Alex H Kral
Dados Biográficos
| ID | 190674 |
|---|---|
| NOME | Alex H Kral |
| PRENOMES | Alex H |
| SOBRENOME | Kral |
| ASSINATURA | KRAL A H |
| AFILIAÇÕES | RTI International |
| ORCID | 0000-0002-9092-3671 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 95 |
| TOTAL DE CITAÇÕES | 153 |
| TOTAL COMO AUTOR | 95 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1991 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 8 |
Police drug market disruptions and number of drug sources among people who use drugs in San Francisco
Overdose mortality in the United States remains high. Law enforcement-based efforts to suppress the illicit drug supply may destabilize markets, prompting people who use drugs to seek alternative sources with uncertain potency, a response that may elevate overdose risk. We tested whether geographical exposure to drug distribution enforcement is associated with number of drug sources among people who use drugs. We analyzed cross-sectional survey d…
Funding Community Health Services for People Who Use Drugs in San Francisco
Introduction The drug overdose mortality crisis persists in the United States. Evidence-based harm reduction interventions reduce overdose mortality and improve health outcomes. However, programs are challenged by social stigma against people who use drugs (PWUD) and insufficient funding, the most consequential determinant of implementation success. This study explored the determinants of funding, identified funding-related barriers and facilitat…
Housing and displacement as risk factors for negative health outcomes among people who inject drugs in Los Angeles, CA, and Denver, CO, USA
The United States is currently experiencing a housing and homelessness crisis. In response, many cities have adopted policies of displacement that move unhoused people from place to place. Recent research indicates that these policies may have negative health impacts on unhoused people who use drugs. We sought to examine health risks associated with forced displacement among unhoused people who inject drugs (PWID). We interviewed a community-recr…
The role of stigma in impeding implementation of harm reduction services in San Francisco
The United States continues to face an epidemic of drug overdose deaths among people who use drugs (PWUD). Harm reduction services are efficacious interventions that reduce overdose deaths and improve the health of PWUD. For decades, San Francisco has remained at the vanguard of the adoption, implementation, and sustainability of harm reduction programs. During a time of national urgency in 2023, we conducted a qualitative study interviewing lead…
Evaluating health outcomes among American Indian/Alaska Native people who use drugs in Oregon
The present study determined the association between identifying as American Indian/Alaska Native (AI/AN) and ever having had an opioid-related overdose, housing status, prior diagnosis of a psychiatric illness, and utilization of syringe service and drug checking services. We recruited and surveyed people who use drugs in community-settings using targeted samplings methods in eight Oregon counties ( N = 468). We conducted logistic regression ana…
Housing assistance among people who are unstably housed and use drugs in Oregon
We found a large gap in housing assistance for people who use drugs in Oregon and identified several factors associated with obtaining housing assistance. Our findings can inform future interventions to connect people who use drugs with stable housing
Policing during a period of drug decriminalization
Drug decriminalization policy under the microscope in the United States
When voters passed the 2020 Ballot Measure 110 (M110), the U.S. State of Oregon changed course from a criminal legal system response to a health-centered approach to substance use. M110 was passed with the goal of making health assessment screenings, treatment, and recovery services for substance use disorder available to all who need them and reduce the harms associated with involving the criminal legal system for people who use drugs. Although …
Public calls for service to the police
Overdose as a complex contagion
BACKGROUND: The opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of increasing overdose by driving consumers towards new suppliers with unpredictable drug products of unknown potency. METHODS: Cross-sectional study using point-level information on law enforcement opioid-related drug seizures from property roo…
Characterizing Opioid Withdrawal Experiences and Consequences Among a Community Sample of People Who Use Opioids
BACKGROUND: Opioid withdrawal symptoms are a highly salient and consequential health condition experienced by people who use opioids (PWUO). This study utilized qualitative interviews to explore opioid withdrawal experiences and consequences among PWUO in Los Angeles County, USA. METHODS: Semi-structured qualitative interviews were conducted with 22 PWUO (aged 27-63 years) between May 2021 and May 2022. Participants self-reported opioid and injec…
Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes
Syringe Services Programs (SSPs) provide evidence-based services like drug use equipment to prevent infectious disease, overdose prevention education, and naloxone distribution to people who use drugs (PWUD). However, inadequate funding threatens provision of these interventions. This study aimed to document how the current funding landscape impacted determinants of SSP implementation, particularly describing financial and staffing barriers, faci…
Updates on syringe coverage and service uptake among needle and syringe programs in the United States, 2019–2020
Both governmental investment in harm reduction programming and needs-based distribution of syringes increased service uptake and thus should be expanded and sustained to reduce harms associated with injection drug use
Radical hospitality
The co-location of an OPS within a multi-service drop-in center is an important example of how such an organization can build positive sociality among PWUD while protecting autonomy and reducing overdose mortality. Overdose response and reversal is an act of relational accountability in which friends, peers, and even strangers intervene to protect and revive one another. This powerful intervention was operationalized as an anti-oppressive, horizo…
Evaluating oxygen monitoring and administration during overdose responses at a sanctioned overdose prevention site in San Francisco, California
New evidence’ for Syringe Services Programs? A call for rigor and skepticism
All carrots and no stick”
Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone
Health risk associated with residential relocation among people who inject drugs in Los Angeles and San Francisco, CA
PWID who have relocated in the past 30 days have higher odds of experiencing violence and life- threatening adverse outcomes, and policies that disrupt living circumstances of PWID should be ended in favor of those that support housing stability
Consuming illicit opioids during a drug overdose epidemic
PWID have the capacity to recognize changes to the illicit opioid supply. Study participants navigated unpredictable fluctuations in the illicit opioid market by employing homegrown discernment techniques, modifying drug use behavior, and co-using non-opioid drugs. Researchers and policymakers should involve PWID as subject matter experts to help modernize harm reduction for the fentanyl age with practical strategies to boost resiliency and save …
Principles and Metrics for Evaluating Oregon’s Innovative Drug Decriminalization Measure
Establishment and Enforcement of Operational Rules at an Unsanctioned Safe Drug Consumption Site in the United States, 2014–2020
Objectives. To examine how operational rules are established and enforced at an unsanctioned safe consumption site (SCS) operating in the United States. Methods. We conducted 44 qualitative interviews with people who use drugs, staff members, and volunteers at an unsanctioned SCS and analyzed them using an inductive thematic approach. Results. Rule-making processes were largely driven by concerns raised by service users rather than driven by exte…
Novel Routes of Potential Hepatitis C Virus Transmission among People Who Inject Drugs
Background: The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that appears to be driven by new cases among people who inject drugs (PWID). While HCV transmission among PWID is believed to occur mostly through direct sharing of syringes, some infections may be spread via secondary processes and materials involved in injecting. Objectives: Here, we present the prevalence of secondary blood exposures on clothing and nearby surfac…
Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia
Perceived occupational risk of fentanyl exposure among law enforcement
Impact of law enforcement on syringe exchange programs
Drug paraphernalia and prescription laws make syringe exchange programs (SEPs) illegal in most states in the U.S. Nonetheless, SEPs have been started in 25 states and the District of Columbia as of September 1995. In some states like California and New Jersey, SEPs have operated despite police arrest of volunteers and clients. We examine the impact of police action and threat on SEPs by comparing an underground syringe exchange site (SES) in West…
HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities
OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack…
Structure, Agency, and Sexual Development of Latino Gay Men
There is a high prevalence of childhood sexual abuse and HIV among Latino gay men, with limited proven HIV prevention interventions. This study used qualitative methods to explicate earlier findings showing differential health outcomes among Latino gay men who had no sex, voluntary, or forced sex before age 16. Analyses of in-depth interviews with 27 Latino gay men revealed that structural factors in childhood contribute to their developing sexua…
Sexual and Injection Risk among Women who Inject Methamphetamine in San Francisco
Characteristics of an Overdose Prevention, Response, and Naloxone Distribution Program in Pittsburgh and Allegheny County, Pennsylvania
Comparing Respondent-Driven Sampling and Targeted Sampling Methods of Recruiting Injection Drug Users in San Francisco
The objective of this article is to compare demographic characteristics, risk behaviors, and service utilization among injection drug users (IDUs) recruited from two separate studies in San Francisco in 2005, one which used targeted sampling (TS) and the other which used respondent-driven sampling (RDS). IDUs were recruited using TS (n = 651) and RDS (n = 534) and participated in quantitative interviews that included demographic characteristics, …
Overdose Prevention Site Acceptability among Residents and Businesses Surrounding a Proposed Site in Philadelphia, USA
How Institutions Deprive
Megan Comfort, Andrea M. Lopez, Christina Powers, Alex H. Kral, Jennifer Lorvick, How Institutions Deprive: Ethnography, Social Work, and Interventionist Ethics Among the Hypermarginalized, RSF: The Russell Sage Foundation Journal of the Social Sciences, Vol. 1, No. 1, Severe Deprivation in America (November 2015), pp. 100-119
HIV Prevalence and Risk Behaviors Among Men Who Have Sex with Men and Inject Drugs in San Francisco
The Impact of Legalizing Syringe Exchange Programs on Arrests Among Injection Drug Users in California
Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area
The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was cond…
Bridging institutional logics
Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco
Opiate overdose is a significant cause of mortality among injection drug users (IDUs) in the United States (US). Opiate overdose can be reversed by administering naloxone, an opiate antagonist. Among IDUs, prevalence of witnessing overdose events is high, and the provision of take-home naloxone to IDUs can be an important intervention to reduce the number of overdose fatalities. The Drug Overdose Prevention and Education (DOPE) Project was the fi…
Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area
Correlates of Sexual Coercion among People Who Inject Drugs (PWID) in Los Angeles and San Francisco, CA
Living Conditions and Psychological Distress in Latino Migrant Day Laborers
The purpose of this study was to examine the relationship between typically difficult living conditions and psychological distress in Latino migrant day laborers (LMDLs), with attention to the potentially protective roles of contact with family in country of origin (i.e., communication, sending money, etc.), availability of local culture (i.e., food, music, people from one's country of origin), and utilization of community resources perceived to …
Predictors and Prevention of Nonfatal Overdose Among Street-Recruited Injection Heroin Users in the San Francisco Bay Area, 1998–1999
Objectives. This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. Methods. From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. Results. Of the 1427 participant…
Principles and Metrics for Evaluating Oregon’s Innovative Drug Decriminalization Measure
Correlates of Transactional Sex and Violent Victimization among Men Who Inject Drugs in Los Angeles and San Francisco, California
Exploring Lifetime Accumulation of Criminal Justice Involvement and Associated Health and Social Outcomes in a Community-Based Sample of Women who Use Drugs
Non-Partner Violence Against Women Who Use Drugs in San Francisco
This article examines non-partner violence among women who use methamphetamine (N = 322), recruited in an inner-city neighborhood of San Francisco. The combined prevalence of non-partner physical or sexual violence in the past 6 months was 28%, roughly equal to the prevalence of partner violence (26%). In multivariate analysis, factors associated with non-partner violence included frequent subsistence difficulty (adjusted odds ratio [AOR] = 2.43,…
Incentives and accessibility
Approval of Syringe Exchange Programs in California
Objectives. We studied the effect of local approval of syringe exchange programs in California (through Assembly AB136) on program availability and performance. Methods. We determined the number of active syringe exchange programs in California by conducting Internet searches and obtaining information from the state and from local programs. To track changes in program availability and performance between 2000 and 2002, we interviewed 24 program d…
Access to Sterile Syringes through San Francisco Pharmacies and the Association with HIV Risk Behavior among Injection Drug Users
Increased options for syringe acquisition and disposal have been associated with reductions in high-risk behaviors. This study determined the extent of pharmacy uptake in accessing syringes among injection drug users (IDUs) and estimated associations between pharmacy uptake and safer injection/disposal practices. Two years after the implementation of California's Disease Prevention Demonstration Project, which removed restrictions to non-prescrip…
Evaluating a Statewide Pilot Syringe Access Program for Injection Drug Users through Pharmacies in California
Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area
The US Preventive Services Task Force recommends that all primary care physicians assess the sexually transmitted disease/human immunodeficiency virus (STD/HIV) risk of all adolescent and adult patients. To determine whether factors amenable to change through continuing medical education are associated with frequent and thorough STD/HIV risk assessment, a telephone survey of primary care physicians in the Washington, DC metropolitan area was cond…
Impact of law enforcement on syringe exchange programs
Drug paraphernalia and prescription laws make syringe exchange programs (SEPs) illegal in most states in the U.S. Nonetheless, SEPs have been started in 25 states and the District of Columbia as of September 1995. In some states like California and New Jersey, SEPs have operated despite police arrest of volunteers and clients. We examine the impact of police action and threat on SEPs by comparing an underground syringe exchange site (SES) in West…
HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities
OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack…
Collateral damage in the war on drugs
Incentives and accessibility
Sexual transmission of HIV-1 among injection drug users in San Francisco, USA
Predictors and Prevention of Nonfatal Overdose Among Street-Recruited Injection Heroin Users in the San Francisco Bay Area, 1998–1999
Objectives. This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. Methods. From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. Results. Of the 1427 participant…
What is it about needle and syringe programmes that make them effective for preventing HIV transmission
Delivering syringe exchange services through “satellite exchangers”
Condom Attitudes and Behaviors Among Injection Drug Users Participating in California Syringe Exchange Programs
Police crackdowns, societal cost, and the need for alternative approaches
HIV Prevalence and Risk Behaviors Among Men Who Have Sex with Men and Inject Drugs in San Francisco
Sexual and Injection Risk among Women who Inject Methamphetamine in San Francisco
The Impact of Legalizing Syringe Exchange Programs on Arrests Among Injection Drug Users in California
Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area
Approval of Syringe Exchange Programs in California
Objectives. We studied the effect of local approval of syringe exchange programs in California (through Assembly AB136) on program availability and performance. Methods. We determined the number of active syringe exchange programs in California by conducting Internet searches and obtaining information from the state and from local programs. To track changes in program availability and performance between 2000 and 2002, we interviewed 24 program d…
HIV Risks and Seroprevalence Among Mexican American Injection Drug Users in California
Latinos in the United States are an ethnically diverse group disproportionately affected by HIV/AIDS. We describe HIV seroprevalence, HIV risk behaviors and utilization of health services among Mexican American injection drug users (IDUs) in California (n = 286) and compare them to White (n = 830) and African American (n = 314) IDUs. Study participants were recruited from syringe exchange programs (n = 24) in California. HIV seroprevalence among …
Access to Sterile Syringes through San Francisco Pharmacies and the Association with HIV Risk Behavior among Injection Drug Users
Increased options for syringe acquisition and disposal have been associated with reductions in high-risk behaviors. This study determined the extent of pharmacy uptake in accessing syringes among injection drug users (IDUs) and estimated associations between pharmacy uptake and safer injection/disposal practices. Two years after the implementation of California's Disease Prevention Demonstration Project, which removed restrictions to non-prescrip…
Evaluating a Statewide Pilot Syringe Access Program for Injection Drug Users through Pharmacies in California
Overdose Prevention and Naloxone Prescription for Opioid Users in San Francisco
Opiate overdose is a significant cause of mortality among injection drug users (IDUs) in the United States (US). Opiate overdose can be reversed by administering naloxone, an opiate antagonist. Among IDUs, prevalence of witnessing overdose events is high, and the provision of take-home naloxone to IDUs can be an important intervention to reduce the number of overdose fatalities. The Drug Overdose Prevention and Education (DOPE) Project was the fi…
Comparing Respondent-Driven Sampling and Targeted Sampling Methods of Recruiting Injection Drug Users in San Francisco
The objective of this article is to compare demographic characteristics, risk behaviors, and service utilization among injection drug users (IDUs) recruited from two separate studies in San Francisco in 2005, one which used targeted sampling (TS) and the other which used respondent-driven sampling (RDS). IDUs were recruited using TS (n = 651) and RDS (n = 534) and participated in quantitative interviews that included demographic characteristics, …
Health and Oral Health Care Needs and Health Care-Seeking Behavior Among Homeless Injection Drug Users in San Francisco
Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testin…
Population-level effects of uninterrupted health insurance on services use among HIV-positive unstably housed adults
Health services research consistently confirms the benefit of insurance coverage on the use of health services sought in the USA. However, few studies have simultaneously addressed the multitude of competing and unmet needs specifically among unstably housed persons. Moreover, few have accounted for the fact that hospitalization may lead to obtaining insurance coverage, rather than the other way around. This study used marginal structural models …
The prospect of implementing a Safer Injection Facility in San Francisco
Assessing geographic and individual level factors associated with arrests among injection drug users in California
Medicine (86 obras) · HIV, Drug Use, Sexual Risk (80 obras) · Opioid Use Disorder Treatment (48 obras) · Psychiatry (46 obras) · Environmental health (39 obras) · Public health (34 obras) · Nursing (33 obras) · Psychology (33 obras) · Political science (31 obras) · Internal Medicine (28 obras)