title: New injectors and the social context of injection initiation.
abstract: BACKGROUND
  Preventing the onset of injecting drug use is an important public health objective yet there is little understanding of the process that leads to injection initiation. This paper draws extensively on narrative data to describe how injection initiation is influenced by social environment. We examine how watching other people inject can habitualise non-injectors to administering drugs with a needle and consider the process by which the stigma of injecting is replaced with curiosity.
  
  
  METHODS
  In-depth interviews (n=54) were conducted as part of a 2-year longitudinal study examining the behaviours of new injecting drug users.
  
  
  RESULTS
  Among our sample, injection initiation was the result of a dynamic process during which administering drugs with a needle became acceptable or even appealing. Most often, this occurred as a result of spending time with current injectors in a social context and the majority of this study's participants were given their first shot by a friend or sexual partner. Initiates could be tenacious in their efforts to acquire an injection trainer and findings suggest that once injecting had been introduced to a drug-using network, it was likely to spread throughout the group.
  
  
  CONCLUSIONS
  Injection initiation should be viewed as a communicable process. New injectors are unlikely to have experienced the negative effects of injecting and may facilitate the initiation of their drug-using friends. Prevention messages should therefore aim to find innovative ways of targeting beginning injectors and present a realistic appraisal of the long-term consequences of injecting. Interventionists should also work with current injectors to develop strategies to refuse requests from non-injectors for their help to initiate.
authors.affiliation: National Development and Research Institutes, Inc., Institute for International Research on Youth at Risk, 71 West 23rd Street, New York, NY 10010, USA. harocopos@ndri.org
authors.forename: Alex
authors.initials: A
authors.lastname: Harocopos
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Goldsamt
authors.forename: Paul
authors.initials: P
authors.lastname: Kobrak
authors.forename: John J
authors.initials: JJ
authors.lastname: Jost
authors.forename: Michael C
authors.initials: MC
authors.lastname: Clatts
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D010379:Peer Group; D012931:Social Environment; D015819:Substance Abuse, Intravenous / Q000523:psychology*
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