title: Risk factors for stimulant use among homeless and unstably housed adult women.
abstract: BACKGROUND
  One of the most common causes of death among homeless and unstably housed women is acute intoxication where cocaine is present. While correlates of stimulant use have been determined in prior research, few studies have assessed risk factors of use specifically in this high-risk population.
  
  
  METHODS
  We sampled biological women with a history of housing instability from community-based venues to participate in a cohort study. Baseline and 6-month follow-up data were used to determine the relative risk of stimulant use (crack cocaine, powder cocaine or methamphetamine) among individuals who did not use at baseline.
  
  
  RESULTS
  Among 260 study participants, the median age was 47 years, 70% were women of color; 47% reported having unmet subsistence needs and 53% reported abstinence from stimulants at baseline. In analyses adjusting for baseline sociodemographics and drug treatment, the risk of using stimulants within 6 months was significantly higher among women who reported recent sexual violence (Adjusted Relative Risk [ARR]=4.31; 95% CI:1.97-9.45), sleeping in a shelter or public place (ARR=2.75; 95% CI:1.15-6.57), and using unprescribed opioid analgesics (ARR=2.54; 95% CI:1.01-6.38).
  
  
  CONCLUSIONS
  We found that almost half of homeless and unstably housed women used stimulants at baseline and 14% of those who did not use began within 6 months. Addressing homelessness and sexual violence is critical to reduce stimulant use among impoverished women.
authors.affiliation: School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA. Electronic address: elise.riley@ucsf.edu.
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
authors.affiliation: School of Medicine, Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
authors.affiliation: School of Medicine, Department of Anthropology, History and Social Medicine, University of California, San Francisco, CA, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Knight
authors.affiliation: School of Medicine, Department of General Internal Medicine, University of California, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.affiliation: School of Medicine, Department of Clinical Pharmacy, University of California, San Francisco, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohen
authors.affiliation: School of Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants; D015331:Cohort Studies; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D008694:Methamphetamine; D008875:Middle Aged; D012307:Risk Factors; D012742:Sex Offenses; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine
keywords: Cocaine; Homeless; Stimulant; Women