Faculty Bibliography

OBJECTIVE: To describe injection drug users (IDUs) who access syringes through different outlets to help inform the prevention needs of IDUs who underuse safe syringe sources in New York City (NYC), where syringe availability is high compared with other U.S. cities. DESIGN: Cross sectional. SETTING: NYC, 2005-2007. PARTICIPANTS: 285 IDUs. INTERVENTION: Participants were recruited using random street-intercept sampling in 36 socioeconomically disadvantaged neighborhoods. MAIN OUTCOME MEASURES: IDUs using syringe exchange programs (SEPs), pharmacies, or other outlets as a primary syringe source were compared based on sociodemographic characteristics, injection practices, and medical service use. RESULTS: Chi-square tests and polytomous logistic regression were used to compare IDUs with different self-reported primary syringe sources used in the 6 months preceding study entry. Compared with IDUs using other syringe sources, those primarily using SEPs were less likely to be black (adjusted odds ratio 0.26 [95% CI 0.11-0.57]), more likely to inject daily (3.32 [1.58-6.98]), and more likely to inject with a new syringe (2.68 [1.30-5.54]). Compared with IDUs using other syringe sources, those primarily using pharmacies were less likely to be black (0.39 [0.17-0.90]). CONCLUSION: These data suggest that pharmacies and SEPs may be reaching different populations of IDUs and highlight a subpopulation of highly marginalized IDUs (i.e., black race, infrequent injectors) who are underusing safe syringe sources in NYC. Targeted interventions are needed to reduce racial disparities and increase use of safe syringe outlets.

We conducted a randomized controlled trial of a sexual risk-reduction intervention targeting non-injection drug users (NIDUs) and members of their drug-use/sexual networks (N=270). The intervention was based primarily on the social-influencing approach, and was delivered in four sessions. Sexual risk behaviors were examined at baseline, and 3, 6, 9, and 12 months after the completion of the intervention using the vaginal equivalent episodes (VEE), a weighted sexual risk behavior index. VEE scores decreased in both the active and control conditions in the first six months post-intervention and continued to decline in the control group. However, in the active condition, VEE scores increased after the nine-month assessment and approached baseline levels by the 12-month assessment. There was no evidence of significant differences in high-risk sexual behaviors between the intervention and control conditions. Future studies are needed to improve behavioral interventions in this population.

UNLABELLED: Hepatitis B (HBV) vaccination coverage remains low among drug users. In 1997, ACIP made hepatitis B vaccine available for persons aged 0-18 years and many states began requiring HBV vaccination for entry into middle school; these programs might affect HBV vaccination and infection rates in younger DUs. We were interested in determining correlates of immunization among younger (<25 years) and older (25 and older) DUs. METHODS: A community-based sample of 1,211 heroin, crack, and cocaine users 18 or older was recruited from Harlem and the Bronx. We assessed previous HBV vaccination and infection and correlates using bivariate analyses. RESULTS: The sample was predominantly male (74.0%), aged > or =25 years (67.1%) and Hispanic (59.9%). In terms of socioeconomic status, 57.1% had less than a high school education, 84.5% had been homeless in their lifetime, and 48.0% had an illegal main income source. Among 399 DUs younger than 25 years of age, 30% demonstrated serological evidence of previous vaccination, 49.9% were susceptible to HBV at baseline, and 20% showed evidence of infection. In our model, previous HBV infection and vaccination status were associated with being 22 years old or younger (AOR = 1.40 and 1.66). Compared to susceptible individuals, those vaccinated were significantly less likely to be born in other countries (AOR = 0.50). Among 812 DUs 25 and older, 10.6% demonstrated serological evidence of previous vaccination, 59.2% were susceptible to HBV at baseline, and 30.2% showed evidence of infection. CONCLUSION: Existing interventions to increase HBV vaccination among adolescents should target high risk groups.

BACKGROUND: Despite growing concern about illicit methadone use in the US and other countries, there is little data about the prevalence and correlates of methadone use in large urban areas. We assessed the prevalence and examined correlates of lifetime and recent illicit methadone use in New York City (NYC). METHODS: 1,415 heroin, crack, and cocaine users aged 15-40 years were recruited in NYC between 2000 and 2004 to complete interviewer-administered questionnaires. RESULTS: In multivariable logistic regression, non-injection drug users who used illicit methadone were more likely to be heroin dependent, less than daily methamphetamine users and to have a heroin using sex partner in the last two months. Injection drug users who used illicit methadone were more likely to use heroin daily, share injection paraphernalia and less likely to have been in a detoxification program and to have not used marijuana in the last six months. CONCLUSION: The results overall suggest that illicit (or street) methadone use is likely not a primary drug of choice, but is instead more common in concert with other illicit drug use.

Illicit drug use in urban settings is a major public health problem. A range of individual level factors are known to influence drug use and its consequences, and a number of recent studies have suggested that the neighborhood in which an individual lives may also play a role. However, studies seeking to identify neighborhood-level determinants of drug use, particularly among marginalized urban populations, need to overcome significant challenges, particularly in the area of sampling and recruitment. One key issue is defining functional neighborhoods that are relevant to local residents. Another arises from the need to sample a representative or even a diverse population when studying marginalized groups such as illicit drug users. These are common problems that raise particular challenges when both need to be addressed in the same study. For example, many sampling approaches for neighborhood-level studies have included some form of random sample of households, but this may systematically overlook marginalized populations. On the other hand, the sampling approaches commonly used in studies of hidden populations such as chain referral, snow ball, and more recently, respondent-driven sampling, typically expand beyond a geographic "neighborhood." We describe the organization and rationale for the IMPACT Studies in New York City as a case illustration on how such issues may be addressed.

To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age

PMID: 18365941

ISSN: 1082-6084

CID: 1535792