Age and sharing of needle injection equipment in a cohort of Massachusetts injection drug users: an observational study

Katherine Tassiopoulos,Edward Bernstein,Judith Bernstein

doi:10.1186/1940-0640-8-20

Katherine Tassiopoulos, Edward Bernstein + Show 1 more

Open Access

https://doi.org/10.1186/1940-0640-8-20

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Abstract

BackgroundHepatitis C infection (HCV) among individuals aged 15–24 years has increased in Massachusetts, likely due to injection drug use. The prevalence of injection equipment sharing (sharing) and its association with age was examined in a cohort of out-of-treatment Massachusetts substance users.MethodsThis analysis included baseline data from a behavioral intervention with substance users. Younger and older (<25 versus ≥25 years) injection drug users were compared on demographic characteristics, substance use practices, including factors present during the most recent sharing event (“event-level factors”), and HCV testing history.ResultsSharing was reported by 41% of the 484 individuals who reported injection drug use in the past 30 days. Prevalence of sharing varied by age (50% <25 years old versus 38% ≥25 years, p = 0.02). In a multivariable logistic regression model younger versus older individuals had twice the odds of sharing (95% CI = 1.26, 3.19). During their most recent sharing event, fewer younger individuals than older had their own drugs available (50% versus 75%, p < 0.001); other injection event-level factors did not vary by age. In the presence of PTSD, history of exchanging sex for money, or not being US born, prevalence of sharing by older users was higher and was similar to that of younger users, such that there was no association between age and sharing.ConclusionsIn this cohort of injection drug users, younger age was associated with higher prevalence of sharing, but only in the absence of certain stressors. Harm reduction efforts might benefit from intervening on mental health and other stressors in addition to substance use. Study findings suggest a particular need to address the dangers of sharing with young individuals initiating injection drug use.

Highlights

Hepatitis C infection (HCV) among individuals aged 15–24 years has increased in Massachusetts, likely due to injection drug use
Toward this end we examined data from a cohort of Greater Boston area injection drug users followed during the period in which HCV infection in Massachusetts was observed to increase
Covariates We considered as potential confounders of the association between age and sharing (Aim 2) several risk factors for sharing identified in the literature, including: race; gender; education level; current working status; living status; frequency of injection use in the past 30 days; specific drugs used in the past 30 days; post-traumatic stress disorder (PTSD) symptoms; history of receiving money in exchange for sex; and whether US born

Summary

Introduction

Hepatitis C infection (HCV) among individuals aged 15–24 years has increased in Massachusetts, likely due to injection drug use. The investigators identified injection drug use as the primary risk factor for HCV infection in this population of adolescents and young adults, with heroin being the primary drug of injection [1]. During this same time period there was. Shared use of injection drug equipment (sharing) is a strong risk factor for HCV infection [3]. What has not been previously explored is whether this association between younger age and sharing holds steady across all cohorts of injection drug users or whether there are factors that might modify this association, as is suggested by the seemingly contradictory findings mentioned above

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