milk supply on this dietary plan. Conclusion: Future research should consider family context as a factor in adherence to a nutrient-dense plant-rich dietary pattern, investigate the possible associations between nutrient-dense plant-rich dietary patterns and reduced nausea and vomiting in early pregnancy, and determine whether nutrient-dense, plant-rich dietary patterns contribute to a reduction in milk production for women who experience over-engorgement.

During the COVID-19 Pandemic, health care provision changed rapidly and funding became available to assess pandemic-related policy change. Research activities, however, were limited to contactless, online delivery. It was clear early on that some elements of online rapid ethnography were feasible and effective, while others would not approach traditional ethnographic depth. We conducted an online Rapid Assessment, Response, and Evaluation (RARE) project from August 2020 to September 2021 to understand how COVID-19 policy impacted people who use drugs. Our interdisciplinary research team conducted online ethnographic interviews and focus groups with 45 providers and community stakeholders, and 19 clients from rural and urban areas throughout Arizona. In addition, 26 webinars, online trainings, and virtual conferences focused on opioid policy and medication for opioid use disorders (MOUD) were opportunities to observe conversations among providers and program representatives about how best to implement policy changes, how to reach people in recovery, and what aspects of the changes should carry forward into better all-around opioid services in the future. Our RARE project was successful in collecting a range of providers' perspectives on both rural and urban implementation of take-home MOUDs as well as a wide view of national conversations, but client perspectives were limited to those who were not impacted by the policies and continued to attend in-person daily clinic visits. We describe challenges to online rapid ethnography and how online research may have allowed for an in-depth, but incomplete picture of how policy changes during COVID-19 policy affected people with opioid use disorders.

Purpose The purpose of this paper is to characterize the relationship between adverse childhood experiences (ACEs) and substance use among people incarcerated in a county jail. Design/methodology/approach A questionnaire was administered to 199 individuals incarcerated in a Southwest county jail as part of a social-epidemiological exploration of converging comorbidities in incarcerated populations. Among 96 participants with complete ACEs data, the authors determined associations between individual ACEs items and a summative score with methamphetamine (meth), heroin, other opiates and cocaine use and binge drinking in the 30 days prior to incarceration using logistic regression. Findings People who self-reported use of methamphetamine, heroin, other opiates or cocaine in the 30 days prior to incarceration had higher average ACEs scores. Methamphetamine use was significantly associated with living with anyone who served time in a correctional facility and with someone trying to make them touch sexually. Opiate use was significantly associated with living with anyone who was depressed, mentally ill or suicidal; living with anyone who used illegal street drugs or misused prescription medications; and if an adult touched them sexually. Binge drinking was significantly associated with having lived with someone who was a problem drinker or alcoholic. Social implications The findings point to a need for research to understand differences between methamphetamine use and opiate use in relation to particular adverse experiences during childhood and a need for tailored intervention for people incarcerated in jail. Originality/value Significant associations between methamphetamine use and opiate use and specific ACEs suggest important entry points for improving jail and community programming.

In this paper, we describe a population of mothers who are opioid dependent at the time of giving birth and neonates exposed to opioids in utero who experience withdrawal following birth. While there have been studies of national trends in this population, there remains a gap in studies of regional trends. Using data from the Arizona Department of Health Services Hospital Discharge Database, this study aimed to characterize the population of neonates with neonatal opioid withdrawal syndrome (NOWS) and mothers who were opioid dependent at the time of giving birth, in Arizona. We analyzed approximately 1.2 million electronic medical records from the Arizona Department of Health Services Hospital Discharge Database to identify patterns and disparities across socioeconomic, ethnic, racial, and/or geographic groupings. In addition, we identified comorbid conditions that are differentially associated with NOWS in neonates or opioid dependence in mothers. Our analysis was designed to assess whether indicators such as race/ethnicity, insurance payer, marital status, and comorbidities are related to the use of opioids while pregnant. Our findings suggest that women and neonates who are non-Hispanic White and economically disadvantaged, tend be part of our populations of interest more frequently than expected. Additionally, women who are opioid dependent at the time of giving birth are unmarried more often than expected, and we suggest that marital status could be a proxy for support. Finally, we identified comorbidities associated with neonates who have NOWS and mothers who are opioid dependent not previously reported.

This study aimed to characterize the population of newborn infants with neonatal abstinence syndrome (NAS) and mothers who were opioid dependent at the time of giving birth, in Arizona. We analyzed approximately 1.2 million electronic medical records from the Arizona Department of Health Services Hospital Discharge Database to identify patterns and disparities across socioeconomic, ethnic/racial, and/or geographic groupings. In addition, we identified comorbid conditions that are differentially associated with NAS in infants or opioid dependence in mothers. Our analysis was designed to assess whether indicators such as race/ethnicity, insurance payer, marital status, and comorbidities are related to the use of opioids while pregnant. In this paper, we describe a population of mothers who are opioid dependent at the time of giving birth and infants who experience withdrawal due to opioid exposure in utero. While there have been studies of national trends in this population (see Patrick et al.), regional trends and issues are less well understood. Using data from the Arizona Department of Health Services Hospital Discharge Database, we find that women and infants who are non-Hispanic White and economically disadvantaged, tend be part of our populations of interest more frequently than expected. Additionally, we find that women who are opioid dependent at the time of giving birth are unmarried more often than expected, and we suggest that marital status could be a proxy for support. Finally, we report comorbidities, some of which have not been previously reported, associated with infants who have NAS and mothers who are opioid dependent.

Objectives. To estimate the association between race/ethnicity and drug- and alcohol-related arrest outcomes.Methods. We used multinomial logistic regression and general estimating equations to estimate the association between race/ethnicity and arrest outcomes in 36 073 drug- and alcohol-related arrests obtained from administrative records in a Southwest US county from 2009 to 2018. Results were stratified by charge type.Results. Among misdemeanor drug- and alcohol-related arrests, American Indian/Alaska Native (AI/AN; adjusted odds ratio [AOR] = 3.60; 95% confidence interval [CI] = 3.32, 3.90), Latino (AOR = 1.53; 95% CI = 1.35, 1.73), and Black persons (AOR = 1.28; 95% CI = 1.05, 1.55) were more likely than White persons to be booked into jail as opposed to cited and released. AI/AN (AOR = 10.77; 95% CI = 9.40, 12.35), Latino (AOR = 2.63; 95% CI = 2.12, 3.28), and Black persons (AOR = 1.84; 95% CI = 1.19, 2.84) also were more likely than White persons to be convicted and serve time for their misdemeanor charges. Results were similar for felony drug- and alcohol-related arrests aggregated and stratified.Conclusions. Our results suggest that race/ethnicity is associated with outcomes in drug-related arrests and that overrepresentation of racial/ethnic minorities in the criminal justice system cannot be attributed to greater use of drugs and alcohol in general.

Successful integration of health care in rural and underserved communities requires attention to power structures, trust, and disciplinary boundaries that inhibit team-based integration of behavioral and primary health care. This paper reports on perceived successes and ongoing challenges of integrating primary and behavioral health care from the perspectives of providers, community leaders, and community members. Data collection consisted of semi-structured qualitative interviews and focus groups conducted as part of a regional health equity assessment in northern Arizona. The authors explore barriers and successes in integrating health care in rural clinics using the perspective of a social ecological framework and the mediating role of culture. Differing expectations, differing professional areas, and interpersonal interactions were primary factors challenging movement toward integrated health care. Results suggest that providers and policymakers working toward health care integration should consider culture and interpersonal interaction as dynamic mediators, particularly in underserved and rural health care contexts.

As a response to the COVID-19 pandemic, the United States Drug Enforcement Administration (DEA) has temporarily relaxed restrictions to serve people who are opioid dependent during social distancing mandates. Changes include allowing patients to take home more doses of methadone and buprenorphine rather than coming to the clinic every day (for methadone) or weekly (for buprenorphine) and relaxed restrictions on telehealth delivery. Telemedicine Program representatives have described the relaxing of federal regulations as a “silver lining” to the COVID-19 pandemic. Drawing from medical anthropology approaches to epidemic surveillance and understandings of risk, we critically evaluate media representations of recent changes to telemedicine, prescribing, and opioid treatment delivery. Ethnographic research with providers and stakeholders in Arizona from 2017 to the present add insight to our analysis of media reports on these topics. Our findings demonstrate that media portrayal of access to medication-assisted treatment (MAT) as the key to preventing both COVID-19 and overdose among people who are opioid dependent misses important risks and potential inequities. Applied social science questions raised by the new guidelines include: who receives take-home doses of methadone and buprenorphine and why; and how media representations of risk and benefit rationales shape real-world policy and practice.

This special issue of Practicing Anthropology presents multidisciplinary and multisectoral views of a community engaged health disparities project titled "Health Disparities in Jail Populations: Converging Epidemics of Infectious Disease, Chronic Illness, Behavioral Health, and Substance Abuse." The overall project incorporated traditional anthropological mixed-methods approaches with theory and methods from informatics, epidemiology, genomics, evolutionary and computational biology, community engagement, and applied/translational science.

Objectives: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. Design: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. Methods: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. Results: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. Conclusions: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.

As local, participatory research becomes more common, the logistics of conducting such research continues to challenge anthropologists' and other researchers' traditional sense of disconnection from research participants. Using interviews with the researchers involved in a study conducted in a local county jail, we consider major barriers to conducting research with incarcerated individuals. Challenges stemmed from concerns about getting to know inmates at the local jail in a small community, as well as frustration with navigating a highly structured and inherently unequal situation. This article will discuss our process, the challenges that have been experienced by others, new challenges we faced, and strategies we utilized to overcome those challenges. In addition, this article will address and explain the specific experience of the authors related to managing the research process, navigating the jail, and working within the established structures of a jail setting.

BACKGROUND:Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations.OBJECTIVE:This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization.METHODS:The project has two processes-a secondary data analysis and primary data collection-which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the "honest broker" system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants.RESULTS:To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome.CONCLUSIONS:This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR1-10.2196/10337.

OBJECTIVES This analysis of a large-scale survey of college students from 2003 to 2007 explores relationships between meeting vigorous physical activity (VPA) recommendations and key demographic, lifestyle, and personal characteristics. METHODS Multivariate logistic regression modeling was used to analyze VPA data from the Utah Higher Education Health Behavior Survey, a descriptive cross-sectional survey conducted in 2003 (N = 4574), 2005 (N = 9673) and 2007 (N = 7938). RESULTS Factors consistently associated with meeting VPA recommendations included involvement in extracurricular sports, being single, and daily consumption of fruits or vegetables. In contrast, factors such as older age (> 23 years old), having a particularly low (<18.5 kg˙m2) or high BMI (> 34.9 kg˙m2), and being a current smoker were associated with not meeting the VPA recommendation. This corroborates paradoxical findings that binge alcohol consumption correlates with meeting VPA. CONCLUSIONS Findings support the need for targeted interventions among college students to support the establishment of long-term protective behavioral patterns against chronic disease risk throughout the life course.