title: Factors associated with initiating someone into illicit drug injection.
abstract: OBJECTIVE
  Most people who inject drugs (PWID) were first initiated into injection by a current PWID. Few studies have examined PWID who assist others into drug injection. Our goal is to describe the prevalence of and risk factors for initiating someone into injection in the last 12 months.
  
  
  METHODS
  We recruited a cross-sectional sample of PWID (N=605) in California from 2011 to 2013. We examined bivariate and multivariate risk factors for initiating someone into injection with a focus on behaviors that might encourage injection initiation such as injecting in front of non-PWID, describing how to inject to non-PWID, and willingness to initiate someone into drug injection.
  
  
  RESULTS
  Having initiated someone into injection was reported by 34% of PWID overall and 7% in the last 12 months. Forty-four PWID had assisted 431 people into injection in the past year. Factors independently associated with initiating someone into injection in the last 12 months were self-reported likelihood of initiating someone in the future (Adjusted Odds Ratio [AOR]=7.09; 95% Confidence Interval [CI]=3.40, 14.79), having injected another PWID in past month (AOR=4.05; 95% confidence interval [CI]=1.94, 8.47), having described how to inject to non-injectors (2.61; 95% CI=1.19, 5.71), and non-injection powder cocaine use in past month (AOR=4.97; 95% CI=2.08, 11.84) while controlling for study site.
  
  
  CONCLUSIONS
  Active PWID are important in facilitating the process of drug injection uptake. Interventions to reduce initiation should include efforts to change behaviors and intentions among PWID that are associated with injection uptake among others.
authors.affiliation: Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California Soto Street Building, SSB 2001 N. Soto Street, MC 9239, Los Angeles, CA 90033, USA. Electronic address: rbluthen@usc.edu.
authors.forename: Ricky N
authors.initials: RN
authors.lastname: Bluthenthal
authors.affiliation: Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Wenger
authors.affiliation: Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California Soto Street Building, SSB 2001 N. Soto Street, MC 9239, Los Angeles, CA 90033, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chu
authors.affiliation: Centre for Population Health, Burnet Institute, 85 Commercial Rd., Melbourne, VIC 3004, Australia.
authors.forename: Brendan
authors.initials: B
authors.lastname: Quinn
authors.affiliation: Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California Soto Street Building, SSB 2001 N. Soto Street, MC 9239, Los Angeles, CA 90033, USA.
authors.forename: James
authors.initials: J
authors.lastname: Thing
authors.affiliation: Urban Health Program, RTI International, 351 California St., San Francisco, CA 94104, USA.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
mesh_terms: D000328:Adult; D016739:Behavior, Addictive / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects*; D007267:Injections; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*
chemical_list: D013287:Illicit Drugs
keywords: HIV/HCV; Initiators; Injection drug use; Injection initiation; Observational epidemiology; PWID