Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings
Objectives People who inject drugs (PWID) play an integral role in facilitating the entry of others into injection drug use (IDU). We sought to assess factors influencing PWID in providing IDU initiation assistance across three distinct North American settings and to generate pooled measures of risk...
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/8/e046957.full |
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| author | Steffanie A Strathdee Xiaoying Sun Richard S Garfein Dan Werb Kora DeBeck Charles Marks Sonia Jain Stephanie A Meyers Kanna Hayashi Patricia Gonzalez-Zuniga M J Milloy Kevin Cummins |
| author_facet | Steffanie A Strathdee Xiaoying Sun Richard S Garfein Dan Werb Kora DeBeck Charles Marks Sonia Jain Stephanie A Meyers Kanna Hayashi Patricia Gonzalez-Zuniga M J Milloy Kevin Cummins |
| author_sort | Steffanie A Strathdee |
| collection | DOAJ |
| description | Objectives People who inject drugs (PWID) play an integral role in facilitating the entry of others into injection drug use (IDU). We sought to assess factors influencing PWID in providing IDU initiation assistance across three distinct North American settings and to generate pooled measures of risk.Design We employed data from three PWID cohort studies participating in PReventing Injecting by Modifying Existing Responses (PRIMER), for this cross-sectional analysis.Setting Tijuana, Mexico; San Diego, USA; Vancouver, Canada.Participants A total of 2944 participants were included in this study (Tijuana: n=766, San Diego: n=353, Vancouver: n=1825).Measurements The outcome was defined as recently (ie, past 6 months) assisting in an IDU initiation event. Independent variables of interest were identified from previous PRIMER analyses. Site-specific multiple modified Poisson regressions were fit. Pooled relative risks (pRR) were calculated and heterogeneity across sites was assessed via linear random effects models.Results Evidence across all three sites indicated that having a history of providing IDU initiation assistance (pRR: 4.83, 95% CI: 3.49 to 6.66) and recently being stopped by law enforcement (pRR: 1.49, 95% CI: 1.07 to 2.07) were associated with a higher risk of providing assistance with IDU initiation; while recent opioid agonist treatment (OAT) enrolment (pRR: 0.64, 95% CI: 0.43 to 0.96) and no recent IDU (pRR: 0.21, 95% CI: 0.07 to 0.64) were associated with a lower risk. We identified substantial differences across site in the association of age (I2: 52%), recent housing insecurity (I2: 39%) and recent non-injection heroin use (I2: 78%).Conclusion We identified common and site-specific factors related to PWID’s risk of assisting in IDU initiation events. Individuals reporting a history of assisting IDU initiations, being recently stopped by law enforcement, and recently injecting methamphetamine/speedball were more likely to have recently assisted an IDU initiation. Whereas those who reported not recently engaging in IDU and those recently enrolled in OAT were less likely to have done so. Interventions and harm reduction strategies aimed at reducing the harms of IDU should incorporate context-specific approaches to reduce the initiation of IDU. |
| format | Article |
| id | doaj-art-f96c7f1a7de842ad81ed7b726d103818 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-f96c7f1a7de842ad81ed7b726d1038182024-12-08T22:20:10ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2020-046957Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settingsSteffanie A Strathdee0Xiaoying Sun1Richard S Garfein2Dan Werb3Kora DeBeck4Charles Marks5Sonia Jain6Stephanie A Meyers7Kanna Hayashi8Patricia Gonzalez-Zuniga9M J Milloy10Kevin Cummins11Department of Medicine, University of California San Diego, La Jolla, California, USAPeking University First Hospital, Department of Rheumatology and Clinical Immunology, Beijing, ChinaHerbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USADepartment of Medicine, University of California San Diego, La Jolla, California, USABritish Columbia Centre on Substance Use, Vancouver, British Columbia, CanadaDepartment of Medicine, University of California San Diego, La Jolla, California, USA7 Family Medicine and Public Health, University of California San Diego, La Jolla, California, USADepartment of Medicine, University of California San Diego, La Jolla, California, USA1 Simon Fraser University Faculty of Health Sciences, Burnaby, British Columbia, CanadaDepartment of Medicine, University of California San Diego, La Jolla, California, USABritish Columbia Centre on Substance Use, Vancouver, British Columbia, CanadaDepartment of Public Health, CSU Fullerton, Fullerton, California, USAObjectives People who inject drugs (PWID) play an integral role in facilitating the entry of others into injection drug use (IDU). We sought to assess factors influencing PWID in providing IDU initiation assistance across three distinct North American settings and to generate pooled measures of risk.Design We employed data from three PWID cohort studies participating in PReventing Injecting by Modifying Existing Responses (PRIMER), for this cross-sectional analysis.Setting Tijuana, Mexico; San Diego, USA; Vancouver, Canada.Participants A total of 2944 participants were included in this study (Tijuana: n=766, San Diego: n=353, Vancouver: n=1825).Measurements The outcome was defined as recently (ie, past 6 months) assisting in an IDU initiation event. Independent variables of interest were identified from previous PRIMER analyses. Site-specific multiple modified Poisson regressions were fit. Pooled relative risks (pRR) were calculated and heterogeneity across sites was assessed via linear random effects models.Results Evidence across all three sites indicated that having a history of providing IDU initiation assistance (pRR: 4.83, 95% CI: 3.49 to 6.66) and recently being stopped by law enforcement (pRR: 1.49, 95% CI: 1.07 to 2.07) were associated with a higher risk of providing assistance with IDU initiation; while recent opioid agonist treatment (OAT) enrolment (pRR: 0.64, 95% CI: 0.43 to 0.96) and no recent IDU (pRR: 0.21, 95% CI: 0.07 to 0.64) were associated with a lower risk. We identified substantial differences across site in the association of age (I2: 52%), recent housing insecurity (I2: 39%) and recent non-injection heroin use (I2: 78%).Conclusion We identified common and site-specific factors related to PWID’s risk of assisting in IDU initiation events. Individuals reporting a history of assisting IDU initiations, being recently stopped by law enforcement, and recently injecting methamphetamine/speedball were more likely to have recently assisted an IDU initiation. Whereas those who reported not recently engaging in IDU and those recently enrolled in OAT were less likely to have done so. Interventions and harm reduction strategies aimed at reducing the harms of IDU should incorporate context-specific approaches to reduce the initiation of IDU.https://bmjopen.bmj.com/content/11/8/e046957.full |
| spellingShingle | Steffanie A Strathdee Xiaoying Sun Richard S Garfein Dan Werb Kora DeBeck Charles Marks Sonia Jain Stephanie A Meyers Kanna Hayashi Patricia Gonzalez-Zuniga M J Milloy Kevin Cummins Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings BMJ Open |
| title | Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings |
| title_full | Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings |
| title_fullStr | Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings |
| title_full_unstemmed | Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings |
| title_short | Involvement of people who inject drugs in injection initiation events: a cross-sectional analysis identifying similarities and differences across three North American settings |
| title_sort | involvement of people who inject drugs in injection initiation events a cross sectional analysis identifying similarities and differences across three north american settings |
| url | https://bmjopen.bmj.com/content/11/8/e046957.full |
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