Saba Rouhani

Assistant Professor of Epidemiology

Professional overview

Dr. Saba Rouhani is an Assistant Professor in the Department of Epidemiology at GPH. She conducts research in social epidemiology, policy evaluation, and overdose prevention. 

Prior to joining NYU Dr. Rouhani worked as research faculty in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health. She also completed a fellowship funded by the National Institutes of Health/National Institute on Drug Abuse. Her research has been published in the International Journal of Drug Policy, Drug and Alcohol Dependence, the Journal of Urban Health, and the American Journal of Public Health and Preventive Medicine.

Dr. Rouhani received her PhD in global disease epidemiology and control from the Johns Hopkins Bloomberg School of Public Health. She holds an MSc in the control of infectious diseases from the London School of Hygiene and Tropical Medicine, and a BSc in medical microbiology from the University of Edinburgh.

Education

PhD Global Disease Epidemiology & Control, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

MS Control of Infectious Diseases, The London School of Hygiene & Tropical Medicine, London, United Kingdom

BS Medical Microbiology, University of Edinburgh, Edinburgh, United Kingdom

Honors and awards

Drug Dependency Epidemiology Training (T32) Fellowship, National Institute of Drug Abuse, National Institutes of Health (2018)

The R. Bradley Sack Family Scholarship Award, Johns Hopkins Bloomberg School of Public Health (2016)

Global Health Established Field Placement Scholarship, Johns Hopkins Bloomberg School of Public Health (2014)

Save the Children Program Management Award, Save the Children International (2012)

Royal Society of Tropical Medicine and Hygiene Award for Best Poster Presentation of Research in Progress (2012)

Publications

Publications

Business and Service Provider Attitudes Towards Police Involvement in Overdose Response: A Cross-Sectional Survey in Rhode Island Overdose Hotspots.

Rouhani, S., Rosen, J. G., Pozo, B. D., Figgatt, M., Aslam, R., Rich, J. D., & Park, J. N. (n.d.).

Publication year

2026

Journal title

J Community Health

Abstract

Abstract

Police presence at overdose scenes can deter life-saving help-seeking behaviors due to fear of legal consequences, leading some jurisdictions to consider police non-attendance policies. However, business stakeholders' attitudes toward the role of law enforcement in overdose response remain understudied. We surveyed 100 business employees and service providers in areas of high overdose concentration in Rhode Island from November 2022 to April 2024. Participants completed structured questionnaires assessing attitudes toward police effectiveness in overdose prevention, service linkage, and public safety. Participants expressed mixed views on police effectiveness: 39% believed police presence helps prevent overdoses, 40% felt it connects people who use drugs to services, and 52% thought it prevents drug selling. Most (66%) agreed police keep communities safe, yet only 5% endorsed incarceration for people who use drugs. Significant variations in attitudes were observed by race, urbanicity, and organization type, including near-universal opposition to incarcerating people who use drugs. While stakeholders valued police for general safety, most did not endorse their effectiveness in overdose prevention and service linkage. Policymakers implementing police non-attendance or alternative response models must proactively engage diverse local stakeholders to address specific safety concerns while leveraging the community's existing receptivity toward non-punitive overdose interventions.

Ghost gun recovery and firearm deaths in California, 2014-2023.

Bather, J. R., Mauri, A. I., Lindenfeld, Z., Rouhani, S., Chen, R., Fang, J., Pag??n, J. A., Silver, D., & Goodman, M. S. (n.d.).

Publication year

2026

Journal title

J Epidemiol Community Health

Page(s)

jech

Abstract

Abstract

BACKGROUND: We investigated whether ghost gun recovery rates are significantly associated with firearm mortality rates in the following year across California's 58 counties from 2014 to 2023. METHODS: We obtained yearly county-level data on ghost guns recovered in California from The Trace's Gun Violence Data Hub. County-level firearm death counts (total, suicide and homicide) were pulled from the Centers for Disease Control and Prevention's Restricted-Use Vital Statistics Data. Spatiotemporal models quantified the covariate-adjusted associations between ghost gun recoveries per capita and firearm death rates (total, suicide and homicide) in the following year. Secondary analyses examined suicide and homicide models stratified by sex and race/ethnicity. RESULTS???: For every 20 ghost guns recovered per 100???000 population, there was an associated 6.4% increase in firearm suicide rate (adjusted incidence rate ratio (aIRR): 1.064, 95% credible interval (CrI) 1.019 to 1.111) in the following year. We found no evidence of a significant ghost gun recovery association with total firearm death rate (aIRR: 1.036, 95% CrI 0.999 to 1.075) and firearm homicide rates (aIRR: 1.002, 95% CrI 0.946 to 1.064). Stratified models for firearm suicide rates suggested variations across sex and racial/ethnic groups, with significant positive associations observed for male (6.5% increase; aIRR: 1.065, 95% CrI 1.017 to 1.115), non-Hispanic white (6.2% increase; aIRR: 1.062, 95% CrI 1.005 to 1.122) and Hispanic (12.6% increase; aIRR: 1.126, 95% CrI 1.031 to 1.230) individuals. A different pattern emerged for firearm homicide death rates, where associations across demographic groups were not statistically significant. CONCLUSIONS: Practitioners concentrating on suicide prevention efforts should be advised about the threat that ghost guns may present.

Higher levels of naloxone protection are associated with lower risk-taking: A longitudinal analysis of New York City residents using unprescribed opioids.

Elliott, L., Harris, A., Crasta, D., Goodman, M. S., Chen, Y., Rouhani, S., Frank, D., Bather, J. R., & Bennett, A. S. (n.d.).

Publication year

2026

Journal title

Drug Alcohol Depend

Volume

278

Page(s)

112989

Abstract

Abstract

OBJECTIVE: To apply risk compensation theory to naloxone peer access and evaluate whether reported naloxone protection-having naloxone and someone to administer it present when using unprescribed opioids-correlated with greater opioid overdose risk behaviors. METHODS: Longitudinal cohort of 422 NYC residents using unprescribed opioids who completed at least three monthly surveys over 24 months. Mixed-effects models estimated unadjusted and adjusted associations between naloxone protection and both opioid risk and overdose events and were used to test whether race/ethnicity and gender modified the relationship between naloxone protection and risk behaviors. RESULTS: Being protected 75???% of the time or more was identified as a meaningful cutoff in the sample and was associated with fewer opioid risk behaviors and overdose events. Race/ethnicity, but not gender, was found to be a significant effect modifier of naloxone protection. CONCLUSIONS: Findings indicate no support for the risk compensation-derived hypothesis that people who use opioids while protected by naloxone pursue more overdose-associated risk behaviors than those unprotected. POLICY IMPLICATIONS: Concerns about how naloxone may disinhibit people who use opioids, leading to greater risk-taking, appear unfounded, reaffirming the importance of universal naloxone access.

HIV prevalence, risk behaviours, and cascade of care among men who have sex with men in Iran: a nationwide, cross-sectional, biobehavioural survey.

Khezri, M., Mehmandoost, S., Tavakoli, F., Rouhani, S., Mehrabi, F., Nourolahzadeh, E., Vassigh, A., Doroudi, F., Haghdoost, A. A., Karamouzian, M., & Sharifi, H. (n.d.).

Publication year

2026

Journal title

Lancet HIV

Volume

13

Issue

2

Page(s)

e116

Abstract

Abstract

BACKGROUND: Men who have sex with men (MSM) in the Middle East and north Africa are often referred to as hard-to-reach because same-sex practices are subject to pervasive stigma, which hinders epidemiological surveillance. We examined HIV prevalence, risk behaviours, and cascade of care among MSM in Iran. METHODS: We did a cross-sectional biobehavioural survey using respondent-driven sampling (RDS) in eight major Iranian cities between August, 2021, and July, 2022. MSM aged 18 years or older who reported oral or anal sex with another man in the past 12 months were recruited, tested for HIV, and completed structured interviews on sociodemographics, substance use, and sexual behaviours. Multivariable logistic regression was used to identify factors associated with HIV seropositivity. FINDINGS: Among 1131 MSM enrolled (mean age 29 years), 136 (12%) identified as transgender women. 63 (5??6%) had HIV (RDS-adjusted HIV prevalence 4??2%, 95% CI 2??5-5??8). In multivariable analysis, HIV seropositivity was positively associated with older age (adjusted odds ratio 4??12, 95% CI 1??72-9??88), lifetime sex work (2??22, 1??24-3??98), incarceration (2??31, 1??11-4??83), and easy access to free condoms in the last 3 months (4??95, 2??40-10??20). HIV seropositivity was also negatively associated with being bisexual compared to being homosexual (0??29, 0??11-0??76). Of 63 MSM with HIV, 44 (70%) were aware of their status, 42 (67%) were linked to care, 39 (62%) were on antiretroviral therapy (ART), and 22 (35%) achieved viral suppression. INTERPRETATION: This study highlights the ongoing HIV burden among MSM in Iran, which is higher than burdens in all other key populations. While two-thirds of MSM living with HIV were aware of their status and engaged in care, gaps remain in HIV testing, ART initiation, and viral suppression. Targeted interventions addressing sociocultural, structural, and behavioural issues are crucial for improving HIV-related outcomes in this underserved population in Iran. FUNDING: UNAIDS.

If you've ever experienced it, you'd feel differently: Exploring willingness and skepticism toward using higher dose naloxone products among people who use drugs in Maryland, United States

Sisson, L. N., Rousch, R. S., Hill, L. G., Zagorski, C. M., Triece, T., Rouhani, S., Owczarzak, J., Sherman, S. G., & Schneider, K. E. (n.d.).

Publication year

2026

Journal title

Addiction

Volume

n/a

Issue

n/a

10.1111/add.70447

Abstract

Abstract

~

Legal Financial Obligations: An Understudied Public Health Exposure.

Lindenfeld, Z., & Rouhani, S. (n.d.).

Publication year

2026

Journal title

Am J Prev Med

Page(s)

108312

Abstract

Abstract

The impacts of exposure to the criminal justice system on health-related outcomes are well studied in the United States (US). However, while previous studies focus on the impacts of arrest, incarceration and re-entry on health, they neglect a critical component of the criminal justice system: legal financial obligations (LFO's). LFOs, which include fines, fees, and other surcharges are levied at nearly every stage of the criminal justice process, entrench individuals into a cycle of poverty and exacerbate known social determinants of health such as food and housing instability and loss of health insurance. Although LFOs are the most widely-used form of punishment in the US, they are understudied as a public health exposure. This paper represents a call for researchers to address this gap in knowledge by including measures of LFOs in research related to the impacts of criminal justice exposure. This article describes what is known in the literature around LFOs, presents a framework outlining hypothesized pathways linking LFOs to health outcomes, discusses gaps in research related to public health costs and outcomes, and highlights critical areas for future research.

Racial discrimination and perceptions of police among US adults.

Huang, M., Bather, J. R., Cuevas, A. G., & Rouhani, S. (n.d.).

Publication year

2026

Journal title

Health Justice

Abstract

Abstract

~

Specialized Mental Health Crisis Response Activities Within US Law Enforcement Agencies.

Lindenfeld, Z., Mauri, A. I., Rouhani, S., & Willison, C. E. (n.d.).

Publication year

2026

Journal title

Community Ment Health J

Volume

62

Issue

1

Page(s)

127

Abstract

Abstract

OBJECTIVE: This study examines the prevalence of specialized police responses to persons experiencing a mental health crisis across U.S. law enforcement agencies and explores whether organizational and community factors are associated with their presence. METHODS: This study used 2020 data from a nationally representative survey of over 2,500 law enforcement agencies. The primary outcomes included whether agencies implemented one of four responses: (1) designated unit, (2) designated personnel, (3) addressed mental health without designated unit or personnel, or (4) did not address. Logistic regression models assessed factors associated with each response type. RESULTS: Over half (51.0%, n???=???1,349) of agencies addressed mental health but lacked designated units or personnel, while 6.9% (n???=???183) did not specifically address mental health. Larger agencies, agencies located in urban areas, as well as those with external partnerships, and a higher number of use of force complaints were significantly more likely to designate a unit or personnel. CONCLUSIONS: Fewer than half of law enforcement agencies have responses for mental health crises. Further research is needed to identify barriers and facilitators to adopting specialized responses, particularly among rural and under-resourced agencies.

Structural Vulnerability and Police Interaction among Women Who Use Drugs amid De Facto Decriminalization in Baltimore, Maryland.

Sisson, L. N., Rouhani, S., Tomko, C., Flath, N., & Sherman, S. G. (n.d.).

Publication year

2026

Journal title

J Urban Health

Abstract

Abstract

Exposure to criminal-legal systems, including policing, arrest, and incarceration, has deleterious effects on access to health and social services among people who use drugs. Women who use drugs (WWUD) may be especially vulnerable to policing, due to the high prevalence of sex work among them, which is also a criminalized behavior. Recent epidemiologic events and policy reforms are thought to have reduced exposure to arrests for low-level, non-violent crimes; in Baltimore City, this decline was demonstrated following the COVID-19 pandemic and implementation of de facto decriminalization of misdemeanor offenses including drug possession and solicitation (prostitution). However, possible impacts of these changes on experiences of policing among WWUD remain unknown. This analysis explores self-reported police interactions and pandemic-related structural vulnerability among a cohort of WWUD in Baltimore City. We used multinomial and logistic regression to explore the association of ability to meet basic needs during the pandemic with the intensity and breadth of police interaction. We observed that overlapping unmet needs, such as access to medications, bathrooms, and harm reduction supplies, were associated with exposure to more intensive enforcement and greater breadth of police practices, as well as exposure to more egregious forms of policing. Despite broad changes to both policing and social service policies amid the pandemic, our results indicate that WWUD continued to experience both disproportionately high levels of material need insecurity and exposure to police. Findings have implications for tailoring policies and interventions to meet the needs of multiply marginalized women amid big events and policy volatility.

All You Can Do is What You Know to Do: Naloxone Knowledge and Uncertainty Among People Who Use Drugs in Maryland amid a Volatile Drug Market

Sisson, L. N., Winiker, A. K., Triece, T., Rousch, R. S., Rouhani, S., Owczarzak, J., Sherman, S. G., & Schneider, K. E. (n.d.).

Publication year

2025

Journal title

Substance Use \& Misuse

Volume

60

Page(s)

1164 - 1172

Abstract

Abstract

~

Beliefs of US chiefs of police about substance use disorder, fentanyl exposure, overdose response, and use of discretion: results from a national survey.

Bailey, A., Andraka-Christou, B., Rouhani, S., Clark, M. H., Atkins, D., & Del, P. B. (n.d.).

Publication year

2025

Journal title

Health Justice

Volume

13

Issue

1

Page(s)

13

Abstract

Abstract

BACKGROUND: To inform the feasibility and acceptability of evidence-informed police practices related to substance use, addiction, and overdose, we sought to better understand how US police chiefs perceive substance use and related policing practices. METHODS: A national sample of randomly selected US police chiefs (N???=???276) completed a 37-item survey about substance use and policing. Nine items assessed chiefs' perceptions of: officers' discretion in making arrests, effectiveness of overdose responses, risks of fentanyl exposure, de-escalation practices, harmful drugs in their community, and illicitly-obtained buprenorphine. Data were analyzed with descriptive statistics and exploratory ordinal logistic regressions. RESULTS: Most chiefs (72.5%) agreed that arrest for any nonviolent misdemeanor was at the discretion of their officers, and they overwhelmingly (94.9%) trusted their officers to make the right arrest decision. The majority of chiefs (87.7%) felt their officers could effectively respond to an opioid overdose, and 83.7% reported their officers carried naloxone on patrol. Chiefs in the Northeast were significantly less likely to be confident in their officers' ability to respond to a methamphetamine overdose than chiefs in the West. Most (90.0%) were receptive to implementing methamphetamine de-escalation strategies (i.e., techniques to resolve crises short of force). Almost all chiefs (91.2%) agreed with the inaccurate statement that fentanyl exposure at a drug overdose scene could harm officers. CONCLUSIONS: Police chiefs express interest in several types of evidence-based public health approaches to policing. Critically, there is a need to curtail fentanyl misinformation and to improve officer knowledge about medications for treating opioid use disorder.

Cumulative Racism and Substance use: Results from the 2023 Racism and Public Health Study

Rouhani, S., Harris, A., Cuevas, A., Rhodes-Bratton, B., McSorley, A.-M., & Goodman, M. (n.d.).

Publication year

2025

Journal title

Substance Use & Misuse

Volume

267

Page(s)

112284

Abstract

Abstract

~

Disparities in willingness to call the police in a 2023 survey of US adults: Implications for alternative crisis response programs.

Rouhani, S., Machavariani, E., McSorley, A.-M., Todd, T. L., & Purtle, J. (n.d.).

Publication year

2025

Journal title

Prev Med

Volume

198

Page(s)

108358

Abstract

Abstract

OBJECTIVE: To estimate willingness to call the police in an emergency among US adults to inform policies addressing emergency response and help-seeking. METHODS: We utilized cross-sectional data from a web-based 2023 Survey of Racism and Health of (N??=??5059) adults in 12 Northeastern and Mid-Atlantic states and D.C. We estimated odds of willingness to call the police as a function of gender, race/ethnicity, and lifetime diagnosis with a behavioral health (substance use or mental health) condition using unadjusted and adjusted logistic regression. RESULTS: Most of the sample (80??%) reported willingness to call the police in an emergency. Dds were observed among Black (aOR 0.33; 95??% CI 0.27-0.41), American Indian/Native American (aOR 0.43; 95??% CI 0.27, 0.70), and Multiracial (aOR 0.36; 95??% CI 0.25-0.52) compared to White respondents, and those with behavioral health diagnoses (aOR 0.73; 95??% CI 0.61, 0.88). Women (aOR 1.23; 95??% CI 1.05, 1.43) and older adults (Age 55+: aOR 4.62; 95??% CI 3.70, 5.80) reported higher willingness to call the police. CONCLUSIONS: Findings highlight subpopulations for whom the police may not be a viable source of emergency response, particularly individuals who are racially minoritized and/or have behavioral health conditions. This has implications for alternative response programs which rely on 911 dispatch to triage calls and highlights a need for targeted messaging and alternative mechanisms to call for service in communities with police mistrust.

Examining the association between psychological resilience and chronic versus discrete stressors among individuals who use opioids in Baltimore, Maryland.

Sisson, L. N., Tomko, C., Rouhani, S., & Sherman, S. G. (n.d.).

Publication year

2025

Journal title

Drug Alcohol Rev

Volume

44

Issue

1

Page(s)

288

Abstract

Abstract

INTRODUCTION: Psychological resilience has emerged as a key construct of interest in the study of substance use. However, very few studies have examined resilience among individuals who are actively using drugs. Furthermore, many studies of psychological resilience have focused on individual-level factors. This study addresses the call for a more 'ecological' approach to the study of resilience by exploring how socio-structural vulnerabilities may shape individuals' assessment of their own ability to cope. METHODS: The Peer Harm Reduction of Maryland Outreach Tiered Evaluation study conducted a cross-sectional survey of people who used opioids in Baltimore, Maryland, USA (n???=???565). Resilience was measured using the 10-item Connor-Davidson Resilience Scale. We used linear regression to examine the association between resilience and stressors commonly encountered by individuals who use drugs, including both chronic, enduring stressors (e.g., homelessness, food insecurity) and discrete, event-based stressors (e.g., overdose, arrest). RESULTS: We observed a negative relationship between self-reported resilience and chronic stressors. Specifically, individuals who reported experiencing three (?????=???-4.08; p???=???0.002) or four (?????=???-4.67; p???=???0.008) types of chronic stress had significantly lower resilience scores. Additionally, we found that an unmet need for mental health treatment was associated with reduced resilience (?????=???-1.74; p???=???0.040) and greater educational attainment was associated with increased resilience (?????=???2.13; p???=???0.005). DISCUSSION AND CONCLUSIONS: Overlapping experiences of socio-structural vulnerability, as well as access to mental health care, may influence how individuals who use drugs evaluate their own resilience. Interventions that seek to promote the resilience of this population should focus on addressing structural drivers of marginalisation and barriers to mental health treatment.

Experiences of a drug decriminalization policy among police and people who use drugs in Baltimore City: a post-structural policy analysis

Rouhani, S., Silberzahn, B. E., Sisson, L. N., Winiker, A. K., Kim, J., Zhang, L., Schneider, K. E., & Sherman, S. G. (n.d.).

Publication year

2025

Journal title

Social Science and Medicine Qualitative Research

Page(s)

100679

Abstract

Abstract

~

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, J. D. (n.d.).

Publication year

2025

Journal title

Int J Drug Policy

Volume

140

Page(s)

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.

Navigating US illicit drug market volatility : Harm reduction strategies employed by people who inject drugs

Winiker, A. K., Sisson, L. N., Schneider, K. E., Rouhani, S., Martin, E. M., Nestadt, D. F., Silberzahn, B. E., Zhang, L., Footer, K., & Sherman, S. G. (n.d.).

Publication year

2025

Journal title

Health Promotion International

Volume

40

Issue

4

10.1093/heapro/daaf125

Abstract

Abstract

The US illicit drug market is increasingly unreliable, with new and often harmful adulterants contributing to overdose risk among people who use drugs. In this context, it is crucial to examine whether people who inject drugs (PWID) are aware of these changes and if so, how they are adapting to inform harm reduction interventions and programs. In-depth interviews were conducted with 23 PWID between July 2022 and January 2023. Interviews explored participants' substance use behaviors and perspectives on harm reduction interventions. A combined deductive and inductive thematic analysis was conducted to identify emergent themes. This analysis focuses upon participants' discussions around drug market activity/changes, drug-related harms, drug use risk perceptions, and harm reduction strategies. Participants demonstrated awareness of the increasing volatility and risk associated with illicit substance use. They reported engaging a range of strategies to reduce the risk of these harms, motivated by individual-level cognitions and behaviors, as well as external-level interpersonal relationship dynamics. These findings highlight that perceived risk translates to behavior change amid a changing market, suggesting the need for universal drug testing access, responsive health education/harm reduction programming, peer-based interventions, and structural changes to reduce barriers to harm reduction behavior change.

Racial Discrimination and Substance Use: Results from a 2023 Survey of Racism and Public Health in the United States.

Rouhani, S., Bather, J. R., Cuevas, A. G., Omari, I., Harris, A., McSorley, A.-M., Rhodes-Bratton, B., & Goodman, M. S. (n.d.).

Publication year

2025

Journal title

Subst Use Misuse

Volume

60

Issue

14

Page(s)

2225

Abstract

Abstract

BACKGROUND: Racial/ethnic disparities in substance use outcomes continue to widen in the US. Despite increasing evidence of the myriad ways that racism impacts health, this has not been extensively studied with respect to substance use outcomes. The current study explores the association between self-reported exposure to racial discrimination across the life course and substance use disorders among US adults. METHODS: We analyzed data from a web-based cross-sectional survey of adults in 13 states and Puerto Rico in March-April 2023. Exposure to racism in childhood, adolescence, adulthood, and within the past year was measured on a cumulative life course scale (range 0-4). Analyses were restricted to respondents identifying as White, Black, and/or Hispanic (N???=???4,338). Multivariable models estimated the adjusted association between cumulative racial discrimination and lifetime substance use disorder (SUD) diagnosis. Among those with exposure to racial discrimination (N???=???1,895), we explored correlates of coping with any form of discrimination by using substances. RESULTS: We detected evidence of an interaction between race/ethnicity and cumulative racial discrimination, with a higher predicted probability of SUD associated with discrimination among those racialized as Black (non-Hispanic Black and Afro-Hispanic). There was evidence of a dose-response relationship between cumulative racial discrimination and the likelihood of coping through increased substance use. CONCLUSIONS: Experiences of racial discrimination over the life course may contribute to disparities in substance use outcomes. More research is needed to disentangle multiple, overlapping forms of discrimination faced by people who use different substances and how they may explain variation in outcomes among them.

Substance Checking Outreach and PrEP Engagement (SCOPE) Study: protocol for a non-randomised clinical trial in Baltimore, Maryland USA.

Schneider, K. E., Nestadt, D. F., Martin, E. M., Morris, M., Rouhani, S., Weir, B. W., & Sherman, S. G. (n.d.).

Publication year

2025

Journal title

BMJ Open

Volume

15

Issue

7

Page(s)

e101380

Abstract

Abstract

INTRODUCTION: As the opioid crisis continues, people who use drugs (PWUD) experience a disproportionate burden of both HIV and overdose, driven by increased injection-related HIV outbreaks and an opaque and rapidly evolving drug market, respectively. Pre-exposure prophylaxis (PrEP) for HIV and point-of-care drug checking services are underused yet potentially impactful interventions to address the harms of the opioid crisis. Implementing such interventions using known strategies to enhance client engagement and reduce access barriers, such as street outreach, mobile services and peer navigation, can optimise intervention and maximise their impact. METHODS AND ANALYSIS: The Substance Checking Outreach and PrEP Engagement (SCOPE) Study is a non-randomised clinical trial evaluating the impact of the Check It intervention, a mobile community PrEP and drug checking intervention in Baltimore, Maryland, USA. SCOPE will recruit a cohort of 500 PWUD at risk for HIV through street-based recruitment methods. Cohort members will be followed semi-annually for 18 months. The primary study outcomes are engagement with the PrEP continuum of care and the number of non-fatal overdoses. We will use both random effects models and marginal structural models to estimate the effects of Check It on participant engagement on the PrEP continuum and the number of non-fatal overdoses over time. ETHICS AND DISSEMINATION: Study procedures have been approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. Risks to participants are low, with the most serious risk being potential data confidentiality breaches. This risk was minimised through the use of secure data storage platforms with limited user access. Study findings will be disseminated through peer-reviewed manuscripts, academic presentations, and reports and fact sheets designed for lay audiences. TRIAL REGISTRATION NUMBER: This study was registered with clinicaltrials.gov (study ID: NCT05977881; Protocol ID: 00017498).

Syringe Service Program Utilization, Behavioral, and Experiential Factors Associated with Greater Naloxone Protection in a Longitudinal Cohort of People Who Use Illicit Opioids in New York City.

Bennett, A. S., Chen, Y., Harris, A., Frank, D., Rouhani, S., Cepeda, A., Valdez, A., Bather, J., Goodman, M., & Elliott, L. (n.d.).

Publication year

2025

Abstract

Abstract

BACKGROUND: Despite efforts to blanket high-mortality communities with no-cost naloxone, drug checking technologies, and alternatives to using opioids alone, there remains a considerable lack of knowledge about how exposure to these low-threshold interventions may impact rates of naloxone protection. METHODS: People who used illicit opioids in New York City were surveyed between April 2019-April 2022. Naloxone protection was defined as the proportion of opioid use events in the past 30 days when opioid use occurred with naloxone present and someone to administer it. Mixed-effect Poisson models examined correlates (syringe service program utilization, behavioral, and experiential factors) of naloxone protection among the overall sample and stratified by gender. RESULTS: Among 428 study participants (mean age 49 years, 64% cisgender male, 35% Black, 41% Latinx), several factors were significantly associated with naloxone protection levels. Visiting a syringe service program (SSP) in the last three months was significantly associated with higher naloxone protection in the full sample (IRR = 1.94, 95% CI: 1.38-2.74) and among males (IRR = 1.84, 95% CI: 1.29-2.64). Significantly lower naloxone protection was also observed among Latinx participants compared to White individuals in the full sample (IRR = 0.64, 95% CI: 0.44-0.94) and among females aged 57-72 years compared to those aged 20-40 years (IRR = 0.39, 95% CI: 0.16-0.95). Participants living with someone who does not use opioids (vs. living with someone who uses opioids) showed significantly lower naloxone protection levels in the full sample (IRR = 0.54, 95% CI: 0.37-0.80) and among males (IRR = 0.46, 95% CI: 0.29-0.73). Other factors associated with lower naloxone protection in the full sample included any opioid withdrawal in the last 30 days, higher pain severity, and more negative life events. Conversely, receiving social support from another person who uses opioids was significantly associated with higher naloxone protection in the full sample (IRR = 1.14, 95% CI: 1.07-1.22) and among females (IRR = 1.30 95% CI 1.16-1.46). Additional factors associated with greater naloxone protection in the full sample included: concurrent opioid and stimulant use, heroin/injection use (1-15 days), fentanyl test strip use, lifetime opioid overdose, and number of lifetime arrests. CONCLUSION: Findings suggest positive impacts of syringe service program engagement and use of harm reduction best-practices and interventions on promoting naloxone protection and highlight differential associations. These results can be used to inform culturally-sensitive and tailored outreach to people at risk of overdose.

Transforming first response through non-police, community safety response programmes: a peer-reviewed and grey literature scoping review protocol.

Todd, T. L., Lappen, H., Neath, S., Markham, M. J., Purtle, J., Allen, B., Rouhani, S., & Friedman, B. (n.d.).

Publication year

2025

Journal title

BMJ Open

Volume

15

Issue

12

Page(s)

e109499

Abstract

Abstract

INTRODUCTION: Police are frequently dispatched to a wide range of 911 calls, including mental and behavioural health crises, despite lacking the training, resources and time to respond effectively. In particular, people with serious mental illness are at elevated risk of experiencing excessive use of force, arrest and continued criminal legal involvement following police contact. Following the murder of George Floyd and other highly publicised police killings, Community Safety Response (CSR) programmes, staffed by unarmed peers, mental health professionals and other trained responders, have proliferated to provide non-police responses to mental and behavioural health and other quality-of-life concerns. CSR programmes have expanded rapidly, yet the evidence base remains fragmented and largely outside the peer-reviewed literature. METHODS AND ANALYSIS: This scoping review will synthesise peer-reviewed and grey literature from 2020 to present on CSR programmes operating in North America. Guided by Joanna Briggs Institute methodology and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards, we will search multiple databases (Medline, PsycINFO, Embase, SocIndex, Web of Science, Policy Commons) and employ complementary grey literature search strategies, including targeted website searches, reference tracking and review of internal and external reports and evaluations. Inclusion criteria require that programmes provide non-police first response to calls traditionally served by law enforcement and include information on programme operations or outcomes. Two reviewers will independently screen and extract data on process metrics including operational characteristics, dispatch, funding, services provided and outcomes such as populations served, diversion from police, service linkage and use of force. ETHICS AND DISSEMINATION: No ethical review for this study is required as it will not include human subjects or any identifiable information. Findings will provide the first national synthesis of CSR programme models, operations and outcomes. Results will inform policy-makers, practitioners, researchers and community members. Findings will be disseminated through peer-reviewed publications and public-facing products to support implementation, scale-up and sustainability of CSR programmes.

Drug Decriminalization in the United States: Emerging Models, Implementation Experiences and Implications for Health and Racial Equity

Rouhani, S., Zhang, L., Winiker, A., Tomko, C., Silberzahn, B., Sherman, S., & Bandara, S. (n.d.).

Publication year

2024

Volume

260

Page(s)

110219

Abstract

Abstract

~

Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities.

Cuevas, A. G., McSorley, A.-M., Lyngdoh, A., Kaba-Diakit??, F., Harris, A., Rhodes-Bratton, B., & Rouhani, S. (n.d.).

Publication year

2024

Journal title

Am J Prev Med

Volume

67

Issue

1

Page(s)

97

Abstract

Abstract

INTRODUCTION: Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. METHODS: Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. RESULTS: Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. CONCLUSIONS: Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.

Emerging models of de facto drug policy reforms in the United States

Rouhani, S., Zhang, L., Winiker, A. K., Sherman, S. G., & Bandara, S. (n.d.).

Publication year

2024

Journal title

Drug and alcohol dependence

Volume

260

10.1016/j.drugalcdep.2024.111341

Abstract

Abstract

Background: Health and human rights organizations have endorsed drug decriminalization to promote public health-oriented approaches to substance use. In the US, policymakers have begun to pursue this via prosecutorial discretion—or the decision by a prosecutor to decline criminal charges for drug possession in their jurisdiction. This study characterizes drivers of adoption, policy design and implementation processes, and barriers to impact and sustainability of this approach to inform evolving policy efforts promoting the health of people who use drugs (PWUD). Methods: We conducted n=22 key informant interviews with policymakers and national policy experts representing 13 jurisdictions implementing de facto drug policy reforms. Analyses were informed by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and analyzed using a hybrid inductive-deductive approach. Results: Drivers of policy adoption included racial inequities, perceived failures of criminalization, and desires to prioritize violent crime given resource constraints. Three distinct policy typologies are described with varying conditions for eligibility, linkage to services, and policy transparency and dissemination. Public misinformation, police resistance and political opposition were seen as threats to sustainability. Conclusions: Given evidence that criminalization amplifies drug-related harms, many policymakers are adopting de facto drug policy reforms in the absence of formal legislation. This is the first study to systematically describe relevant implementation processes and emerging policy models. Findings have implications for designing rigorous evaluations on health outcomes and informing sustainable evidence-based policies to promote health and racial equity of PWUD in the US.

Epidemiology of drug arrests in the United States : Evidence from the national survey on drug use and health, 2015–2019

Rouhani, S., Luo, L., Byregowda, H., Weaver, N., & Park, J. N. (n.d.).

Publication year

2024

Journal title

Preventive Medicine

Volume

185

10.1016/j.ypmed.2024.108058

Abstract

Abstract

Objective: Following changes to drug criminalization policies, we re-examine the epidemiology of drug arrests among people who use drugs (PWUD) in the U.S. Methods: Serial cross-sectional data from the National Survey on Drug Use and Health (2015–2019) were utilized. Past-year illicit drug use (excluding cannabis) and drug arrests were described by year, area of residence, drug use characteristics and participant demographics. Adjusted associations between race and drug arrest were estimated using multivariable logistic regression. Results: Past-year illicit drug use remained consistent over time and was highest among non-Hispanic (NH) white respondents. Of those reporting past-year illicit drug use (n = 25,429), prevalence of drug arrests remained stable over time overall and in metro areas while increasing in non-metro areas. Arrests were elevated among NH Black participants and those with lower income, unemployment, housing transience, non-metro area residence, polysubstance use, history of drug injection, substance use dependence and past-year drug selling. Adjusted odds of drug arrest remained significantly higher among NH Black individuals [aOR 1.92, 95% CI 1.30, 2.84]. Conclusion: Despite recent shifts away from punitive drug policies, we detected no reduction in drug arrests nationally and increasing prevalence in non-metro areas. Despite reporting the lowest level of illicit substance use and drug selling, NH Black individuals had significantly increased odds of arrest across years. Findings highlight the need for further examination of policy implementation and policing practices in different settings, with more research focused non-metro areas, to address enduring structural racism in drug enforcement and its consequences for health.