Race and distance effects on regular syringe exchange program use and injection risks: a geobehavioral analysis.
OBJECTIVE
We conducted "geobehavioral" analyses by race to understand how distances among injection drug users' (IDUs') residences, drug purchase and use locations, and syringe exchange programs (SEPs) are associated with injection behaviors.


METHODS
Data were from the HIV Prevention Trial Network 037 (2002-2006) site in Philadelphia, Pennsylvania, a randomized study evaluating the efficacy of a network-oriented HIV prevention intervention for IDUs. At prescreening, participants were asked the nearest intersections to their residence, where they buy and use drugs, and about their injection behaviors.


RESULTS
Geographic distances had independent and interactive effects on injection risk behaviors and SEP use. Blacks, regardless of distance, were less likely than Whites to inject in public places (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.43, 0.90), to use syringes after someone else (OR = 0.27; 95% CI = 0.19, 0.38), and to access syringes from SEPs (OR = 2.08; 95% CI = 1.48, 2.92). Latinos' injection behaviors were more distance-dependent than Blacks' or Whites'.


CONCLUSIONS
Distances among IDUs' homes, drug purchase and injecting sites, and prevention resources affected safe injection practices differentially by race. Understanding individuals' geographic relation to the risks and resources that surround them is an important aspect of understanding effects of the environment on health and behavior and the development of targeted interventions.
Williams
Chyvette T
CT
University of Illinois School of Public Health, 1603 West Taylor St, M/C 923, Chicago, IL 60612, USA. chevy@uic.edu
Metzger
David S
DS
D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D016001:Confidence Intervals; D055030:Drug Users / Q000523:psychology*; D005260:Female; D005843:Geography; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000523:psychology / Q000706:statistics & numerical data; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D016017:Odds Ratio; D015143:Philadelphia / Q000453:epidemiology; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000523:psychology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
Public Health Rep. 1998 Jun;113 Suppl 1:75-80
9722812
Med Anthropol. 1997 Dec;18(1):61-83
9458668
J Urban Health. 2003 Sep;80(3):438-54
12930882
J Infect Dis. 2000 Dec;182(6):1588-94
11069228
J Urban Health. 2003 Jun;80(2):261-73
12791802
Int J Drug Policy. 2007 Jan;18(1):62-5
17689345
J Urban Health. 1999 Dec;76(4):448-60
10609594
AIDS. 2000 Mar 31;14(5):605-11
10780722
Am J Public Health. 1991 Oct;81(10):1291-5
1928528
Health Place. 2007 Jun;13(2):432-9
16798055
Am J Public Health. 2007 Jan;97(1):125-32
17138921
Milbank Q. 2004;82(1):125-56
15016246
Sex Transm Dis. 1999 May;26(5):250-61
10333277
Sex Transm Dis. 1998 Mar;25(3):125-9
9524987
Soc Sci Med. 2009 Feb;68(4):740-8
19070413
Am J Prev Med. 2007 Jun;32(6 Suppl):S203-10
17543712
Int J Drug Policy. 2007 Jan;18(1):46-53
17689343
Soc Sci Med. 1993 Sep;37(6):711-7
8211286
Soc Sci Med. 2005 Sep;61(5):1026-44
15955404
Drug Alcohol Depend. 2008 Apr 1;94(1-3):221-33
18242879
Soc Sci Med. 2005 Aug;61(3):673-84
15899325
Med Care. 1981 Feb;19(2):127-40
7206846
Am J Public Health. 2005 Feb;95(2):233-6
15671455
JAMA. 1994 Jan 12;271(2):115-20
8264065
Subst Use Misuse. 2006;41(14):1991-2001
17162601
CMAJ. 2006 Nov 21;175(11):1399-404
17116909
J Acquir Immune Defic Syndr. 2007 May 1;45(1):108-14
17460474
Aust N Z J Public Health. 2000 Oct;24(5):540-2
11109694
J Infect Dis. 2005 Feb 1;191 Suppl 1:S115-22
15627221
Health Psychol. 2005 Jan;24(1):96-100
15631567
Am J Community Psychol. 1994 Jun;22(3):415-30
7879749
Drug Alcohol Depend. 2007 Feb 23;87(1):63-8
16962254