Alcohol-related affordances and group subjectivities: A Q-Methodology study

Aims: An Ecological approach to alcohol behaviour focuses on understanding individual–environment transactions, rather than on cognitive antecedents of behaviour. Meaning exists in the interdependence of individuals and their environments, in terms of affordances. Through subjective experience, this study focussed on group viewpoints related to alcohol-related affordances, or opportunities to consume alcohol in shared drinking environments. Methods: Forty students with a range of self-reported drinking behaviours participated in a Q-Methodology study, ranking 60 statements along a symmetrical grid. This varied concourse of alcohol-related affordances was obtained from a previous observation study within licenced premises and a photo-elicitation interview study with drinkers. Findings: Factor analysis and post-sort interviews revealed four subjective perspectives held by groups about their drinking behaviour: 13 participants were aware of contextual influences, but autonomous in their drinking choices; 12 participants were conscious of influences and compliant to their effects; six participants were unaware of influences, but unanimous with their peers; two participants were concerned about acting appropriately in a context by taking up canonical affordances. Conclusions: Grouping subjectivities from a varied concourse of affordances can reveal subjective experience in relation to drinking environments and alcohol behaviour. This conceptual approach for understanding drinking behaviour should be studied further.     

Regional and district peer effects in obesity: A UK panel data analysis

Most research concerning the causes of obesity has focused on macroeconomic trends or individual‐level determinants relating to socioeconomic status. There is now growing interest in the psychosocial determinants of obesity. Little research has been conducted into wide‐scale peer effects and so the aim of this study was to determine whether regional and district peer effects determine individual‐level obesity in the UK. Data from the British Household Panel Survey (for the years 2004 and 2006) were used to model individual‐level BMI and probability of obesity as a function of regional and district BMI, controlling for a variety of other variables. Instrumental variable techniques were used to investigate simultaneity bias. We found no statistically significant regional peer effect in the UK. For men, we found that a 1 point increase in average district BMI increased individual BMI by 0.640 and probability of being obese by 1.9% points; for women, BMI increased by 0.230 and probability of being obese by 1.6% points. Men appear to be more susceptible to these effects than women. Peer effects at the district level may have played a significant role in the rise of obesity in the UK. Further research must aim to disentangle the two routes by which these processes are theorised to function.     

Engaging new refugee in Australian communities at risk for chronic hepatitis B infection into care: A peer‐educator intervention

Chronic Hepatitis B (CHB) infection and subsequent liver complications are rising in prevalence in Australia due to increased migration from endemic regions. Nearly 50% of all those living with CHB in Australia are undiagnosed, leading to missed opportunities for liver cancer and cirrhosis prevention. Health literacy around CHB among refugee communities such as Afghan, Rohingyan, and Sudanese populations (all with a high prevalence of CHB) is low, partly due to a paucity of targeted health promotion programmes; despite the release of the Victorian Hepatitis B Strategy (2016–2020). We developed a peer‐education intervention in these three communities to deliver CHB focused radio programmes and community forums in their own language, following a needs assessment consisting of semistructured interviews and surveys. Effectiveness of this intervention was measured through paired comparison of disease‐knowledge assessment pre and post forum. Community forums were held between 2015 and 2016, with 25 attendees at the Rohingyan forum (68% male), 10 attendees at the Afghan forum (90% male) and 0 attendees at the Sudanese forum. Participants demonstrated a significant improvement in CHB knowledge between pre‐ and post‐forum surveys (p‐value < 0.05). A peer‐educator approach was a cost‐effective health promotion strategy in building CHB knowledge and dispelling misconceptions within the Afghan and Rohingya communities. There were significant barriers in the engagement of the South Sudanese community, which will inform future strategies for health promotion.     

Incarceration history,social network composition,and substance use among homeless youth in Los Angeles

Background: Homeless youth in the United States have high rates of substance use. Existing research has identified social network composition and street-associated stressors as contributing factors. Incarceration is a highly prevalent stressor for homeless youth. Its effect on youth’s social network composition and substance use, however, has been neglected.

Aims: This study investigated the direct and indirect associations between incarceration history and substance use (through social networks) among homeless youth in Los Angeles, California.

Methods: A sample of 1047 homeless youths were recruited between 2011 and 2013. Computerized self-administrated surveys and social network interviews were conducted to collect youth’s sociodemographic characteristics, incarceration history, social network composition, and substance use. Bootstrapping was used to identify the direct and indirect associations between youth’s incarceration history and substance use.

Results: Incarceration history was positively associated with youth’s cannabis, methamphetamine, and injection drug use. The percentage of cannabis-using peers partially mediated the associations between incarceration history and youth’s cannabis, cocaine, and heroin use. The percentage of methamphetamine-using peers partially mediated the associations between incarceration history and youth's methamphetamine, cocaine, and injection drug use. The percentage of heroin-using peers partially mediated the association between incarceration history and youth’s heroin use. Moreover, the percentage of peers who inject drugs partially mediated the associations between incarceration history and youth’s methamphetamine, heroin, and injection drug use.

Discussion: Incarceration history should be taken to a more central place in future research and practice with homeless youth in the United States.     

Peer-Led Seeking Safety: Results of a Pilot Outcome Study with Relevance to Public Health

There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safety (SS). SS is the most evidence-based and widely implemented therapy for SUD with co-occurring PTSD or other trauma-related problems. Eighteen women in residential substance-abuse treatment participated. All met SUD criteria (primarily opiate and cocaine dependence); most had a comorbid mental health disorder; and they had elevated trauma-related symptoms. The 25 SS topics were conducted twice-weekly. Participants were assessed at baseline and end-of-treatment, with some measures also collected monthly. Results showed significant positive outcomes in trauma-related problems (the Trauma Symptom Checklist-40); psychopathology (the Brief Symptom Inventory); functioning (the BASIS-32, including impulsive-addictive behavior); self-compassion (the Self-Compassion Scale); and SS coping skills. Effect sizes were consistently large. SS satisfaction and fidelity ratings were high. Substance use levels could not be assessed due to the residential setting. Qualitative data indicated enthusiasm for peer-SS by both peers and staff. Study limitations, future research, and public health relevance are discussed.     

Volunteer Involvement in Advance Care Planning: A Scoping Review

ContextVolunteer involvement may support organizations to initiate and operationalize complex interventions such as advance care planning (ACP).ObjectivesA scoping review was conducted to map existing research on volunteer involvement in ACP and to identify gaps in current knowledge base.MethodsWe followed the PRISMA extension for Scoping Reviews (PRISMA-ScR) guidelines. The review included studies of any design reporting original research. ACP was defined as any intervention aimed at supporting people to consider and communicate their current and future health treatment goals in the context of their own preferences and values. Studies were included if they reported data relating to volunteers at any stage in the delivery of ACP.ResultsOf 11 studies identified, nine different ACP models (initiatives to improve uptake of ACP) were described. Most of the models involved volunteers facilitating ACP conversations or advance care directive completion (n = 6); and three focused on ACP education, training, and support. However, a framework for volunteer involvement in ACP was not described; the studies often provided limited detail of the scope of volunteers' roles in ACP, and in three of the models, volunteers delivered ACP initiatives in addition to undertaking other tasks, in their primary role as a volunteer navigator. Increased frequency of ACP conversation or documentation was most commonly used to evaluate the effectiveness of the studies, with most showing a trend toward improvement.ConclusionsCurrent literature on volunteer involvement in ACP is lacking a systematic approach to implementation. We suggest future research should focus on person-centered outcomes related to ACP to evaluate the effectiveness of volunteer involvement.     

The transition from patient to mental health peer worker: A grounded theory approach

Peer workers are increasingly being engaged in contemporary mental healthcare. To become a peer worker, patients must evolve from having a patient identity to a peer worker identity. This study aims to understand how mental health peer workers experience their transition and how it affects their view of themselves and their direct working context. A grounded theory approach was used. Seventeen mental health peer workers in Belgium were recruited through theoretical sampling. Semi‐structured interviews were conducted and analysed according to the constant comparative method. The results indicate that novice peer workers experience peer work as an opportunity to liberate themselves from the process of mental suffering and realise an acceptable form of personal self‐maintenance. As peer workers become more experienced, they are confronted with external factors that influence their self‐maintenance and personal development. Experiencing clarity in their duties and responsibilities, equality, and transparency in the workplace reinforce their experience of self‐maintenance and positively influence their self‐development. Experiencing a lack of clarity in their duties and responsibilities, inequality, and lack of openness discourage peer workers’ self‐development process. These experiences challenge their personal motivations to become peer workers, which are usually linked to building a meaningful life for themselves. The insights can encourage organisations to build up a supportive environment collaboratively with peer workers and ensure that peer workers can exert their authentically unique role in mental healthcare.