title: Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico.
abstract: OBJECTIVE
  Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico.
  
  
  METHODS
  Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit.
  
  
  RESULTS
  Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27-3.53 and AOR: 2.65; 95% CI: 1.52-4.53 respectively].
  
  
  CONCLUSIONS
  Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance ('hit doctors') may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality.
authors: Division of Global Public Health, University of California, La Jolla, USA.|Graduate School of Public Health, San Diego State University, San Diego, USA.
authors: Claudia
authors: C
authors: Rafful
authors: School of Community Health Sciences, University of Nevada, Reno, USA.
authors: Karla D
authors: KD
authors: Wagner
authors: Division of Global Public Health, University of California, La Jolla, USA.
authors: Dan
authors: D
authors: Werb
authors: Division of Global Public Health, University of California, La Jolla, USA.
authors: Patricia E
authors: PE
authors: González-Zúñiga
authors: Division of Global Public Health, University of California, La Jolla, USA.|Instituto de Servicios de Salud Pública de Baja California, Tijuana, Mexico.
authors: Silvia
authors: S
authors: Verdugo
authors: Secretariat of Health, Mexico.|Mexico-United States Border Health Commission, Mexico.
authors: Gudelia
authors: G
authors: Rangel
authors: Division of Global Public Health, University of California, La Jolla, USA.
authors: Steffanie A
authors: SA
authors: Strathdee
mesh_terms: D000328:Adult; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009333:Neck; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Mexico; injecting drug use; injection site; polydrug use; psychosocial factor