INTRODUCTION:Given structural barriers, access to services is key for preventing drug-related harms and managing chronic disease among people who inject drugs (PWID). The Patient Activation Measure (PAM), a validated scale to assess self-efficacy in navigating one's own health care, was operationalised to improve service utilisation and outcomes but has not been assessed among PWID. We characterised PAM and its association with healthcare and harm reduction utilisation among PWID in the AIDS Linked to IntraVenous Experience cohort in Baltimore. METHODS:From 2019 to 2020, participants completed surveys on PAM, service utilisation and drug use. We used log-binomial regression to identify correlates of "Lower" PAM and modelled the association between lower PAM and service utilisation, stratified by recent IDU. RESULTS:Participants (n = 351) were primarily male (67%), Black (85%) and 24% reported recent IDU. Lower PAM was significantly more common in those reporting IDU (aPR 1.45; 95% CI 1.03, 2.04), heavy alcohol (aPR 1.77; 95% CI 1.24, 2.51) and marijuana (aPR: 1.70; 95% CI 1.23, 2.36) but less common among women (aPR 0.57; 95% CI 0.38, 0.84) and those living with HIV (APR 0.52; 95% CI 0.35, 0.78). In modelling service utilisation, lower PAM was associated with a lower prevalence of methadone utilisation (aPR 0.27; 95% CI 0.09, 0.84) among those reporting IDU, but a higher prevalence of methadone utilisation (aPR 2.72; 95% CI 1.46, 5.08) among those not reporting IDU, after controlling for correlates of PAM. DISCUSSION AND CONCLUSION:PAM-tailored interventions targeting methadone utilisation warrant consideration but should account for socio-structural barriers to utilisation and correlates of PAM among PWID.

Objectives. To describe all-outcome injurious shootings by police and compare characteristics of fatal versus nonfatal injurious shootings nationally. Methods. From July 2021 to April 2023, we manually reviewed publicly available records on all 2015-2020 injurious shootings by US police, identified from Gun Violence Archive. We estimated injury frequency, case fatality rates, and relative odds of death by incident and victim characteristics. Results. A total of 1769 people were injured annually in shootings by police, 55% fatally. When a shooting injury occurred, odds of fatality were 46% higher following dispatched responses than police-initiated responses. Injuries associated with physically threatening or threat-making behaviors, behavioral health needs, and well-being checks were most frequently fatal. Relative to White victims, Black victims were overrepresented but had 35% lower odds of fatal injury when shot. Conclusions. This first multiyear, nationwide analysis of injurious shootings by US police suggests that injury disparities are underestimated by fatal shootings alone. Nonpolicing responses to social needs may prevent future injuries. Public Health Implications. We call for enhanced reporting systems, comprehensive evaluation of emerging reforms, and targeted investment in social services for equitable injury prevention. (Am J Public Health. 2024;114(4):387-397. https://doi.org/10.2105/AJPH.2023.307560).

Hepatitis C virus (HCV) causes substantial morbidity and mortality, particularly among people who inject drugs (PWID). While elimination of HCV as a public health problem may be possible through treatment-as-prevention, reinfection can attenuate the impact of treatment scale-up. There is a need to better understand the distribution and temporal trends in HCV infection risk, including among HCV-seropositive individuals who will be eligible for treatment and at risk for subsequent reinfection. In this analysis of 840 seronegative and seropositive PWID in Baltimore, MD USA, we used random forest methods to develop a composite risk score of HCV infection from sociodemographic and behavioural risk factors. We characterised the individual heterogeneity and temporal trajectories in this composite risk score using latent class methods and compared that index with a simpler, conventional measure, injection drug use frequency. We found that 15% of the population remained at high risk of HCV infection and reinfection by the composite metric for at least 10 years from study enrolment, while others experienced transient periods of moderate and low risk. Membership in this high-risk group was strongly associated with higher rates of HCV seroconversion and post-treatment viraemia, as a proxy of reinfection risk. Injection frequency alone was a poor measure of risk, evidenced by the weak associations between injection frequency classes and HCV-associated outcomes. Together, our results indicate HCV infection risk is not equally distributed among PWID nor well captured by injection frequency alone. HCV elimination programmes should consider targeted, multifaceted interventions among high-risk individuals to reduce reinfection.

The COVID-19 pandemic has caused a decline in the physical, social, emotional, and mental well-being for many adolescents and young adults (AYA) in the United States. Early research suggests that AYA with existing mental health conditions may be susceptible to adverse mental health effects from pandemic-related disruptions. However, the impact of COVID-19 risk mitigation interventions (e.g., school closures and social gathering restrictions) on mental health outcomes among AYA remains poorly understood. The purpose of this analysis was to qualitatively examine the perspectives of AYA on the impact of COVID-19 disruptions in order to develop strategies for promoting and improving mental health outcomes. From April – August 2021, we enrolled 19 AYA who were engaged in care at the Johns Hopkins All Children's Hospital Adolescent Health Specialty Clinic prior to COVID-19. Eligibility criteria included being between the ages of 12-21 and having documented worsening mental health based on medical chart review. In-depth phone interviews were conducted by clinical staff and interview transcripts were auto-generated by Microsoft Teams software. Three research team members listened to the recorded audio files and edited the transcripts for accuracy. An initial coding guide was developed by senior investigators which was piloted and refined. After finalizing the coding guide, research assistant double-coded each transcript using Atlas.ti software. Upon completing the coding, the transcripts were compared to ensure agreement. Discrepancies were resolved through discussion among all the coders until reaching consensus. We then linked and classified the codes across transcripts to identify emergent themes. All study procedures were approved by the Johns Hopkins School of Medicine Institutional Review Board. The study sample was mostly non-Hispanic White (n=13, 68%), female (n=16, 84%), with a median age of 16 (interquartile range: 15-17). Five key themes were identified. AYA consistently described negative mental health changes during the pandemic, including declining or new onset of depression, anxiety, and eating disorders. Adverse mental health outcomes among AYA were provoked by experiences of loneliness and social isolation, especially due to school closures which disrupted routines, access to educational and social support, and key cultural milestones. AYA reported negative effects to their physical health (e.g., sleep, hygiene, physical activity, and diet) caused by a loss of motivation linked to mental health decline. The increased use of illicit substances was a notable strategy for coping with worsening mental health symptoms among AYA. Given the rapid changes in COVID-19 risk mitigation policy, AYA identified consistent support from parents, teachers, and clinicians as an approach to offset the potentially harmful mental consequences of the pandemic. COVID-19 risk mitigation interventions have precipitated adverse mental health outcomes among AYA. Findings from this study deepen our understanding of the key factors influencing the psychosocial well-being of AYA during the pandemic. Our results may help inform researchers, clinicians, and policymakers to develop guidelines and community-based strategies for mitigating the potentially negative effects of pandemic-related disruptions to mental health among AYA.