Sociology Commons^™

Identifying Youth Appeals In Alcohol Alternative Social Media Content Through Framing, Melina Oneal

West Chester University Master’s Theses

Proposed regulations for alcohol advertising prevent beverage companies from targeting people under the legal drinking age. However, similar regulations for alcohol alternative beverages are less explored, which could allow alcohol alternative products to create awareness for alcoholic beverages among youth. Alcohol alternatives beverages, including no-alcohol and low-alcohol products, are increasing in popularity and can function as compliments to alcoholic products to decrease the total alcohol volume consumed or as substitutes for alcoholic products. Framing theory can be operationalized through the Content Appealing to Youth Index, an index of content elements found in research literature to be appealing to youth, to …

Root Causes Of Homelessness In Marin County And Prevention Strategies, Michaela George, Kelsey Bas, Joe Blakely, Naila Saghir, Garrett Siebels, Liliana Valle-Contreras, Sehrish Khan

Global Public Health | Student Research Posters

Even with increased prevalence of homelessness in the US, there is limited research that investigates circumstances that can lead to homelessness. This lack of understanding perpetuates the inequities in health and wellbeing, access to basic necessities, effective prevention strategies and meaningful policy changes.

More individuals are experiencing homelessness in California than ever before In Marin, the Ritter Center (RC) strives to prevent and resolve homelessness and improve the health and well-being of individuals living in poverty

How Financial Status Affects Food Decisions In Households Of Marin City, Joe Blakely

Global Public Health | Student Research Posters

• Food insecurity is a multifaceted issue influenced by various factors, including socioeconomic status and access to nutritious foods. Research has shown that low-income households often face challenges in accessing healthy food options due to financial constraints.
• Cultural and psychological factors also play significant roles in shaping food choices among low-income populations. Additionally, the availability and affordability of healthy foods within local food environments significantly impact dietary behaviors.
• Economic factors such as income levels and household expenses further compound the challenges of food insecurity. Studies on food spending decisions among low-income demographics revealed that financial constraints often force families to prioritize …

Unlv Title Iii Aanapisi & Mcnair Scholars Institute Research Journal 2024, Jesica Godinez-Paredes, Kian Hassankhan, Apia Hickman, Robin Ruth Kee, Kevin Ayala Pineda, Briana Melendez, Kalli Ramos, Saturn L. Reyes, Fabian Leija, Selena Pepe, Silva Topchyan, Celeste Ainsley, Mayra Arzate, Jessica Balistreri, Zantana Ephrem, Mirella Jasso, Karl Panou, Nichole Pelaez, Miklo Alcala, Akshay Dave, Mey Mey Heng, Michael Finkle, Janessa Montenegro, Reynafe Naol Aniga, Victor Mejia, Angelica G. Diaz, Anayeli Flores-Garibay, Kari Lee Joe Goold, Samantha Hernandez, Lianelys Cabrera Martinez, Caitlin Reynolds, Kimberly N. Usbeck, Abdulrahman Alahdal, Angelica Diaz, Willaine Mae Kahano, Raquel Jackson, Cecia Ruiz-Hernandez, Kers Ung-Watson, Yessenia Henriquez, Vanessa Marie Booth, Alexia Brown, Darlyn Magana, Bianca Navarro, Nicholas Pereira, Gia Renemae Calip, Lucky Heng, Ralph Sagun, Lucas Abreu, Alexandra Maria Acosta, Tristan Benally, Cosset Hernandez Pena, Adrian Montenegro, Cierra Paaaina-Daquioag, Nicole Torosian, Tracy Fuentes, Julissa Martinez, Medina Mcallister, Michal Newhouse-Van Vlerin, Tiria Carr, Nima Abkenar, Isabella Aceituno, Yuhan Bi, Victoria Campos, Melika Cummings, Zachary J. Johnigan, Alexis Sotolongo-Marin

McNair Journal

Journal articles based on research conducted by undergraduate students in the AANAPISI, LSAMP, and McNair Scholars Program.

Table of Contents

About AANAPISI

Dr. Chris Heavey, Interim President

Dr. Keith Rogers, Vice President for Student Affairs

Ms. Zhanna Aronov, Associate Vice President for Retention & Outreach

Impact Of A Covid-19 Related Lockdown On The Experience Of Informal Caregiving In Singapore, Vicky Mengqi Qin, Abhijit Visaria, Rahul Malhotra

ROSA Journal Articles and Publications

Introduction: Lockdowns, while limiting COVID-19 transmission, can affect provision of care by informal caregivers and their caregiving experience. We assessed, among informal caregivers in Singapore, (a) the perceived impact of a 2-month (April to May 2020) nationwide lockdown on their care provision, (b) correlates of different perceptions of the impact of the lockdown on care provision, and (c) association of different perceptions of the impact with negative and positive experiences of caregiving. Methods: In the August 2020 wave of the Singapore Life Panel (SLP; nationally representative, longitudinal monthly survey of Singapore citizens and permanent residents aged 50-70 years at baseline), …

Improving Screening For Intimate Partner Violence Amongst Older Adults, Olivia Bell

Honors Undergraduate Theses

This systematic literature review was conducted to gather a better understanding of screening for intimate partner violence (IPV) among older adults. IPV affects millions of people every year. Many screenings are conducted with women of reproductive age in medical settings, not older adults. This study focused on ways to improve screenings for older adults by addressing topics including elder abuse and IPV and the lack of resources/knowledge for IPV survivors who are older adults. This study was a literature review conducted with the University of Central Florida’s PRIMO database to find articles on IPV among older adults over the last …

Health Consequences Of Racial Disparity In Access To Abortion: A Systematic Review, Lacy M. Frye, Calvin Odhiambo

University of South Carolina Upstate Student Research Journal

Prior to the 2022 Dobbs decision, Black women already experienced negative maternal health outcomes at an alarmingly disparate rate in comparison to White women. Given that the Dobbs decision emboldens state power to enforce abortion restrictions or protections, there has been significant strides made in both directions. Nonetheless, within states where reproductive rights have been significantly eroded, the heightened abortion restrictions may compound the limited access that Black women previously had before Dobbs. This, in turn will exacerbate the already disparate negative maternal outcomes that Black women experience. However, research on the relationship between the lack of access to abortion …

Cultural Predictors Of Self-Esteem Among Black Women With Criminal Justice Involvement And Herpes Simplex Virus, Natalie Malone, Jardin N. Dogan-Dixon, Shemeka Thorpe, Shawndaya S. Thrasher, Paris Wheeler, Danelle Stevens-Watkins, Carrie B. Oser

Sociology Faculty Publications

Black women have disproportionately alarming HSV-2 infection rates yet receive little attention in sexual health literature. Using a strengths-based resilience framework, this study sought to determine culturally relevant protective predictors of self-esteem for Black women who are justice-involved and have HSV-2. The authors conducted secondary data analysis on data from the “Black Women in the Study of Epidemics (B-WISE) Project,” a longitudinal prospective study investigating health disparities and health services utilization among Black women with justice involvement. At baseline, N = 151 Black women with HSV-2 who were incarcerated or on probation completed survey measures assessing selfesteem, ethnic identity affirmation …

Addressing Healthcare Disparities Faced By Aging Down Syndrome Populations, Rhea Mistry

Pitzer Senior Theses

Down syndrome (DS) is a chromosomal genetic condition that impacts the development of the body and brain. The life expectancy of individuals with DS has drastically improved over the decades, increasing from 9 years in 1929 to 25 years in 1983 and further reaching 60 years by 2002. Individuals with DS face a variety of prominent co-occurring health conditions that are subject to change over time, including cognitive, visual, and hearing impairments, sleep apnea, cardiovascular defects, Down syndrome regression disorder, and dementia. Despite this increase in life span, DS is still most familiar to pediatric care providers, resulting in healthcare …

Examining Adolescent Sexual Patterns In Creek Town, Nigeria: Insights From A Cross-Sectional Survey And Implications For Tailored Interventions, Rowland Edet, Kabiru K. Salami

Department of Sociology: Faculty Publications

In the dynamic landscape of global health, the sexual behaviors of adolescents are of particular significance due to their profound implications for individual well-being and public health. This article focuses on Creek Town, a vibrant community in Nigeria, and aims to provide a nuanced exploration of the sexual behaviors of adolescents within the context of local culture and socioeconomic factors. A cross-sectional survey design was employed, involving a multi-stage sampling approach with 422 participants. A comprehensive 112-item questionnaire captured various aspects of adolescent sexual behaviors. Additionally, four focus group discussions, including both in-school and out-of-school adolescents, provided qualitative insights. The …

Social Determinants Of Health: Evaluation Using Rates Of Vision Screening And Follow-Up Examinations, Madeline Dyer

Williams Honors College, Honors Research Projects

Vision care is essential to the quality of life of young children, impacting them over the course of their lives. Social Determinants of Health (SDOH) affect the likelihood of a child having access to appropriate care specified by the Bright Futures. The aim of this study was to assess the impact of SDOH on the completion of vision screening and the rate of follow-up with an eye care provider when applicable. In addition, rates of instrument-based vision screening and recommended ophthalmology follow-up were compared with COI, a metric assessing the quality of resources available and the conditions that matter for …

Occupational Pressures Of Frontline Workers Enforcing Covid-19 Pandemic Measures In Ontario And Quebec, Canada, Pamela Hopwood, Ellen Maceachen, Daniel Côté, Samantha B. Meyer, Shannon Majowicz, Ai-Thuy Huynh, Meghan K. Crouch, Joyceline Amoako, Yamin T. Jahangir, Amelia León Correal, Antonela Ilic

Études primaires

BACKGROUND:During the COVID-19 pandemic, low-wage public-facing frontline workers (FLWs), such as grocery store clerks, were required to monitor retail customers and enforce COVID-19 protocols. OBJECTIVE:This analysis aimed to examine FLWs experiences of enforcing COVID-19 pandemic measures. METHODS:Between September 2020 and March 2021, in Ontario and Quebec (Canada), we conducted in-depth interviews about customer-related work and health risks with FLWs who interacted with the public (n = 40) and their supervisors (n = 16). Using a lens of situational analysis, verbatim transcripts were coded according to recurring topics. RESULTS:We found that enforcing public health measures placed already-precarious workers in difficult occupational …

Les Pratiques Professionnelles Des Pomiculteurs Exposés Aux Pesticides : Des Savoir-Faire De Métier Aux Pratiques Stratégiques, Caroline Jolly, Alain Garrigou, Elise Ledoux

Études primaires

Dans les très petites entreprises pomicoles, le propriétaire assume majoritairement seul la préparation et la pulvérisation des pesticides. Le respect des mesures de prévention prescrites n’élimine pas l’exposition, pouvant occasionner des effets à la santé. L’objectif est de décrire les pratiques professionnelles développées par les pomiculteurs. Elles visent à limiter l’exposition aux pesticides tout en produisant des fruits de qualité, contribuant ainsi à l'essor de leur entreprise. La recherche-intervention mobilisant l’ergotoxicologie a été réalisée auprès de pomiculteurs au Québec. La diversité des pratiques professionnelles présentées s’inscrit dans les domaines d’activités de la gestion stratégique (p. ex. : développement de l’entreprise) …

An Appalachian Perspective On Suicide: A Focus On West Virginia’S Unique Context, Erin Delaney Caswell

Graduate Theses, Dissertations, and Problem Reports (ETD)

INTRODUCTION: The Appalachian region, spanning 13 states from New York to northern Mississippi, experiences the suicide rates in the United States (U.S.), underscoring a public health crisis exacerbated by persistent socioeconomic challenges. West Virginia (WV), the only state entirely within Appalachia, serves as a focal point for understanding the broader suicide crisis in the region, as WV has the highest suicide rates in the region. Moreover, the state has several unique socioeconomic factors, like increased poverty, lower educational attainment, limited access to healthcare, and a high prevalence of chronic pain and substance that may contribute to elevated rates of suicide. …

"Shut Down And Closed Off": A Routine Activity Approach To Investigating The Relationship Between Covid-19 School Closures And Child Sexual Abuse Report Characteristics In Georgia, Spencer E. Riner

College of Graduate Studies: Theses & Dissertations

The COVID-19 pandemic of 2020 created a public health crisis that led to an unprecedented number of school closures. A major concern raised by child advocates, law enforcement, and social service providers was the possible increase in undetected child abuse and maltreatment. Undergirding this concern was the belief that this mitigation effort might place child abuse victims and offenders within proximity for extended periods of time. While this was a significant concern, it has rarely been analyzed empirically. To address this gap in the literature, this thesis investigates how school closures impacted the characteristics of child sexual abuse (CSA) reports …

The Menstrual Cycle In Psychotherapy: Interventions, Therapist Engagement, And Blind Spots, Rozita Alaluf

Dissertations and Theses

There is a dearth of literature on psychotherapy and menstruation, except for the treatment and diagnosis of issues associated with premenstrual distress. This study aimed to bridge this gap by investigating the frequency and context of discussions about the menstrual cycle, the factors influencing therapists’ engagement with this topic, and the therapeutic approaches utilized to address the menstrual cycle within psychotherapy.

In phase 1, 118 psychotherapists from various theoretical backgrounds completed a survey on menstruation in clinical practice. The data was analyzed using descriptive statistics. In phase 2, semi-structured interviews were conducted with 7 psychotherapists, primarily identifying their theoretical orientation …

Work As A Social Determinant Of Maternal Health: A Qualitative Exploration Of College-Educated Black Women’S Experiences At Work During Pregnancy And Postpartum, Serwaa S Omowale, Laurenia C Mangum, Andrea Joseph-Mccatty, Cherell Cottrell-Daniels, Kaiya A Farris, Rashon King, Brittany C Slatton

Faculty, Staff and Student Publications

BACKGROUND: Black women are disproportionately impacted by higher rates of maternal mortality in the United States (US). Limited research has focused on adverse maternal health outcomes among college-educated Black women, although research has found these outcomes persistent among this population.

OBJECTIVES: This study aimed to fill a critical gap in current research by elucidating the nuanced experiences of college-educated Black women in the workplace during pregnancy and postpartum. By exploring this under-researched area, our study contributes to the academic discourse on Black maternal health disparities within the scope of occupational health. It offers practical insights for enhancing workplace gender equity, …

Perceptions Of Acute Care Telemedicine Among Caregivers For Persons Living With Dementia: A Qualitative Study, Anita Chary, Norvin Hernandez, Ana Paulina Rivera, Vivian Ramont, Tracey Obi, Ilianna Santangelo, Christine Ritchie, Hardeep Singh, Emily Hayden, Aanand D Naik, Shan Liu, Maura Kennedy

Faculty, Staff and Student Publications

Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication …

Social Determinants Of Health Predict Readmission Following Covid-19 Hospitalization: A Health Information Exchange-Based Retrospective Cohort Study, Micaela N Sandoval, Jennifer L Mikhail, Melyssa K Fink, Guillermo A Tortolero, Tru Cao, Ryan Ramphul, Junaid Husain, Eric Boerwinkle

Faculty, Staff and Student Publications

INTRODUCTION: Since February 2020, over 104 million people in the United States have been diagnosed with SARS-CoV-2 infection, or COVID-19, with over 8.5 million reported in the state of Texas. This study analyzed social determinants of health as predictors for readmission among COVID-19 patients in Southeast Texas, United States.

METHODS: A retrospective cohort study was conducted investigating demographic and clinical risk factors for 30, 60, and 90-day readmission outcomes among adult patients with a COVID-19-associated inpatient hospitalization encounter within a regional health information exchange between February 1, 2020, to December 1, 2022.

RESULTS AND DISCUSSION: In this cohort of 91,007 …

The Relationship Of Neighborhood Disadvantage, Biological Aging, And Psychosocial Risk And Resilience Factors In Heart Failure Incidence Among Black Persons: A Moderated Mediation Analysis, Ganga S Bey, James R Pike, Anthony S Zannas, Qian Xiao, Bing Yu, Amil M Shah, Priya Palta

Faculty, Staff and Student Publications

Objectives: Deprived living environments contribute to greater heart failure (HF) risk among non-Hispanic Black persons, who disproportionately occupy disadvantaged neighborhoods. The mechanisms for these effects are not fully explicated, partially attributable to an insufficient understanding of the individual factors that contribute additional risk or resilience to the impact of neighborhood disadvantage on health. The objective of this study was, therefore, to clarify the complex pathways over which such exposures act to facilitate more targeted, effective interventions. Given the evidence for a mediating role of biological age and a moderating role of individual psychosocial characteristics in the neighborhood disadvantage-HF link, we …

Self-Perception Of Mental Health, Covid-19 And Associated Sociodemographic-Contextual Factors In Latin America, Pablo Roa, Guillermo Rosas, Gloria Isabel Niño-Cruz, Sergio Mauricio Moreno-López, Juliana Mejía-Grueso, Haney Aguirre-Loaiza, Javiera Alarcón-Aguilar, Rodrigo Reis, Adriano Akira Ferreira Hino, Fernando López, Deborah Salvo, Andrea Ramírez-Varela

Faculty, Staff and Student Publications

This study aimed to estimate the prevalence of alterations in self-perceived mental health during the COVID-19 pandemic and their associated factors in four Latin American countries. This is a cross-sectional study based on data collected from adults in 2021 through the Collaborative Response COVID-19 Survey by the MacDonnell Academy at Washington University in St. Louis (United States). The sample was composed of 8,125 individuals from Brazil, Colombia, Mexico, and Chile. A generalized linear model for a binary outcome variable with a logistic link and fixed country effects was used. There were 2,336 (28.75%) individuals who considered having suffered alterations in …

Colonial Drivers And Cultural Protectors Of Brain Health Among Indigenous Peoples Internationally, Rita Henderson, Joyla A Furlano, Shayla Scott Claringbold, Ashley Cornect-Benoit, Anh Ly, Jennifer Walker, Lisa Zaretsky, Pamela Roach

Faculty, Staff and Student Publications

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This …

Secondhand Tobacco Smoke Exposure In Homes And Vehicles In Youth: Disparities Among Racial, And Sexual And Gender Minorities, Rajesh Talluri, Sahil S Shete, Surendra S Shastri, Sanjay Shete

Faculty, Staff and Student Publications

BACKGROUND: Secondhand smoke exposure (SHSe) among youth is a serious public health concern, leading to an increased risk of conditions such as asthma and respiratory infections. However, there is little research on SHSe among vulnerable populations, such as racial and sexual minorities. Understanding the factors associated with youth SHSe in homes and vehicles is crucial to developing better protective policies.

METHODS: This study utilized 2020 data from the National Youth Tobacco Survey, a representative sample of middle- and high-school students in the US. The primary outcomes were youth SHSe at home and while riding in a vehicle. Multinomial regression models …

Family Structure, Family Transitions, And Child Overweight And Obesity: Comparing Australia, The United Kingdom, And The United States, Sadie A. Slighting, Kirsten Rasmussen, Mikaela J. Dufur, Jonathan A. Jarvis, Shana Pribesh, Alyssa J. Alexander, Carolina Otero

STEMPS Faculty Publications

Growing rates of childhood obesity globally create concern for individuals' health outcomes and demands on health systems. While many policy approaches focus on macro-level interventions, we examine how the type of stability of a family structure might provide opportunities for policy interventions at the micro level. We examine the association between family structure trajectories and childhood overweight and obesity across three Anglophone countries using an expanded set of eight family structure categories that capture biological relationships and instability, along with potential explanatory variables that might vary across family trajectories and provide opportunities for intervention, including access to resources, family stressors, …

"Why Does This Have To Be So Hard?": Perinatal Experiences From An Ecological Systems Approach, Caitlin Senk

Antioch University Dissertations & Theses

This study examines the lived experience of the perinatal population to understand how they can be supported from the lens of different ecological systems and what counselors can do to better serve people with uteruses during their perinatal experience. Furthermore, this study aims to utilize an inclusive framework for capturing the perinatal experience of people with uteruses and to explore barriers and facilitators to care through an ecological systems framework. Fifteen participants who have experienced infertility, conception, pregnancy, miscarriage, childbirth, stillbirth, and postpartum were recruited through various means throughout the United States. Thematic analysis was used, with semi-structured interviews and …

Beyond Borders: Exploring The Lived Experiences Of International Migrant Women In Nigeria, A Deep Dive Into Healthcare Realities And Utilization, Juliet Nwafor, Rowland Edet, Ezebunwa Nwokoch

Department of Sociology: Faculty Publications

This study explored access to and utilization of healthcare facilities among migrant women in an urban slum community in Nigeria, focusing on factors influencing healthcare-seeking behaviors and the implications for public health interventions. A qualitative case study-oriented research design was employed, involving in-depth interviews with 21 migrant women of reproductive age and 4 key informant interviews with healthcare workers in the Ayobo community of Lagos State, Nigeria. Data collection occurred from June to September 2018, and thematic analysis was used to interpret the findings. Three main themes emerged: living conditions, pattern of healthcare utilization, and factors influencing accessibility and utilization …

A Descriptive Analysis Of Depressive Symptoms And Body Image By Race/Ethnicity And Nativity Status Among Adolescents, Radhika Prasad

Electronic Theses & Dissertations (2024 - present)

Previous research on the immigrant health paradox among children and adolescents show a mental health advantage yet it is unclear if this applies in a similar magnitude to females (Fillion et al., 2018; Zarei et al., 2023). Immigrants may be exposed to stressors related to immigration and acculturation. Some research suggests that females respond more to stress through internalizing symptoms relative to males (Hall-Lande et al., 2007; Adkins et al., 2009). Given these gender differences in stress response, female immigrants may be particularly vulnerable to the psychological consequences of immigration related stressors. The immigrant health paradox has also overlooked subjective …

Rural Racial Disparities And Barriers In Mammography Utilization Among Medicare Beneficiaries In Texas: A Longitudinal Study, Zhaoli Liu, Yong Shan, Yong-Fang Kuo, Sharon H Giordano

Faculty, Staff and Student Publications

This study examined rural racial/ethnic disparities in long-term mammography screening practices among Medicare beneficiaries. A retrospective longitudinal study was conducted using 100% Texas Medicare data for women aged 65-74 who enrolled in Medicare between 2010-2013. Of the 114,939 eligible women, 21.2% of Hispanics, 33.3% of non-Hispanic Blacks (NHB), and 38.4% non-Hispanic Whites (NHW) in rural areas were regular users of mammography, compared to 33.5%, 44.9%, and 45.3% of their counterparts in urban areas, respectively. Stratification analyses showed rural Hispanics and NHB were 33% (95% CI, 25% - 40%) and 22% (95% CI, 6% - 36%) less likely to be regular …

"They Are Expecting Us To Stay Strong": How Ambulance Personnel Navigate And Manage Their Emotions In A Rural Region Of Northern California, Tina M. Orton-Owens

Cal Poly Humboldt theses and projects

This research examines how emergency medical service (EMS) workers navigate and manage their calls in Humboldt County, a rural region of Northern California. The primary theoretical framework is drawn from Arlie Hochschild’s theory of Emotional Labor. This paper examines how emotional labor impacts EMS workers within a rural environment and with limited resources. I also look at how COVID-19 complicated EMS workers’ experiences. This paper is based on qualitative research where I conducted 13 mostly face-to-face interviews with EMS workers throughout the County between 2020 and 2022. Interviews consisted of 30 questions and interviews ranged in length from 1 to …

High-Risk Individuals And Naloxone Use: Implications For Thn Programs In Rural Appalachian Communities, Victor Garcia, Lisa Mccann, Erick Lauber, Christian Vaccaro, Melissa Swauger, Alex Daniel Heckert

Journal of Appalachian Health

Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others.

Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of …