The influence of neighborhood socioeconomic disadvantage and social discomfort on high-risk injection behavior among people who inject drugs

Research on the determinants of injection drug use behavior has traditionally concentrated on factors operating at the individual level. However, more recent studies have found that behaviors surrounding injection drug use are shaped, not only by individual-level characteristics, but also by the environment in which they occur. The risk environment paradigm, proposed by Rhodes and colleagues, describes how factors exogenous to the individual influence high-risk injection behavior and blood borne virus (BBV) transmission among people who inject drugs (PWID). To date, few elements of the risk environment have been evaluated as potential determinants of high-risk injection behavior. The purpose of this dissertation was to study the influence of two elements of the risk environment on unsafe injection practices among PWID – neighborhood socioeconomic disadvantage and social discomfort surrounding the acquisition of sterile syringes from syringe exchange programs (SEPs) and pharmacies. To this end, a systematic literature review was conducted on the relation between neighborhood context and injection drug use behavior. Research gaps and methodological challenges identified in this review were used to design analyses exploring relations among neighborhood disadvantage, social discomfort, and high-risk injection behavior. These analyses were conducted using data collected from 484 PWID enrolled in the Pharmacists as Resources Making Links to Community Services (PHARM-Link) study, combined with data from the American Community Survey. Poisson regression with robust error variance was used to estimate associations between measures of neighborhood socioeconomic disadvantage and high-risk injection behavior. SEP accessibility and drug-related police activity were evaluated as potential modifiers of these relations. Similar methods were used to estimate associations between measures of social discomfort and high-risk injection behavior, including neighborhood socioeconomic disadvantage as a potential effect modifier. The systematic literature review on neighborhood context and injection drug use behavior identified few articles pertaining to this relation (n=22). Selected studies primarily investigated the influence of structural aspects of the neighborhood environment on behaviors surrounding injection drug use, while aspects of the social environment and potential modifiers of neighborhood-behavior relations were understudied. Subsequent quantitative analyses revealed that neighborhood socioeconomic disadvantage was associated with safer injection behaviors among PWID. Injectors in disadvantaged neighborhoods reported less receptive syringe sharing and less unsterile syringe use than their counterparts in relatively better off neighborhoods. Drug-related police activity attenuated associations between neighborhood disadvantage and unsterile syringe use, while the direction of associations between neighborhood disadvantage and the use of unsafe syringe sources varied with levels of SEP accessibility. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased use of unsafe syringe sources, while in neighborhoods with low SEP accessibility, neighborhood disadvantage was associated with increased use of unsafe syringe sources. Social discomfort was not associated with high-risk injection behavior, but effect modification was detected between neighborhood disadvantage and two items measuring the quality of relationships between participants and syringe staff: “Pharmacists care about my health and well-being” and “The staff at syringe exchange programs seems to care about my health and well-being.” In disadvantaged neighborhoods, participants who reported positive relationships with syringe staff were less likely to engage in receptive syringe sharing. However, in relatively better off neighborhoods, positive relationships with syringe staff were associated with increased receptive syringe sharing. Overall, the results of this dissertation support the validity of the risk environment paradigm in shaping high-risk injection behavior among PWID. Future studies should continue to investigate contextual factors as determinants of behavior surrounding injection drug use. Understanding how aspects of local-area environments influence injection risk behavior will be essential to eliminating the transmission of BBVs among PWID

Dickens in the New Millennium

This special issue of the Cahiers victoriens et édouardiens initially published in 2012 means to celebrate Charles Dickens’s bicentenary of his birthday and offers a selection of articles derived from the yearly conference of the Dickens Society which took place in Aix-en-Provence. The aim of this volume is to consider how Dickens’s fiction is understood, interpreted and taught nowadays, and whether it answers twenty-first-century concerns. The essays collected here also examine how today’s public views the mid-Victorian period through Dickens’s writing. The editors would like to thank all the authors for their contributions to the present volume as well as the research centres which made this publication possible : the LERMA (Laboratoire d’Études et de Recherche sur le Monde Anglophone – Université d’Aix-Marseille 1), EMMA (Études Montpelliéraines du Monde Anglophone – Université de Montpellier 3), CECILLE (Centre d’Études en Civilisations, Langues et Littératures Étrangères – Université Charles de Gaulle Lille 3), the PULM (Presses Universitaires de la Méditerranée), the Dickens Society and the Dickens Museum for their kind permission to use Robert William Buss’s ‘Dickens’s Dream’. The volume consists of six sections. ‘Making a Start on Dickens’ contains three essays focusing on teaching Dickens or stressing the relevance of Dickens’s work in the information age. ‘Iconic and Cinematic Dickens’ is about the visual potentialities of Dickens’s work in book illustrations or cinematic adaptations. ‘Reading Dickens’ reviews the value of reading itself in the Victorian author’s fiction as well as his recourse to sentimentality or to a double narrating stance. The articles in ‘Scientific Dickens’ show the contribution that science and the history of science still bring to the interpretation of his work today. ‘Hypo/Hyper Dickens’ explores another contribution to his legacy in the form of Dickensian doubles, either in his own fiction or as post-Dickens neo-Victorian rewritings. Finally ‘Metafictional, Prototypical and Archetypal Dickens’ studies a selection of metanarratives (mythological, apocalyptic, geological), which Dickens used to decipher the signs of his times. Ce numéro hors série des Cahiers victoriens et édouardiens entend célébrer le bicentenaire de la naissance de Charles Dickens (1812-1870). Il réunit une sélection d’articles dérivés du Congrès de la Dickens Society qui s’est tenu à Aix-en-Provence en 2012. Le but de cette publication est d’évaluer la façon dont la fiction de Dickens est comprise, interprétée et enseignée aujourd’hui, et de voir si cette fiction répond aux préoccupations du XXIe siècle. Les articles regroupés ici examinent également la manière dont le public d’aujourd’hui considère la période victorienne à travers les écrits de Charles Dickens. Les rédacteurs en chef remercient les auteurs des contributions de ce volume ainsi que les centres de recherche qui en ont permis la publication : le LERMA (Laboratoire d’Études et de Recherche sur le Monde Anglophone – Université d’Aix-Marseille 1), EMMA (Études Montpelliéraines du Monde Anglophone – Université de Montpellier 3), CECILLE (Centre d’Études en Civilisations, Langues et Littératures Étrangères – Université Charles de Gaulle Lille 3), les PULM (Presses Universitaires de la Méditerranée), la Dickens Society et le Dickens Museum pour leur autorisation de faire usage du tableau de Robert William Buss, ‘Dickens’s Dream’, comme couverture. Le volume se compose de six sections. ‘Making a Start on Dickens’ regroupe trois articles qui se concentrent sur l’enseignement des oeuvres de Dickens dans un contexte secondaire ou universitaire ou sur leur pertinence dans le monde numérique et connecté d’aujourd’hui. ‘Iconic and Cinematic Dickens’ se concentre sur les potentialités visuelles de ses œuvres par le biais des illustrations publiées dans des éditions posthumes ou des adaptations cinématographiques. ‘Reading Dickens’ considère la valeur qu’attribuait l’auteur victorien à la lecture au travers de ses fictions, son recours au sentimentalisme ou à une double instance narrative. Les articles de la section intitulée ‘Scientific Dickens’ montre la contribution que la science et l’histoire de la science continuent d’apporter à l’interprétation de ses oeuvres aujourdhui. ‘Hypo/Hyper Dickens’ explore une autre contribution à son patrimoine sous la forme des doubles dickensiens, soit au sein de ses œuvres, soit dans le domaine des réécritures néo-victoriennes. Enfin, ‘Metafictional, Prototypical and Archetypal Dickens’ aborde un ensemble de méta-récits (mythologique, apocalyptique, géologique), auxquels Dickens a eu recours pour déchiffrer les signes de son temps

Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19–Associated Hospitalization Among Immunocompetent Adults Aged ≥65 Years — IVY Network, 18 States, September 8–November 30, 2022

Monovalent COVID-19 mRNA vaccines, designed against the ancestral strain of SARS-CoV-2, successfully reduced COVID-19-related morbidity and mortality in the United States and globally (1,2). However, vaccine effectiveness (VE) against COVID-19-associated hospitalization has declined over time, likely related to a combination of factors, including waning immunity and, with the emergence of the Omicron variant and its sublineages, immune evasion (3). To address these factors, on September 1, 2022, the Advisory Committee on Immunization Practices recommended a bivalent COVID-19 mRNA booster (bivalent booster) dose, developed against the spike protein from ancestral SARS-CoV-2 and Omicron BA.4/BA.5 sublineages, for persons who had completed at least a primary COVID-19 vaccination series (with or without monovalent booster doses) ≥2 months earlier (4). Data on the effectiveness of a bivalent booster dose against COVID-19 hospitalization in the United States are lacking, including among older adults, who are at highest risk for severe COVID-19-associated illness. During September 8-November 30, 2022, the Investigating Respiratory Viruses in the Acutely Ill (IVY) Network§ assessed effectiveness of a bivalent booster dose received after ≥2 doses of monovalent mRNA vaccine against COVID-19-associated hospitalization among immunocompetent adults aged ≥65 years. When compared with unvaccinated persons, VE of a bivalent booster dose received ≥7 days before illness onset (median = 29 days) against COVID-19-associated hospitalization was 84%. Compared with persons who received ≥2 monovalent-only mRNA vaccine doses, relative VE of a bivalent booster dose was 73%. These early findings show that a bivalent booster dose provided strong protection against COVID-19-associated hospitalization in older adults and additional protection among persons with previous monovalent-only mRNA vaccination. All eligible persons, especially adults aged ≥65 years, should receive a bivalent booster dose to maximize protection against COVID-19 hospitalization this winter season. Additional strategies to prevent respiratory illness, such as masking in indoor public spaces, should also be considered, especially in areas where COVID-19 community levels are high (4,5)