{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T13:11:49Z","timestamp":1773493909136,"version":"3.50.1"},"reference-count":64,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100007154","name":"Wake Forest University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007154","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["AIDS Behav"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>People who inject drugs (PWID) experience stigma related to drug use and HIV prevention, which can impede engagement with the HIV prevention continuum. Resilience may buffer against stigma\u2019s harmful effects, but limited research has examined how resilience operates across different social contexts and stigma types among PWID. Using qualitative interviews and cognitive interviews, we adapted the 10-item Connor-Davidson Resilience Scale to measure resilience to drug use-related stigma and HIV prevention-related stigma among PWID in rural Appalachian Ohio in three contexts: medical, social, and employment. To validate the scale adaptations, we administered a quantitative survey. We assessed internal consistency using Cronbach\u2019s alpha and fit Poisson regression models to test the association between high resilience and pre-exposure prophylaxis (PrEP) awareness and overdose response training. Among the 250 PWID who completed the quantitative survey, the six resilience scales demonstrated strong internal consistency. Examining frequency distributions, Bland\u2013Altman plots, and factor analysis, we found the resilience responses varied by stigma type and context. Results of regression models indicated high resilience to HIV prevention-related stigma in the medical context was associated with PrEP awareness (adjusted prevalence ratio [aPR]: 1.37; 95% CI 1.05, 1.80) and overdose response training (aPR: 1.31; 95% CI 1.07, 1.61). Our study provides a novel approach to measuring context-specific resilience to stigma among PWID. Findings highlight the importance of tailoring interventions to both individual resilience and structural stigma, particularly in medical settings. Enhancing resilience and reducing stigma may support greater engagement with HIV prevention and harm reduction services in rural communities.<\/jats:p>","DOI":"10.1007\/s10461-025-04915-4","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:58:00Z","timestamp":1761663480000},"page":"894-906","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Resilience to Stigma in Medical, Social, and Employment Contexts Among People Who Inject Drugs in Rural Ohio: Adapting the 10-Item Connor-Davidson Resilience Scale"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2592-0781","authenticated-orcid":false,"given":"Madison N.","family":"Enderle","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca H.","family":"Neiberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacy M.","family":"Endres-Dighe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4765-7179","authenticated-orcid":false,"given":"Nisha","family":"Gottfredson O\u2019Shea","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivian F.","family":"Go","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William C.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2389-6973","authenticated-orcid":false,"given":"Kathryn E.","family":"Lancaster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"4915_CR1","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.drugalcdep.2019.01.037","volume":"198","author":"DL Biancarelli","year":"2019","unstructured":"Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, et al. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug Alcohol Depend. 2019;198:80\u20136.","journal-title":"Drug Alcohol Depend"},{"key":"4915_CR2","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1111\/jrh.12129","volume":"32","author":"T Browne","year":"2016","unstructured":"Browne T, Priester MA, Clone S, Iachini A, DeHart D, Hock R. Barriers and facilitators to substance use treatment in the rural south: a qualitative study. J Rural Health. 2016;32:92\u2013101.","journal-title":"J Rural Health"},{"key":"4915_CR3","doi-asserted-by":"publisher","first-page":"102588","DOI":"10.1016\/j.drugpo.2019.11.001","volume":"85","author":"M Fadanelli","year":"2020","unstructured":"Fadanelli M, Cloud DH, Ibragimov U, Ballard AM, Prood N, Young AM, et al. People, places, and stigma: a qualitative study exploring the overdose risk environment in rural Kentucky. Int J Drug Policy. 2020;85:102588.","journal-title":"Int J Drug Policy"},{"key":"4915_CR4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.drugpo.2018.04.004","volume":"57","author":"CE Paquette","year":"2018","unstructured":"Paquette CE, Syvertsen JL, Pollini RA. Stigma at every turn: health services experiences among people who inject drugs. Int J Drug Policy. 2018;57:104\u201310.","journal-title":"Int J Drug Policy"},{"key":"4915_CR5","doi-asserted-by":"publisher","first-page":"102704","DOI":"10.1016\/j.drugpo.2020.102704","volume":"85","author":"EL Richard","year":"2020","unstructured":"Richard EL, Schalkoff CA, Piscalko HM, Brook DL, Sibley AL, Lancaster KE, et al. \u201cYou are not clean until you\u2019re not on anything\u201d: perceptions of medication-assisted treatment in rural Appalachia. Int J Drug Policy. 2020;85:102704.","journal-title":"Int J Drug Policy"},{"key":"4915_CR6","doi-asserted-by":"publisher","first-page":"3085","DOI":"10.1007\/s10461-021-03304-x","volume":"25","author":"G Carter","year":"2021","unstructured":"Carter G, Meyerson B, Rivers P, Crosby R, Lawrence C, Cope SD, et al. Living at the confluence of stigmas: PrEP awareness and feasibility among people who inject drugs in two predominantly rural states. AIDS Behav. 2021;25:3085\u201396.","journal-title":"AIDS Behav"},{"key":"4915_CR7","doi-asserted-by":"publisher","first-page":"108878","DOI":"10.1016\/j.drugalcdep.2021.108878","volume":"226","author":"HL Surratt","year":"2021","unstructured":"Surratt HL, Otachi JK, McLouth CJ, Vundi N. Healthcare stigma and HIV risk among rural people who inject drugs. Drug Alcohol Depend. 2021;226:108878.","journal-title":"Drug Alcohol Depend"},{"key":"4915_CR8","unstructured":"Hepatitis C: Five year status report. Ohio Dep. Health [cited 2025 Jan 16]. Available from: https:\/\/odh.ohio.gov\/know-our-programs\/viral-hepatitis\/data-statistics\/hcv-5yr-report"},{"key":"4915_CR9","doi-asserted-by":"publisher","first-page":"175","DOI":"10.2105\/AJPH.2017.304132","volume":"108","author":"JE Zibbell","year":"2018","unstructured":"Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108:175\u201381.","journal-title":"Am J Public Health"},{"key":"4915_CR10","doi-asserted-by":"publisher","first-page":"470","DOI":"10.15585\/mmwr.mm6618a3","volume":"66","author":"SW Patrick","year":"2017","unstructured":"Patrick SW, Bauer AM, Warren MD, Jones TF, Wester C. Hepatitis C virus infection among women giving birth\u2014Tennessee and United States, 2009\u20132014. MMWR Morb Mortal Wkly Rep. 2017;66:470\u20133.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"5","key":"4915_CR11","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1080\/10826084.2021.1887248","volume":"56","author":"CA Schalkoff","year":"2021","unstructured":"Schalkoff CA, Richard EL, Piscalko HM, Sibley AL, Brook DL, Lancaster KE, et al. \u201cNow we are seeing the tides wash in\u201d: trauma and the opioid epidemic in rural Appalachian Ohio. Subst Use Misuse. 2021;56(5):650\u20139.","journal-title":"Subst Use Misuse"},{"key":"4915_CR12","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.jrurstud.2018.12.004","volume":"68","author":"SM Monnat","year":"2019","unstructured":"Monnat SM. The contributions of socioeconomic and opioid supply factors to U.S. drug mortality rates: urban\u2013rural and within-rural differences. J Rural Stud. 2019;68:319\u201335.","journal-title":"J Rural Stud"},{"key":"4915_CR13","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s11904-018-0393-0","volume":"15","author":"AJ Schranz","year":"2018","unstructured":"Schranz AJ, Barrett J, Hurt CB, Malvestutto C, Miller WC. Challenges facing a rural opioid epidemic: treatment and prevention of HIV and Hepatitis C. Curr HIV AIDS Rep. 2018;15:245\u201354.","journal-title":"Curr HIV AIDS Rep"},{"key":"4915_CR14","doi-asserted-by":"publisher","first-page":"2278","DOI":"10.1177\/1049732320948829","volume":"30","author":"AL Sibley","year":"2020","unstructured":"Sibley AL, Schalkoff CA, Richard EL, Piscalko HM, Brook DL, Lancaster KE, et al. \u201cI was raised in addiction\u201d: constructions of the self and the other in discourses of addiction and recovery. Qual Health Res. 2020;30:2278\u201390. https:\/\/doi.org\/10.1177\/1049732320948829.","journal-title":"Qual Health Res"},{"key":"4915_CR15","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1037\/rmh0000248","volume":"48","author":"AM Wilson","year":"2024","unstructured":"Wilson AM, Brown AR. Barriers to utilizing substance use disorder treatment and harm reduction services in Appalachia. J Rural Ment Health. 2024;48:15\u201325. https:\/\/doi.org\/10.1037\/rmh0000248.","journal-title":"J Rural Ment Health"},{"key":"4915_CR16","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1037\/a0032705","volume":"68","author":"VA Earnshaw","year":"2013","unstructured":"Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial\/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68:225\u201336. https:\/\/doi.org\/10.1037\/a0032705.","journal-title":"Am Psychol"},{"key":"4915_CR17","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1177\/1359105313507964","volume":"20","author":"VA Earnshaw","year":"2015","unstructured":"Earnshaw VA, Smith LR, Cunningham CO, Copenhaver MM. Intersectionality of internalized HIV stigma and internalized substance use stigma: implications for depressive symptoms. J Health Psychol. 2015;20:1083\u20139. https:\/\/doi.org\/10.1177\/1359105313507964.","journal-title":"J Health Psychol"},{"key":"4915_CR18","volume-title":"Intersectionality","author":"P Hill Collins","year":"2020","unstructured":"Hill Collins P, Bilge S. Intersectionality. 2nd ed. Cambridge Medford, MA: Polity Press; 2020.","edition":"2"},{"key":"4915_CR19","doi-asserted-by":"publisher","first-page":"102607","DOI":"10.1016\/j.drugpo.2019.11.015","volume":"85","author":"N Thomas","year":"2020","unstructured":"Thomas N, van de Ven K, Mulrooney KJD. The impact of rurality on opioid-related harms: a systematic review of qualitative research. Int J Drug Policy. 2020;85:102607.","journal-title":"Int J Drug Policy"},{"key":"4915_CR20","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1111\/add.15151","volume":"116","author":"RH White","year":"2021","unstructured":"White RH, O\u2019Rourke A, Kilkenny ME, Schneider KE, Weir BW, Grieb SM, et al. Prevalence and correlates of receptive syringe-sharing among people who inject drugs in rural Appalachia. Addiction. 2021;116:328\u201336. https:\/\/doi.org\/10.1111\/add.15151.","journal-title":"Addiction"},{"key":"4915_CR21","doi-asserted-by":"publisher","first-page":"905314","DOI":"10.3389\/fpsyt.2022.905314","volume":"13","author":"HL Surratt","year":"2022","unstructured":"Surratt HL, Yeager HJ, Adu A, Gonz\u00e1lez EA, Nelson EO, Walker T. Pre-exposure prophylaxis barriers, facilitators and unmet need among rural people who inject drugs: a qualitative examination of syringe service program client perspectives. Front Psychiatry. 2022;13:905314.","journal-title":"Front Psychiatry"},{"key":"4915_CR22","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12954-018-0263-5","volume":"15","author":"KB Biello","year":"2018","unstructured":"Biello KB, Bazzi AR, Mimiaga MJ, Biancarelli DL, Edeza A, Salhaney P, et al. Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs. Harm Reduct J. 2018;15:55.","journal-title":"Harm Reduct J"},{"key":"4915_CR23","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.1007\/s10508-020-01684-0","volume":"49","author":"M Felsher","year":"2020","unstructured":"Felsher M, Ziegler E, Smith LR, Sherman SG, Amico KR, Fox R, et al. An exploration of pre-exposure prophylaxis (PrEP) initiation among women who inject drugs. Arch Sex Behav. 2020;49:2205\u201312. https:\/\/doi.org\/10.1007\/s10508-020-01684-0.","journal-title":"Arch Sex Behav"},{"key":"4915_CR24","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1089\/apc.2013.0330","volume":"28","author":"GW Harper","year":"2014","unstructured":"Harper GW, Bruce D, Hosek SG, Fernandez MI, Rood BA. Resilience processes demonstrated by young gay and bisexual men living with HIV: implications for intervention. AIDS Patient Care STDs. 2014;28:666\u201376.","journal-title":"AIDS Patient Care STDs"},{"key":"4915_CR25","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1002\/da.10113","volume":"18","author":"KM Connor","year":"2003","unstructured":"Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76\u201382. https:\/\/doi.org\/10.1002\/da.10113.","journal-title":"Depress Anxiety"},{"key":"4915_CR26","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1146\/annurev.publhealth.26.021304.144357","volume":"26","author":"S Fergus","year":"2005","unstructured":"Fergus S, Zimmerman MA. Adolescent resilience: a framework for understanding healthy development in the face of risk. Annu Rev Public Health. 2005;26:399\u2013419.","journal-title":"Annu Rev Public Health"},{"key":"4915_CR27","doi-asserted-by":"publisher","first-page":"S6","DOI":"10.1080\/09540121.2018.1515470","volume":"30","author":"AJ Dulin","year":"2018","unstructured":"Dulin AJ, Dale SK, Earnshaw VA, Fava JL, Mugavero MJ, Napravnik S, et al. Resilience and HIV: a review of the definition and study of resilience. AIDS Care. 2018;30:S6-17. https:\/\/doi.org\/10.1080\/09540121.2018.1515470.","journal-title":"AIDS Care"},{"key":"4915_CR28","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1111\/1467-8624.00164","volume":"71","author":"SS Luthar","year":"2000","unstructured":"Luthar SS, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000;71:543\u201362.","journal-title":"Child Dev"},{"key":"4915_CR29","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1177\/1090198113493782","volume":"40","author":"MA Zimmerman","year":"2013","unstructured":"Zimmerman MA. Resiliency theory: a strengths-based approach to research and practice for adolescent health. Health Educ Behav. 2013;40:381\u20133. https:\/\/doi.org\/10.1177\/1090198113493782.","journal-title":"Health Educ Behav"},{"key":"4915_CR30","doi-asserted-by":"publisher","first-page":"e001285","DOI":"10.1136\/bmjgh-2018-001285","volume":"4","author":"M Pantelic","year":"2019","unstructured":"Pantelic M, Steinert JI, Park J, Mellors S, Murau F. \u201cManagement of a spoiled identity\u201d: systematic review of interventions to address self-stigma among people living with and affected by HIV. BMJ Glob Health. 2019;4:e001285.","journal-title":"BMJ Glob Health"},{"key":"4915_CR31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.drugpo.2016.06.004","volume":"37","author":"S Brothers","year":"2016","unstructured":"Brothers S. Merchants, samaritans, and public health workers: secondary syringe exchanger discursive practices. Int J Drug Policy. 2016;37:1\u20138.","journal-title":"Int J Drug Policy"},{"key":"4915_CR32","doi-asserted-by":"publisher","first-page":"232595821987128","DOI":"10.1177\/2325958219871289","volume":"18","author":"R Kteily-Hawa","year":"2019","unstructured":"Kteily-Hawa R, Warren L, Kazemi M, Logie CH, Islam S, Kaida A, et al. Examining multilevel factors associated with the process of resilience among women living with HIV in a large Canadian cohort study: a structural equation modeling approach. J Int Assoc Provid AIDS Care. 2019;18:2325958219871289.","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"4915_CR33","doi-asserted-by":"publisher","first-page":"2860","DOI":"10.1007\/s10461-016-1608-2","volume":"21","author":"EN Woodward","year":"2017","unstructured":"Woodward EN, Banks RJ, Marks AK, Pantalone DW. Identifying resilience resources for HIV prevention among sexual minority men: a systematic review. AIDS Behav. 2017;21:2860\u201373.","journal-title":"AIDS Behav"},{"key":"4915_CR34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2147\/SAR.S304566","volume":"13","author":"A Cheetham","year":"2022","unstructured":"Cheetham A, Picco L, Barnett A, Lubman DI, Nielsen S. The impact of stigma on people with opioid use disorder, opioid treatment, and policy. Subst Abuse Rehabil. 2022;13:1\u201312.","journal-title":"Subst Abuse Rehabil"},{"key":"4915_CR35","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1002\/jts.20271","volume":"20","author":"L Campbell-Sills","year":"2007","unstructured":"Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience. J Trauma Stress. 2007;20:1019\u201328.","journal-title":"J Trauma Stress"},{"issue":"3","key":"4915_CR36","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1097\/QAI.0000000000001098","volume":"73","author":"MM Van Handel","year":"2016","unstructured":"Van Handel MM, Rose CE, Hallisey EJ, Kolling JL, Zibbell JE, Lewis B, et al. County-level vulnerability assessment for rapid dissemination of HIV or HCV infections among persons who inject drugs, United States. JAIDS J Acquir Immune Defic Syndr. 2016;73(3):323\u201331.","journal-title":"JAIDS J Acquir Immune Defic Syndr"},{"key":"4915_CR37","unstructured":"B03003: Hispanic or Latino Origin\u2014Census Bureau Table [cited 2025 Mar 27]. Available from: https:\/\/data.census.gov\/table\/ACSDT5Y2022.B03003?q=race"},{"key":"4915_CR38","unstructured":"B02001: Race\u2014Census Bureau Table [cited 2025 Mar 27]. Available from: https:\/\/data.census.gov\/table\/ACSDT5Y2022.B02001?q=race"},{"key":"4915_CR39","unstructured":"County Economic Status in Appalachia, FY 2025. Appalach. Reg. Comm [cited 2024 Sep 3]. Available from: https:\/\/www.arc.gov\/map\/county-economic-status-in-appalachia-fy-2025\/"},{"key":"4915_CR40","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/s12954-025-01160-9","volume":"22","author":"S Endres-Dighe","year":"2025","unstructured":"Endres-Dighe S, Sucaldito AD, McDowell R, Wright A, LoVette A, Miller WC, et al. Mechanisms of resilience and coping to intersectional HIV prevention and drug-use stigma among people who inject drugs in rural Appalachian Ohio. Harm Reduct J. 2025;22:18.","journal-title":"Harm Reduct J"},{"key":"4915_CR41","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.1177\/1077800414545235","volume":"20","author":"K Charmaz","year":"2014","unstructured":"Charmaz K. Grounded theory in global perspective: reviews by international researchers. Qual Inquiry. 2014;20:1074\u201384. https:\/\/doi.org\/10.1177\/1077800414545235.","journal-title":"Qual Inquiry"},{"key":"4915_CR42","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s12874-024-02206-5","volume":"24","author":"AE Rudolph","year":"2024","unstructured":"Rudolph AE, Nance RM, Bobashev G, Brook D, Akhtar W, Cook R, et al. Evaluation of respondent-driven sampling in seven studies of people who use drugs from rural populations: findings from the rural opioid initiative. BMC Med Res Methodol. 2024;24:94.","journal-title":"BMC Med Res Methodol"},{"key":"4915_CR43","unstructured":"Osborne JW. Best practices in exploratory factor analysis. Scotts Valley, CA: CreateSpace Independent Publishing; 2014. Available from: https:\/\/www.researchgate.net\/publication\/299519231_Exploratory_factor_analysis_with_SAS"},{"key":"4915_CR44","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2288-3-21","volume":"3","author":"AJD Barros","year":"2003","unstructured":"Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.","journal-title":"BMC Med Res Methodol"},{"key":"4915_CR45","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","volume":"159","author":"G Zou","year":"2004","unstructured":"Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159:702\u20136.","journal-title":"Am J Epidemiol"},{"key":"4915_CR46","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1111\/pcn.12772","volume":"72","author":"J Okuyama","year":"2018","unstructured":"Okuyama J, Funakoshi S, Tomita H, Yamaguchi T, Matsuoka H. Longitudinal characteristics of resilience among adolescents: a high school student cohort study to assess the psychological impact of the Great East Japan Earthquake. Psychiatry Clin Neurosci. 2018;72:821\u201335.","journal-title":"Psychiatry Clin Neurosci"},{"key":"4915_CR47","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.ejon.2017.01.004","volume":"27","author":"ZJ Ye","year":"2017","unstructured":"Ye ZJ, Qiu HZ, Li PF, Chen P, Liang MZ, Liu ML, et al. Validation and application of the Chinese version of the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) among parents of children with cancer diagnosis. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc. 2017;27:36\u201344.","journal-title":"Eur J Oncol Nurs Off J Eur Oncol Nurs Soc"},{"key":"4915_CR48","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1111\/dar.13959","volume":"44","author":"LN Sisson","year":"2025","unstructured":"Sisson LN, Tomko C, Rouhani S, Sherman SG. Examining the association between psychological resilience and chronic versus discrete stressors among individuals who use opioids in Baltimore, Maryland. Drug Alcohol Rev. 2025;44:288\u201397. https:\/\/doi.org\/10.1111\/dar.13959.","journal-title":"Drug Alcohol Rev"},{"key":"4915_CR49","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1007\/s12144-021-01564-3","volume":"42","author":"T Kav\u010di\u010d","year":"2023","unstructured":"Kav\u010di\u010d T, Zager Kocjan G, Dolenc P. Measurement invariance of the CD-RISC-10 across gender, age, and education: a study with Slovenian adults. Curr Psychol. 2023;42:1727\u201337. https:\/\/doi.org\/10.1007\/s12144-021-01564-3.","journal-title":"Curr Psychol"},{"key":"4915_CR50","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1080\/10376178.2018.1503549","volume":"54","author":"H Trip","year":"2018","unstructured":"Trip H, Tabakakis K, Maskill V, Richardson S, Dolan B, Josland H, et al. Psychological health and resilience: the impact of significant earthquake events on tertiary level professional students. A cross-sectional study. Contemp Nurse. 2018;54:319\u201332. https:\/\/doi.org\/10.1080\/10376178.2018.1503549.","journal-title":"Contemp Nurse"},{"key":"4915_CR51","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-24277-4","volume-title":"ggplot2: elegant graphics for data analysis","author":"H Wickham","year":"2016","unstructured":"Wickham H. ggplot2: elegant graphics for data analysis. New York: Springer-Verlag; 2016."},{"key":"4915_CR52","unstructured":"Davidson J. Connor-Davidson Resilience Scale (CD-RISC) Manual. 2018 [cited 2025 Aug 5]. Available from: https:\/\/www.cd-risc.com\/user-guide.php"},{"key":"4915_CR53","doi-asserted-by":"publisher","first-page":"813","DOI":"10.2105\/AJPH.2012.301069","volume":"103","author":"ML Hatzenbuehler","year":"2013","unstructured":"Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103:813\u201321.","journal-title":"Am J Public Health"},{"key":"4915_CR54","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s11904-020-00533-y","volume":"17","author":"SK Calabrese","year":"2020","unstructured":"Calabrese SK. Understanding, contextualizing, and addressing PrEP stigma to enhance PrEP implementation. Curr HIV-AIDS Rep. 2020;17:579\u201388. https:\/\/doi.org\/10.1007\/s11904-020-00533-y.","journal-title":"Curr HIV-AIDS Rep"},{"key":"4915_CR55","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1007\/s10461-013-0437-9","volume":"17","author":"VA Earnshaw","year":"2013","unstructured":"Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17:1785\u201395.","journal-title":"AIDS Behav"},{"key":"4915_CR56","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1007\/s10461-021-03488-2","volume":"26","author":"SM Walters","year":"2022","unstructured":"Walters SM, Frank D, Van Ham B, Jaiswal J, Muncan B, Earnshaw V, et al. PrEP care continuum engagement among persons who inject drugs: rural and urban differences in stigma and social infrastructure. AIDS Behav. 2022;26:1308\u201320. https:\/\/doi.org\/10.1007\/s10461-021-03488-2.","journal-title":"AIDS Behav"},{"key":"4915_CR57","first-page":"74","volume":"18","author":"JL Syvertsen","year":"2014","unstructured":"Syvertsen JL, Robertson Bazzi AM, Scheibe A, Adebajo S, Strathdee SA, Wechsberg WM. The promise and peril of pre-exposure prophylaxis (PrEP): using social science to inform prep interventions among female sex workers. Afr J Reprod Health. 2014;18:74\u201383.","journal-title":"Afr J Reprod Health"},{"key":"4915_CR58","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12954-022-00595-8","volume":"19","author":"AR Iryawan","year":"2022","unstructured":"Iryawan AR, Stoicescu C, Sjahrial F, Nio K, Dominich A. The impact of peer support on testing, linkage to and engagement in HIV care for people who inject drugs in Indonesia: qualitative perspectives from a community-led study. Harm Reduct J. 2022;19:16.","journal-title":"Harm Reduct J"},{"key":"4915_CR59","doi-asserted-by":"publisher","first-page":"215013192110640","DOI":"10.1177\/21501319211063999","volume":"13","author":"B Pleuhs","year":"2022","unstructured":"Pleuhs B, Mistler CB, Quinn KG, Dickson-Gomez J, Walsh JL, Petroll AE, et al. Evidence of potential discriminatory HIV pre-exposure prophylaxis (PrEP) prescribing practices for people who inject drugs among a small percentage of providers in the U.S. J Prim Care Community Health. 2022;13:21501319211064000.","journal-title":"J Prim Care Community Health"},{"key":"4915_CR60","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1037\/sah0000426","volume":"8","author":"SM Walters","year":"2023","unstructured":"Walters SM, Kerr J, Cano M, Earnshaw V, Link B. Intersectional stigma as a fundamental cause of health disparities: a case study of how drug use stigma intersecting with racism and xenophobia creates health inequities for Black and Hispanic persons who use drugs over time. Stigma Health. 2023;8:325\u201343. https:\/\/doi.org\/10.1037\/sah0000426.","journal-title":"Stigma Health"},{"key":"4915_CR61","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12954-021-00461-z","volume":"18","author":"J Chang","year":"2021","unstructured":"Chang J, Shelly S, Busz M, Stoicescu C, Iryawan AR, Madybaeva D, et al. Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries. Harm Reduct J. 2021;18:15. https:\/\/doi.org\/10.1186\/s12954-021-00461-z.","journal-title":"Harm Reduct J"},{"key":"4915_CR62","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s12954-024-00981-4","volume":"21","author":"JM Ezell","year":"2024","unstructured":"Ezell JM, Pho MT, Simek E, Ajayi BP, Shetty N, Walters SM. How do people who use opioids express their qualities and capacities? An assessment of attitudes, behaviors, and opportunities. Harm Reduct J. 2024;21:79. https:\/\/doi.org\/10.1186\/s12954-024-00981-4.","journal-title":"Harm Reduct J"},{"key":"4915_CR63","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s11904-022-00619-9","volume":"19","author":"KE Lancaster","year":"2022","unstructured":"Lancaster KE, Endres-Dighe S, Sucaldito AD, Piscalko H, Madhu A, Kiriazova T, et al. Measuring and addressing stigma within HIV interventions for people who use drugs: a scoping review of recent research. Curr HIV-AIDS Rep. 2022;19:301\u201311.","journal-title":"Curr HIV-AIDS Rep"},{"key":"4915_CR64","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1186\/s12909-022-03682-3","volume":"22","author":"K Claborn","year":"2022","unstructured":"Claborn K, Scott K, Becker SJ. Cross-training needs among community-based clinicians in HIV and substance use. BMC Med Educ. 2022;22:629.","journal-title":"BMC Med Educ"}],"container-title":["AIDS and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-025-04915-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10461-025-04915-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10461-025-04915-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T11:50:22Z","timestamp":1773489022000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10461-025-04915-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":64,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["4915"],"URL":"https:\/\/doi.org\/10.1007\/s10461-025-04915-4","relation":{},"ISSN":["1090-7165","1573-3254"],"issn-type":[{"value":"1090-7165","type":"print"},{"value":"1573-3254","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]},"assertion":[{"value":"12 September 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by The Ohio State University Institutional Review Board.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}}]}}