Lauren Dayton

Background: Drug use settings are critical determinants of overdose risk and other drug-related harms. Although sex differences in drug use patterns are well documented, less is known about sex differences in the types of locations where people use drugs. This study examined sex differences in drug use settings among people who use opioids. Methods: Data were from the baseline survey of the OASIS project, a community-based study conducted in Baltimore, Maryland (N = 869), focusing on 9 specific types of locations where participants reported drug use in the past 30 days: their own residence, someone else’s residence, street, alley, park, abandoned building, public restroom, car, and other locations. Bivariate and multivariable logistic regression models examined associations between sex and drug use settings, adjusting for age, race, education, homelessness, and frequency of drug use. Results: The sample included 346 women and 523 men. In adjusted models, women had significantly lower odds than men of using drugs on the street (aOR = 0.49, 95% CI 0.35–0.70), in alleys (aOR = 0.50, 95% CI 0.35–0.69), parks (aOR = 0.57, 95% CI 0.42–0.78), abandoned buildings (aOR = 0.53, 95% CI 0.38–0.75), cars (aOR = 0.55, 95% CI 0.41–0.73), and other locations (aOR = 0.59, 95% CI 0.37–0.94). Sex was not significantly associated with drug use at one’s own residence or someone else’s residence. Conclusions: Women who use opioids were significantly less likely than men to use drugs in public and semi-public settings, which may reflect gendered patterns of stigma, interpersonal violence, and safety concerns. Harm reduction programs should focus on making current drug use settings safer and developing additional safer settings with an emphasis on addressing barriers for women to access harm reduction services, including women-centered overdose prevention centers and household-based overdose response training.

Background: Xylazine, an adulterant in the illicit opioid supply, heightens the risks of overdose, withdrawal severity, and severe wounds among people who use opioids (PWUO). Despite increasing prevalence, gaps remain regarding xylazine awareness in the drug supply and effective harm reduction interventions to address it. Methods: We conducted a cross-sectional survey of 703 PWUO in Baltimore, MD (2023–2025), to assess xylazine awareness, perceptions, and experiences. Multivariable logistic regression models examined correlates of xylazine awareness and self-reported xylazine-attributed wounds. Results: 84.8% of White participants, 48.6% Black participants, 64.3% of males, and 51.4% females had heard of xylazine. Nearly half (45%) of those who used xylazine reported that it caused more severe withdrawal symptoms. In the multivariable model of xylazine awareness, the largest odds ratios were year of survey administration (2024 vs. 2023: aOR = 4.30, 95% CI = 2.91–6.37; 2025 vs. 2023: aOR = 6.32, 95% CI = 3.31–12.07) and White race (aOR = 3.22, 95% CI = 1.85–5.57). Other significant demographic variables included education and gender. In the multivariable model of xylazine-attributed wounds, survey year 2025 vs. 2023 (aOR = 2.65, 95% CI = 1.06–6.61) and injection drug use in the prior year (aOR = 17.74, 95% CI = 5.58–56.39) were statistically significant. Conclusions: Awareness of xylazine in the drug supply remains incomplete among PWUO, with differences by race, age, and gender. The finding of a strong association of xylazine-attributed wounds and injection drug use should be the focus of future research. These findings underscore the need for enhanced surveillance systems, peer education, and community-based harm reduction strategies. Real-time monitoring and rapid response strategies are essential to protect against health risks of toxic adulterants, such as xylazine, medetomidine, and BTMP, in the drug supply.

Mobile health (mHealth) applications represent low-cost, scalable interventions with broad reach and are valuable for people who use opioids (PWUO), a population that often experiences low retention in traditional research studies. This study examines engagement patterns with the OASIS app, an mHealth app prompting PWUO in Baltimore, Maryland, to report daily on substance use locations and overdose prevention behaviors over 14 days. Between December 2022 and September 2023, 210 PWUO participated. Engagement was measured by survey completion, with high engagement defined as completing at least 75% of surveys. The median number of surveys completed was 9.0 (mean: 7.57), and 29.4% of participants demonstrated high engagement. Logistic regression models showed that residential stability was significantly associated with higher engagement (adjusted odds ratio [aOR]: 4.90; 95% CI: 1.35, 17.84), while weekly or more frequent injection drug use was associated with lower engagement (aOR: 0.31; 95% CI: 0.11, 0.89). Mobile device proficiency and other demographics were not significantly associated with engagement, likely due to mandatory in-person training reducing tech barriers. Results indicate that PWUO can meaningfully engage with mHealth apps, especially when supported by structural factors, such as stable housing.

Background: Climate change and sustainability are highly interconnected. Addressing climate change requires major social change and collective action. The current study examined the prevalence of, and factors associated with, four climate change activism behaviors in a U.S. nationally representative sample. Methods: Data were derived from the Pew Research Center American Trends Panel conducted in April 2021 of 13,749 panelists. Key outcomes included (1) attending a protest or rally addressing climate change, (2) volunteering for a climate change activity, (3) donating money to an organization focused on climate change, and (4) contacting an elected official to urge them to address climate change. Multivariable logistic regression models examined the independent associations with psychosocial and demographic variables. Results: A fourth (24.7%) of participants reported engagement in one or more climate change activism behaviors. Of those who reported climate change activism, most (54.7%) only engaged in one activity. In the multivariable regression models, individual and social factors were significantly associated with all four climate action outcomes. Factors include social network communications and social norms variables, such as encouragement to take action, criticism for not taking action, and climate change communication frequency. Discussion: This study’s findings indicate that over 41 million U.S. adults reported having donated money to an organization focused on addressing climate change in the prior year, 25 million volunteered, and 26 million contacted an elected official. The association of social and communication variables with climate change activism suggests the importance of training people to talk about and encourage others to engage in climate change activism.

Background: Methadone and buprenorphine can reduce overdose-related mortality. Behavioral approaches can also reduce fatal overdoses. The current study examined the relationship between methadone and buprenorphine and overdose history and overdose prevention and treatment behaviors. Methods: Between December 2022 and August 2024, 647 individuals who used opioids in the prior month enrolled in a community recruited study on overdose. Participants were administered a face-to-face survey. Key behaviors assessed included overdose recency, testing drugs for potency, ingesting drugs slowly, using fentanyl test strips, using drugs alone, and carrying naloxone. Chi-square and logistic regression models examined the relationships between methadone and buprenorphine and overdose-related outcomes. Results: In total, 32.9% of participants were currently taking methadone and 15.5% buprenorphine. Most (69.2%) reported ever overdosing, and among those, 33.7% had overdosed within the prior 6 months. There were no significant associations between methadone or buprenorphine status and overdose prevention and care behaviors. In the multivariable logistic regression model, methadone use was associated with a lower odds ratio (aOR = 0.49, 95% CI = 0.30–0.79of a recent overdose compared to buprenorphine. Daily or almost daily crack use was associated with greater odds of a recent overdose (aOR = 2.21, 95% CI = 1.44–3.39. Discussion: Findings suggest the importance of promoting overdose prevention and care behaviors to people in drug treatment and training them to promote overdose prevention and care behaviors among their drug-using network members and other community members.

To enact climate mitigation policies, sustained collective activism is essential to create political pressure and prioritize addressing climate change. Climate change activism includes behaviors such as contacting elected officials to urge them to take action on climate change, volunteering, and signing petitions. Climate change activism is often measured as a one-time event, not sustained activism efforts, which are necessary to enact sufficiently impactful policy changes. To examine barriers to and facilitators of sustained climate change activism, 23 in-depth interviews were conducted between August and December 2023 among members of an innovative national climate change-focused organization. Eligibility included being at least 18 years of age, English-speaking, a US resident, and highly engaged in a climate change activism group. Content analysis of interview transcripts was employed, and five themes emerged as barriers, four themes as facilitators, and five themes as both facilitators of and barriers to sustained climate change activism. The study identified strategies to promote the critical behavior of sustained climate change activism, which included fostering a community of climate change activists, clear instructions on how to engage in activism behaviors for all technical abilities, supporting mental health, and creating climate change activism as a habit and identity.

Enacting policies to reduce greenhouse gas emissions requires climate change activism (CCA). CCA behaviors include volunteering/donating to organizations addressing climate change and lobbying policymakers. However, effective methods to promote CCA are not well understood. In August 2022, 622 US adults participated in a randomized control trial and one-month follow-up to assess the efficacy of the Climate Change Activism Peer Educator Training Program, a brief one-time training that aims to train people to talk to their social network members about engaging in CCA. Participants reported high levels of satisfaction. The CCA training increased self-efficacy in having conversations about CCA but did not significantly impact the frequency of communicating about or engaging in CCA. Study findings suggest that future CCA interventions target people motivated to take action about climate change for peer educators, tailor training modules to social network characteristics, integrate prompts to reinforce behavior change, and provide easy and specific targets for CCA.

It is critical to understand the determinants of climate change activism (CCA) and CCA communications (CCAC). Such information can help organizations that are committed to addressing climate understand and predict who will engage in CCA, identify barriers to CCA, and develop programs to address these barriers to diffuse climate change activism messages and behaviors through social networks and to mobilize action. This study longitudinally investigates psychosocial predictors of CCAC. Study participants were drawn from a randomized clinical trial of US adults (N = 622). Participants completed baseline and follow-up surveys between August to September 2022. Logistic regression models assessed psychosocial factors and implementation intention factors that predicted CCAC at follow-up. The multivariate logistic regression model baseline factors of positive social network norms related to CCAC (aOR: 1.25, 95% CI: 1.10–1.43), comfort encouraging others to engage in CCAC (aOR: 1.74, 95% CI: 1.01–2.88), and following a climate change social media account (aOR: 2.65, 95% CI: 1.74–4.02) were significantly associated with CCAC at follow-up. In a sub-analysis, plans on talking within a week and having in-person conversations versus texting/email were positively associated with CCAC. These findings suggest that strategies to improve comfort talking about CCA and implementation intentions may increase interpersonal CCAC.

Understanding everyday conversations about climate change may provide insights into framing the issue to promote climate change action. As part of a longitudinal online study in the US launched in June 2021, 805 respondents were asked if they had discussed climate change with a friend or family member in the prior month; if not, why not, and if yes, they were asked to delineate the conversation topic. Concurrent mixed methods were used to analyze the data. The majority (62.6%) of respondents reported not having a conversation about climate change in the prior month. Among those who indicated that they had discussed climate change, five themes were identified from the conversation topics, with many having reported discussing the impact of climate change on weather patterns. Very few discussed actions to address climate change, and most of these discussions focused on individual-level behaviors rather than collective actions. Among participants who had not recently discussed climate change, the most prevalent theme was that it was not a priority or an issue they cared about. Results suggest that conversations may not lead to collective actions and that policymakers and environmental organizations should provide guidance on effectively channeling climate change concerns into action.