Using Table 7.2 (Royse, et al., p.200) as a guide, develop a similar table using the research articles on NEP/SEP provided for the program evaluation assignments (there are 7).? Find an

Part 1

Valente et al. (2001) conducted research whereby the research questions include: What is the influence of the use of Needle Exchange programs (NEP) on syringe circulation times and syringe relay behavior among intravenous drug users? Valente et al. (2001, P.341) state, “This article determines the extent NEP use was associated with exclusive versus secondary exchange and how it was associated with syringe circulation times.” The purpose of this question is to determine the efficacy of NEPs in preventing HIV transmission among IDUs. The sample consists of 2,574 individuals participating in Maryland's Baltimore Needle Exchange Program (BNEP). From August 1994 to February 1997, 30 months were devoted to the study. The primary dependent variable is HIV seroconversion, which refers to the participants' acquisition of HIV during the study period. The principal independent variable is BNEP use. A registration questionnaire was administered to participants upon enrollment in the BNEP to capture the data. The most significant finding is that exclusive NEP users (participants who returned their syringes) had an inferior risk of HIV seroconversion than NEP users who engaged in syringe relays (returning syringes issued to someone else).

Kerr et al. (2010) explored the research question of whether the SEP policy change was linked to variations in syringe sharing and the prevalence of HIV. Kerr et al. (2010, P.1449) state, "We sought to determine if the change in SEP policy was associated with changes in rates of used syringe sharing and HIV incidence among IDU.” The goal of the question was to observe the effect of changes in SEP policy, specifically a shift from an emphasis on syringe exchange to an emphasis on syringe distribution, syringe-sharing behaviors, and the incidence of HIV among IDUs. The sample comprised one thousand two hundred twenty-eight injection drug users (IDUs) in British Columbia, Vancouver, and Canada. Results were tracked longitudinally through baseline and twice a year follow-up visits, including an interviewer directed questionnaire and a blood sample. The investigation was conducted between 1998 and 2003. The incidence of HIV among injection drug users (IDUs) is the dependent variable, while the independent variables include the period preceding and following the variation in SEP policy, age, and gender. Participants completed a questionnaire administered by an interviewer and provided a blood sample during semiannual follow up visits to collect data. The most important finding was that the period after the change in SEP policy, which improved access to sterile syringes, was autonomously allied with significant decreases in syringe lending, syringe borrowing, and HIV incidence among injection drug users.

Target population behavior and definition can significantly affect program evaluation for marginalized or stigmatized populations like NEP/SEP. The target population's views and biases can influence program design, implementation, and evaluation. NEP/SEP target populations, such as injection drug users, typically experience stigma and negative preconceptions due to drug use. Stigmatization can lead policymakers and the public to regard NEP/SEP as encouraging drug use rather than a harm reduction method. Negative impressions may hamper program acceptability and support, making implementation and expansion difficult for marginalized groups, including the LGBTQ community (Lewis et al., 2017). Additionally, they are affected by the public perception of "Otherness." Programs for "other" populations may be resisted by society. NEP/SEP programs may be considered as assisting a marginalized or unworthy demographic. Some groups may oppose these programs, influencing financing, support, and political will.

The success of such programs can be assessed by reducing HIV incidence and other related issues. If the incidence of a setting goes down, it indicates that the programs have been successful. In terms of bias, it can have a significant effect on the outcomes, and therefore, measuring success can only include observing the attitudes and inclusion of populations in studies and the healthcare process. More inclusion and better studies indicate lesser occurrences of biases. In general, Policymakers, researchers, and the general public hold beliefs, attitudes, and prejudices regarding the target population of a program or intervention. In his case, the target population refers to the individual's research aims to understand or help. NEP/SEP programs, for example, target injectable drug users, a stigmatized group. Negative perceptions can affect program evaluation research designs, data collecting, and interpretation. Target population perceptions can skew program evaluations: Society and healthcare providers may stigmatize injectable drug users. This can hinder target population participation in NEP/SEP programs. Selection bias might restrict the generalizability of evaluation findings if particular injection drug user populations are disproportionately excluded or reluctant to participate in the program. Finally, Politicians that see injection drug users negatively may be less likely to sponsor NEP/SEP programs. This is true because social construction has been seen to affect policy agenda (Schneider & Ingram, 1993). Thus, these initiatives may be under-capacitated and lack sufficient support. Insufficient resources can limit program execution and data collecting, affecting program assessments.

References

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Kerr, T., Small, W., Buchner, C., Zhang, R., Li, K., Montaner, J., & Wood, E. (2010). Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. American journal of public health, 100(8), 1449-1453.

Lewis, D. C., Flores, A. R., Haider-Markel, D. P., Miller, P. R., Tadlock, B. L., & Taylor, J. K. (2017). Degrees of acceptance: Variation in public attitudes toward segments of the LGBT community. Political Research Quarterly, 70(4), 861–875. https://doi.org/10.1177/1065912917717352

Schneider, A., & Ingram, H. (1993). Social construction of target populations: Implications for politics and policy. American political science review, 87(2), 334–347. https://doi.org/10.2307/2939044

Valente, T. W., Foreman, R. K., Junge, B., & Vlahov, D. (2001). Needle-exchange participation, effectiveness, and policy: syringe relay, gender, and the paradox of public health. Journal of Urban Health, 78, 340-349. https://doi.org/10.1093/jurban/78.2.340

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What is the NEP/SEP research question? Provide the direct quote-properly cited (reference APA Publication Manual for guidance with citation format).  Do not quote from the Abstract.  Why is the question being asked? The NEP/SEP is a needle exchange programs in Central regions in the United States. It is a social service program that allows injecting drug users to obtain clean and unused hypodermic. The quote states “This raises questions whether risk reduction among needle-exchange users is sufficient to prevent transmission of blood-borne viruses or whether residual risk behavior may lead to infection.

Briefly describe the sample in terms of size, important characteristics, location, and time. The Needle exchange program was an urgent program put together to help address the public health concerns of infectious disease. The location is Seattle from June 1994 through May 1997. Some important characteristics to remember is the illicit drug user, Spanish speaking individuals starting at the age 14 and up.

What are the primary dependent and independent variables?

The primary dependent variable was any injection risk created by assigning a value of 1 to participants reporting one or more of the following, needle sharing, cookers, sharing a filter, and not being as clean as you should be skin wise having an effect on risk behavior at follow up. The IV is the needle exchange use as the independent variable.

Describe how the data was collected. The data collection is collected during an ethnographic field observation, doing intense interviews and a series of questions. From randomly selected individuals who have tested and are eligible through questionnaires that have generated different information about primary dependent and independent variables between a different variety of people.

What is the most important finding? The most important finding is the different participation that the needle exchange program had while in Seattle. The impact was noticeable at the time in drug users actually taking advantage of clean syringes. It wasn’t as clear on the users and non-exchange users that participates in injection practices.

Was the research question answered? The research question regarding the effectiveness of the NEP/SEP needle exchange program has been extensively studied. Numerous studies have shown these programs are effective in reducing the transmission of bloodborne diseases promoting safer injection practices and connecting individuals to healthcare and supportive services. Overall, the evidence suggests that needle exchange program plays a crucial role in harm reduction and public health.

Application: Based on the section in the Program evaluation text, Chapter 2 on "Compensation and Incentive Payments" discuss the use of such payments for program evaluation  in general and for this particular study. A good answer will provide a summary of the compensation/incentives issue as presented by Royse, Thyer, and Padgett.  The summary will be used to assess the compensation program used by Hagan and Thiede. Be sure to properly cite sources.  Compensation and incentive payments are commonly used in program evaluation to encourage participation and ensure accurate data collection. Within this study payments may have been utilized to incentivize participates to provide honest and detailed feedback. This is crucial when it comes to comprehensive program evaluation. These payments can help mitigate any potential bias and increase the validity of the study findings.

References

Hagan, H., & Thiede, H. (2000). Changes in injection risk behavior associated with participation in the Seattle needle-exchange program.  Journal of Urban Health,  77(3), 369–382

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What is the NEP/SEP

Williams and Metzger (2010) examine how geographic distances between injection drug users' IDUs' residences, drug purchase, and use locations, and syringe exchange programs (SEPs) affect injection behaviors, focusing on race. The question is being asked to understand better the impact of geographic distances on injection risk behaviors and the utilization of syringe exchange programs. Philadelphia's HIV Prevention Study Network 037 provided the study sample from 2002 to 2006. 2,599 participants were injected medicines.

Sample in Terms & Size

"Objectives. We conducted ‘‘geobehavioral’’ analyses by race to understand how distances among injection drug users’ (IDUs’) residences, drug purchase and use locations, and syringe exchange programs (SEPs) are associated with injection behaviors." 14% Latino, 45% Black. Age (mean 39), gender (75% male), education (68% high school diploma or equivalent), and relationship status (54% main sexual partner) matter. Whites and Latinos lived further from drug dealers than Blacks.

Primary Variables

The study's primary dependent variables are injection behaviors, including the location of the most recent injection (private apartment, shooting gallery, or public venue), the regular supply of syringes (SEP or non-SEP), and the frequency of receptive injection equipment sharing. The research addresses race and geography. Drug procurement, usage, and SEP distances are the key independent variables.

Important finding/Research Question being answered

The data was acquired by prescreening interviews in mobile assessment units near risk pockets in the target zip codes. Geographic software was used to determine the latitudes and longitudes of the reported sites (residences, drug purchase locations, and drug consumption locations) to approximate Manhattan distances (in miles) between each pair. Prescreening interviews asked about race and other traits. Injection behaviors, syringe sources, and receptivity were also recorded. Williams and Metzger's (2010) main finding were that geographic distances between IDUs' homes, drug purchase, and use locations, SEPs influenced injection risk behaviors, and SEP use differentially by race. Blacks were less likely than Whites to inject in public, share syringes, and receive them from SEPs, regardless of distance. Latinos injected further than Blacks or Whites. The research question regarding the association between geographic distances and injection behaviors was answered, revealing important racial disparities in risk behaviors and SEP utilization. The study stresses the geographical context for devising injection-related risk solutions for different ethnic groups. More research is required to understand these ethnic disparities and the factors influencing behavior in different regions.

Application

Cultural sensitivity and addressing race, ethnicity, and socioeconomic characteristics are vital for fair and successful program evaluation. Evaluation procedures must be culturally responsive to prevent marginalizing groups and account for their specific needs and experiences. (Williams & Metzger 2010) discusses the impact of Needle Exchange Programs (NEPs)/Syringe Exchange Programs (SEPs) on injection habits. Recognizing and addressing the cultural context of interventions is cultural sensitivity in program assessment. Understanding the population's cultural norms, beliefs, and practices and how they affect their behavior is necessary. This requires NEPs/SEPs to recognize injectable drug users' cultural variety and adapt assessment methods accordingly. Language difficulties, stigmatization, and trust concerns might affect program participation and engagement in the assessment process.

Cultural competency is crucial in research on sexual minorities, as well as racial and ethnic minorities, according to Bauer and Wayne (2005). For the NEP/SEP project, cultural competency means ensuring that the research team is diverse and reflects the communities being investigated. Data collecting must also be culturally appropriate. Researchers should respect participants' race, ethnicity, and drug use experiences. Socioeconomic variables can affect NEP/SEP efficacy and accessibility. Socioeconomic differences may impact access to resources, healthcare, and education, affecting drug use and program participation. Program assessment should examine how socioeconomic variables affect NEP/SEP use and if disadvantaged communities are reached. This entails recognizing diverse groups' economic hurdles, such as housing instability, poverty, and restricted healthcare access. In the NEP/SEP trial, researchers should have employed culturally appropriate recruiting and survey procedures to guarantee culturally sensitive assessment. They should have considered Philadelphia's injectable drug users' racial and cultural diversity. Finally, data on socioeconomic status and its impact on injection practices and program use would have been useful.

References

Bauer, G. R., & Wayne, L. D. (2005). Cultural sensitivity and research involving sexual minorities. Perspectives on Sexual and Reproductive Health, 37(1), 45–47. https://doi.org/10.1363/psrh.37.45.05

Royse D. D., et al. Program Evaluation: An Introduction to an Evidence-Based Approach. 6th ed., Boston, Ma Cengage Learning, 2016.

Williams, C. T., & Metzger, D. S. (2010). Race and Distance Effects on Regular Syringe Exchange Program Use and Injection Risks: A Geobehavioral Analysis. American Journal of Public Health, 100(6), 1068–1074. https://doi.org/10.2105/ajph.2008.158337

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Program Evaluation

Article-Specific Research Questions

Article 1 by Des Jarlais, 2000 "How effective are needle exchange programs in preventing HIV transmission among injection drug users, and how do program coordination, sterile injection equipment availability, and political considerations affect their success?"

Article 2 by Tempalski et al. (2007) "What social, political, socioeconomic, and organizational factors contribute to the presence of syringe exchange programs (SEPs) in different metropolitan areas in the United States, and how do these factors interact to shape the availability of SEPs?"

Article 3 by "Kerr et al. (2019). What organizational, community, and policy factors facilitated the development of the Louisville Metro Department of Public Health and Wellness syringe exchange program, and how did coalition building, advocacy, and media engagement contribute to its successful establishment and uptake?"

Common Research Thread

These articles examine syringe exchange programs (SEPs) and their impact on HIV, hepatitis C, and injectable drug use. Each paper examines SEPs' HIV prevention efficacy, their presence in diverse regions, and their successful establishment and adoption. These articles explore SEPs' impact, determinants, and development techniques, advancing harm reduction strategies, and their public health implications.

What Makes the Des Jarlais Article Different?

Tempalski et al. and Kerr et al. differ in research approach and focus from Des Jarlais. All three studies discuss syringe exchange programs (SEPs) and their effects, although their approaches vary. The Des Jarlais article appears to be a literature review and analysis of existing research, historical background, and expert insights. The article discusses SEPs' history, opposition, political influences, and HIV prevention. It analyzes statistics, government policies, historical shifts, and public health narratives. Tempalski and Kerr use empirical research methods.

Key Findings

Article 1: Needle exchange reduces HIV transmission among injectable drug users. Coordination, sterile equipment, and politics affect success.

Article 2: Social, political, socioeconomic, and organizational aspects affect syringe exchange programs (SEPs) in metropolitan regions. They affect SEP availability.

Article 3: Coalition building, timely advocacy, and media engagement helped the Louisville Metro Department of Public Health and Wellness establish and implement a syringe exchange program.

Big Lesson Program Evaluators Should Learn

The three articles shed light on syringe exchange program (SEP) design, implementation, and evaluation. SEP efficacy is shaped by political concerns, community engagement, coalition building, and media involvement. The articles underline the necessity to evaluate local context, navigate opposition, and carefully explain the public health benefits of SEPs to combat stigma. They also emphasize the need to identify the changing substance use and health environment and the role of advocacy in policy reform. Program evaluators should acknowledge that SEPs are complex interventions entangled with social dynamics, requiring a complete approach that goes beyond traditional metrics to include socio-political and cultural aspects to maximize their positive impact.

Politics and related social and cultural issues shape the policy process and program evaluation of Needle Exchange Programs (NEPs) or Syringe Exchange Programs (SEPs). Politics can affect funding, decision-making, and program evaluation performance (Lewis et al., 2017). These political considerations can complicate NEPs/SEPs.

The policy process is inherently intertwined with political dynamics. Political ideology, public perception, and bigger policy goals can affect NEPs/SEPs (Miller & Grollman, 2015). Political difficulties may include the optics of supporting harm reduction initiatives like needle exchange, especially given drug use's stigma. Ideological divides can also affect how stakeholders evaluate these initiatives, affecting study questions, data-gathering methods, and outcomes interpretation.

Cultural and social factors further contribute to the intricacies of NEP/SEP evaluations. Cultural views on drug use, harm reduction, and public health initiatives might affect how communities evaluate their efficacy and necessity. Researchers must be sensitive to cultural differences in drug use, healthcare, and public initiatives. Ignoring or misinterpreting these cultural differences may skew findings or hamper program implementation.

A multifaceted approach is needed to examine NEPs/SEPs while considering cultural and political issues. First, considering the local context and including stakeholders from varied backgrounds in the review process might reveal community values and expectations. Engaging community members, program participants, and local leaders can help ensure that the evaluation design respects cultural norms and meets community issues.

Second, researchers should use mixed-methods approaches that incorporate quantitative and qualitative data. Quantitative statistics can show the program's influence on disease transmission and risk behaviors, while qualitative methodologies can capture program participants' narratives and experiences in their cultural and social context. Using this method, researchers can better grasp NEPs/SEPs' statistical and societal effects.

Transparency, framing, and open dialogue are needed to present findings in a politically sensitive atmosphere. Researchers should admit biases, highlight limits, and contextualize results in the cultural and political context. Transparency improves program performance and policy discussions (Schneider & Ingram, 1993). Additionally, NEPs/SEPs have benefits beyond illness prevention. Thus, researchers should focus on them. These programs' benefits to community well-being, public health, and outreach and education might appeal to legislators and the public. Personal tales and testimonies from program participants help humanize these initiatives and counter unfavorable impressions.

References

Lewis, D. C., Flores, A. R., Haider-Markel, D. P., Miller, P. R., Tadlock, B. L., & Taylor, J. K. (2017). Degrees of Acceptance: Variation in Public Attitudes toward Segments of the LGBT Community. Political Research Quarterly, 70(4), 861–875.

Miller, L. R., & Grollman, E. A. (2015). The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health. Sociological Forum, 30(3), 809–831.

Schneider, A., & Ingram, H. (1993). Social Construction of Target Populations: Implications for Politics and Policy. American Political Science Review, 87(2), 334–347.

Des Jarlais, D. C. D. J. (2000). Research, politics, and needle exchange. American Journal of Public Health, 90(9), 1392–1394. https://doi.org/10.2105/ajph.90.9.1392

Kerr, J., Atlas, M., Crabtree, W., Chen, Y.-T., & Moyer, S. (2019). Examining Social–Ecological Factors in Developing the Louisville Metro Department of Public Health and Wellness Syringe Exchange Program. American Journal of Public Health, 109(3), 454–457. https://doi.org/10.2105/ajph.2018.304897

Tempalski, B., Flom, P. L., Friedman, S. R., Des Jarlais, D. C., Friedman, J. J., McKnight, C., & Friedman, R. (2007). Social and Political Factors Predicting the Presence of Syringe Exchange Programs in 96 US Metropolitan Areas. American Journal of Public Health, 97(3), 437–447. https://doi.org/10.2105/ajph.2005.065961

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