{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T11:33:12Z","timestamp":1786620792049,"version":"build-2736575974"},"reference-count":33,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"University of Louisiana Monroe College of Pharmacy","award":["TI084938"],"award-info":[{"award-number":["TI084938"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use: Research and Treatment"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Existing opioid overdose reversal (OOR) trainings for first responders frequently demonstrate improvements in naloxone knowledge and overdose response competencies. While some programs have incorporated broader risk reduction and stigma-related content, these domains are less commonly evaluated directly, particularly using instruments designed for first responder populations. The ULM HERO program implemented a comprehensive risk reduction curriculum for Louisiana first responders and developed the Risk Reduction Attitude Scale (RRAS) to evaluate changes in risk reduction attitudes following training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of the ULM HERO program on first responders\u2019 risk reduction attitudes using the RRAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This IRB-approved study (October 2023\u2013March 2025) used a single-group pre\u2013post design to evaluate 2-hour in-person risk reduction training for first responders. Participants completed pre- and post-training surveys including demographics and the 22-item Risk Reduction Attitude Scale (RRAS). The RRAS demonstrated acceptable reliability and validity using pre-training data. Pre\u2013post changes were assessed using paired t-tests, effect sizes, and adjusted regression models examining occupation and parish differences statewide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sample included 861 Louisiana first responders, primarily law enforcement (80.8%), representing multiple parishes, most commonly Orleans\/Jefferson (60.8%) and Ouachita (14.2%). Overall RRAS scores improved significantly post-training (mean increase 3.73 points; d\u1dbb = 0.65; p &lt; .001). All occupation\u2013parish subgroups demonstrated significant gains (1.99\u20137.20 points). The largest improvements and highest adjusted post-training scores occurred among non-law enforcement personnel in Ouachita Parish, indicating differential impact by occupational role and geographic context after accounting for baseline scores and participant demographics statewide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrates that a risk reduction focused training program can meaningfully improve attitudes among first responders across multiple parishes in Louisiana. Importantly, improvements were observed across urban and non-urban parishes, including regions traditionally perceived as more conservative. These findings support the scalability of a risk reduction focused training as an effective strategy statewide.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29768357261477214","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T11:17:30Z","timestamp":1786447050000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Changing Perceptions of Risk Reduction Among First Responders: Outcomes of a Training Program in Louisiana"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0426-4439","authenticated-orcid":false,"given":"Alexis E.","family":"Horace","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, University of Louisiana Monroe College of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, University of Louisiana Monroe College of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jameshia","family":"Below","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, University of Louisiana Monroe College of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, University of Louisiana Monroe College of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"e_1_3_8_2_2","unstructured":"Centers for Disease Control and Prevention. Provisional drug overdose death counts. National Center for Health Statistics. https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm. Updated April 2024. Accessed December 2025."},{"key":"e_1_3_8_3_2","unstructured":"National Center for Health Statistics. Drug overdose mortality by state. Centers for Disease Control and Prevention. https:\/\/www.cdc.gov\/nchs\/pressroom\/sosmap\/drug_poisoning_mortality\/drug_poisoning.htm. Last reviewed January 10 2025. Accessed December 2025."},{"key":"e_1_3_8_4_2","unstructured":"Louisiana Department of Health. Louisiana Opioid Data and Surveillance System. https:\/\/lodss.ldh.la.gov. Accessed December 16 2025."},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2015.05.022"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-022-00682-w"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.05.008"},{"key":"e_1_3_8_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2019.04.011"},{"key":"e_1_3_8_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0271418"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1353\/cpr.2023.a900206"},{"key":"e_1_3_8_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40352-023-00250-9"},{"key":"e_1_3_8_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/00220426251353368"},{"key":"e_1_3_8_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.10.026"},{"key":"e_1_3_8_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.03.011"},{"key":"e_1_3_8_15_2","unstructured":"Substance Abuse and Mental Health Services Administration. Harm reduction. https:\/\/www.samhsa.gov\/substance-use\/harm-reduction. Accessed May 15 2025."},{"key":"e_1_3_8_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/21650799231188364"},{"key":"e_1_3_8_17_2","doi-asserted-by":"publisher","DOI":"10.3821\/145.3.cpj124"},{"key":"e_1_3_8_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2013.02.007"},{"key":"e_1_3_8_19_2","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2022.2092150"},{"key":"e_1_3_8_20_2","unstructured":"SHIELD Training Initiative. SHIELD Training: Home. Accessed May 26 2026. https:\/\/www.shieldtraining.org\/"},{"key":"e_1_3_8_21_2","unstructured":"Police Assisted Addiction and Recovery Initiative. PAARI: Police Assisted Addiction & Recovery Initiative. Accessed May 26 2026. https:\/\/paariusa.org\/"},{"key":"e_1_3_8_22_2","unstructured":"Center for Health and Justice at TASC. Deflection and pre-arrest diversion. Accessed May 26 2026. https:\/\/www.centerforhealthandjustice.org\/chjweb\/tertiary_page.aspx?id=62&title=Law-Enforcement-Pre-arrest-Diversion"},{"key":"e_1_3_8_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-020-00402-2"},{"key":"e_1_3_8_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40352-024-00309-1"},{"key":"e_1_3_8_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-024-00957-4"},{"key":"e_1_3_8_26_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306644"},{"key":"e_1_3_8_27_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2019.305030"},{"key":"e_1_3_8_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.japh.2025.102945"},{"key":"e_1_3_8_29_2","unstructured":"Substance Abuse and Mental Health Services Administration. SAMHSA opioid overdose prevention toolkit: five essential steps for first responders. https:\/\/store.samhsa.gov\/sites\/default\/files\/d7\/priv\/five-essential-steps-for-first-responders.pdf. Accessed August 12 2025."},{"key":"e_1_3_8_30_2","doi-asserted-by":"publisher","DOI":"10.52965\/001c.35630"},{"key":"e_1_3_8_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/1461355720962524"},{"key":"e_1_3_8_32_2","doi-asserted-by":"publisher","DOI":"10.1080\/10826084.2023.2227698"},{"key":"e_1_3_8_33_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-024-01114-7"},{"key":"e_1_3_8_34_2","unstructured":"National Association of County and City Health Officials. First responder substance use stigma measures toolkit. https:\/\/www.naccho.org\/uploads\/downloadable-resources\/Programs\/Community-Health\/First-Responder-Substance-Use-Stigma-Measures-Toolkit.pdf. Published 2024. Accessed May 26 2026."}],"container-title":["Substance Use: Research and Treatment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/29768357261477214","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/29768357261477214","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/29768357261477214","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T10:53:29Z","timestamp":1786618409000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/29768357261477214"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":33,"alternative-id":["10.1177\/29768357261477214"],"URL":"https:\/\/doi.org\/10.1177\/29768357261477214","relation":{},"ISSN":["2976-8357","2976-8357"],"issn-type":[{"value":"2976-8357","type":"print"},{"value":"2976-8357","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"article-number":"29768357261477214"}}