Danielle C Ompad

Professor of Epidemiology

Professional overview

Dr. Danielle Ompad is an epidemiologist whose work is focused in the areas of urban health, HIV, illicit drug use, and adult access to vaccines. With respect to illicit drug use, her work has spanned the entire natural history of addiction – from initiation to cessation, with particular attention paid to risk for infectious diseases such as HIV, hepatitis B and C, and STIs.  She has primarily worked with people who use heroin, crack, cocaine, and/or club drugs.  

In New York City, she has been examining heroin cessation among current, former, and relapsed heroin users. Working with Alliance for Public Health and the Ukrainian Institute on Public Health Policy, she analyzes harm reduction service utilization among people who inject drugs, in order to optimize service delivery in Ukraine.  Since 2013, she has served as faculty for the Fogarty-funded New York State International Training and Research Program with the goal of building research capacity in Ukraine.

Dr. Ompad’s National Institute of Allergy and Infectious Diseases-funded study aims to determine if herpes simplex 1 and 2 infections explain racial disparities in HIV incidence among a cohort of young gay, bisexual, and other men who have sex with men (YMSM).  In addition, Dr. Ompad and colleagues are assessing HPV infection prevalence, persistence, and clearance among this same cohort.

Education

BS, Biology, Bowie State University, Bowie, MD

MHS, Epidemiology, Johns Hopkins University, Baltimore, MD

PhD, Epidemiology, Johns Hopkins University, Baltimore, MD

Honors and awards

Excellence in Public Health Teaching Award, New York University (2014)

Excellence in Public Health Teaching Award, New York University (2013)

National Hispanic Science Network on Drug Abuse Scientific Development Travel Fellowship (2010)

Delta Omega Honorary Society, Alpha Chapter (2002)

Areas of research and study

Epidemiology

HIV/AIDS

Infectious Diseases

Social Determinants of Health

STIs

Substance Abuse

Vaccines

Publications

Publications

Depression among people living with tuberculosis and tuberculosis/HIV coinfection in Ukraine: a cross-sectional study

Salnikova, A., Makarenko, O., Sereda, Y., Kiriazova, T., Lunze, K., DeHovitz, J., & Ompad, D. C. (n.d.).

Publication year

2025

Journal title

Global Health Action

Volume

18

Issue

1

10.1080/16549716.2024.2448894

Abstract

Abstract

Background: Depressive disorders are associated with poor treatment outcomes, physical health, and quality of life among people living with TB (PLWTB) and TB/HIV (PLWTBHIV). Data on depression among PLWTB/HIV are limited in Ukraine. Objectives: This cross-sectional study aimed to examine depression risk and its correlates and describe the willingness to seek depression treatment among PLWTB/HIV in Ukraine. Methods: This secondary analysis included patients with and without HIV who initiated TB treatment within 30 days in two tertiary hospitals in Kyiv and Odesa. A survey was conducted from February 2021 to October 2022 and reviewed patients’ health records. We used the Center for Epidemiological Studies-Depression Scale (CES-D) to indicate risk for clinical depression. Factors associated with depressive symptoms were identified using logistic regression. Results: The sample included 209 participants (n = 100 with TB; n = 109 with TB/HIV). The mean age of participants was 43 (SD = 11) years; 66% of sample identified as male. Approximately 28% of participants were at risk for clinical depression; of whom 66% were willing to seek therapeutic or medical help. HIV coinfection (adjusted odds ratio [aOR] = 2.95, 95% confidence interval [CI]: 1.46,6.20), past 30 days illicit drug use (aOR = 3.57, 95% CI = 1.18,11.60), TB stigma (moderate stigma aOR = 7.40, 95% CI = 2.22,34.1; high stigma aOR = 15.50, 95% CI = 4.52,73.20), and unemployment status (aOR = 2.25, 95% CI = 1.12,4.60) were significantly associated with the odds of depressive symptoms among PLWTB. Conclusion: Findings support integration of a brief depression screening tool into routine clinical care of PLWTB/HIV and highlight the importance of linking TB/HIV care with mental health services.

Genetic Characterization of Plasmodium falciparum Histidine-Rich Protein 2 Deletions and Their Impact on Malaria Interventions in Odisha, India

Mohanty, S., Jones, A. M., Dash, S., Chhatria, S. R., Padhan, T. K., Mohanty, S., Carlton, J. M., Ompad, D. C., Kessler, A., & Sahu, P. K. (n.d.).

Publication year

2025

Journal title

American Journal of Tropical Medicine and Hygiene

Volume

112

Issue

3

Page(s)

601-609

10.4269/ajtmh.24-0330

Abstract

Abstract

Diagnostic escape via Plasmodium falciparum (P. falciparum) histidine-rich protein 2 (pfhrp2) gene deletions is a major potential hurdle for global malaria elimination efforts. We investigated the prevalence of pfhrp2 gene deletions in 15 malaria-endemic villages in the state of Odisha, India, and modeled their impact on an ongoing in-country malaria intervention program. We found that 61.6% of subpatent P. falciparum infections (i.e., rapid diagnostic test [RDT]-negative and positive by polymerase chain reaction [PCR]) had pfhrp2 gene deletions, which were predominantly located in the exon 2 region (96.2%) and largely identified in samples from febrile individuals (82.6%). DNA sequencing and protein diversity features were characterized in a subset of samples from individuals with subpatent infections carrying intact pfhrp2 exon 2 loci. Our analyses revealed novel amino acid repeat motifs (231–293 amino acids), and these variant repeat sequences differed from those of RDT1/PCR1 samples. We also evaluated the state-sponsored mass screening and treatment intervention in the context of pfhrp2 gene deletions. We found that mass screening and treatment conducted alongside additional interventions (e.g., long-lasting insecticidal net distribution, indoor residual spraying) reduced the relative risk of infection for both P. falciparum parasites harboring a pfhrp2 deletion (adjusted relative risk ratio [aRRR] 5 0.3; 95% CI 5 0.1–1.0) and P. falciparum parasites with intact pfhrp2 genes (aRRR 5 0.4; 95% CI 5 0.2–1.1) when compared with the use of mass screening and treatment by RDT alone. Combined, our findings highlight the need for alternative diagnostic targets and tools as India moves toward its goal of malaria elimination by 2030.

Harms associated with injecting in public spaces: a global systematic review and meta-analysis

Khezri, M., Kimball, S., McKnight, C., Rouhani, S., Bunting, A. M., Karamouzian, M., Ompad, D. C., & Des Jarlais, D. (n.d.).

Publication year

2025

Journal title

International Journal of Drug Policy

Volume

140

10.1016/j.drugpo.2025.104819

Abstract

Abstract

Background: Despite increasing backlash against harm reduction efforts and the need to understand the risk environments encountered by people who inject drugs (PWID), a quantitative systematic review on public injecting and associated health and drug-related outcomes is lacking. We aimed to summarize the global evidence on the prevalence and harms associated with injecting in public spaces. Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, Scopus, Global Health, and Web of Science from inception to March 21, 2024. We pooled data from included studies using random-effects meta-analyses to quantify the associations between recent (i.e., current or within the last year) public injecting and associated outcomes. Public injecting was defined as injecting in public or semi-public spaces, including streets, parks, and abandoned buildings. Risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tool. Results: Of the 6144 initial records, 84 studies were eligible for inclusion. The pooled prevalence of recent public injecting was 48.85 % (95 % confidence intervals [CI] 43.87, 53.85). Public injecting was associated with increased odds of recent non-fatal overdose (odds ratio [OR] 2.51, 95 % CI 2.01, 3.13), HCV infection (OR 1.55, 95 % CI 1.18, 2.02), recent needle/syringe sharing (OR 2.41, 95 % CI 1.97, 2.94), recent sex work (OR 1.75, 95 % CI 1.03, 2.97), recent incarceration (OR 2.10, 95 % CI 1.78, 2.47), and recent unstable housing/homelessness (OR 4.23, 95 % CI 3.17, 5.65). Public injecting showed a statistically non-significant association with HIV infection (OR 1.41, 95 % CI 0.80, 2.46). Public injecting was also associated with a higher willingness to use supervised injection facilities (OR 2.66, 95 % CI 1.86, 3.80). Conclusion: Public injecting is prevalent among PWID and associated with various adverse drug- and health-related outcomes, highlighting the need for increased access to safe injection spaces. Findings support developing interventions to reduce harms from public injecting, such as addressing structural risks from law enforcement, expanding naloxone programs, and establishing overdose prevention centers. Housing interventions, in particular, could serve as an effective upstream strategy to reduce public injecting and related harms.

Macro-level determinants of gender differences in the prevalence of major depression and alcohol use disorder in the United States and across Europe

Hagen, D., Bambra, C., Ompad, D. C., & Goldmann, E. (n.d.).

Publication year

2025

Journal title

Journal of Affective Disorders

Volume

370

Page(s)

301-312

10.1016/j.jad.2024.10.082

Abstract

Abstract

Background: Major depressive disorder (MDD) and alcohol use disorder (AUD) are leading psychiatric causes of burden of disease. Although research has found pronounced gender differences in these disorders, the magnitude of these differences varies substantially between settings. However, integrated analyses of both disorders are lacking, limiting the comparability of findings. Moreover, few studies conceptualize political and socio-cultural characteristics as separate macro-level determinants of gender differences. This paper analyzes the association between gender differences in the prevalence of both MDD and AUD with social policy expenditures and indicators of gender equality. Methods: Data for adults from the U.S. Behavioral Risk Factor Surveillance System 2006/2008 (n = 234,020) and the European Social Survey 2014 (n = 30,416) were used. Cross-sectional analyses were conducted using modified Poisson regression models adjusted for individual-level and macro-level covariates; multiplicative and additive interaction were evaluated. Results: Social policy expenditures and support for gender equality were negatively associated with gender differences in AUD in Europe (p < 0.001), with the male excess prevalence varying between 26.1 % at lowest and 9.4 % at highest observed levels of expenditures, and between 23.3 % at lowest and 6.8 % at highest levels of gender equality. In the U.S., state-level reproductive rights were negatively associated with gender differences in AUD (p = 0.036). No equivalent effects were observed for gender differences in MDD. Conclusion: The prevalence of AUD among men and women tends to converge in settings with higher levels of social policy generosity and gender equality, respectively. This effect does not seem to apply to gender differences in MDD in either setting.

The impact of the 2014 military conflict in the east of Ukraine and the Autonomous Republic of the Crimea among patients receiving opioid agonist therapies

Meteliuk, A., Sazonova, Y., Goldmann, E., Xu, S., Liutyi, V., Liakh, T., Spirina, T., Lekholetova, M., Islam, Z., & Ompad, D. C. (n.d.).

Publication year

2024

Journal title

Journal of Substance Use and Addiction Treatment

Volume

160

10.1016/j.josat.2024.209312

Abstract

Abstract

Background: Opioid agonist therapies (OAT) for people with opioid use disorders (OUD) have been available in Ukraine since 2004. This study assessed the effect of 2014 Russian invasion of Ukraine on OAT re-enrollment and retention in conflict areas. Methods: We analyzed the Ukraine national registry of OAT patients containing 1868 people with OUD receiving OAT as of January 2014 in conflict areas (Donetsk, Luhansk, and the Autonomous Republic [AR] of the Crimea). We developed logistic regression models to assess the correlates of re-enrollment of OAT patients in government-controlled areas (GCA) from conflict areas and retention on OAT at 12 months after re-enrollment. Results: Overall, 377 (20.2 %) patients were re-enrolled at an OAT site in a GCA from confict areas, of whom 182 (48.3 %) were retained on OAT through 2021. Correlates of re-enrollment were residing in Donetsk (adjusted odds ratios (aOR) = 7.06; 95 % CI: 4.97–10.20) or Luhansk (aOR = 6.20; 95 % CI: 4.38–8.93) vs. AR Crimea; age 18–34 (aOR = 2.03; 95 % CI: 1.07–3.96) or 35–44 (aOR = 2.09; 95 % CI: 1.24–3.71) vs. ≥55 years, and being on optimal (aOR = 1.78; 95 % CI: 1.33–2.39) or high OAT dosing (aOR = 2.76; 95 % CI: 1.93–3.96) vs. low dosing. Correlates of retention were drug use experience 15–19 years (aOR = 3.69; 95 % CI: 1.47–9.49) vs. <14 years of drug use; take-home (aOR = 3.42; 95 % CI: 1.99–5.96) vs. daily on-site dosing, and optimal (aOR = 2.19; 95 % CI:1.05–4.72) vs. low OAT dosing. Conclusion: Our study showed that one-fifth of patients were re-enrolled at sites in GCA areas, less than half of re-enrolled patients were retained. Disruption of OAT has implications for drug-, HIV-, and HCV-related morbidity and mortality. Funding: AM was funded by NIH-funded grant D43TW010562; DCO was funded by the NIDA-funded Center for Drug Use and HIV|HCV Research (P30DA011041).

Creation and Validation of a New Socio-built Environment Index Measure of Opioid Overdose Risk for Use in Both Non-urban and Urban Settings

Williams, L. D., Kolak, M., Villanueva, C., Ompad, D. C., & Tempalski, B. (n.d.).

Publication year

2023

Journal title

Journal of Urban Health

Volume

100

Issue

5

Page(s)

1048-1061

10.1007/s11524-023-00754-7

Abstract

Abstract

A great deal of literature has examined features of the physical built environment as predictors of opioid overdose and other substance use-related outcomes. Other literature suggests that social characteristics of settings are important predictors of substance use outcomes. However, there is a dearth of literature simultaneously measuring both physical and social characteristics of settings in an effort to better predict opioid overdose. There is also a dearth of literature examining built environment as a predictor of overdose in non-urban settings. The present study presents a novel socio-built environment index measure of opioid overdose risk comprised of indicators measuring both social and physical characteristics of settings — and developed for use in both urban and non-urban settings — and assesses its validity among 565 urban, suburban, and rural New Jersey municipalities. We found that this novel measure had good convergent validity, based on significant positive associations with a social vulnerability index and crime rates, and significant negative associations with a municipal revitalization index and high school graduation rates. The index measure had good discriminant validity, based on lack of association with three different racial isolation indices. Finally, our index measure had good health outcome-based criterion validity, based on significant positive associations with recent overdose mortality. There were no major differences between rural, suburban, and urban municipalities in validity analysis findings. This promising new socio-built environment risk index measure could improve ability to target and allocate resources to settings with the greatest risk, in order to improve their impact on overdose outcomes.

How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States

Walters, S. M., Frank, D., Felsher, M., Jaiswal, J., Fletcher, S., Bennett, A. S., Friedman, S. R., Ouellet, L. J., Ompad, D. C., Jenkins, W., & Pho, M. T. (n.d.).

Publication year

2023

Journal title

International Journal of Drug Policy

Volume

112

10.1016/j.drugpo.2022.103930

Abstract

Abstract

Background: Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois. Methods: Nineteen in-depth semi-structured interviews were conducted with PWID from August 2019 through February 2020 (i.e., pre-COVID-19 pandemic) and four with key informants who professionally worked with PWID. Interviews were recorded, professionally transcribed, and coded using qualitative software. We followed a grounded theory approach for coding and analyses. Results: We identify economic, physical, policy, and social factors that may influence HCV transmission risk and serve as barriers to HCV care. Economic instability and lack of economic opportunities, a lack of physically available HCV prevention and treatment services, structural stigma such as policies that criminalize drug use, and social stigma emerged in interviews as potential risks for transmission and barriers to care. Conclusion: The rural risk environment framework acknowledges the importance of community and structural factors that influence HCV infection and other disease transmission and care. We find that larger structural factors produce vulnerabilities and reduce access to resources, which negatively impact hepatitis C disease outcomes.

I Don’t Believe a Person Has to Die When Trying to Get High: Overdose Prevention and Response Strategies in Rural Illinois

Walters, S. M., Felsher, M., Frank, D., Jaiswal, J., Townsend, T., Muncan, B., Bennett, A. S., Friedman, S. R., Jenkins, W., Pho, M. T., Fletcher, S., & Ompad, D. C. (n.d.).

Publication year

2023

Journal title

International journal of environmental research and public health

Volume

20

Issue

2

10.3390/ijerph20021648

Abstract

Abstract

Background: Overdose is a leading cause of morbidity and mortality among people who inject drugs. Illicitly manufactured fentanyl is now a major driver of opioid overdose deaths. Methods: Semi-structured interviews were conducted with 23 participants (19 persons who inject drugs and 4 service providers) from rural southern Illinois. Data were analyzed using constant comparison and theoretical sampling methods. Results: Participants were concerned about the growing presence of fentanyl in both opioids and stimulants, and many disclosed overdose experiences. Strategies participants reported using to lower overdose risk included purchasing drugs from trusted sellers and modifying drug use practices by partially injecting and/or changing the route of transmission. Approximately half of persons who inject drugs sampled had heard of fentanyl test strips, however fentanyl test strip use was low. To reverse overdoses, participants reported using cold water baths. Use of naloxone to reverse overdose was low. Barriers to naloxone access and use included fear of arrest and opioid withdrawal. Conclusions: People who inject drugs understood fentanyl to be a potential contaminant in their drug supply and actively engaged in harm reduction techniques to try to prevent overdose. Interventions to increase harm reduction education and information about and access to fentanyl test strips and naloxone would be beneficial.

The effectiveness of malaria camps as part of the malaria control program in Odisha, India

Ompad, D. C., Padhan, T. K., Kessler, A., Tozan, Y., Jones, A. M., Van Eijk, A. M., Sullivan, S. A., Haque, M. A., Pradhan, M. M., Mohanty, S., Carlton, J. M., & Sahu, P. K. (n.d.).

Publication year

2023

Journal title

Scientific reports

Volume

13

Issue

1

10.1038/s41598-023-46220-x

Abstract

Abstract

Durgama Anchalare Malaria Nirakaran (DAMaN) is a multi-component malaria intervention for hard-to-reach villages in Odisha, India. The main component, malaria camps (MCs), consists of mass screening, treatment, education, and intensified vector control. We evaluated MC effectiveness using a quasi-experimental cluster-assigned stepped-wedge study with a pretest–posttest control group in 15 villages: six immediate (Arm A), six delayed (Arm B), and three previous interventions (Arm C). The primary outcome was PCR + Plasmodium infection prevalence. The time (i.e., baseline vs. follow-up 3) x study arm interaction term shows that there were statistically significant lower odds of PCR + Plasmodium infection in Arm A (AOR = 0.36, 95% CI = 0.17, 0.74) but not Arm C as compared to Arm B at the third follow-up. The cost per person ranged between US$3–8, the cost per tested US$4–9, and the cost per treated US$82–1,614, per camp round. These results suggest that the DAMaN intervention is a promising and financially feasible approach for malaria control.

Conceptualizing the Socio-Built Environment: An Expanded Theoretical Framework to Promote a Better Understanding of Risk for Nonmedical Opioid Overdose Outcomes in Urban and Non-Urban Settings

Tempalski, B., Williams, L. D., Kolak, M., Ompad, D. C., Koschinsky, J., & McLafferty, S. L. (n.d.).

Publication year

2022

Journal title

Journal of Urban Health

Volume

99

Issue

4

Page(s)

701-716

10.1007/s11524-022-00645-3

Abstract

Abstract

Nonmedical opioid (NMO) use has been linked to significant increases in rates of NMO morbidity and mortality in non-urban areas. While there has been a great deal of empirical evidence suggesting that physical features of built environments represent strong predictors of drug use and mental health outcomes in urban settings, there is a dearth of research assessing the physical, built environment features of non-urban settings in order to predict risk for NMO overdose outcomes. Likewise, there is strong extant literature suggesting that social characteristics of environments also predict NMO overdoses and other NMO use outcomes, but limited research that considers the combined effects of both physical and social characteristics of environments on NMO outcomes. As a result, important gaps in the scientific literature currently limit our understanding of how both physical and social features of environments shape risk for NMO overdose in rural and suburban settings and therefore limit our ability to intervene effectively. In order to foster a more holistic understanding of environmental features predicting the emerging epidemic of NMO overdose, this article presents a novel, expanded theoretical framework that conceptualizes “socio-built environments” as comprised of (a) environmental characteristics that are applicable to both non-urban and urban settings and (b) not only traditional features of environments as conceptualized by the extant built environment framework, but also social features of environments. This novel framework can help improve our ability to identify settings at highest risk for high rates of NMO overdose, in order to improve resource allocation, targeting, and implementation for interventions such as opioid treatment services, mental health services, and care and harm reduction services for people who use drugs.

Copycat and lookalike edible cannabis product packaging in the United States

Ompad, D. C., Snyder, K. M., Sandh, S., Hagen, D., Collier, K. J., Goldmann, E., Goodman, M. S., & Tan, A. S. (n.d.).

Publication year

2022

Journal title

Drug and alcohol dependence

Volume

235

10.1016/j.drugalcdep.2022.109409

Abstract

Abstract

Background: Recent media reports have highlighted copycat/lookalike cannabis edibles as a public health concern. No empirical papers have described this phenomenon. Methods: From May 2020-August 2021, we collected photos of cannabis products via an online survey of cannabis users and through personal contacts. Copycat/lookalike products are defined as those that use the same or similar brand name, logo, and/or imagery as an existing commercial non-cannabis counterpart (CNCC). We assessed each package for similarities with its CNCC with respect to brand name, product name, font, color, flavors, and brand/promotional characters. We examined cannabis content indicators including: THC content per package and serving, cannabis leaf symbol, product warnings, cannabis terms, cannabis motifs, activation time, and guidance on edible use. Results: We collected photos of 731 cannabis products; 267 (36%) were edibles of which 22 (8%) represented 13 unique copycat/lookalike products. Eight used exact brand/product names as existing CNCCs, and five used similar names. Packages copied or imitated a mean of 3.9 of six features and indicated cannabis content with a mean of 4.1 of eight features. Thirteen packages indicated a mean THC content of 459 mg/package. Four reported THC dose per serving, with a mean dose of 47.5 mg. Conclusions: Our content analysis highlights three key concerns. First, copycat/lookalike edibles subtly indicate cannabis content while using high fidelity replication or imitation of their CNCC. Second, THC content is high and there were multiple 10 mg THC doses in the equivalent of 1 serving of a CNCC. Third, these products may be attractive to children.

No Good Time Without Drugs: Qualitative Study Among Nightlife Attendees in Tbilisi, Georgia

Kirtadze, I., Mgebrishvili, T., Beselia, A., Gvasalia, T., Chokheli, M., Ompad, D. C., & Otiashvili, D. (n.d.).

Publication year

2022

Journal title

Adiktologie

Volume

22

Issue

3

Page(s)

152-160

10.35198/01-2022-003-0003

Abstract

Abstract

INTRODUCTION: Individuals who visit nightclubs and electronic dance music (EDM) festivals tend to use psychoactive substances, often multiple substances, in this setting and are at risk of serious negative health effects. This paper aims to explore respondents’ experiences and perceptions in order to have a better understanding of patterns and motives related to psychoactive substance use and high-risk behaviours in EDM event attendees. METHODS: In-depth and focus group interviews with 30 EDM event attendees who reported psychoactive substance use at nightlife events. The data was analysed using the Nvivo-v.10 software. RESULTS: Mixing multiple substances to get the desired effects was common. Ecstasy was often combined with Jager (alcohol). Drug use in nightlife settings occurred in a group of friends and was perceived as an essential part of having a good time. Most participants reported that they did not use drugs outside nightlife settings. The dangerous synthetic hallucinogen NBOMe was still on the scene. The respondents had a very low level of knowledge about, and perception of, the risks associated with drug consumption. Knowledge about risk minimisation strategies was very low or non-existent. CONCLUSIONS: Polydrug use and a lack of perceived harmful effects put drug-using nightlife attendees at increased risk of negative health consequences. Future research should focus on identifying strategies to raise the awareness of people who use drugs in nightlife settings and encourage them to employ health protection strategies. Using the social network infrastructure can be thought of as one potentially beneficial approach.

Predictors of Anal High-Risk HPV Infection Across Time in a Cohort of Young Adult Sexual Minority Men and Transgender Women in New York City, 2015–2020

LoSchiavo, C., D’Avanzo, P. A., Emmert, C., Krause, K. D., Ompad, D. C., Kapadia, F., & Halkitis, P. N. (n.d.).

Publication year

2022

Journal title

American Journal of Men's Health

Volume

16

Issue

4

10.1177/15579883221119084

Abstract

Abstract

Cisgender sexual minority men (SMM) and transgender women are disproportionately vulnerable to HPV-related anal cancer, but little is known about longitudinal predictors of high-risk human papillomavirus (hrHPV) infection in this population. As such, this analysis aims to identify factors associated with incident anal hrHPV infection in a diverse cohort of young SMM and transgender women. This study of HPV infection, nested within a larger cohort study, took place between October 2015 and January 2020. Participants completed a brief computer survey assessing HPV symptomatology, risk, and prevention alongside multi-site testing, in addition to biannual cohort study assessments. In the analytic sample of 137 participants, 31.6% tested positive for an anal hrHPV infection, with 27.0% and 29.9% testing positive for incident anal hrHPV infections at Visits 2 and 3, respectively. When adjusting for time between study visits, participants had significantly greater odds of incident anal hrHPV at Visit 2 if they had a concurrent HSV infection (AOR = 5.08 [1.43, 18.00]). At Visit 3, participants had significantly greater odds of incident anal hrHPV infection if they reported a greater number of sex partners in the previous month (AOR = 1.25 [1.03, 1.51]). Prevalence of cancer-causing HPV at baseline was high and many participants tested positive for additional types of anal hrHPV at subsequent visits. Risk for newly detected anal hrHPV infection was significantly associated with biological and behavioral factors. Our findings strongly indicate a need for programs to increase uptake of HPV vaccination and provide HPV-related health education for sexual and gender minorities.

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

Walters, S. M., Frank, D., Van Ham, B., Jaiswal, J., Muncan, B., Earnshaw, V., Schneider, J., Friedman, S. R., & Ompad, D. C. (n.d.).

Publication year

2022

Journal title

AIDS and Behavior

Volume

26

Issue

4

Page(s)

1308-1320

10.1007/s10461-021-03488-2

Abstract

Abstract

Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.

Presence of Content Appealing to Youth on Cannabis-Infused Edibles Packaging

Tan, A. S., Weinreich, E., Padon, A., Sanchez, M., Snyder, K. M., Vasilyeva, A., Sandh, S., Goldmann, E., Goodman, M., & Ompad, D. C. (n.d.).

Publication year

2022

Journal title

Substance Use and Misuse

Volume

57

Issue

8

Page(s)

1215-1219

10.1080/10826084.2022.2069268

Abstract

Abstract

Background: There is a lack of consistent regulation of cannabis edibles packaging to restrict youth-appealing content in the United States. Objective: To describe content appealing to youth on U.S. cannabis-infused edibles packaging. Methods: We analyzed 256 photos of cannabis-infused edibles packaging collected from U.S. adults from 25 states, District of Columbia, and Puerto Rico between May 2020 to August 2021. We coded the presence of product knockoffs, human and non-human creatures, images indicating flavor, text indicating flavor, and the number of colors. We compared these codes across states’ legalization status (medical and non-medical cannabis, medical cannabis only, or limited cannabis legalization). Results: Overall, 15% of packages resembled product knockoffs, 23% contained human/non-human creatures, 35% contained flavor images, 91% contained flavor text, and median number of colors was 5 (range from 1 to 10+). Packages purchased in states with medical and non-medical cannabis, medical cannabis only, or limited cannabis legalization differed significantly on product knockoffs (11%, 26%, 38%, p = 0.007), human/non-human creatures (19%, 33%, 63%, p = 0.002), flavor text (93%, 81%, 100%, p = 0.046), and number of colors (median of 5, 5, and 10, p = 0.022). Conclusions: Existing laws have not adequately limited content appealing to youth on U.S. cannabis-infused edibles packaging. Robust and consistent regulations in the U.S. are needed to ensure that the packaging of such products does not contain content that appeal to youth and lead to initiation or inadvertent ingestion.

Principles and Metrics for Evaluating Oregon’s Innovative Drug Decriminalization Measure

Netherland, J., Kral, A. H., Ompad, D. C., Davis, C. S., Bluthenthal, R. N., Dasgupta, N., Gilbert, M., Morgan, R., & Wheelock, H. (n.d.).

Publication year

2022

Journal title

Journal of Urban Health

Volume

99

Issue

2

Page(s)

328-331

10.1007/s11524-022-00606-w

Structural and community changes during COVID-19 and their effects on overdose precursors among rural people who use drugs: a mixed-methods analysis

Walters, S. M., Bolinski, R. S., Almirol, E., Grundy, S., Fletcher, S., Schneider, J., Friedman, S. R., Ouellet, L. J., Ompad, D. C., Jenkins, W., & Pho, M. T. (n.d.).

Publication year

2022

Journal title

Addiction Science and Clinical Practice

Volume

17

Issue

1

10.1186/s13722-022-00303-8

Abstract

Abstract

Background: Drug overdose rates in the United States have been steadily increasing, particularly in rural areas. The COVID-19 pandemic and associated mitigation strategies may have increased overdose risk for people who use drugs by impacting social, community, and structural factors. Methods: The study included a quantitative survey focused on COVID-19 administered to 50 people who use drugs and semi-structured qualitative interviews with 17 people who use drugs, 12 of whom also participated in the quantitative survey. Descriptive statistics were run for the quantitative data. Qualitative coding was line-by-line then grouped thematically. Quantitative and qualitative data were integrated during analysis. Results: Findings demonstrate how COVID-19 disruptions at the structural and community level affected outcomes related to mental health and drug use at the individual level. Themes that emerged from the qualitative interviews were (1) lack of employment opportunities, (2) food and housing insecurity, (3) community stigma impacting health service use, (4) mental health strains, and (5) drug market disruptions. Structural and community changes increased anxiety, depression, and loneliness on the individual level, as well as changes in drug use patterns, all of which are likely to increase overdose risk. Conclusion: The COVID-19 pandemic, and mitigation strategies aimed at curbing infection, disrupted communities and lives of people who use drugs. These disruptions altered individual drug use and mental health outcomes, which could increase risk for overdose. We recommend addressing structural and community factors, including developing multi-level interventions, to combat overdose. Trial registration Clinicaltrails.gov: NCT04427202. Registered June 11, 2020: https://clinicaltrials.gov/ct2/show/NCT04427202?term=pho+mai&draw=2&rank=3.

The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings

Bolinski, R. S., Walters, S., Salisbury-Afshar, E., Ouellet, L. J., Jenkins, W. D., Almirol, E., Van Ham, B., Fletcher, S., Johnson, C., Schneider, J. A., Ompad, D., & Pho, M. T. (n.d.).

Publication year

2022

Journal title

International journal of environmental research and public health

Volume

19

Issue

4

10.3390/ijerph19042230

Abstract

Abstract

Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.

Acceptability and Effectiveness of Hepatitis C Care at Syringe Service Programs for People Who Inject Drugs in New York City

Muncan, B., Jordan, A. E., Perlman, D. C., Frank, D., Ompad, D. C., & Walters, S. M. (n.d.).

Publication year

2021

Journal title

Substance Use and Misuse

Volume

56

Issue

5

Page(s)

728-737

10.1080/10826084.2021.1892142

Abstract

Abstract

Introduction/Objectives: The incidence of hepatitis C (HCV) infection is rising among people who inject drugs (PWID). Even in the context of known HCV prevention and treatment strategies, some PWID remain unengaged in HCV care. This study aimed to identify and characterize experiences and perceptions of PWID regarding the acceptability and effectiveness of HCV testing and treatment at a local syringe service program (SSP). Methods: A total of 36 PWID participated in semi-structured interviews at an SSP in New York City. Interviews were audio-recorded, transcribed, and coded by three coders, following a constructivist grounded theory approach. Relevant themes were identified as they emerged from the data. Results: Interviews with PWID revealed three themes related to the impact of SSPs on HCV care: (1) non-stigmatizing SSP environments, (2) the role of SSPs in improving HCV knowledge, and (3) acceptability of SSPs as sites for HCV care among PWID. Discussion: This paper contributes to the ongoing understanding that SSPs provide a well-accepted source of HCV services for PWID. Participants believed that SSPs are accessible and effective sites for HCV care, and suggested that stigma among PWID continues to affect receipt of HCV care in traditional settings. Conclusions: Understanding attitudes and beliefs of PWID regarding the effectiveness of SSPs as sites for HCV care is crucial for the development of focused strategies to reduce HCV transmission, and to ultimately achieve HCV elimination. Given this, further research is warranted investigating how best to improve HCV care at harm reduction sites such as SSPs.

Dominican Provider Attitudes Towards HPV Testing for Cervical Cancer Screening and, Current Challenges to Cervical Cancer Prevention in the Dominican Republic: a Mixed Methods Study

Liebermann, E., Van Devanter, N., Frías Gúzman, N., Hammer, M. J., & Ompad, D. (n.d.).

Publication year

2021

Journal title

Journal of Cancer Education

Volume

36

Issue

6

Page(s)

1170-1185

10.1007/s13187-020-01746-w

Abstract

Abstract

Creating effective programs for cervical cancer prevention is essential to avoid premature deaths from cervical cancer. The Dominican Republic has persistently high rates of cervical cancer, despite the availability of Pap smear screening. This study explored Dominican provider attitudes towards human papillomavirus (HPV) testing and current challenges to effective cervical cancer prevention. In this Consolidated Framework for Implementation Research (CFIR)–driven mixed methods study, we conducted in-depth interviews (N = 21) and surveys (N = 202) with Dominican providers in Santo Domingo and Monte Plata provinces regarding their perspectives on barriers to cervical cancer prevention and their knowledge and attitudes towards HPV testing as an alternative to Pap smear. Providers believed the main barrier to cervical cancer prevention was lack of cervical cancer awareness and resulting inadequate population screening coverage. Providers felt that Pap smear was widely available to women in the Dominican Republic and were unsure how a change to HPV testing for screening would address gaps in current cervical cancer screening programs. A subset of providers felt HPV testing offered important advantages for early detection of cervical cancer and were in favor of more widespread use. Cost of the HPV test and target age for screening with HPV testing were the main barriers to acceptability. Providers had limited knowledge of HPV testing as a screening test. The group was divided in terms of the potential impact of a change in screening test in addressing barriers to cervical cancer prevention in the Dominican Republic. Findings may inform interventions to disseminate global evidence-based recommendations for cervical cancer screening.

Dominican Provider Practices for Cervical Cancer Screening in Santo Domingo and Monte Plata Provinces

Liebermann, E., Hammer, M. J., Gúzman, N. F., Van Devanter, N., & Ompad, D. (n.d.).

Publication year

2021

Journal title

Journal of Cancer Education

Volume

36

Issue

4

Page(s)

693-701

10.1007/s13187-020-01690-9

Abstract

Abstract

Cervical cancer is the second leading cause of cancer death for women in the Dominican Republic. Pap smear screening in the Dominican Republic has not achieved adequate reduction in cervical cancer mortality. The purpose of this study was to examine Dominican provider practices for cervical cancer screening and the use of national or international screening guidelines. We surveyed 101 gynecology specialists, 50 non-specialists, and 51 obstetrics-gynecology residents in the Santo Domingo and Monte Plata provinces of the Dominican Republic regarding their cervical cancer screening practices and use of guidelines. Bivariate (chi-square) analyses were conducted to compare screening practices by demographic and practice characteristics. The majority of providers followed WHO guidelines (62.9%) and/or Dominican national norms (59.4%). The majority (87%) of providers use time since first sexual activity as the basis for screening initiation; 96% advise screening every 6–12 months. The most commonly used screening test is the conventional Pap smear. Colposcopy was recommended most often for all abnormal Pap results. Dominican providers report they follow national and/or international cervical cancer screening guidelines. They do not follow age-based screening guidelines, nor have they adopted an extended interval for screening and continue to recommend screening at least annually. A culture of early and frequent screening has consequences in terms of cost, high demand for follow-up services, and reduced capacity to reach the populations at highest risk. Early screening also may challenge the acceptability of adopting alternative screening technologies such as HPV testing.

How urban and rural built environments influence the health attitudes and behaviors of people who use drugs

Ezell, J. M., Ompad, D. C., & Walters, S. (n.d.).

Publication year

2021

Journal title

Health and Place

Volume

69

10.1016/j.healthplace.2021.102578

Abstract

Abstract

Research suggests that the built environment is associated with drug use. However, there is limited scholarship focusing on specific features of the built environment that influence drug use behaviors, experiences, and patterns and how risk factors for drug use are placed in distinctive urban and rural settings. Applying Neely and Samura's conceptual theory that describes space as contested, fluid and historical, interactional and relational, and defined by inequality and difference, we assessed data from semi-structured qualitative interviews conducted between 2019 and 2020 with consumers at syringe exchange programs (SEPs) in an urban location (New York City) and a rural location (southern Illinois). We aimed to contextualize how drug use manifests in each space. In total, 65 individuals, including 59 people who use drugs (PWUD) and six professionals who worked with PWUD, were interviewed. Findings illustrate that, in both the urban and rural setting, the built environment regulates the drug use milieu by mediating social reproduction, namely the degree of agency PWUD exert to acquire and use drugs where they desire. Processes of “stigma zoning,” defined as socio-spatial policing of boundaries of behavior deemed undesirable or deviant, impacted PWUD's socio-geographic mobility, social conditions, and resource access, and modulated PWUD's broader capacity and self-efficacy. Similar patterns of drug use, according to social and economic inequities chiefly related to housing instability, were further observed in both settings.

Racial and ethnic disparities in "stop-and-frisk" experience among young sexual minority men in New York City

Khan, M. R., Kapadia, F., Geller, A., Mazumdar, M., Scheidell, J. D., Krause, K. D., Martino, R. J., Cleland, C. M., Dyer, T. V., Ompad, D. C., & Halkitis, P. N. (n.d.).

Publication year

2021

Journal title

PloS one

Volume

16

Issue

8

10.1371/journal.pone.0256201

Abstract

Abstract

Although racial/ethnic disparities in police contact are well documented, less is known about other dimensions of inequity in policing. Sexual minority groups may face disproportionate police contact. We used data from the P18 Cohort Study (Version 2), a study conducted to measure determinants of inequity in STI/HIV risk among young sexual minority men (YSMM) in New York City, to measure across-time trends, racial/ethnic disparities, and correlates of self-reported stop-and-frisk experience over the cohort follow-up (2014-2019). Over the study period, 43% reported stop-and-frisk with higher levels reported among Black (47%) and Hispanic/Latinx (45%) than White (38%) participants. Stop-and-frisk levels declined over follow-up for each racial/ethnic group. The per capita rates among P18 participants calculated based on self-reported stop-and-frisk were much higher than rates calculated based on New York City Police Department official counts. We stratified respondents' ZIP codes of residence into tertiles of per capita stop rates and observed pronounced disparities in Black versus White stop-and-frisk rates, particularly in neighborhoods with low or moderate levels of stop-and-frisk activity. YSMM facing the greatest economic vulnerability and mental disorder symptoms were most likely to report stop-and-frisk. Among White respondents levels of past year stop-and-frisk were markedly higher among those who reported past 30 day marijuana use (41%) versus those reporting no use (17%) while among Black and Hispanic/Latinx respondents stop-and-frisk levels were comparable among those reporting marijuana use (38%) versus those reporting no use (31%). These findings suggest inequity in policing is observed not only among racial/ethnic but also sexual minority groups and that racial/ethnic YSMM, who are at the intersection of multiple minority statuses, face disproportionate risk. Because the most socially vulnerable experience disproportionate stop-and-frisk risk, we need to reach YSMM with community resources to promote health and wellbeing as an alternative to targeting this group with stressful and stigmatizing police exposure.

The effectiveness of malaria camps as part of the Durgama Anchalare Malaria Nirakaran (DAMaN) program in Odisha, India: study protocol for a cluster-assigned quasi-experimental study

Ompad, D. C., Kessler, A., Van Eijk, A. M., Padhan, T. K., Haque, M. A., Sullivan, S. A., Tozan, Y., Rocklöv, J., Mohanty, S., Pradhan, M. M., Sahu, P. K., & Carlton, J. M. (n.d.).

Publication year

2021

Journal title

Global Health Action

Volume

14

Issue

1

10.1080/16549716.2021.1886458

Abstract

Abstract

The Indian state of Odisha has a longstanding battle with forest malaria. Many remote and rural villages have poor access to health care, a problem that is exacerbated during the rainy season when malaria transmission is at its peak. Approximately 62% of the rural population consists of tribal groups who are among the communities most negatively impacted by malaria. To address the persistently high rates of malaria in these remote regions, the Odisha State Malaria Control Program introduced ‘malaria camps’ in 2017 where teams of health workers visit villages to educate the population, enhance vector control methods, and perform village-wide screening and treatment. Malaria rates declined statewide, particularly in forested areas, following the introduction of the malaria camps, but the impact of the intervention is yet to be externally evaluated. This study protocol describes a cluster-assigned quasi-experimental stepped-wedge study with a pretest-posttest control group design that evaluates if malaria camps reduce the prevalence of malaria, compared to control villages which receive the usual malaria control interventions (e.g. IRS, ITNs), as detected by PCR.

"they look at us like junkies": Influences of drug use stigma on the healthcare engagement of people who inject drugs in New York City

Muncan, B., Walters, S. M., Ezell, J., & Ompad, D. C. (n.d.).

Publication year

2020

Journal title

Harm Reduction Journal

Volume

17

Issue

1

10.1186/s12954-020-00399-8

Abstract

Abstract

Background: People who inject drugs (PWID) are a medically and socially vulnerable population with a high incidence of overdose, mental illness, and infections like HIV and hepatitis C. Existing literature describes social and economic correlations to increased health risk, including stigma. Injection drug use stigma has been identified as a major contributor to healthcare disparities for PWID. However, data on this topic, particularly in terms of the interface between enacted, anticipated, and internalized stigma, is still limited. To fill this gap, we examined perspectives from PWID whose stigmatizing experiences impacted their views of the healthcare system and syringe service programs (SSPs) and influenced their decisions regarding future medical care. Methods: Semi-structured interviews conducted with 32 self-identified PWID in New York City. Interviews were audio recorded and transcribed. Interview transcripts were coded using a grounded theory approach by three trained coders and key themes were identified as they emerged. Results: A total of 25 participants (78.1%) reported at least one instance of stigma related to healthcare system engagement. Twenty-three participants (71.9%) reported some form of enacted stigma with healthcare, 19 participants (59.4%) described anticipated stigma with healthcare, and 20 participants (62.5%) reported positive experiences at SSPs. Participants attributed healthcare stigma to their drug injection use status and overwhelmingly felt distrustful of, and frustrated with, medical providers and other healthcare staff at hospitals and local clinics. PWID did not report internalized stigma, in part due to the availability of non-stigmatizing medical care at SSPs. Conclusions: Stigmatizing experiences of PWID in formal healthcare settings contributed to negative attitudes toward seeking healthcare in the future. Many participants describe SSPs as accessible sites to receive high-quality medical care, which may curb the manifestation of internalized stigma derived from negative experiences in the broader healthcare system. Our findings align with those reported in the literature and reveal the potentially important role of SSPs. With the goal of limiting stigmatizing interactions and their consequences on PWID health, we recommend that future research include explorations of mechanisms by which PWID make decisions in stigmatizing healthcare settings, as well as improving medical care availability at SSPs.