When public health professionals entered the Walter E. Washington Convention Center in D.C. this week for the APHA Annual Meeting, they knew they had found their people. Thousands of people dedicated to improving the health of this nation and across the world moved through the conference halls. In one area of the expo, there was a constant buzz of conversation: Welcome to the poster sessions, where dozens of public health workers and students shared their passions through their research. 

Improving acceptance of harm reduction strategies

Emily Kiefer surveyed adults in Pennsylvania to determine tolerance for harm reduction strategies, specifically for fentanyl test strips and safe injection facilities. Keifer is an undergraduate student at Penn State at Harrisburg who is hoping to attend medical school and obtain a master’s in public health. 

Drug use is a significant public health crisis. In 2023, 4,721 people in Pennsylvania died from overdose. Kiefer wanted to examine how demographic factors — including gender, age, political ideology, geography and income — affected residents’ stigma of harm reduction strategies.

Of the 1,033 adults surveyed across the state, those who had more of a liberal political ideology, less desire to social distance from substance users and lower levels of stigma were more likely to support harm reduction strategies, Kiefer explained. 

“In Pennsylvania and all around the country naloxone is becoming really, really common to see, but we’re not really seeing safe injection sites or fentanyl strips come up nearly as much.” 

In fact, fentanyl test strips were categorized as illegal drug paraphernalia in Pennsylvania until a new 2023 state law decriminalizing them. It would be interesting to see now that fentanyl test strips are legal, and as people become more aware of them, whether individual stigma against them drops further, Kiefer said.

Kiefer said she was surprised that age, annual household income, familiarity of substance use disorder, and urban/rural status were not significant in a person’s level of support for these harm reduction strategies. 

Trauma-informed alternative to traditional discipline

Chyna Miller, a doctor of public health student at Florida A&M University in Gainesville, developed an alternative program to punitive discipline. She was aiming to reduce suspensions of high school students who had more adverse childhood experiences. 

Miller examined data from the 2021 High School Youth Risk Behavior Survey for Alachua County, where Gainesville is located. She found that students with higher ACE scores — who are more likely to be Black and Hispanic — receive a disproportionate amount of student discipline in the county. 

“I work professionally as a prevention consultant in the area with a child welfare agency, so that’s how I’m aware of what’s happening in the school districts there.” 

Among the risk factors for discipline were students who had been suspended from school within the past 12 months. Miller focused on those students, creating a program called RESET (Resilient Empowerment, Support, Empathy and Transformation).

RESET aims to improve mental health outcomes for students with high ACE scores, reduce exclusionary disciplinary actions in school and create a supportive and trauma-informed school environment. 

RESET is using art to help students with emotional regulation and healing. Miller is a visual artist who earned an art degree before earning a master’s in public health. 

“My entry point into public health was through the arts. … I would use my art to advocate for and bring awareness to different social issues. Through that, I’ve carried that through public health practice.” 

She continued, “Marrying the two together was profound for me, and building a program off of that makes me happy.” 

Miller began to develop the RESET program as part of her MPH work and built upon it as a doctoral student. Next up, she’s seeking funding to pilot the program in the local school district. 

Pulmonary harm of different forms of cannabis

As people now use cannabis in many other ways beyond smoking, Cesar Arredondo Abreu, a PhD candidate at Oregon State, wanted to better understand how cannabis consumption affects lung health. 

Using the 2020 Behavioral Risk Factor Surveillance System cannabis supplement, he compared cannabis users who only smoked, only ate edibles or only vaped to determine their risk of having a pulmonary health condition, such as chronic obstructive pulmonary disease, emphysema or chronic bronchitis. 

“When comparing smoking (cannabis) with edibles, edibles had a significantly higher odds ratio, which is kind of surprising,” he said. “You wouldn’t expect that considering edibles are ingested instead of inhaled.” 

While more research is needed, Abreu theorizes that edible users may have switched from smoking because of existing lung problems or on the advice of a health care professional. 

“The research on different methods of consumption and the possible negative health outcomes they have is still new, even though these methods of consumption are not new,” Abreu said.

More research on which methods have fewer health risks is important to inform education and harm reduction programs, he said. 

“Here I only looked into methods of consumption, but there’s a lot of (questions) like how much THC, or what’s the potency of the product, or are you combining it with any other cannabinoids. There are just so many questions that we don’t have the answers to yet.” 

Photos: Fariah Mahmood and Emily Kiefer; Chyna Miller and April McCray; Cesar Arredondo Abreu. Photos courtesy Melanie Padgett Powers.