以社区为基础招募的乌鲁木齐市吸毒者首次吸毒发生情况的调查

目的:在横断面调查的基础上,采用生存分析方法(survivalanalysis)探讨乌鲁木齐市社区吸毒人群发生首次吸毒的情况及其影响因素。方法:于2005年4-6月,以应答驱动抽样为主要招募方式,在社区招募吸毒者参加调查;应用结构式问卷调查吸毒者的社会人口学特征、首次口吸和静脉注射毒品时间、方式,首次吸毒前的个人成瘾性行为(如吸烟、饮酒)及家庭成员、亲友吸毒情况等。结果:401名静脉注射毒品者进入本次横断面调查,首次吸毒方式为口吸和静脉注射毒品者分别为95·0%(381/401)和5·0%(20/401),首次使用的毒品均为海洛因,首次吸毒年龄19·8a±s5·0a,首次吸毒年龄最小值为6·4a,15a以前开始吸毒者占14·2%(57/401)。从出生到首次吸毒的发生率为5·0/100人年(95%CI:4·5-5·5),影响首次吸毒发生的变量为:维族(HR=2·161,95%CI:1·713-2·726)、15a以前开始吸烟(HR=1·273,95%CI:1·006-1·610)、16a以前开始饮酒(HR=1·774,95%CI:1·387-2·269)、有亲戚吸毒(HR=1·411,95%CI:1·032-1·928)。从出生到发生首次吸毒的时间分别为:维族17·9(95%CI:17·2-18·5)a,15a以前开始吸烟者为20·0(95%CI:20·0-20·8)a,16a以前开始饮酒者为17·0(95%CI:16·6-17·7)a,有亲戚吸毒者为19·2(95%CI:18·6-20·0)a。结论:提示吸毒流行严重地区,吸毒低龄化可能会加速艾滋病的流行。在青少年早期开展个人成瘾性行为(如吸烟、饮酒)的干预教育及艾滋病知识的宣传教育非常必要,维族青少年应该是重点干预人群。     

吸毒人群从首次吸毒到静脉注射吸毒的转变研究

目的:了解四川省某地区吸毒人群从首次吸毒到静脉注射吸毒的发生率及影响因素.方法:于2002年11月在社区招募吸毒人员382人,调查该人群的社会人口学特征,首次吸毒、首次静脉注射吸毒时间等.结果:从首次吸毒到静脉注射吸毒的发生率为32.56/100人年.在多因素分析中,首次吸毒时年龄(HR值为1.66;95%CI为1.35-2.05)、民族(HR值为1.38;95%CI为1.10-1.74)、文化(HR值为0.75;95%CI为0.60-0.93)和收入(HR值为0.64;95%CI为0.52-0.79)与首次吸毒转变为静脉吸毒的发生率有统计学意义.结论:应针对不同的民族、文化、收入及年龄特点,对吸毒人群开展健康教育和行为干预,控制艾滋病病毒的传播.     

乌鲁木齐市吸毒人群首次注射吸毒和共用器具注射吸毒的调查研究

目的：了解新疆乌鲁木齐市吸毒人群从首次注射吸毒到首次共用器具注射吸毒的发生情况及影响因素。方法：于2005年4-6月以社区为基础招募吸毒者，调查其社会人口学特征、首次吸毒、首次注射吸毒和首次共用器具注射吸毒情况。结果：在调查的静脉吸毒者401人中，68．6％（275／401）的吸毒者曾经共用器具注射吸毒。从首次吸毒到首次注射吸毒的发生率为23．58／100人年（95％CI=21。27-25．89），多因素Cox比例风险回归模型分析结果显示：女性（HR=1.65，95％CI=1．21-2，24）和首次吸毒年份为1994年及以后（HR=3．56，95％CI=2．84～4．47）与首次注射吸毒发生的关系有统计学意义；从首次注射吸毒到首次共用器具注射毒品的发生率为24．99／100人年（95％CI=22．04-27，94），多因素Cox比例风险回归模型分析结果显示：维族（HR=I，41，95％CI=1.08～1．85）、初中及以下文化程度（HR=1，41，95％CI=1.09-1．82）和首次注射吸毒年份为1998年及以后（HR=1．56，95％CI=1．20-2．04）与首次共用器具注射吸毒发生的关系有统计学意义。结论：近期开始滥用毒品的吸毒者易于从口吸转变为注射吸毒进而共用器具注射吸毒。注射吸毒是HIV感染和传播的主要途径。     

四川省西昌市吸毒人群首次吸毒情况的调查分析

目的:调查四川省西昌市吸毒人群首次吸毒的发生情况。方法:在四川省凉山彝族自治州西昌市戒毒所、拘留所和看守所调查吸毒人员的人口学特征,吸毒前吸烟和饮酒的情况,朋友、亲戚和家人吸毒的人数,首次吸毒的时间和使用毒品的方式和种类,吸毒前是否有被治安处理或违法行为。结果:共调查了619名吸毒人员,从出生到首次吸毒的发生率为4·08/100(95%可信区间为3·76-4·40)人年。在多因素Cox比例风险模型中,15a以前开始吸烟(危险率比值为1·58;95%可信区间为1·35-1·86),朋友中吸毒的人数(朋友中有1-4人吸毒危险率比值为1·25;95%可信区间为1·04-1·51,朋友中有5人及以上吸毒危险率比值为1·71;95%可信区间为1·39-2·09)和研究对象来源(拘留所和看守所危险率比值为1·52;95%可信区间为1·18-1·96)与首次吸毒的发生率有统计学意义。结论:需进一步了解首次吸毒发生的情况及其影响因素,为开展健康教育和行为干预来预防吸毒和有关疾病的传播提供科学依据。     

乌鲁木齐市吸毒人群共用器具注射毒品行为特征及其影响因素

目的:了解乌鲁木齐市吸毒人群共用器具注射毒品的行为特征及其影响因素。方法:于2004年9-10月,应用结构式问卷调查乌鲁木齐市吸毒者的人口学特征、首次吸毒前的吸烟和饮酒情况;首次吸毒和首次静脉注射毒品及共用注射器具注射毒品的行为特征及相关因素等。结果:提供知情同意书的509名吸毒者中,既往共用器具注射吸毒者占59.5%(303/509)。近3个月有新的共用器具注射毒品伙伴者占17.3%(88/509);共用器具注射毒品≥5次者占14.9%(76/509);近3个月33.2%(169/509)的调查对象共用器具注射毒品;直接共用者占27.9%(142/509),间接共用者占23.2%(118/509)。Logistic回归模型结果显示,与共用器具注射毒品≥5次有统计学意义的变量是年龄(OR=1.77,95%CI:1.07-2.91)和文化程度(OR=0.31,95%CI:0.15-0.64);与直接共用有关的变量是近6个月工作(OR=0.57,95%CI:0.38-0.86)、年收入(OR=0.58,95%CI:0.38-0.86)和15a以前开始吸烟(OR=1.79,95%CI:1.18-2.72);与间接共用有关的变量是民族(OR=0.58,95%CI:0.37-0.92)和近6个月工作(OR=0.61,95%CI:0.40-0.92)。结论:乌鲁木齐地区吸毒人群共用器具注射毒品比例高;年龄、文化程度、稳定的工作和年收入及15a以前开始吸烟与共用注射器具吸毒有关。提示:推广高危行为干预和强化个体化降低毒品危害咨询的必要性。     

社区暗娼吸毒情况及其影响因素调查研究

目的:了解四川省凉山彝族自治州某吸毒严重地区暗娼吸毒情况及其影响因素。方法:从社区招募暗娼调查其社会人口学、吸毒、性行为方式和安全套使用情况。结果:提供知情同意和符合纳入标准的343人中,近3个月内暗娼中吸毒的占9.3%(32/343),其中静脉吸毒的占43.8%(14/32)。多因素分析结果显示当地居民(OR值为7.16;95%CI为2.47-20.69)、低档性服务场所(OR值为10.66;95%CI为2.79-40.72)、近6个月内新性伴人数多(OR值为4.12;95%CI为1.22-13.96)和吸烟(OR值为45.36;95%CI为9.61-214.17)与暗娼吸毒有关。结论:暗娼中存在着经吸毒和性传播HIV的高危行为,需针对这一人群采取有效的干预措施。     

西昌市静脉吸毒人群前瞻性队列研究2年随访死亡分析

目的:了解四川省凉山彝族自治州西昌市静脉吸毒人群死亡率及死因。方法:于2002年11月招募静脉吸毒人群前瞻性研究队列376人,调查其社会人口学、吸毒行为和性行为特征。计算静脉吸毒人群随访2年的死亡率和死因构成,对其影响因素采用单因素和多因素Cox回归模型分析。结果:在队列2年随访中,死亡39人,死亡率为55.30/1000人年(95%CI:37.95-72.66),标准化死亡比为34.53(95%CI:21.60-54.54)。吸毒过量占全部死因的66.7%(26/39)。多因素Cox回归模型分析未见与全因死亡关系有统计学意义的变量;但见吸毒年限(≥9年)与吸毒过量死亡有统计学关联(P=0.0347),其危险比是2.31(95%CI:1.06-5.04)。结论:吸毒过量是西昌市静脉吸毒者的主要死因,需进一步探讨吸毒过量死亡的影响因素及其干预对策。     

毒品滥用对男性吸毒人群性行为的影响

目的:了解毒品滥用对男性吸毒人群性行为的影响。方法:2004年5-7月,在四川省西昌市调查男性吸毒人员的社会人口学、吸烟、饮酒、吸毒和性行为方式及频率。结果:共调查男性吸毒者892人,在多因素Logistic回归模型中,近6个月与固定性伴性行为的关系有统计学意义的变量为:年龄(OR值,0·49,95%CI:0·28-0·87),住自己的房子(OR值,0·56,95%CI:0·36-0·88)和吸毒年限(OR值,0·54,95%CI:0·33-0·87);近6个月与临时性伴性行为的关系有统计学意义的变量为:无业(OR值,1·40,95%CI:1·03-1·91),有固定性伴(OR值,0·56,95%CI:0·40-0·79)和近3个月静脉吸毒频率(OR值,1·53,95%CI:1·11-2·10)。结论:长期毒品滥用可降低男性与固定性伴的性行为和近3个月毒品滥用可增加男性与临时性伴的性行为。     

四川省西昌市吸毒人群初次共用注射器具吸毒情况调查分析

目的:了解四川省西昌市吸毒人群初次共用注射器具的发生情况及其影响因素。方法:于2004年5-7月,从社区中招募吸毒人员,调查其社会人口学、初次吸烟、饮酒和吸毒相关行为特征情况。结果:在调查的451名吸毒人员中,82·04%(370/451)在调查前注射毒品;50·33%(227/451)曾经共用过注射器具。从初次吸毒到初次共用注射器具静脉注射毒品的发生率为9·69/100人年,多因素Cox比例风险模型分析结果显示,与初次共用注射器具的发生相关的变量为男性(危险率比值为1·80;95%可信区间为1·11-2·91)、初中以下文化(危险率比值为1·48;95%可信区间为1·14-1·94)和15a以前开始吸烟(危险率比值为1·40;95%可信区间为1·06-1·84)。从初次静脉注射毒品到初次共用注射器具注射毒品的发生率为34·12/100人年,多因素Cox比例风险模型分析结果显示,与初次共用注射器具发生相关的变量为男性(危险率比值为1·92;95%可信区间为1·20-3·06)和初中以下文化(危险率比值为1·31;95%可信区间为1·00-1·71)。结论:西昌市吸毒人群中男性、文化程度低和吸烟年龄早是其初次共用注射器具发生的影响因素。     

新疆乌鲁木齐市社区静脉吸毒人群HIV感染情况调查

目的：了解新疆乌鲁木齐市社区静脉注射吸毒人群艾滋病病毒（HIV）感染情况。方法：于2005年4—6月以社区为基础招募静脉吸毒者，调查其社会人口学、静脉吸毒行为和性行为方式，并采集血样检测HIV和梅毒抗体。结果：调查的401名静脉吸毒者中，HIV感染率为36.4％（146／401），多因素Logistic回归分析结果显示，维族（OR，8．42；95％CI，4.44—15．99）、结婚或同居（OR，2．30；95％CI，1.33—3.97）、累积共用注射吸毒10次及以上（OR，3.10；95％CI，1.81—5.33）、静脉吸毒5年以上（OR，4．10；95％CI，2．47—6．81）与HIV感染关系有统计学意义。结论：该地区静脉吸毒人群HIV感染率高，应针对当地静脉吸毒人群共用注射吸毒行为开展干预来控制HIV的传播和流行。     

Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: a nationwide follow-up study of Danish substance users in treatment

This is a register-based cohort study of 20,581 individuals in treatment for illicit substance use disorders in Denmark between 1996 and 2006. All in all, 1441 deaths were recorded during 111,445 person-years of follow-up. Standardized mortality ratios (SMRs) associated with different primary substance types were calculated and Cox-regression analyses were performed in order to establish hazard ratios (HR) associated with injection drug use and psychiatric comorbidity. SMRs for primary users of specific substances were: cannabis: 4.9 (95% confidence interval (CI): 4.2-5.8), cocaine: 6.4 (CI: 3.9-10.0), amphetamine: 6.0 (CI: 4.2-8.3), heroin: 9.1 (CI: 8.5-9.8), and other opioids 7.7 (CI: 6.6-8.9). For MDMA ('ecstasy') the crude mortality rate was 1.7/1000 person-years (CI: 0.4-7.0) and the SMR was not significantly elevated. Injection drug use was associated with significantly increased hazard ratios in users of opioids and cocaine/amphetamine. Overall, psychiatric comorbidity was not associated with increased mortality (HR: 1.1 [CI: 0.9-1.2], p=.28), but an association was found specifically among cocaine/amphetamine users (HR: 3.6 [CI: 2.1-6.4], p<.001).     

The prevalence and correlates of single cigarette selling among urban disadvantaged drug users in Baltimore,Maryland

Background

Selling of single cigarettes, also known as loosies, is a public health concern. Loosies allow for those with fewer resources to buy cigarettes without having to purchase a pack. Selling of loosies may cue smoking behaviors. In the US, socioeconomically disadvantaged populations have high rates of smoking and illicit drug use and the selling of loosies appears to be linked to the urban informal economy. We examined the proportion and frequency of cigarette selling and roles in the informal economy associated with selling loosies among a sample of urban drug users.

Methods

There were 801 participants, recruited by community outreach, assessed at baseline, who were enrolled in an HIV prevention intervention for drug users.

Results

Most (89%) smoked cigarettes in the prior 30 days, of whom 92% smoked daily. Self-reported selling of cigarettes was common with 58% reporting that they had sold cigarettes within the last six months; 20.4% reported selling cigarettes a few times a week and 7.4% reported daily selling of cigarettes. In a stepwise regression model, four sources of income were associated with frequent cigarette selling: providing street security (OR = 2.214, 95% CI 1.177–4.164), selling food stamps (OR = 1.461, 95% CI 1.003–2.126), pawning items (OR = 2.15, 95% CI 1.475–3.135), and selling drugs (OR = 1.634, 95% CI 1.008–2.648).

Conclusion

There is a high rate of selling loosies among urban substance users. The wide availability of loosies may promote smoking. Smoking cessation programs with drug treatment and economic development programs may help to reduce economic pressures to sell loosies.     

Correlates of initiation of injection drug use among young drug users in Baltimore, Maryland: the need for early intervention

This article examines individual and social factors associated with initiation of illicit drug injection, with a focus on racial differences. Data were derived from across-sectional survey of young injection and noninjection drug users in Baltimore, Maryland. Participants were aged 15 to 30 and had initiated use of heroin, cocaine, and/or crack within the prior five years. Bivariate and multivariate logistic regression models were used to identify correlates of injection initiation. Of 579 drug users, 73% were injectors, 56% were male, and 41% were African American. In a multivariate model controlling for age, correlates of injection initiation were: being an African American male [Adjusted Odds Ratio (AOR): 0.08; 95% Confidence Interval (CI): 0.04, 0.17] or female (AOR = 0.12; 95%CI: 0.06, 0.27) compared to being a White male; younger age of first use of alcohol, marijuana, or inhalants (AOR=0.73; 95%CI: 0.65, 0.82); shorter time between first use of alcohol, marijuana, or inhalants and first use of heroin, crack, or cocaine (per year decrease, AOR=0.63, 95%CI: 0.40, 0.87); parental drug use (AOR=0.54, 95%CI: 0.32, 0.92); seeing someone inject prior to injection, AOR=1.96, 95%CI: 1.01, 3.50); and crack smoking (AOR=1.77, 95%CI: 1.07, 2.99). Early drug use patterns and drug exposure factors are associated with initiation injection. Interventions are needed that target noninjection drug users to prevent transition to injection drug use.     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.