title: Public crack cocaine smoking and willingness to use a supervised inhalation facility: implications for street disorder.
abstract: BACKGROUND
  The health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility.
  
  
  METHODS
  Data for this study were derived from a Canadian prospective cohort of injection drug users. Using multivariate logistic regression we identified factors associated with smoking crack cocaine in public areas. Among public crack smokers we then identified factors associated with willingness to use a supervised inhalation facility.
  
  
  RESULTS
  Among our sample of 623 people who reported crack smoking, 61% reported recently using in public locations. In multivariate analysis, factors independently associated with public crack smoking included: daily crack cocaine smoking; daily heroin injection; having encounters with police; and engaging in drug dealing. In sub analysis, 71% of public crack smokers reported willingness to use a supervised inhalation facility. Factors independently associated with willingness include: female gender, engaging in risky pipe sharing; and having encounters with police.
  
  
  CONCLUSIONS
  We found a high prevalence of public crack smoking locally, and this behavior was independently associated with encounters with police. However, a majority of public crack smokers reported being willing to use a supervised inhalation facility, and individuals who had recent encounters with police were more likely to report willingness. These findings suggest that supervised inhalation facilities offer potential to reduce street-disorder and reduce encounters with police.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
authors.forename: Kora
authors.initials: K
authors.lastname: DeBeck
authors.forename: Jane
authors.initials: J
authors.lastname: Buxton
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Jiezhi
authors.initials: J
authors.lastname: Qi
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology* / Q000628:therapy*; D016578:Crack Cocaine / Q000008:administration & dosage* / Q000009:adverse effects*; D003415:Crime / Q000706:statistics & numerical data; D005260:Female; D040261:Harm Reduction; D006703:Ill-Housed Persons; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D011633:Public Facilities; D012309:Risk-Taking; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*
chemical_list: D016578:Crack Cocaine