Open Access. Powered by Scholars. Published by Universities.®

Digital Commons Network™

Open Access. Powered by Scholars. Published by Universities.®

Medicine and Health Sciences

Institution
Keyword
Publication Year
Publication
Publication Type
File Type

Articles 361 - 390 of 3242

Full-Text Articles in Entire DC Network

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard Jul 2024

Self-Harm In Female Youth With Undiagnosed Adhd: Implementing American Academy Of Pediatrics Screening Guidelines, Roselie M. Woodard

Dissertations

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. If undiagnosed or untreated, ADHD can lead to severe psychosocial issues such as academic failure, substance abuse, unplanned pregnancy, and incarceration. The financial burden in the U.S. from diagnostic errors creates an immense, rising fiscal impact. Early diagnosis and management are crucial to prevent these complications.

Females with ADHD, particularly those with the inattentive subtype, often face diagnostic challenges due to symptom masking and over-compensation. This results in poorer cognitive functioning and self-esteem compared to males with ADHD. ADHD is linked to autonomic nervous …


Intersectional Analysis Of Vaccination Inequity Among Individuals With Disabilities In The United States During Covid-19 Pandemic, Philip Ndoki Ndoki Jul 2024

Intersectional Analysis Of Vaccination Inequity Among Individuals With Disabilities In The United States During Covid-19 Pandemic, Philip Ndoki Ndoki

Walden Dissertations and Doctoral Studies

This study was an investigation of how disability status, types, sociodemographic indicators, and reasons for not receiving vaccinations influenced COVID-19 vaccination rates among individuals with disabilities in the United States. Despite efforts, vaccination disparities persisted, necessitating an understanding of barriers to uptake. Using intersectionality theory and the social determinants of health framework, this study examined the impact of marginalized identities and structural inequalities. Key questions included the association between disability status and vaccination uptake, differences among disability types moderated by sociodemographic factors, and the interaction between disability status and reasons for not vaccinating. Household Pulse Survey data from the US …


Examining The Tax Landscape Of Recreational Cannabis: Trends And Considerations From The Past 10 Years Of Policy, Thomas A. Norton, Amanda K. Thompson-Abbott, Raymond Keener Iii, Alberto Coustasse Jul 2024

Examining The Tax Landscape Of Recreational Cannabis: Trends And Considerations From The Past 10 Years Of Policy, Thomas A. Norton, Amanda K. Thompson-Abbott, Raymond Keener Iii, Alberto Coustasse

Accounting Faculty Research

This article aims to provide an overview of the taxation of recreational cannabis in states where it has been legalized for recreational purposes. By delving into the various approaches taken by different jurisdictions, analyzing the economic impacts, and examining the challenges and opportunities inherent in cannabis taxation, we seek to shed light on a topic that is rapidly shaping the future of the cannabis industry and the broader economy. From excise taxes to sales taxes and licensing fees to revenue allocation, the taxation framework surrounding recreational cannabis is a dynamic and evolving landscape. Potential federal excise taxes could further complicate …


Exploring The Role Of Occupational Therapy In The Criminal Justice System At The County Level, Marisa Given Jul 2024

Exploring The Role Of Occupational Therapy In The Criminal Justice System At The County Level, Marisa Given

Occupational Therapy Student Capstones

No abstract provided.


Exploring The Impact Of Neonatal Transport On The Health Of Black Preterm Infants And Psychosocial Challenges Faced By Parents In Relation To Social Determinants Of Socioeconomic And Racial Inequities, Karen Faye Warren Jul 2024

Exploring The Impact Of Neonatal Transport On The Health Of Black Preterm Infants And Psychosocial Challenges Faced By Parents In Relation To Social Determinants Of Socioeconomic And Racial Inequities, Karen Faye Warren

Theses and Dissertations

Neonatal transport is a unique aspect of preterm birth. This descriptive, exploratory dissertation study used a multiple-case study design, and mixed methods approach to describe the trajectory of Black preterm outborn infants and their mothers from birth, through transport to a referral center through NICU hospitalization until discharge, for a detailed analysis of each case. The specific aims were 1) Describe each infant's transport trajectory, including baseline characteristics of the community hospital of birth (size, level of care, birthing resources), transport characteristics (mode, distance, personnel), and infant health from birth to arrival of regional referral neonatal intensive care unit; 2) …


Effect Of Incarceration On Prisoners Diagnosed With Mental Health Conditions: Trauma, Treatment, And Transitioning, Ingria S. Haywood Jun 2024

Effect Of Incarceration On Prisoners Diagnosed With Mental Health Conditions: Trauma, Treatment, And Transitioning, Ingria S. Haywood

Doctoral Dissertations and Projects

A mental illness is a medical disorder that affects a person’s behavior, thoughts, and emotions. It also has an impact on social and cognitive functions. Misuse of substances, biological factors, or abuse, whether as a victim or a bystander to repeated abuse, are all variables that contribute to mental illness. The prevalence of mental illness among incarcerated prisoners is alarming, and it is nondiscriminatory in that it affects both men and women. Several variables contribute to inmates’ susceptibility to mental health problems. Anxiety disorders, depression as a mood disorder, dementia, and schizophrenia are examples of these. A diagnosis of mental …


The Health Risks Of Deportation: Impacts Of Family Separation On Relationships And Wellbeing In Latinx Communities, Shantay Rhea Rocha Jun 2024

The Health Risks Of Deportation: Impacts Of Family Separation On Relationships And Wellbeing In Latinx Communities, Shantay Rhea Rocha

University Honors Theses

Anti-immigration policy and deportation practices create multifaceted implications for Latinx communities in the United States. A comprehensive literature review drawing from public health and immigration studies was used to examine the direct and indirect implications of separation of families due to deportation. This thesis synthesizes existing research to illuminate the health threats pertaining to Latinx wellbeing in the context of being undocumented and fearing being separated from their family. Addressing the dimensions of deportation-related health risks, policy makers, health care professionals, and community organizations can work towards promoting Latinx health and well-being in the U.S. to mitigate the health consequences …


The Effects Of Covid-19 On Asian American Perception Of Mental Health, Emily Tseung Jun 2024

The Effects Of Covid-19 On Asian American Perception Of Mental Health, Emily Tseung

Electronic Theses and Dissertations

This study describes a qualitative study using a grounded theory, constructivist approach, which sampled (N = 6) Asian American college students who lived in the United States during the peak of the COVID-19 pandemic. Research shows that COVID significantly impacted the Asian American perception of mental health, including mental health help- seeking behaviors and discrimination experienced. The long-term effects of this are still largely unknown. In depth, semi-structured interviews were used to explore the lived experiences of these Asian Americans. Qualitative analysis revealed thematic differences for the following themes: (a) experience with mental illness, (b) mental health help- seeking …


Reimagining Health: Calling For Reform Of The Canadian Healthcare System Through Afrofuturism And Speculative Design, Diane Oyedeji Ms, Stephanie J. Kiggundu Ms Jun 2024

Reimagining Health: Calling For Reform Of The Canadian Healthcare System Through Afrofuturism And Speculative Design, Diane Oyedeji Ms, Stephanie J. Kiggundu Ms

Bridges: An Undergraduate Journal of Contemporary Connections

This exploratory essay addresses the health inequalities currently affecting the African/Black diaspora in Canada and proposes a healthcare system reform to address the inequalities. Despite the Canadian healthcare system’s goals of being universal and accessible, there are disparities in African/Black patient representation. This essay proposes a healthcare system reform through incorporating African/Black patient input through the implementation of collaborative design through the lens of Afrofuturism and its values such as inclusivity and empowerment. The goal is to implement a Canadian healthcare system that is equitable, and patient-centered through emphasizing African/Black voices in technological design, clinical practices, and promoting a more …


Abstract Book (Pdf), Department Of Psychiatry Jun 2024

Abstract Book (Pdf), Department Of Psychiatry

Dept. of Psychiatry Research Symposium

Abstract book for the 2nd Annual Department of Psychiatry Research Symposium held June 2024.
Abstracts are in alphabetical by last name of the lead author.

Accessibility statement: The attached document has been formatted to meet PDF/UA v1 accessibility compliance standards. Please contact [email protected] if further assistance is needed.


Discharge To Success: A Life Skills Manual Developed By Ots For Transitioning Individuals With Smi From Forensic Hospitals, Kelsie Cooper Jun 2024

Discharge To Success: A Life Skills Manual Developed By Ots For Transitioning Individuals With Smi From Forensic Hospitals, Kelsie Cooper

OT Student Capstones

This research project examined the development of and staff training using a discharge manual aimed at improving transition outcomes for individuals with serious mental illness (SMI) within a forensic psychiatric setting. The manual, tailored to the needs of patients at Arizona State Hospital (ASH), addresses barriers to community reintegration through the provision of occupation-based interventions and resources. Occupational therapists (OTs) played a central role in the project, emphasizing the importance of meaningful activities in promoting independence and well-being among individuals with SMI in an effort to reduce recidivism. Interdisciplinary collaboration among healthcare professionals underscored the holistic approach to mental health …


Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus Jun 2024

Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus

Dissertations and Theses

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at …


Determining Factors For Improved Uptake Of Harm Reduction Services In The United States: A Study Of Inclusive, Culturally Sensitive Messaging, Lauretta Ekanem Omale Jun 2024

Determining Factors For Improved Uptake Of Harm Reduction Services In The United States: A Study Of Inclusive, Culturally Sensitive Messaging, Lauretta Ekanem Omale

Dissertations

Harm reduction refers to public health policies and programs aimed at decreasing the adverse consequences associated with drug use. While harm reduction services (e.g., syringe exchange programs) can mitigate health risks, marginalized groups face barriers to service access and utilization, partially due to ineffective messaging approaches that fail to align with cultural values and experiences. A one-size-fits-all approach to messaging can negatively impact service utilization, health outcomes, and health disparities. Ineffective communication can lead to poor adherence to treatment, poorer health outcomes, and increased adverse events.

Culturally insensitive communication contributes to stigma, mistrust, and lack of perceived relevance, discouraging service …


Incarceration Vs Treatment: Is One More Effective Than The Other In Preventing Recidivism For Drug Abuse?, Scott G. Kang Jun 2024

Incarceration Vs Treatment: Is One More Effective Than The Other In Preventing Recidivism For Drug Abuse?, Scott G. Kang

Student Theses

This study aims to determine the most effective approach for reducing recidivism among drug offenders, comparing incarceration with treatment. Two hypotheses were formulated for this research: 1) Drug offenders undergoing residential treatment will experience lower recidivism rates compared to those sentenced to incarceration. 2) Extended therapeutic treatment is more likely to positively influence behavior change among drug abusers compared to longer prison sentences. These hypotheses were tested using data from 263 participants in the Drug Treatment Alternative-to-Prison (DTAP) program, analyzed through logistic regression in SPSS. The results indicate that therapeutic interventions, specifically rehabilitative treatment, are more effective than incarceration in …


Classic Grounded Theory: Identifying The Main Concern, Justine Connor, Tracy Flenady, Deb Massey, Trudy Dwyer Jun 2024

Classic Grounded Theory: Identifying The Main Concern, Justine Connor, Tracy Flenady, Deb Massey, Trudy Dwyer

Research outputs 2022 to 2026

Grounded theory comprises a family of research approaches designed to support the generation of a theory explaining a phenomenon experienced by a group of participants. One style of grounded theory, Classic grounded theory, is used less often than other types of grounded theory. The less frequent use of Classic grounded theory may be attributed to the limited availability of clearly articulated processes for conducting this method. Particularly important within Classic grounded theory, and not used in other forms of grounded theory, is identifying the participants' main concern. Identifying the participants' main concern is a signature feature of Classic grounded theory …


Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp Jun 2024

Challenges And Implications For Substance Use And Mental Healthcare Among Under-Resourced Women In The Covid-19 Era, Maria C Mejia, Alicia Kowalchuk, Sandra J Gonzalez, Muktha Nair, Lisa Webb, Nadine Scamp

Faculty, Staff and Students Publications

BACKGROUND: The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes toward it, and its impact on substance use and treatment access.

METHODS: A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive …


Health Equity Engineering: Optimizing Hope For A New Generation Of Healthcare, Felicity T Enders, Joyce E Balls-Berry, Et Al. May 2024

Health Equity Engineering: Optimizing Hope For A New Generation Of Healthcare, Felicity T Enders, Joyce E Balls-Berry, Et Al.

2020-Current year OA Pubs

Medical researchers are increasingly prioritizing the inclusion of underserved communities in clinical studies. However, mere inclusion is not enough. People from underserved communities frequently experience chronic stress that may lead to accelerated biological aging and early morbidity and mortality. It is our hope and intent that the medical community come together to engineer improved health outcomes for vulnerable populations. Here, we introduce Health Equity Engineering (HEE), a comprehensive scientific framework to guide research on the development of tools to identify individuals at risk of poor health outcomes due to chronic stress, the integration of these tools within existing healthcare system …


Some Kind Of Unfolding: A Micro- To Macrosystemic Exploration Of The Emic Experiences Of Formerly Incarcerated Mothers, Mary Anne Gunter Phd Lpc Lmft May 2024

Some Kind Of Unfolding: A Micro- To Macrosystemic Exploration Of The Emic Experiences Of Formerly Incarcerated Mothers, Mary Anne Gunter Phd Lpc Lmft

Journal of Interprofessional Practice and Collaboration

Problem

The incarceration of women has increased exponentially in the past 40 years. Over 80% of incarcerated women are mothers separated from their children. A mother’s incarceration can impose a destabilizing influence upon an already fragile family system.

Significance

Incarcerated mothers have been inconsistently provided supportive rehabilitative programs, which have demonstrated a correlation to decreased recidivism.

This qualitative study conducted semi-structured interviews that explored the phenomenological experiences of eight disenfranchised incarcerated mothers who were separated from their children, as well as of their experiences of a carceral setting and involvement with prison programs.

Implications

Thematic analysis of the data revealed …


05.20.2024 Orsp Connect, Liz Williamson May 2024

05.20.2024 Orsp Connect, Liz Williamson

ORED Newsletter

NIH RPPR Update (Research Performance Progress Report)


Animals In Prison: Is There Value In Inmate-Animal Rehabilitation Programs?, I. H. C. May 2024

Animals In Prison: Is There Value In Inmate-Animal Rehabilitation Programs?, I. H. C.

Tredway Library Prize for First-Year Research

This paper demonstrates the benefits of animal rehabilitation programs in alleviating the mental harm of incarceration and improving outcomes for individuals upon their release. I.H.C. details the overwhelming mental health crises and conditions that inmates face in prison, arguing to redefine rehabilitation to center both practical preparations and on healing the underlying traumas and mental health concerns before release. His numerous examples drawn from prisons around the world thoroughly uphold the evidence that animal rehabilitation programs improve inmate wellbeing, decrease violent incidents in prison, enhance vocational and employment opportunities post-incarceration, and overall change inmates’ behavior – all benefits that ultimately …


Deconstructing Drugs: Addressing The Stigma, Harm Reduction, And Policy Solutions, Charlotte Theriault May 2024

Deconstructing Drugs: Addressing The Stigma, Harm Reduction, And Policy Solutions, Charlotte Theriault

Themis: Research Journal of Justice Studies and Forensic Science

Black and homeless people who struggle with substance use disorder (SUD), especially opioid use disorder (OUD), have experienced unique obstacles due to inequalities relating to their social determinants of health (SDOH). Historical context and peer-reviewed research were used to evaluate racial bias and expand upon the factors that contributed to the opioid crisis, the effects of COVID-19 on drug overdoses, and the presence of fentanyl in illicit drug supplies. Various studies combat the stigma surrounding substance use disorder (SUD) by acknowledging the disease as a chronic health condition. Research showed that the most effective way to combat these inequalities and …


Artistic Expression Of Medical Experiences Of Mothers Of Color: Perspectives Using Art Therapy, Lauren Barrett May 2024

Artistic Expression Of Medical Experiences Of Mothers Of Color: Perspectives Using Art Therapy, Lauren Barrett

Expressive Therapies Dissertations

The purpose of this study was to qualitatively examine perspectives of mothers of color living in the US and their experiences in the healthcare system through art therapy. The study aimed to further identify personal narrative experiences of mothers of color navigating the healthcare system, promote individual voices, and acknowledge disparities impacting those within marginalized communities. The participants in this study included a total of eight identified mothers of color (non-White) living in the US. Participants took part in four weeks of consecutive art therapy sessions either in 60-minute group or individual virtual meetings. One art therapy directive was provided …


A Trauma-Informed Socially Just Approach To Working With Juvenile Justice-Involved Youth Utilizing Expressive Arts Therapy, Ciara Carr May 2024

A Trauma-Informed Socially Just Approach To Working With Juvenile Justice-Involved Youth Utilizing Expressive Arts Therapy, Ciara Carr

Expressive Therapies Capstone Theses

Youth involved with the juvenile justice system often have a history of trauma and oppression resulting from their positionality and circumstances. Most juvenile justice-involved youth are boys, youth of color, low-income, LGBTQIA2S+, disabled, and traumatized. This literature review explores the history of the juvenile justice system, issues with the present-day model, and trauma-informed and transformative justice approaches to practice. The implementation of socially just, trauma-informed expressive arts therapy programs is proposed as a more equitable practice to replace commonly used punitive practices across the United States. More research is needed to understand the impact of such programs on this population …


What Can Pharmacists Do To Reduce Drug Abuse?, Saul E. Alvarado-Rosario May 2024

What Can Pharmacists Do To Reduce Drug Abuse?, Saul E. Alvarado-Rosario

College of Pharmacy Student Research

This review paper provides an overview of the current status of substance abuse, involving both illicit drugs and medically regulated medications. Although global statistics are considered, the primary focus is the substance abuse crisis within the United States. Through review of experimental and observational peer-reviewed articles, this report examines the definition of substance abuse, demographic impacts, and governmental interventions, with particular emphasizes on the role of the pharmacy profession and individual pharmacists in addressing this widespread issue.


Increasing The Optimal Usage Of The Gad-7 And Phq-9 Screening Tools To Better Detect Co-Occurring Disorders In An Alcohol Use Disorder Clinic, Lauren Swansick May 2024

Increasing The Optimal Usage Of The Gad-7 And Phq-9 Screening Tools To Better Detect Co-Occurring Disorders In An Alcohol Use Disorder Clinic, Lauren Swansick

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Co-occurring disorders include substance use disorders and mental health conditions. These disorders affect 21.5 million individuals. Mental health screening tools, such as the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), are effective in screening individuals for depressive and anxiety mental health conditions within addiction settings.

Problem: Of those with an anxiety disorder, 20-40% will be diagnosed with an alcohol use disorder (AUD). Depressive disorders are the most common mental health conditions that can occur alongside an AUD. A literature review revealed that the PHQ-9 and GAD-7 are used in addiction treatment settings; however, not as …


Youth Interest In Reusable Menstrual Hygiene Products: An Opportunity For Improving Menstruation Management, Makenna R. Eccles May 2024

Youth Interest In Reusable Menstrual Hygiene Products: An Opportunity For Improving Menstruation Management, Makenna R. Eccles

College Honors Program

Adolescents experience inconsistent menstrual hygiene material access that is exacerbated by poverty and results in menstruation management difficulty, health risks, and interruptions to school attendance. The study centered the adolescent menstruation management experience through qualitative interviews to identify management difficulties and to assess knowledge, interest, and perceived feasibility of implementing reusable menstrual hygiene materials such as reusable sanitary pads, period underwear, menstrual cups, and menstrual disks to improve both menstrual hygiene access and menstrual management experiences. Inductive and deductive coding was used to analyze interview data and identify key themes. Adolescents expressed interest in reusable menstrual hygiene materials due to …


Exploring Social Workers Potential Role In Mitigating Maternal Mortality Through Coordinated Care, Jena Brown-Talib May 2024

Exploring Social Workers Potential Role In Mitigating Maternal Mortality Through Coordinated Care, Jena Brown-Talib

Honors Theses

Maternal health disparities persist as a significant challenge in Mississippi, particularly for African American women. This thesis explores the intersection of coordinated care models and social work interventions in addressing maternal mortality. Coordinated care involves collaboration among physicians, nurses, practitioners, social workers, community health workers, and other support services, aiming to maximize pregnant patients' overall health outcomes.

Analyzing strategies of social workers within coordinated care models is important for improving maternal health outcomes within this study. A qualitative approach was chosen to delve beyond statistics and illuminate the reality of maternal health disparities and the efforts to resolve them. Data …


Barriers, Facilitators, And Competencies In Advocating For Adults With Intellectual Disabilities With Health Disparities, Carol Adams May 2024

Barriers, Facilitators, And Competencies In Advocating For Adults With Intellectual Disabilities With Health Disparities, Carol Adams

Electronic Theses and Dissertations

Background: Nurses working in the specialty of intellectual disabilities are positioned to advocate for individuals with intellectual disabilities and other health disparities. This study explored nurses’ perceived competencies, barriers, and facilitators when advocating for improved health status in adult patients with intellectual disabilities.

Methods: Twenty-five nurses working in the specialty of intellectual disabilities were interviewed using semi-structured interviews, and the data were analyzed using thematic analysis.

Results: Barriers identified in advocacy were: Funding, Communication, Negative Perceptions and Misperceptions, Lack of access, and Diagnostic Overshadowing. Nurses were also facilitated in advocating for improved health status in people with intellectual disabilities. Facilitators …


Impact Of An Electronic Human Papillomavirus Vaccination Catch-Up Module For Women With Criminal-Legal System Involvement, Shawana Moore May 2024

Impact Of An Electronic Human Papillomavirus Vaccination Catch-Up Module For Women With Criminal-Legal System Involvement, Shawana Moore

Electronic Theses and Dissertations

Introduction: Cervical cancer can often be prevented with targeted strategies such as Pap smear screenings and the human papillomavirus (HPV) vaccination, now also recommended for those aged 27-45 who have not received the vaccine previously. However, women involved in the criminal-legal system often miss out on primary and secondary prevention measures and are at increased risk for the development of cervical cancer caused by HPV. Purpose: The purpose of this study was to examine the feasibility and acceptability of an electronic HPV catch-up module for women in the criminal-legal system aged 27-45. The study, guided by the Health Belief Model, …


Assessing The Effectiveness Of Treatment Programs Among Veterans With Opioid Use Disorder In New York State, Olatoye Oluwaseyi Itaniyi May 2024

Assessing The Effectiveness Of Treatment Programs Among Veterans With Opioid Use Disorder In New York State, Olatoye Oluwaseyi Itaniyi

Walden Dissertations and Doctoral Studies

New York State (NYS) is home to millions of veterans and has the fifth-largest veteran population in the country. Veterans represent a vulnerable population and are at higher risk for mental and physical health struggles. The focus of this quantitative study was to assess if there is any significant difference between pre- and post-OUD 24-hour detoxification treatment services, residential/rehabilitation treatment services, ambulatory outpatient treatment services, frequency of opioid use at discharge, and mental disorder among veterans with opioid use disorder in NYS when controlling for age, gender, race, and marital status. The study utilized the harm reduction framework and the …