Addiction Vol. 106; No. 11: P. 1966-1974 (11..11) - Wednesday,
ALIVE (AIDS Linked to the Intravenous Experience) is a
prospective cohort with semi-annual follow-up since 1988. The
current study, set in Baltimore, was designed to determine the
incidence of long-term injection cessation and its association
with residential relocation and neighborhood deprivation. Its
subjects were 1,697 active injectors from ALIVE with at least
eight semi-annual study visits.
Multi-level discrete time-to-event models were constructed to
investigate individual and neighborhood-level predictors of
long-term injection cessation, which was defined as three
consecutive years without self-reported injection drug use.
Forty-two percent of injectors (n=706) achieved long-term
cessation (incidence=7.6 per 100 person-years). After
adjusting for individual-level factors, the researchers found
that long-term cessation was 29 percent less likely in
neighborhoods in the third quartile of deprivation (hazard
ratio=0.71, 95 percent confidence interval: 0.53, 0.95) and 43
percent less likely in the highest quartile of deprivation
(HR=0.57, 95 percent CI: 0.43, 0.76) compared with the first
Residential relocation was found to be associated with an
increased likelihood of long-term injection cessation
(HR=1.55, 95 percent CI: 1.31, 1.82), although the authors
noted that "the impact of relocation varied depending on the
deprivation in the destination neighborhood." Compared to
subjects who stayed in less deprived neighborhoods, the
strongest positive impact on long-term cessation was noted
among those who relocated from highly deprived to less
deprived neighborhoods (HR=1.96, 95 percent CI: 1.50, 2.57).
Staying in the most deprived neighborhoods was detrimental
(HR=0.76, 95 percent CI: 0.63, 0.93).
"Long-term cessation of injection of opiates and cocaine
occurred frequently following a median of nine years of
injection, and contextual factors appear to be important," the
authors concluded. "Our findings suggest that improvements in
the socio-economic environment may improve the effectiveness
of cessation programs."