Durieux Jared, Curtis Andrew, Mirka Melissa, Jefferis Eric, Felix Chaz, Essel Baaba
College of Public Health, Kent State University, Kent, OH 44242, USA.
Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA.
Int J Environ Res Public Health. 2022 Mar 8;19(6):3149. doi: 10.3390/ijerph19063149.
The street homeless, those who spend their nights either in shelters or unofficial camps, whether in tents on a street or in society's hidden spaces such as beneath an overpass, face multiple challenges beyond finding a safe place to sleep. Of further concern is how official actions can worsen these situations, through day-to-day activities or planned intervention strategies. In this paper we explore how a planned intervention may be negatively perceived-even as a form of "structural violence"-and may prevent Narcan (naloxone) use to stop an overdose related death in the Skid Row of Los Angeles. Data for this study consisted of a combination of Spatial Video Geonarratives (SVGs) and 325 incident reports from the Homeless Health Care Los Angeles Center for Harm Reduction (HHCLA-HRC) between November 2014 and December 2015. Chi-square and simple logistic regression models were used to examine the association between fear-of-arrest and other covariates of interest. Mapping results are presented with different sets of shapefiles created for (1) all Narcan uses, (2) all homeless, (3) all homeless with a worry about being arrested, (4) all Narcan uses where an ambulance attended, (5) and the same as 4 but also with police attendance. In the multivariable model, the estimated adjusted odds of fear-of-arrest is over three times higher among Narcan users ages 30-39 when compared to users under the age of 30. Analyzing the association of calling 9-1-1 on Narcan user demographics, socio-contextual characteristics, and overdose victim demographics, the crude estimated probability of calling 9-1-1 for Narcan users aged 50 and older is nearly three times higher when compared to Narcan users aged 19-29. Conclusion: Results suggest that the fear-of-arrest and calling 9-1-1 during an overdose is still a concern among Narcan users despite protective legislation and access to harm reduction resources.
街头无家可归者，那些夜晚要么在收容所要么在非官方营地过夜的人，不管是在街边帐篷里还是在诸如天桥下等社会隐蔽空间里，他们面临着诸多挑战，远不止是找个安全的地方睡觉。更令人担忧的是官方行动如何通过日常活动或计划好的干预策略使这些情况恶化。在本文中，我们探讨了一项计划好的干预措施如何可能被负面看待——甚至被视为一种“结构性暴力”形式——以及它如何可能阻止在洛杉矶贫民窟使用纳洛酮来防止因过量用药导致的死亡。本研究的数据由空间视频地理叙事（SVG）以及2014年11月至2015年12月期间洛杉矶无家可归者医疗保健减少伤害中心（HHCLA - HRC）的325份事件报告组成。使用卡方检验和简单逻辑回归模型来检验对被捕的恐惧与其他感兴趣的协变量之间的关联。绘制结果时使用了为以下各项创建的不同形状文件集：（1）所有纳洛酮使用情况，（2）所有无家可归者，（3）所有担心被捕的无家可归者，（4）所有有救护车到场的纳洛酮使用情况，（5）与（4）相同但也有警察到场的情况。在多变量模型中，与30岁以下的纳洛酮使用者相比，30 - 39岁的纳洛酮使用者对被捕的恐惧的估计调整比值高出三倍多。分析拨打911与纳洛酮使用者人口统计学、社会背景特征以及过量用药受害者人口统计学之间的关联，50岁及以上的纳洛酮使用者拨打911的粗略估计概率与19 - 29岁的纳洛酮使用者相比高出近三倍。结论：结果表明，尽管有保护性立法且能获取减少伤害资源，但对被捕的恐惧以及在过量用药时拨打911仍是纳洛酮使用者所担忧的问题。
