The Rikers Island Hot Spotters: Defining the Needs of the Most Frequently Incarcerated

We used "hot spotting" to characterize the persons most frequently admitted to the New York City jail system in 2013.

We used our Correctional Health Services electronic health record to identify 800 patients admitted in 2013 who returned most since November 2008. We compared them to a randomly selected control group of 800 others admitted in 2013, by using descriptive statistics and cross-tabulations, including data through December 2014.

The frequently incarcerated individuals had a median of 21 incarcerations (median duration 11 days), representing 18 713 admissions and $129 million in custody and health costs versus $38 million for the controls. The frequently incarcerated were: 

• significantly older (42 vs 35 years), 
• and more likely to have serious mental illness (19% vs 8.5%) 
• and homelessness (51.5% vs 14.7%) in their record. 
• Significant substance use was highly prevalent (96.9% vs 55.6%). 
• Most top criminal charges (88.7%) for the frequently incarcerated were misdemeanors; assault charges were less common (2.8% vs 10.4%). 

Frequently incarcerated persons have chronic mental health and substance use problems, their charges are generally minor, and incarceration is costly. Tailored supportive housing is likely to be less costly and improve outcomes.

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By: MacDonald R1, Kaba F1, Rosner Z1, Vise A1, Weiss D1, Brittner M1, Skerker M1, Dickey N1, Venters H1.

• 1All of the authors are with the New York City Department of Health and Mental Hygiene, Bureau of Correctional Health Services, Queens, NY.

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Perceptions, Attitudes, and Experience Regarding mHealth among Homeless Persons in New York City Shelters

Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants' average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. 

The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. 

Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. 

These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.

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Factors Associated with Illicit Methadone Injecting in a Canadian Setting

Background And Objectives:  While methadone is well established as an evidence-based treatment for opioid use disorder, safety concerns persist regarding its diversion. The authors examine the prevalence of and risk factors associated with injection of methadone in an urban population.

Methods: Between December 2005 and November 2013, data were derived from two open prospective studies of persons who inject drugs (PWID) in Vancouver, Canada. Generalized estimating equations (GEE) logistic regression was used to determine factors independently associated with illicit methadone injecting.

Results: During the study, 1911 individuals (34% women) were recruited; 134 (7%) participants reported methadone injecting at least once. In multivariable analysis, Caucasian ethnicity; homelessness; drug dealing ; ≥daily heroin injection; ≥daily crack smoking; being a victim of violence; and non-fatal overdose were independently and positively associated with methadone injection; female gender was negatively associated.

Discussion and Conclusions: The diversion of methadone for illicit injection in this urban setting was associated with several markers of addiction severity and other health and social vulnerabilities.

Scientific Significance: These findings underscore the need to ensure methadone accessibility while limiting diversion-related risk.

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Assessment of Sexual and Reproductive Health Status of Street Children in Addis Ababa, Ethiopia

Below:  Reasons of street children to join street life in Addis Ababa, January, 2011

Below:  The distribution of street children by their reasons for rejoinig the street life in Addis Ababa, January, 2011

Below:  Percentage distribution of reasons for substance use among street children in Addis Ababa, January, 2011

Below:  Common day time activities by street children in Addis Ababa, January, 2011

Below:  Distribution of street children by preferable place for sexual and reproductive health services and advices in Addis Ababa, January, 2011

Below:  The distribution of street children due to the reason that inhibite visiting the health facilities in Addis Ababa, January, 2011

Below:  Barriers for street children utilization of local sexual and reproductive health services in Addis Ababa, January, 2011

Below:  The distribution of street children by their satisfaction status with SRH services in Addis Ababa, January, 2011

Street children worldwide do not have the information, skills, health services, and support they need to go through sexual development during adolescence. This study is undertaken to systematically investigate the fit between street children's sexual and reproductive health needs and the existing services. A cross-sectional study was conducted among 422 street children and four service providers. About 72.5% of the respondents were sexually active during data collection and 84.3% of males and 85.7% of females tended to have multiple sexual partners. 

More than two-thirds (67.3%) of the participants had used at least one type of substance. History of substance use and being on the street for the first one to three years increased the likelihood of having sexual activity. More than half (64.9%) of the street children did not attend any kind of sexual or reproductive health education programs. Lack of information on available services (26.5%) was the biggest barrier for utilization of local sexual and reproductive health services. From the individual interview with coordinator, the financial and networking problems were hindering the service delivery for street children. 

In conclusion, street children who are special high risk group have not been targeted and hence continue to remain vulnerable and lacking in sexual and reproductive health services and sexual health services are poorly advertised and delivered to them.

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How Should Network-Based Prevention for Homeless Youth Be Implemented?

Below:  Sociometric data on life-time methamphetamine use (in grey) among homeless youth, Holllywood, CA, 2008 (n = 136)

There is a great desire both among academics [2-11] and our community-based collaborators to utilize network-based prevention programs to reduce risk taking among homeless youth. This interest is driven by the relatively low cost of these programs, coupled with an understanding that such programs might engage homeless youth who are transient, hidden and distrustful of adults. This represents an exciting convergence around the desirability and probable acceptability of network based prevention. What remains unclear is how and with whom to implement these programs.

RAND present fascinating results indicating that opinion leaders and popular peers are among those with whom youth are most likely to drink and use drugs. RAND recognize the complexity of recruiting substance using opinion leaders for interventions to reduce substance use, but suggest that these peers may still be appropriate people to train as peer leaders. We respectfully question this interpretation. It is entirely possible that these popular and respected peers are popular and respected because of their participation in risky behaviors. Being popular and respected often requires adhering to the norms and values of a network—in this case a network for whom risk-taking is normative. Thus, it is possible that asking youth to curb or abandon risk behaviors could compromise the popularity and respect they hold. As an illustrative example, Fig. 1 shows that substance-using youth are not only popular within egocentric networks of youth (as RAND have shown), but also occupy central positions within sociometric networks of homeless youth, lending further evidence to the hypothesis that risky behavior might be an important component of popularity for homeless youth. Given the often tenuous nature of social standing among homeless youth, we are wary of the practical efficacy of attempting to change norms that may confer status among this population.

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