Socio-Demographic Correlates of Injection Drug Use Among Male Drug Users: A Cross Sectional Study in Nepal

Drug abuse is one of the major public health problems in Nepal. The objective of this study is to explore the factors responsible for the injecting drug use in Nepal. A cross sectional study was conducted among drug users in Pokhara sub metropolitan city in Nepal. Taking prevalence of 20 % at 95 % confidence interval and 20 % non-response rate, 448 samples were calculated for face to face interviews. Most of the study participants were >24 year’s age. Sixty-one percentage of the participants were unemployed. The largest percentage belonged to Gurung/Rai/Pun (37 %) ethnic groups, and had completed secondary level of education (47.5 %). In the logistic regression analysis occupation, motivating factors for drug use, ever been to custody, age at first drug use, age at first sex, money spent on drugs, ever been rehabilitated and age of the respondents showed a statistically significant association with injecting drug use status. The respondents having business [Adjusted Odds ratio (aOR) 4.506, 95 % CI (1.677–12.104)], service [aOR 2.698, 95 % CI (a1.146-6.355], having tragedy/turmoil [aOR 3.867, 95 % CI (1.596–9.367)], family problem [aOR 2.010, 95 % CI (2.010–53.496)], had sex at >19 years [aOR 1.683, 95 % CI (1.017–2.785)], rehabilitated >2 times [aOR 4.699, 95 % CI (1.401–15.763)], >24 years age group [aOR 1.741, 95 % CI (1.025–2.957)] had higher odds of having injecting habits. Having money spent on drugs >3,000 NRs (300 USD) [aOR 0.489, 95 %CI (0.274–0.870), not been to custody (aOR 0.330, 95 %CI (0.203–0.537)] and having curiosity for drug use [aOR 0.147, 95 % CI (0.029–0.737)] were found to be protective for injecting drug use. This study recommends the harm reduction program specifically focused on drug users of occupational groups like business, service and the youths through public health actions to stop transiting them to injecting drug use.     

福建省近年来吸毒人群吸毒行为特征的调查分析

［目的］了解福建省吸毒人群的吸毒行为特征，为艾滋病防制措施的制定提供依据。［方法］1998-2000年，对福州市某强制戒毒所中的1637名戒毒人员进行问卷调查。［结果］吸毒者中注射吸毒的比例已从1998年的29.2%上升到2000年的61.0%，注射吸毒者中有21.1%曾与他人共用过注射针具。［结论］福建省注射吸毒者中存在HIV流行传播的危险性，迫切需要进行预防艾滋病的健康教育和行为干预活动。     

中山市2005年静脉吸毒人群艾滋病相关行为调查

目的 了解中山市静脉吸毒者艾滋病的相关危险行为因素.方法 对中山市戒毒所内戒毒者和社区吸毒者进行面对面行为学问卷调查.结果 共调查225名静脉吸毒者,在最近1个月中,77.3%的静脉注射吸毒每天有2次以上注射毒品;最近1次吸毒16.4%有共用针具行为,最近半年中共用针具的比例显著低于2002年广东省的调查结果（75.7%,x^2=8.29,P＜0.05）.吸毒者与临时性伴的安全套使用率为63.26%,与固定性伴的使用率仅为34.00%;最近半年内与临时性伴使用安全套的情况比2002年的调查结果有所提高,但差异无统计学意义（x^2=3.66,P＞0.05）.接受过自愿咨询检测（VCT）者占27.11%,男性低于女性（x^2=5.26,P＞0.05）.结论 中山市针对静脉吸毒者的艾滋病宣传教育初见成效,共用针具的比例有所下降,但是,还应进一步降低无保护性行为的比例,加大VCT的力度.     

Update and Overview of Practical Epidemiologic Aspects of HIV/AIDS among Injection Drug Users in the United States

In a changing public health landscape in which local, state, and federal agencies must confront threats of bioterrorism, emerging infections, and numerous chronic diseases, transmission of HIV among injection drug users (IDUs) continues to be an important public health issue and one of the driving forces behind the HIV epidemic. Using a computerized MEDLINE search of published articles from January 1981 through October 2005, we conducted a literature review of practical epidemiologic aspects of HIV/AIDS among IDUs in the United States. Although recent trends indicate a decline in the proportion of newly diagnosed HIV infections associated with injection drug use, drug-use behaviors overall still account for 32% of new HIV diagnoses. Factors in addition to syringe sharing contribute to HIV transmission among IDUs: risky sexual behaviors, sharing of drug preparation equipment and drug solutions, and contextual and social factors. Promising approaches for HIV prevention include rapid HIV testing, office-based substance abuse treatment, behavioral interventions, improved communication about syringe exchange programs, and case management. HIV among IDUs continues to be an important public health problem in the 21st century. It is imperative that public health agencies continue to monitor and combat the HIV epidemic among IDUs to ensure that hard-won gains will not be eroded. Santibanez, Garfein, Swartzendruber, Purcell, Paxton, and Greenberg are with the Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop K-39, Atlanta, GA 30333, USA.     

Risk of smoking initiation among Mexican immigrants before and after immigration to the United States

Research has suggested that Latinos are less likely to initiate smoking than non-Latino whites. This advantage may be due in part to social and structural factors that deter smoking initiation among Latino immigrants, such as entry into the restrictive regulatory environment surrounding smoking in the U.S. and decreased exposure to family smoking influences, given that immigrants often leave parents and siblings behind in countries of origin. Although available data do not support a direct test of this hypothesis this study conducts an indirect test by comparing risk of initiation among Mexican immigrants before and after immigration to the U.S. If such factors influence initiation among Mexican immigrants, their risk should decline after immigration, relative to risk before immigration, since they are subject to these forces only after moving to the U.S.     

Association of Alcohol Abuse and Injection Drug Use with Immunologic and Virologic Responses to HAART in HIV-positive Patients from Urban Community Health Clinics

The purpose of this study is to examine the association of alcohol abuse and injection drug use (IDU) with the immunologic and virologic responses to highly active antiretroviral treatment (HAART) in urban community health clinics. The medical records of 293 HIV-infected adult patients who visited either of two urban health clinics in New Haven, Connecticut, from June 2003 to December 2004 were retrospectively reviewed. Changes in mean CD4 lymphocyte counts and undetectable viral loads were compared before and after the initiation of HAART for patients categorized into one of four substance abuse groups: history of neither alcohol abuse nor IDU, alcohol abuse only, IDU only, or both. Unadjusted mean improvements in CD4 count for the four groups were 136, 97, 20, and 27, respectively. In a linear regression model adjusted for age, gender, and baseline CD4 count, history of IDU only (P = 0.037) and a combination of alcohol abuse and IDU (P = 0.038) were associated with a lesser increase in CD4 count after HAART compared with those with neither alcohol nor IDU. No significant associations were found between substance abuse history and changes in detectable viral load. Our results show that many patients at urban health clinics have a history of either injection drug use or alcohol abuse, and that injection drug use is negatively associated with the immunologic response to HAART in urban HIV-infected individuals. This study highlights the importance for clinicians of understanding the negative associations of substance abuse with the treatment response of HIV-infected patients at urban health centers.     

Perceived Neighborhood-Level Drivers of Food Insecurity Among Aging Women in the United States: A Qualitative Study

BackgroundAging populations in the United States exhibit high rates of food insecurity and chronic illness. Few studies have explored the neighborhood-level drivers of food insecurity among such populations, and how they intersect with experiences of aging.ObjectiveThe aim of this study was to explore how aging women experience food insecurity in the United States, and the neighborhood-level factors that influence these experiences.DesignSemistructured qualitative interviews were conducted to elicit participants’ perceptions of how their neighborhood influenced their experiences with food security and aging.Participants/settingThirty-eight food-insecure women aged 50 years and older were purposively sampled from the Northern California, Georgia, and North Carolina sites of the Women’s Interagency Human Immunodeficiency Virus Study. Interviews were conducted between November 2017 and July 2018 at the three Women’s Interagency Human Immunodeficiency Virus Study sites.Statistical analysisThree researchers thematically analyzed the data using an inductive–deductive approach.ResultsParticipants described neighborhood-level drivers of food insecurity that centered around three themes: accessibility of food from traditional food stores, the role of food aid institutions, and the intersection of aging with the food environment. Participants explained that food insecurity was related to limited access to food stores largely due to long distances and poor public transportation in Georgia and North Carolina, and high food prices in Northern California. Most participants described being dependent on food aid programs, but found this difficult due to poor quality food and long wait times. Aging-related issues emerged as a cross-cutting theme, with fatigue, poor strength, and chronic illness amplifying barriers to accessing food.ConclusionsFindings from this study reveal the structural barriers that aging women face in accessing healthy food within their neighborhoods, and how experiences with aging and chronic illnesses exacerbate these barriers. Although future programs should address common neighborhood-level barriers such as the accessibility and affordability of healthy foods, they should also be tailored to aging women and the local context.     

50例HIV感染吸毒者针具使用行为特征分析

目的通过调查了解福州市HIV感染吸毒者针具使用行为特征,以期为吸毒人群HIV感染的预防控制提供依据。方法选取福州市1998年～2007年间吸毒人群中的HIV感染者共50例为研究对象,由调查员面对面对调查吸毒及针具使用行为特征。结果50例HIV感染吸毒者100%注射吸毒;92.0%的人曾共用针具;共用方式主要为互相借用针具及公共洗针水;89.1%的人共用针具前曾没有处理;50.0%的人重复使用注射器;72.0%的人将使用过的注射器扔进垃圾堆;文化程度初中以下的HIV阳性吸毒者从别人针筒分水的行为发生率高(P=0.038);非在婚的HIV阳性吸毒者将针具借给其他吸毒者的行为发生率高(P=0.002)。结论福州市HIV感染吸毒者中存在较严重的HIV感染危险和危害行为,应加大艾滋病健康教育及行为干预的工作力度,尽快开展清洁针具交换工作。     

Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis

Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.     

Estimates of the Population Prevalence of Injection Drug Users among Hispanic Residents of Large US Metropolitan Areas

Little information exists on the population prevalence or geographic distribution of injection drug users (IDUs) who are Hispanic in the USA. Here, we present yearly estimates of IDU population prevalence among Hispanic residents of the 96 most populated US metropolitan statistical areas (MSAs) for 1992–2002. First, yearly estimates of the proportion of IDUs who were Hispanic in each MSA were created by combining data on (1) IDUs receiving drug treatment services in Substance Abuse and Mental Health Services Administration (SAMHSA)’s Treatment Entry Data System, (2) IDUs being tested in the Centers for Disease Control and Prevention (CDC) HIV-Counseling and Testing System, and (3) incident AIDS diagnoses among IDUs, supplemented by (4) data on IDUs who were living with AIDS. Then, the resulting proportions were multiplied by published yearly estimates of the number of IDUs of all racial/ethnic groups in each MSA to produce Hispanic IDU population estimates. These were divided by Hispanic population data to produce population prevalence rates. Time trends were tested using mixed-effects regression models. Hispanic IDU prevalence declined significantly on average (1992 mean = 192, median = 133; 2002 mean = 144, median = 93; units are per 10,000 Hispanics aged 15–64). The highest prevalence rates across time tended to be in smaller northeastern MSAs. Comparing the last three study years to the first three, prevalence decreased in 82% of MSAs and increased in 18%. Comparisons with data on drug-related mortality and hepatitis C mortality supported the validity of the estimates. Generally, estimates of Hispanic IDU population prevalence were higher than published estimates for non-Hispanic White residents and lower than published estimates for non-Hispanic Black residents. Further analysis indicated that the proportion of IDUs that was Hispanic decreased in 52% and increased in 48% of MSAs between 2002 and 2007. The estimates resulting from this study can be used to investigate MSA-level social and economic factors that may have contributed to variations across MSAs and to help guide prevention program planning for Hispanic IDUs within MSAs. Future research should attempt to determine to what extent these trends are applicable to Hispanic national origin subgroups.     

男性吸毒人群甲型肝炎病毒感染状况及其影响因素的研究

目的　了解吸毒人员中甲型肝炎病毒的感染状况 ,为防制甲肝提供科学依据。　方法　采用现况研究 ,通过整群抽样 ,以问卷的方式调查男性吸毒人员 45 2名 ,收集有关资料并采集血标本 45 2份。用酶联免疫吸附试验 (ELISA法 ) ,检测血清中抗 -HAV。采用Chi-square检验和Logistic回归分析对数据进行统计学分析。　 结果　 45 2名男性吸毒人员中检出抗 -HAV阳性 2 91人 ,总感染率为 64 .3 8% ;单因素分析 :不同地区甲肝感染率差异有显著性 (χ2 =7 3 49,P <0 .0 5 ) ;不同文化程度 ,不同年龄组 ,不同职业 ,不同吸毒年限甲肝感染率差异无显著性 (P >0 .0 5 )。多因素分析 :不同地区 ,不同职业 ,是否喝生水的甲肝感染率差异有显著性。　结论　吸毒人群是甲型肝炎感染的高危人群。吸毒人员中甲肝的感染与地区差异、职业及卫生习惯有关     

未成年子女面对母亲罹患乳腺癌的心理体验质性研究

目的 了解未成年子女面对母亲罹患乳腺癌的心理体验,为制定科学的心理支持方案,帮助未成年子女健康成长提供参考.方法 对30例乳腺癌患者的未成年子女进行半结构式访谈,并采用Colaizzi七步法进行分析整理,提炼主题.结果 未成年子女的心理体验主要表现为五大主题:害怕失去母亲;对母亲患病的无能为力感到自责和担忧;因母亲患病...     

Prevalence and correlates of illicit methylphenidate use among 8th, 10th, and 12th grade students in the United States, 2001

The prevalence and correlates of illicit methylphenidate use were examined within a nationally representative U.S. sample of 8th, 10th, and 12th graders. The annual prevalence of illicit methylphenidate use was 4%. Race, grade level, geographical region, grade point average, and substance use were all significantly associated with illicit methylphenidate use.     

Estimating the Prevalence of Injection Drug Users in the U.S. and in Large U.S. Metropolitan Areas from 1992 to 2002

This paper estimates the prevalence of current injection drug users (IDUs) in 96 large U.S. metropolitan statistical areas (MSAs) annually from 1992 to 2002. Multiplier/allocation methods were used to estimate the prevalence of injectors because confidentiality restrictions precluded the use of other commonly used estimation methods, such as capture-recapture. We first estimated the number of IDUs in the U.S. each year from 1992 to 2002 and then apportioned these estimates to MSAs using multiplier methods. Four different types of data indicating drug injection were used to allocate national annual totals to MSAs, creating four distinct series of estimates of the number of injectors in each MSA. Each series was smoothed over time; and the mean value of the four component estimates was taken as the best estimate of IDUs for that MSA and year (with the range of component estimates indicating the degree of uncertainty in the estimates). Annual cross-sectional correlations of the MSA-level IDU estimates with measures of unemployment, hepatitis C mortality prevalence, and poisoning mortality prevalence were used to validate our estimates. MSA-level IDU estimates correlated moderately well with validators, demonstrating adequate convergence validity. Overall, the number of IDUs per 10,000 persons aged 15-64 years varied from 30 to 348 across MSAs (mean 126.9, standard deviation 65.3, median 106.6, interquartile range 78-162) in 1992 and from 37 to 336 across MSAs (mean 110.6, standard deviation 57.7, median 96.1, interquartile range 67-134) in 2002. A multilevel model showed that overall, across the 96 MSAs, the number of injectors declined each year until 2000, after which the IDU prevalence began to increase. Despite the variation in component estimates and methodological and component data set limitations, these local IDU prevalence estimates may be used to assess: (1) predictors of change in IDU prevalence; (2) differing IDU trends between localities; (3) the adequacy of service delivery to IDUs; and (4) infectious disease dynamics among IDUs across time.     

Substance use,generation and time in the United States: The modifying role of gender for immigrant urban adolescents

Although immigrant youth have lower rates of substance use than US born youth, whether substance use varies by generation and time in the US is unclear. This study examines adolescent alcohol, tobacco and marijuana use by generation/time in US (i.e., first generation, in US ≤4 years; first generation, in US >4 years; second generation; and third generation or higher). Data come from a 2008 survey of Boston, Massachusetts public high school students (n = 1485). Multivariable logistic regression models were used to examine the association between generation/time in the US and risk of past 30-day substance use, adjusting for age and race/ethnicity. To determine whether the associations differed by gender, we fit gender stratified regression models. The prevalence of substance use was lowest among immigrants who had been in the US ≤4 years. Among girls, generation/time in US was not related to alcohol use or to tobacco use. For boys, being an immigrant regardless of number of years in the US, as well as second generation was associated with a significantly lower risk of tobacco use, compared to third generation youth. Additionally, immigrant boys who had been in the US ≤4 years had a significantly lower risk of alcohol use. Among both boys and girls, all first and second generation youth were significantly less likely to report marijuana use compared to third generation youth. Immigrant youth have a lower risk of alcohol, tobacco and marijuana use relative to US born youth; however the protective effect of foreign nativity on alcohol was eroded much more quickly than for tobacco or marijuana. The effects of generation and time in US on substance use differ by gender and the particular substance.