title: Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study.
abstract: BACKGROUND
  We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs.
  
  
  METHODS
  Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups by age and wound status. Factors associated with the presence of chronic wounds in participants ≥45 years were analyzed using logistic regression.
  
  
  RESULTS
  Of the 152 participants, 19.7% had a chronic wound. Of those with chronic wounds, 18 were ≥45 years old (60.0%). Individuals ≥45 years old with chronic wounds were more likely to be enrolled in a drug treatment program (Odds ratio (OR) 3.4, 95% Confidence interval (CI) 1.0-10.8) and less likely to use cigarette filters when drawing up prepared drug (OR 0.2, 95% CI 0.03-0.7) compared to the same age group without chronic wounds. Compared to individuals <45 years old without chronic wounds, individuals ≥45 with a chronic wound were more likely to report cleaning reused needles with bleach (OR 10.7, 95% CI 1.2-93.9) and to use the clinic, rather than an emergency room, as a primary source of medical care (OR 3.4, 95% CI 1.1-10.4).
  
  
  CONCLUSIONS
  Older IDUs with chronic wounds have different, and perhaps less risky, injection and hygiene behaviors than their peers and younger IDUs without wounds in Baltimore City. Because of these differences, older IDUs with wounds may be more receptive to community-based healthcare and substance abuse treatment messages.
authors.forename: Maria Elisa
authors.initials: ME
authors.lastname: Smith
authors.forename: Natanya
authors.initials: N
authors.lastname: Robinowitz
authors.forename: Patrick
authors.initials: P
authors.lastname: Chaulk
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins Medical Institutions, 5200 Eastern Avenue, MFL Building, Center Tower, 3rd Floor, Baltimore, MD 21224, USA. kej1229@gmail.com.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Johnson
mesh_terms: D000367:Age Factors; D015142:Baltimore / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006184:Habits; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data; D015995:Prevalence; D040242:Risk Reduction Behavior; D012648:Self Care; D012883:Skin Ulcer / Q000453:epidemiology*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*