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Mandell, Wallace; Vlahov, David; Latkin, Carl A.; Oziemkowska, Maria; Cohn, Sylvia |
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Title |
Correlates of needle sharing among injection drug users |
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Journal Article |
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Year |
1994 |
Publication |
American journal of public health : official journal of the American Public Health Association |
Abbreviated Journal |
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84 |
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6; 06/1994 |
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920-923 |
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AOD use, abuse, and dependence; intravenous drug user; needle sharing; HIV infection; risk factors; United States; study |
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Abstract  |
OBJECTIVES. The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. METHODS. Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. RESULTS. Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. CONCLUSIONS. These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing. |
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0090-0036 (Print); 1541-0048 (Electronic) |
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50-ac |
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59506 |
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van Ameijden, Erik J.C.; van den Hoek, Anneke A.R.; Coutinho, Roel A. |
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Title |
Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs |
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Journal Article |
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Year |
1994 |
Publication |
American journal of public health : official journal of the American Public Health Association |
Abbreviated Journal |
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Volume |
84 |
Issue |
2; 02/1994 |
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275-281 |
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Keywords |
intravenous drug user; risk-taking behavior; needle sharing; HIV infection; treatment and maintenance; methadone maintenance; drug substitution therapy; harm reduction; needle distribution and exchange; Netherlands; Amsterdam |
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Abstract |
OBJECTIVES. Serial, cross-sectional trends in injecting risk behavior were studied among drug users from 1986 to 1992. METHODS. From a cohort study in Amsterdam, 616 intake visits of drug users who had injected in the 6 months preceding intake were selected. RESULTS. The proportion of drug users who reported borrowing and lending used injection equipment and reusing needles/syringes (in the previous 6 months), continuously declined from 51% to 20%, from 46% to 10% and from 63% to 39%, respectively. In multivariate analysis, it appeared unlikely that a selective recruitment of participants over time was responsible for these trends. Participants, recruited later in time, had been previously tested for human immunodeficiency virus (HIV) more often, had received daily methadone less often, and had obtained a higher proportion of new needles via exchange programs. Indications were found that (1) voluntary HIV testing and counseling leads to less borrowing, lending, and reusing equipment; and (2) obtaining needles via exchange programs leads to less reusing needles/syringes. It appeared that nonattenders of methadone and exchange programs have reduced borrowing and lending to the same extent as attenders. CONCLUSIONS. Methodologically, evaluating specific measures is difficult. However, the combination of various preventive measures in Amsterdam is likely to be responsible for the observed decrease in injecting risk behavior. |
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0090-0036 (Print); 1541-0048 (Electronic) |
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50-x |
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59501 |
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Schütze, Madlen; Boeing, Heiner; Pischon, Tobias; various |
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Title |
alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study |
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Journal Article |
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2011 |
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British medical journal |
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online first; 04.01.2011 |
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10 |
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cancer; alcohol; social and economic cost of AOD; statistical data; research; Europe; study |
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OBJECTIVE:To compute the burden of cancer attributable to current and former alcohol consumption in eight European countries based on direct relative risk estimates from a cohort study. DESIGN: Combination of prospective cohort study with representative population based data on alcohol exposure. Setting Eight countries (France, Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Denmark) participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. PARTICIPANTS: 109,118 men and 254,870 women, mainly aged 37-70. MAIN OUTCOME MEASURES: Hazard rate ratios expressing the relative risk of cancer incidence for former and current alcohol consumption among EPIC participants. Hazard rate ratios combined with representative information on alcohol consumption to calculate alcohol attributable fractions of causally related cancers by country and sex. Partial alcohol attributable fractions for consumption higher than the recommended upper limit (two drinks a day for men with about 24 g alcohol, one for women with about 12 g alcohol) and the estimated total annual number of cases of alcohol attributable cancer. RESULTS: If we assume causality, among men and women, 10% (95% confidence interval 7 to 13%) and 3% (1 to 5%) of the incidence of total cancer was attributable to former and current alcohol consumption in the selected European countries. For selected cancers the figures were 44% (31 to 56%) and 25% (5 to 46%) for upper aerodigestive tract, 33% (11 to 54%) and 18% (-3 to 38%) for liver, 17% (10 to 25%) and 4% (-1 to 10%) for colorectal cancer for men and women, respectively, and 5.0% (2 to 8%) for female breast cancer. A substantial part of the alcohol attributable fraction in 2008 was associated with alcohol consumption higher than the recommended upper limit: 33,037 of 178,578 alcohol related cancer cases in men and 17,470 of 397,043 alcohol related cases in women. CONCLUSIONS:In western Europe, an important proportion of cases of cancer can be attributable to alcohol consumption, especially consumption higher than the recommended upper limits. These data support current political efforts to reduce or to abstain from alcohol consumption to reduce the incidence of cancer. |
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0959-535x |
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50-11797 |
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59941 |
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Kuendig, Hervé; Hasselberg, Marie; Gmel, Gerhard; Daeppen, Jean-Bernard; Laflamme, Lucie |
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Acute and usual drinking among emergency trauma patients: a study on alcohol consumption and injury patterns |
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Journal Article |
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2009 |
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Injury prevention |
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15 |
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4 |
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270-274 |
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addiction; AOD use, abuse, and dependence; chemical addiction; alcohol; AOD consumption; AOD effects and consequences; injury; risk factors; study; Switzerland; Lausanne |
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Objective: To investigate the relationship between usual and acute alcohol consumption among injured patients and, when combined, how they covary with other injury attributes. Methods: Data from a randomised sample of 486 injured patients interviewed in an emergency department (Lausanne University Hospital, Switzerland) were analysed using the χ2 test for independence and cluster analysis. Results: Acute alcohol consumption (24.7%) was associated with usual drinking and particularly with high volumes of consumption. Six injury clusters were identified. Over-representations of acute consumption were found in a cluster typical of injuries sustained through interpersonal violence and in another formed by miscellaneous circumstances. A third cluster, typical of sports injuries, was linked to a group of frequent heavy episodic drinkers (without acute consumption). Conclusions: Among injured patients, acute alcohol consumption is common and associated with usual drinking. Acute and/or usual consumption form part of some, but not all, injury clusters. |
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1475-5785 |
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50-11638 |
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59918 |
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Stark, Klaus; Muller, Reinhold; Bienzle, Ulrich; Guggenmoos-Holzmann, Irene |
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Frontloading: a risk factor for HIV and hepatitis C virus infection among injecting drug users in Berlin |
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Journal Article |
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1996 |
Publication |
Aids |
Abbreviated Journal |
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10 |
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311.317 |
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health promotion |
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Objective: To determine whether frontloading (i.e., syringe-mediated drug-sharing) is a risk factor for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection among injecting drug users (IDU). Design: Cross-sectional study. Data on sociodemographic and behavioural characteristics were obtained by a standardized questionnaire. Serum samples were tested for seromarkers for HIV, HBV and HCV. Setting and participants: IDU were recruited at ’low-threshold’ storefront agencies (out-of-treatment sample), and at a centre for long-term drug use treatment (in-treatment sample). Individuals were included in the study if they had injected drugs within the previous 3 months. Main outcome measures: Serological evidence for HIV, HBV, HCV exposure. Results: Of all IDU (n = 324), 84% had ever practised frontloading with non-sterile injecting equipment, and 46% had done so more than 100 times; 32% had front-loaded during the 6 months prior to the interview. The crude seroprevalence rates for HIV, HBV and HCV increased with the overall frequency of frontloading, and reached 22, 71 and 94%, respectively, among IDU who had frontloaded more than 100 times. After controlling for confounding effects by logistic regression, having practised front-loading more than 100 times was significantly associated with HIV infection [adjusted prevalence odds ratio (POR) 3.5; 95% confidence interval (CI), 1.4-9], and HCV infection (adjusted POR, 5.4; 95% CI, 2.3-12), but not with HBV infection. Another independent risk factor for all three virus infections was needle-sharing in prison. Conclusions: In communities where sterile injection equipment is readily available, and IDU have substantially reduced their overall levels of needle-sharing, the practice of frontloading appears to be a major risk factor for infections by blood-borne viruses among IDU. Prevention activities should specifically address this risk behaviour. |
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0269-9370 |
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50-02835 |
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59760 |
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Kuendig, Hervé; Hasselberg, Marie; Laflamme, Lucie; Daeppen, Jean-Bernard; Gmel, Gerhard |
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Acute alcohol consumption and injury : risk associations and attributable fractions for different injury mechanisms |
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Journal Article |
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2008 |
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Journal of studies on alcohol and drugs |
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69 |
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2; 03/2008 |
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218-226 |
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addiction; AOD use, abuse, and dependence; chemical addiction; alcohol; AOD consumption; AOD effects and consequences; AODR violence; injury; risk factors; prevention; intervention (persuasion to treatment); study; Switzerland; Lausanne |
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OBJECTIVE: Most studies on alcohol as a risk factor for injuries have been mechanism specific, and few have considered several mechanisms simultaneously or reported alcohol-attributable fractions (AAFs)-which was the aim of the current study. METHOD: Data from 3,592 injured and 3,489 noninjured patients collected between January 2003 and June 2004 in the surgical ward of the emergency department of the Lausanne University Hospital (Switzerland) were analyzed. Four injury mechanisms derived from the International Classification of Diseases, 10th Revision, were considered: transportation-related injuries, falls, exposure to forces and other events, and interpersonal violence. Multinomial logistic regression models were calculated to estimate the risk relationships of different levels of alcohol consumption, using noninjured patients as quasi-controls. The AAFs were then calculated. RESULTS: Risk relationships between injury and acute consumption were found across all mechanisms, commonly resulting in dose-response relationships. Marked differences between mechanisms were observed for relative risks and AAFs, which varied between 15.2% and 33.1% and between 10.1% and 35.9%, depending on the time window of consumption (either 6 hours or 24 hours before injury, respectively). Low and medium levels of alcohol consumption generally were associated with the most AAFs. CONCLUSIONS: This study underscores the implications of even low levels of alcohol consumption on the risk of sustaining injuries through any of the mechanisms considered. Substantial AAFs are reported for each mechanism, particularly for injuries resulting from interpersonal violence. Observation of a so-called preventive paradox phenomenon is discussed, and prevention or intervention measures are described. |
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59917 |
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Hawkins, J. David; Oesterle, Sabrina; Brown, Eric C.; Arthur, Michael W.; Abbott, Robert D.; Fagan, Abigail A.; Catalano, Richard F. |
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Results of a type 2 translational research trial to prevent adolescent drug use and delinquency : a test of Communities That Care |
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2009 |
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Archives of pediatrics and adolescent medicine |
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163 |
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9; 09/2009 |
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789-798 |
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prevention; adolescent; criminality; United States |
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Objective To test whether the Communities That Care (CTC) prevention system reduces adolescent alcohol, tobacco, and other drug use and delinquent behavior communitywide. Design The Community Youth Development Study is the first randomized trial of CTC. Setting In 2003, 24 small towns in 7 states, matched within state, were randomly assigned to control or CTC conditions. Participants A panel of 4407 fifth-grade students was surveyed annually through eighth grade. Intervention A coalition of community stakeholders received training and technical assistance to install the CTC prevention system. They used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their community’s specific profile from a menu of effective programs for families, schools, and youths aged 10 to 14 years. Main Outcome Measures Incidence and prevalence of alcohol, tobacco, and other drug use and delinquent behavior by spring of grade 8. Results The incidences of alcohol, cigarette and smokeless tobacco initiation, and delinquent behavior were significantly lower in CTC than in control communities for students in grades 5 through 8. In grade 8, the prevalences of alcohol and smokeless tobacco use in the last 30 days, binge drinking in the last 2 weeks, and the number of different delinquent behaviors committed in the last year were significantly lower for students in CTC communities. Conclusion Using the CTC system to reduce health-risking behaviors in adolescents can significantly reduce these behaviors communitywide. |
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1072-4710 |
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50-10599 |
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59867 |
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Mathers, Bradley M.; Degenhardt, Louisa; Bucello, Chiara; Lemon, James; Wiessing, Lucas; Hickman, Mathew |
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Mortality among people who inject drugs : a systematic review and meta-analysis |
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2013 |
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Bulletin of the World Health Organization |
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91 |
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2; 02/2013 |
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102-123 |
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AOD user; intravenous drug user; risk; AODR mortality; AOD overdose mortality; viral disease; communicable disease; HIV infection; Aids; statistical data; meta-analysis; international area |
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Objective To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. Methods Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). Findings Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person–years (95% confidence interval, CI: 2.12–2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01–16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. Conclusion Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose. |
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Conclusions in Arabic, Chinese, French, Russian, Spanish |
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50-12926 |
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60000 |
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Leonard, Lynne; Forrester, Leslie; Navarro, Christine; Hansen, Janice; Doucet, Cynthia |
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The effectiveness of needle exchange programs in modifying HIV-related outcomes : a systematic review of the evidence 1997-1999 : Infectious disease, sexually transmitted diseases (STDs) including HIV/AIDS |
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1999 |
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ii, 79 |
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harm reduction; needle distribution and exchange; prevention; HIV infection; impact of policy or law; Canada |
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Objective To examine the effectiveness of needle exchange programs (NEPs) in modifying HIV-related outcomes in injection drug users (IDUs). Methods On-line computer searches of six electronic databases, hand searches of core journals and relevant studies, combined with key informant suggestions at the federal and front line level for potentially relevant studies, and review of local and community publications, resulted in the retrieval of 84 studies from 1997 to 1999 related to the effectiveness of needle exchange programs. The HIV-related outcomes of interest examined were behavioural (modifications in HIV-risk-related injection practices) and end-point physical health status outcomes (changes in rates of HIV, hepatitis B (HBV) and hepatitis C (HCV) seroprevalence or incidence) at either the population (most frequently, city; less frequently, country) or individual level. Results Relevance and quality assessment reviews resulted in the inclusion in this review of 21 relevant but largely methodologically weak primary studies. From the evidence of these primary studies, NEPs appear to continue to be effective in modifying most HIV risk-related injection practices although engagement in sharing drug preparation equipment continues. The earlier protective effect of NEP attendance against HIV, HBV and HCV seroconversion has not been consistently sustained. However, NEPs appear to be effective in attracting a group of IDUs experiencing higher HIV risk conditions and who are thereby at increased risk for HIV infection. Conclusions NEPs appear well positioned, as an accessible service, to continue to offer the knowledge and the means to modify engagement in HIV-risk-related injection practices. Enhanced programming is needed to address the documented continued sharing of injection preparation equipment, to modify engagement in a potentially effective, yet largely unrecognized, method of HIV transmission. The potential role of NEPs to expand and diversify as an acceptable comprehensive health resource for a marginalized group of people for whom mainstream health care has not always been easily accessible must be realized. |
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University of Ottawa, Department of Epidemiology and Community Medicine, Community Health Research Unit |
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Ottawa |
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56058 |
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Kuepper, Rebecca; van Os, Jim; Lieb, Roselind; Wittchen, Hans-Ulrich; Höfler, Michael; Henquet, Cécile |
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Continued cannabis use and risk of incidence and persistence of psychotic symptoms : 10 year follow-up cohort study |
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2011 |
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British medical journal |
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342 |
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8 |
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AOD use, abuse, and dependence; AOD dependence; chemical addiction; cannabis; adolescence; AODR psychosis; risk factors; Germany |
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Objective To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis). Design Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study). Setting Population based cohort study in Germany. Participants 1923 individuals from the general population, aged 14-24 at baseline. Main outcome measure Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI). Results In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively. Conclusion Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms. |
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0959-535x; 0959-8146 |
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50-11711 |
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59925 |
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