title: Risky injecting practices associated with snowballing: a qualitative study.
abstract: OBJECTIVE
  Crack cocaine injecting is associated with a higher prevalence of sharing behaviours, increased rates of hepatitis C infection and a higher likelihood of homelessness. The limited available evidence on snowballing (co-injecting of heroin and crack cocaine) suggests that this is associated with an increase in risky injection practices. This study sets out to explore the views and experiences of a group of drug users who 'snowball', with a view to inform the improvement of harm reduction services for such clients.
  
  
  METHODS
  This is a qualitative interview study of 18 male and female homeless drug users attending a needle exchange service in Nottingham, UK.
  
  
  RESULTS
  For all those interviewed, snowballing represented a communal activity which affected peer injection practices. The individual perceptions of the terms 'sharing' and 'splitting' affected the levels of concerns when snowballs were used with others. The study highlighted the importance of knowing current vaccination and screening history of injecting partners in order to manage risk behaviour when drugs are used communally.
  
  
  CONCLUSIONS
  Harm reduction services need to target information so it is meaningful and appropriate to those who engage in communal drug use.
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK. louise.wilkins@nottinghamcity.nhs.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Wilkins
authors.forename: Paul
authors.initials: P
authors.lastname: Bissell
authors.forename: Petra S
authors.initials: PS
authors.lastname: Meier
mesh_terms: D000328:Adult; D016578:Crack Cocaine / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D055030:Drug Users / Q000523:psychology; D005260:Female; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D003932:Heroin / Q000008:administration & dosage* / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D016485:Needle Sharing / Q000523:psychology*; D036301:Qualitative Research; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology*
chemical_list: D016578:Crack Cocaine; D004338:Drug Combinations; D003932:Heroin