title: Health behaviors of young adult heroin injectors in the Seattle area.
abstract: BACKGROUND
  Recent indicators point to substantial increases in the number of young heroin users across much of the United States as well as across Washington State. This study characterizes this younger generation of heroin injectors in order to inform public health responses.
  
  
  METHODS
  A cross-sectional analysis was conducted using street-intercept surveys at King County, WA syringe exchange programs in 2013. Survey responses were restricted to heroin injectors (n=389) and then categorized by the participant's age (<30 and ≥30) for a descriptive epidemiological analysis. A manual stepwise logistic regression tested the independent relationship of user characteristics with being under the age of 30.
  
  
  RESULTS
  In regression analyses, adjusting for other characteristics, young adults were significantly (p<0.05) more likely to: re-use syringes 2-4 times (OR=2.28 compared to those who used a syringe once), share syringes (OR=2.92), report they were "hooked on" prescription-type opioids prior to using heroin (OR=2.54), have had a sexual partner in the prior year (opposite sex OR=7.37, same sex OR=23.29, both genders OR=22.04), and report powder cocaine use in the prior 3 months (OR=2.49) compared to those ages 30 and older. Young adults were significantly less likely to report using pain medicines (OR=0.33), having an abscess in the prior year (OR=0.33) or having tested positive for hepatitis C (OR=0.22) than older adults adjusting for other variables.
  
  
  CONCLUSIONS
  Younger heroin injectors engage in risky injection practices more than older heroin injectors. Along with other significant differences, these findings have implications for outreach programs and medical care for younger heroin injectors.
authors.affiliation: University of Washington School of Public Health, Department of Health Services, 1959 NE Pacific St, Box 357660, Seattle, WA 98195, United States. Electronic address: emily.cedarbaum@ucsf.edu.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Cedarbaum
authors.affiliation: Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St, Suite 120, Seattle, WA 98105-4631, United States. Electronic address: calebbg@uw.edu.
authors.forename: Caleb J
authors.initials: CJ
authors.lastname: Banta-Green
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006556:Heroin Dependence / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs; D057566:Self Report; D015819:Substance Abuse, Intravenous / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013594:Syringes; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
keywords: Epidemiology; Heroin; Injection drug use; Syringe exchange; Young adult