[Show abstract][Hide abstract] ABSTRACT: Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed methods study examined the accounts of 30 young female IDUs in Los Angeles, California from 2004-2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young women's injection events contributes to HIV/HCV risk. Women's initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate women's risk; these phenomena should be considered as a behavioral risk factor when designing interventions.
[Show abstract][Hide abstract] ABSTRACT: Gang membership is an indicator of chronic illicit substance use and such patterns of use may have a normalized character. Using epidemiological and qualitative data collected between 2006 and 2007, this manuscript examines the drug normalization thesis among a small sample (n=60) of gang youth aged 16–25 years from Los Angeles. Overall, while evidence does suggest that illicit drug use was pervasive among the sample, data do not support the idea that all drugs were normalized. However, findings do indicate that marijuana use was normalized. This was due to the sample's high frequency of marijuana use, wide access to marijuana, intent to use marijuana, positive attitudes about marijuana use, critical attitudes of the use of certain ‘hard’ illicit drugs, and cultural references supportive of marijuana use. Illicit substance use among gang youth could seemingly be divided into two categories: marijuana and everything else. In this respect, the values of gang members in relation to illicit substance use appear very similar to those of youth from the general population who also use illicit substances. This question the applicability of theories couched in pathology to understand the differential patterns of substance use among serious young offenders.
[Show abstract][Hide abstract] ABSTRACT: This article describes how the drug type injected at the first injection event is related to characteristics of the initiate, risk behaviors at initiation, and future drug-using trajectories. A diverse sample (n=222) of young injection drug users (IDUs) were recruited from public settings in New York, New Orleans, and Los Angeles during 2004 and 2005. The sample was between 16 and 29 years old, and had injected ketamine at least once in the preceding two years. Interview data was analyzed both quantitatively and qualitatively. Young IDUs initiated with four primary drug types: heroin (48.6%), methamphetamine (20.3%), ketamine (17.1%), and cocaine (14%). Several variables evidenced statistically significant relationships with drug type: age at injection initiation, level of education, region of initiation, setting, mode of administration, patterns of self-injection, number of drugs ever injected, current housing status, and their hepatitis C virus (HCV) status. Qualitative analyses revealed that rationale for injection initiation and subjective experiences at first injection differed by drug type.
Journal of drug issues 04/2010; 40(2):241-262. DOI:10.1177/002204261004000201 · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Longitudinal studies that research homeless persons or transient drug users face particular challenges in retaining subjects. Between 2005 and 2006, 101 mobile young injection drug users were recruited in Los Angeles into a 2-year longitudinal study. Several features of ethnographic methodology, including fieldwork and qualitative interviews, and modifications to the original design, such as toll-free calls routed directly to ethnographer cell phones and wiring incentive payments, resulted in retention of 78% of subjects for the first follow-up interview. Longitudinal studies that are flexible and based upon qualitative methodologies are more likely to retain mobile subjects while also uncovering emergent research findings.
[Show abstract][Hide abstract] ABSTRACT: Gang youth are notoriously difficult to access for research purposes. Despite this difficulty, qualitative research about substance use among gang youth is important because research indicates that such youth use more substances than their nongang peers. This manuscript discusses how a small sample of gang youth (n = 60) in Los Angeles was accessed and interviewed during a National Institute of Drug Abuse-funded pilot study on substance use and other risk behaviors. Topics discussed include the rationale and operationalization of the research methodology, working with community-based organizations, and the recruitment of different gang youth with varying levels of substance use.
[Show abstract][Hide abstract] ABSTRACT: Gang youth are at an increased likelihood of participating in unsafe sexual behaviors and at an elevated risk of exposure to sexually transmitted infection (STIs), including HIV. This manuscript presents quantitative and qualitative data on sexual behaviors among a sample of predominately heterosexual, male gang youth aged 16 to 25 years interviewed in Los Angeles between 2006 and 2007 (n = 60). In particular, sexual identity, initiation and frequency of sex, and number of sexual partners; use of condoms, children, and other pregnancies; group sex; and STIs and sex with drug users. We argue that gang youth are a particular public health concern, due to their heightened risky sexual activity, and that behavioral interventions targeting gang youth need to include a component on reducing sexual risks and promoting safe sexual health.
International Journal for Equity in Health 11/2009; 2(1):61-71. · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research indicates a link between drug use and offending, particularly amongst high-risk individuals, such as homeless youth. The extent to which such youth interpret their offending as being related to their drug use, though, is understudied. This manuscript investigates the interpretations of drug-related offenses offered by 151 primarily white, male, homeless IDUs aged 16-29 years. Youth were asked specific questions about their drug-related offenses during in-depth interviews as part of a larger study investigating health risks surrounding drug injection between 2004 and 2006. The first section of the manuscript outlines offenses youth revealed committing either in pursuit of or after using a variety of substances. The second part of the manuscript examines the overall context (motivation, environment), and provides a seven-tiered typology of drug-related offending based on youth's interpretations, linking certain drugs to specific offenses within particular contexts. From here, some theoretical and practical implications of the findings are discussed.
Journal of drug issues 10/2009; 39(4):777-802. DOI:10.1177/002204260903900401 · 0.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gang youth often come from socially and economically marginalized communities. Such youth report significantly higher rates of participation in violence, substance use, and risky sexual behaviors than their nongang peers.
This manuscript argues that gang-identified youth constitute a vulnerable population.
Data are drawn from the general research literature and a case example of how a nurse in Los Angeles partnered with law enforcement to provide preventive health care to gang youth and youth at-risk for joining gangs.
Gang youth are a vulnerable population amenable to nursing intervention. Gang youth may have particular health care needs and may need special access to health care.
Public Health Nursing 08/2009; 26(4):346-52. DOI:10.1111/j.1525-1446.2009.00789.x · 0.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hurricane Katrina may offer many lessons regarding the impact of a wide-spread urban disaster on high risk populations, yet few studies have explored the effects of the hurricane on young drug users. We investigated health risks and health service utilization among a sample of young injection drug users (IDU) in New Orleans during the post Hurricane Katrina period. During the period of July 2006 April 2007, 34 young IDUs were administered a set of structured and unstructured questions about their experiences, health risks and service utilization in New Orleans following Hurricane Katrina. Qualitative and quantitative analyses revealed a series of results. Young IDUs described a range of health concerns, such as high rates of homelessness (94%), need for medical services (47%), squatting in abandoned buildings (32%) and problems finding clean syringes (24%). In addition to these broader concerns, young IDUs voiced three primary health risks: injection safety, violent injury including rape, and environmental health issues including mold and occupational hazards. Exposure to health risks was managed using several strategies, including avoidance of risky situations, reduction of drug abuse, and using protective equipment on job sites. Services most used in post-Katrina New Orleans included local hospitals or ERs, health clinics and drop-in sites. While seemingly a unique historical event, Hurricane Katrina offers many lessons regarding the impact of a large-scale disaster in an urban area. Findings may help anticipate the kinds of risk and protective behaviors to be found among young drug users following depopulation, destruction, and social disorganization.
136st APHA Annual Meeting and Exposition 2008; 10/2008
[Show abstract][Hide abstract] ABSTRACT: Background: No previous studies have modeled trajectories of ketamine injection longitudinally, which may offer important insights into patterns of cessation and continuation. Methods: A sample of 68 young ketamine injecting drug users (IDUs) aged 16 to 29 - was interviewed about ketamine injection every three to four months over a two-year period. Longitudinal models of ketamine injection were developed using Proc Traj (SAS). Trajectories of ketamine injection frequency were illustrated using a censored normal model of standardized rates of use at each follow-up. Trajectories of ketamine injection likelihood were illustrated using a logistic model of use (yes/no) at each follow-up. Findings: Approximately 50% did not inject ketamine at any follow-up. A censored normal model indicated that 42.5% followed a flat linear, low-use trajectory injecting ketamine approximately once per year during follow-up, while 7.8% followed a declining linear, high-to-low use trajectory decreasing ketamine injection from a mean rate of once per month to once per year. A logistic model revealed that 33.9% nearly all injected ketamine in the year prior to first interview - had a 50% likelihood of injecting ketamine at each follow-up (declining linear trajectory) while 16.3% - none injected ketamine in the year prior to first interview increased to a 10% likelihood of injecting ketamine at each follow up (slightly increasing linear trajectory). Co-variates, including gender and homeless status, improved model fit but were not statistically significant. Conclusions: Longitudinal models indicated that most IDUs ceased ketamine injection or injected sporadically, while frequent injectors decreased use during the study.
136st APHA Annual Meeting and Exposition 2008; 10/2008
[Show abstract][Hide abstract] ABSTRACT: Homeless youth are a diverse population of at risk adolescents and young adults who experience various negative health outcomes,
including drug dependence, drug overdose, infectious diseases, and victimization. Previous studies have been directed toward
understanding subgroups of homeless youth, such as injection drug users (IDUs) and young men who have sex with men (YMSM);
yet limited research has focused on describing homeless “travelers,” a migratory subgroup of homeless youth who move from
city to city. Based upon a larger three site study of young IDUs recruited in Los Angeles, New Orleans, and New York, a total
of 133 travelers were identified. A subsample of 56 travelers participated in follow-up interviews, and provided data points
for mapping. Travelers in all sites had extensive histories of criminal justice involvement and injection drug use. Four common
traveling routes within and across the United States were identified. Reasons for traveling often related to drug use, money-making
opportunities, and law enforcement. Risk-reduction services, such as shelters, syringe exchanges, or HIV/HCV testing, were
used infrequently or occasionally. Mapping data documents the mobility of young IDUs across both urban and rural areas, which
suggests that migration among IDUs across broad geographic regions may be a factor in the spread of blood-borne viruses.
[Show abstract][Hide abstract] ABSTRACT: Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting.
Journal of Adolescence 09/2008; 32(2):339-55. DOI:10.1016/j.adolescence.2008.02.001 · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diverse forms of drug use are an emerging theme within research on young people and substance use. This manuscript, based on a three city study of health risks amongst young injection drug users, explores multiple drug use and polydrug use amongst a subset of homeless youth referred to as "travelers." In particular, we outline characteristics of homeless traveler youths and the various ways in which they practiced multiple drug use and polydrug use. From here, we discuss some theoretical and public health implications of multiple drug use and polydrug use amongst this particular population.
Journal of Ethnicity in Substance Abuse 04/2008; 7(1):23-40. DOI:10.1080/15332640802081893 · 0.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ketamine is a dissociative anesthetic with powerful sedative and hallucinogenic properties. Despite the wide variability in reported subjective experiences, no study has attempted to describe the particular factors that shape these experiences. This manuscript is based upon a sample of 213 young injection drug users recruited in New York, New Orleans, and Los Angeles with histories of ketamine use. Qualitative interviews focused on specific ketamine events, such as first injection of ketamine, most recent injection of ketamine, and most recent experience sniffing ketamine. Findings indicate that six factors impacted both positive and negative ketamine experiences: polydrug use, drug using history, mode of administration, quantity and quality of ketamine, user group, and setting. Most subjective experiences during any given ketamine event were shaped by a combination of these factors. Additionally, subjective ketamine experiences were particularly influenced by a lifestyle characterized by homelessness and traveling.
Addiction Research and Theory 02/2008; 16(3):273-287. DOI:10.1080/16066350801983749 · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Tryptamines and phenethylamines are two broad categories of psychoactive substances with a long history of licit and illicit use. Profiles of users of recently emerging tryptamines and phenethylamines are nonexistent, however, since surveillance studies do not query the use of these substances. This manuscript describes the types, modes of administration, onset of use, and context of use of a variety of lesser known tryptamines and phenethylamines among a sample of high-risk youth. Findings are based upon in-depth interviews with 42 youth recruited in public settings in Los Angles during 2005 and 2006 as part of larger study examining health risks associated with injecting ketamine. Youth reported that their use of tryptamines and phenethylamines was infrequent, spontaneous, and predominately occurred at music venues, such as festivals, concerts, or raves. Several purchased a variety of these "research chemicals" from the Internet and used them in private locations. While many described positive experiences, reports of short-term negative health outcomes included nausea, vomiting, diarrhea, disorientations, and frightening hallucinations. These findings, based upon pilot study data, move toward an epidemiology of tryptamine and phenethylamine use among high-risk youth.
[Show abstract][Hide abstract] ABSTRACT: Background: Research indicates that high risk' youth such as injection drug users and the homeless are often victims of violence. Methods: Data are based upon in depth interviews with 62 young injection drug users (IDUs) aged 16-29 recruited in Los Angeles between 2005 and 2007. Questions focused on dimensions of violence. Findings: All of the youth were IDUs, all were currently homelessness and all had histories of involvement in the criminal justice system. Many of these youths grew up with violence: 37.1% described the neighborhoods they grew up in as unsafe'; 56.5% mentioned bullying in their schools; and 53.2% discussed violence and fighting in their neighborhoods. Abuse in the home by a parent or guardian was relatively common: 39.7% reported physical abuse; 3.2% were forced to use drugs/alcohol; 7.9% were forced to have sex. Moreover, 17.5% reported at least one of these forms of abuse by other youth in these households. Abuse by an adult in an institutional setting was less common: 16.1% reported physical abuse; and 1.6% reported sexual abuse. Violence on the streets or while homeless was more common: 51.6% were physically abused/fought; 3.2% were forced to used drugs/alcohol; 25.8% were forced to have sex. Moreover, 64.5% witnessed at least one of these forms of violence. In terms of violence perpetration, 46.8% have physically abused someone at least once either in a household setting, institution, or while experiencing homelessness. Conclusion: The data offer further support for a relationship between violence victimization and violence perpetration amongst high risk youth.
135st APHA Annual Meeting and Exposition 2007; 11/2007
[Show abstract][Hide abstract] ABSTRACT: Young injection drug users (IDUs) with histories of homelessness frequently experience health problems associated with their high-risk lifestyles, including injury, sexually transmitted infections (STI), pregnancy, and depression. Previous research suggests young IDUs have less access to treatment than other youth populations. Yet, there is limited data concerning how young IDUs manage health issues and the contexts in which they seek treatment. Data presented are drawn from a two-year longitudinal study in Los Angeles. A total of 56 IDUs, aged 16-29 years, were interviewed about their overall health status, recent health problems, service utilization, and history of hospitalization. While the majority rated their overall health as good,' preliminary data shows many reported recent health problems in the following areas: dental (62.5%); mental health (48.2%); vision (42.9%); non-injection related skin infections (35.7%); injection-related abscesses (19.6%); hearing (14.3%); and STI (5.4%). During the past year, half (50%) visited a free health clinic, and over one-third (35.7%) sought treatment from a hospital emergency department. Less than one-fifth (17.9%) reported visiting a private physician in the past year, however, nearly forty-five percent (44.6%) encountered medical professionals while incarcerated. Furthermore, nearly half (48.2%) reported at least one overnight hospital stay occurring after the age of twelve. Overall, while many young IDUs perceived themselves to be in good' health, they experienced a range of health problems. Moreover, these findings suggest a disparity between healthcare needs and service utilization among this population. Additional qualitative data will contextualize the nature of their reported health problems and subsequent treatment utilization.
135st APHA Annual Meeting and Exposition 2007; 11/2007
[Show abstract][Hide abstract] ABSTRACT: Background: Longitudinal studies of drug use can offer important insights into patterns of use, including cessation, continuation, and binging.
Methods: A sample of 69 young injection drug users (IDUs) were interviewed about ketamine use (sniffing and injecting) every three to four months over a two year period. IDUs qualified if they were between the ages of 16 and 28 years old and had injected ketamine at least once in the preceding two years.
Findings: Nearly half the sample (46.4%) reported no ketamine use during follow-up, and could be described as experimentalists. The remainder of the sample (53.6%) consisted of three primary groups: sniffers only (14.5%); infrequent injectors (30.4%) who injected between one and six times during follow-up; and consistent injectors (8.7%) who injected between nine and 41 times during follow-up. Compared to other groups, experimentalists more often had injected ketamine only once at baseline interview, initiated injection drug use with ketamine, preferred modes other than injection to administer drug of choice, and sold ketamine. In contrast, consistent injectors more often injected ketamine ten or more times at baseline interview, sniffed ketamine once or never at baseline interview, preferred injection as the primary mode to administer drug of choice, and had limited involvement in selling ketamine.
Conclusions: These findings suggest that prior drug using history including preferred mode of administration - is an important predictor of future ketamine using patterns. Additional qualitative data will help formulate a descriptive and predictive model of patterns of ketamine use among young IDUs.
135st APHA Annual Meeting and Exposition 2007; 11/2007
[Show abstract][Hide abstract] ABSTRACT: Introduction: Polydrug use is a high risk practice associated with adverse health outcomes. In cross-sectional studies, ketamine abuse has been shown to be associated with high levels of polydrug use. Longitudinal research has been limited, particularly among young injection drug users (IDUs). Methods: We recruited a sample of 67 IDUs aged 16 to 28 who injected ketamine at least once in the previous two years. We conducted three to six interviews with these IDUs over a two-year period, asking about use of ketamine and other drugs. To assess polydrug use, we devised a multiple drug use measure, defined as the number of different illegal substances used in the previous 30 days. Results: At baseline, respondents reported using a mean of 3.552 (95% confidence interval: 3.127, 3.977) illegal substances during the previous 30 days. Multiple drug use was similar across gender and age groups. Respondents who reported being HCV positive used a greater number of drugs (mean 4.500). Over the follow up period respondents over age 21 reported a mean decrease of 1.881 substances (95% confidence interval: 1.152, 2.610). Younger respondents showed no such decrease. Rather multiple drug use in this group was characterized by continued high diversity, or intermittent high/low patterns. Gender and HCV status showed no association with longitudinal change in multiple drug use. Conclusion: This longitudinal study indicates that multiple drug use is common among young IDUs who inject ketamine. Polydrug using practices may decrease in prevalence as IDUs mature.
135st APHA Annual Meeting and Exposition 2007; 11/2007
[Show abstract][Hide abstract] ABSTRACT: Ketamine, a dissociative anesthetic, has emerged as an increasingly common drug among subgroups of young injection drug users (IDUs) in cities across the United States. In-depth qualitative interviews were conducted with 213 young IDUs aged 16-28 years recruited in New York, New Orleans, and Los Angeles between 2004 and 2006. While some initiated injection drug use with ketamine, the drug was more frequently injected by IDUs with extensive polydrug using histories. IDUs initiating with ketamine commonly self-injected via an intramuscular mode of administration. The injection group provided crucial knowledge and material resources that enabled the injection event to occur, including ketamine, syringes, and injection skills. Injection paraphernalia was commonly shared during the first injection of ketamine, particularly vials of pharmaceutically-packaged liquid ketamine. Injection events infrequently occurred in a rave or club and more typically in a private home, which challenges ketamine's designation as a 'club' drug. The first injection of ketamine was a noteworthy event since it introduced a novel drug or new mode of administration to be further explored by some, or exposed others to a drug to be avoided in the future. Risk reduction messages directed towards young IDUs should be expanded to include ketamine.
Drug and Alcohol Dependence 04/2007; 87(2-3):183-93. DOI:10.1016/j.drugalcdep.2006.08.015 · 3.42 Impact Factor