title: Spatial access to syringe exchange programs and pharmacies selling over-the-counter syringes as predictors of drug injectors' use of sterile syringes.
abstract: OBJECTIVE
  We examined relationships of spatial access to syringe exchange programs (SEPs) and pharmacies selling over-the-counter (OTC) syringes with New York City drug injectors' harm reduction practices.
  
  
  METHODS
  Each year from 1995 to 2006, we measured the percentage of 42 city health districts' surface area that was within 1 mile of an SEP or OTC pharmacy. We applied hierarchical generalized linear models to investigate relationships between these exposures and the odds that injectors (n = 4003) used a sterile syringe for at least 75% of injections in the past 6 months.
  
  
  RESULTS
  A 1-unit increase in the natural log of the percentage of a district's surface area within a mile of an SEP in 1995 was associated with a 26% increase in the odds of injecting with a sterile syringe; a 1-unit increase in this exposure over time increased these odds 23%. A 1-unit increase in the natural log of OTC pharmacy access improved these odds 15%.
  
  
  CONCLUSIONS
  Greater spatial access to SEPs and OTC pharmacies improved injectors' capacity to engage in harm reduction practices that reduce HIV and HCV transmission.
authors.affiliation: Dept of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Rd NE, Room 526, Atlanta, GA, 30322, USA. hcoope3@sph.emory.edu
authors.forename: Hannah L F
authors.initials: HL
authors.lastname: Cooper
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: Zev
authors.initials: Z
authors.lastname: Ross
authors.forename: Barbara
authors.initials: B
authors.lastname: Tempalski
authors.forename: Brian
authors.initials: B
authors.lastname: Bossak
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D018671:Needle-Exchange Programs / Q000600:supply & distribution*; D009519:New York City; D010594:Pharmacies / Q000191:economics / Q000600:supply & distribution*; D017062:Small-Area Analysis; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D013594:Syringes / Q000600:supply & distribution*; D055815:Young Adult