A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs.
A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs.
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DOI：
10.1007/s11524-011-9575-4
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发表时间：
2011-08
影响因子：
6.6
通讯作者：
Kerr, Thomas
中科院分区：
文献类型：
--
作者：
DeBeck, Kora;Wood, Evan;Zhang, Ruth;Buxton, Jane;Montaner, Julio;Kerr, Thomas
虽然与毒品有关的街头骚乱对社区的影响已得到很好的描述，但较少注意到与毒品有关的街头吸毒者暴露在毒品现场对健康和社会的潜在影响。因此，我们试图评估在加拿大的环境下，注射吸毒者(IDU)暴露在街头毒品场景中的影响。数据来自一项名为温哥华注射吸毒者研究的前瞻性队列研究。根据每天在街上度过的小时数，定义了四类毒品现场暴露。构建了3个广义估计方程(GEE)Logistic回归模型，以识别2005年12月至2009年3月期间不同水平的药物现场暴露(2-6、6-15、超过15小时)的相关因素。在我们的1,486名吸毒者样本中，在基线情况下，总共有314人(21%)符合高度药物现场暴露的标准(每天15小时)。在多变量GEE分析中，显著和独立地与高暴露相关的因素包括：不稳定的住房(调整后的优势比[ = ]9.50；95%可信区间[CI]，6.36-14.20)；每天使用毒品(调整后的优势比 = 2.70；95%可信区间，2.07-3.52)；与警察接触(调整后的优势比 = 2.11；95%可信区间，1.62-2.75)；以及遭受暴力(调整后的优势比 = 1.49；95%可信区间，1.14-1.95)。经常工作(AOR = 0.5 0；95%CI，0.38~0.6 5)和参与成瘾治疗(AOR = 0.5 8；95%CI，0.45~0.75)与高暴露负相关。我们的发现表明，毒品现场暴露与易感和更高强度成瘾的标志有关。毒品现场暴露的强度与易受伤害的指标以剂量依赖的方式相关。这些发现突出了政策干预的机会，以解决在就业、住房和成瘾治疗领域暴露于街头混乱的问题。
While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2–6, 6–15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36–14.20); daily crack use (AOR = 2.70; 95% CI, 2.07–3.52); encounters with police (AOR = 2.11; 95% CI, 1.62–2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14–1.95). Regular employment (AOR = 0.50; 95% CI, 0.38–0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45–0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.
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影响因子：
2.8
作者：
Kerr, Thomas;Small, William;Wood, Evan
通讯作者：
Wood, Evan
影响因子：
4.4
作者：
Aidala, Angela A.;Sumartojo, Esther
通讯作者：
Sumartojo, Esther
影响因子：
6
作者：
Friedman, SR;Furst, RT;Ildefonso, G
通讯作者：
Ildefonso, G
影响因子：
5
作者：
Mitchell, D
通讯作者：
Mitchell, D
影响因子：
4.4
作者：
Navarro, C.;Leonard, L.
通讯作者：
Leonard, L.