Health Behavior Survey Among People Who Use Opioids: Protocol for Implementing Technology-Based Rapid Response Surveillance in Community Settings

Abstract

Background In 2018, 2 million Americans met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnostic criteria for an opioid use disorder, and 9.9 million Americans had misused prescription pain relievers the previous year. Despite a rapid increase in opioid misuse, opioid use disorders, and overdoses, data are limited on the behavioral and contextual risks as well as the protective factors fueling the opioid epidemic in some hard hit US cities—Atlanta, Los Angeles, and Las Vegas. Opioid use also contributes to the risk of other health problems such as HIV and hepatitis C virus infections or mental health disorders and is linked to behavioral and environmental risks (eg, homelessness, experiences of violence, involvement in the justice system). Knowledge of the relationships between these linked vulnerabilities and how they influence service utilization is critical to effective policy and interventions. Objective This survey explores the relationships between demographic and economic characteristics, behavioral and environmental risk factors, and service utilization of people who use opioids to inform public health practice, policy, and future efforts to mitigate the risks faced by this population experiencing multiple health, social, and economic vulnerabilities. The results of this survey will be used to identify needs and intervention points for people who use drugs currently served by public health organizations. Methods We implemented a community-engaged strategy that involved development and execution of a two-stage purposive sampling plan involving selection of partner organizations (syringe exchange programs in urban settings) and recruitment and enrollment of participants aged 18-69 years served by these organizations in Atlanta, Los Angeles, and Las Vegas from 2019 to 2020. The recruited participants completed a survey, including a variety of measures to assess health (physical and mental) and health behaviors such as sexual behavior, vaccine receipt, and HIV/ hepatitis C virus infection testing. Additional items assessed drug use and misuse, syringe exchange and health service utilization, sex exchange, histories of interpersonal violence, and vaccine confidence. Results This protocol was successfully implemented despite challenges such as real-time technology issues and rapidly finding and surveying a difficult-to-reach population. We sampled 1127 unique participants (248 in Atlanta, 465 in Los Angeles, and 414 in Las Vegas). Conclusions The establishment and utilization of strong community partnerships enabled the rapid collection of data from a typically difficult-to-reach population. Local efforts such as these are needed to develop policies and practices that promote harm reduction among people who use opioids. International Registered Report Identifier (IRRID) RR1-10.2196/25575

Vaccine confidence among people who use drugs: A cross-sectional survey

“…Vaccine confidence among PWUD was surveyed as part of a larger cross-sectional study of health behaviors of PWUD in the United States. 46 , 64 Atlanta, Georgia, Los Angeles, California, and Las Vegas, Nevada were chosen as project locations based on characteristics of the populations of PWUD living in those cities, including vulnerability to HIV, viral hepatitis, and other vaccine-preventable diseases. Project protocols were approved by the University of Nevada Las Vegas Institutional Review Board (IRB), as well as independent determinations for secondary analyses by the IRBs of Emory University, the University of Nevada Las Vegas (#1428464-5), and the University of California Los Angeles (#19-001173).…”

“…As described in the survey protocol, the sample size was chosen for adequate margin of error in estimation and subpopulation analyses and to fit logistical constraints. 64 Harrell’s conservative rules for limiting sample size suggest that this sample could support over 50 predictors in a linear regression, or 17 in a logistic regression with an outcome rate of 30%. 65…”

Violence Victimization, Homelessness, and Severe Mental Illness Among People Who Use Opioids in Three U.S. Cities

“…A full description of the parent study’s methods and sampling has been presented elsewhere ( Frew et al, 2021 ). Briefly, recruitment and data collection were conducted from May 2019 to February 2020 across three study sites: Los Angeles, CA; Las Vegas, NV; and Atlanta, GA.…”

Acceptability of injectable pre-exposure prophylaxis among people who inject drugs in three urban U.S. settings

“…Our survey was developed with valid and reliable measures and was offered to participants in English and Spanish. A full explanation of the survey and protocol for data collection have been previously published [ 29 ].…”