AEGiS-14IAC: The effect of race, neighborhood, and social network on adolescent initiation of injection drug use among recont-onset injection drug users in Baltimore, Maryland.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

The effect of race, neighborhood, and social network on adolescent initiation of injection drug use among recont-onset injection drug users in Baltimore, Maryland.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. WeOrE1356)

Fuller CM, Borrell LN, Galea S, Vlahov D
Columbia University, Mailman School of Public Health, New York, United States

BACKGROUND: To determine the extent to which individual-level factors (race, social network, injection risks) and contextual-level factors (neighborhood racial composition, poverty, education levels) contribute to adolescent initiation of injection drug use (?21 yrs of age) in a population of injection drug users (IDUs).

METHODS: Street-recruited IDUs from 12 neighborhoods (15-30 yrs) injecting ?5 yrs. underwent HIV testing and a survey of high-risk practices, and social factors. GEE was used to estimate the contribution of individual- and contextual-level factors on adolescent initiation while adjusting for the correlation between individuals within neighborhoods.

RESULTS: Of 144 IDUs: 69% female, 63% black. In the final model (individual and contextual factors), adolescent initiates (AIs) were less likely to be black (OR=0.05), report early sharing (OR=0.37), and more likely to have dropped out of school (OR=2.05) and report an early high-risk network soon after initiation (OR=9.98) than adult initiates. AIs were also more likely to come from neighborhoods with a high minority composition (OR=3.95) and less likely to come from neighborhoods with a high poverty level (OR=0.28) than adult initiates. The probability of a black adolescent from a low poverty/low minority neighborhood initiating injection was 29% compared with 84% for a black adolescent coming from a high poverty/high minority neighborhood. The probability of a white adolescent from a low poverty/low minority neighborhood initiating injection was 88% compared with 96% for a white adolescent from a high poverty/high minority neighborhood.

CONCLUSION: These data suggest that while individual factors play a role in age of injection initiation and high-risk behavior soon after initiation, social processes within neighborhoods also play an independent role. Public health efforts to curb adolescent initiation and early high-risk networks should consider the individuals? connection to their social environment.

Keywords: AEGIS, Residence Characteristics, Baltimore, Maryland, Social Support, Substance-Related Disorders, HIV Infections, Social Environment, African Americans, Poverty, Social Behavior, Adolescent Behavior, Adolescent, Human, Adolescence, Adult, Female

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