York City Neighborhoods Research Articles

Neighborhood disparities in prevalence of childhood obesity among low-income children before and after implementation of New York City child care regulations.

IntroductionNew York City Article 47 regulations, implemented in 2007, require licensed child care centers to improve the nutrition, physical activity, and television-viewing behaviors of enrolled children. To supplement an evaluation of the Article 47 regulations, we conducted an exploratory ecologic study to examine changes in childhood obesity prevalence among low-income preschool children enrolled in the Nutrition Program for Women, Infants, and Children (WIC) in New York City neighborhoods with or without a district public health office. We conducted the study 3 years before (from 2004 through 2006) and after (from 2008 through 2010) the implementation of the regulations in 2007.MethodsWe used an ecologic, time-trend analysis to compare 3-year cumulative obesity prevalence among WIC-enrolled preschool children during 2004 to 2006 and 2008 to 2010. Outcome data were obtained from the New York State component of the Centers for Disease Control and Prevention’s Pediatric Nutrition Surveillance System.ResultsEarly childhood obesity prevalence declined in all study neighborhoods from 2004–2006 to 2008–2010. The greatest decline occurred in Manhattan high-risk neighborhoods where obesity prevalence decreased from 18.6% in 2004–2006 to 15.3% in 2008–2010. The results showed a narrowing of the gap in obesity prevalence between high-risk and low-risk neighborhoods in Manhattan and the Bronx, but not in Brooklyn.ConclusionThe reductions in early childhood obesity prevalence in some high-risk and low-risk neighborhoods in New York City suggest that progress was made in reducing health disparities during the years just before and after implementation of the 2007 regulations. Future research should consider the built environment and markers of differential exposure to known interventions and policies related to childhood obesity prevention.

Urban environmental stewardship and changes in vegetative cover and building footprint in New York City neighborhoods (2000–2010)

This study explores the connections between vegetation cover change, environmental stewardship, and building footprint change in New York City neighborhoods from the years 2000 to 2010. We use a mixed-methods multidisciplinary approach to analyze spatially explicit social and ecological data. Most neighborhoods lost vegetation during the study period. Neighborhoods that gained vegetation tended to have, on average, more stewardship groups. We contextualize the ways in which stewardship groups lead to the observed decadal- and neighborhood-scale changes in urban vegetation cover. This multidisciplinary synthesis combines the strengths of quantitative data to identify patterns, and qualitative data to understand process. While we recognize the complexity of cities and the potential confounding factors, this exploratory analysis uses sound theory and data from a mixed methodological approach to show the role of urban environmental stewardship in affecting the New York City landscape.

Pre- and post-delinquency behavior: cross-neighborhood variation in New York City

This study examines whether and how mortgage default risk and the resolution process of defaults interact with neighborhoods where homeowners reside. It uses a unique data that matches household information from the Center for New York City Neighborhoods (CNYCN) with a variety of census tract data. Findings suggest that loan-related triggers of mortgage distress (e.g., payment adjustment) are more significant in neighborhoods with higher price depreciation and higher vacancy rates. With respect to post-delinquency behavior, distressed homeowners residing in neighborhoods with higher house prices tend to underutilize CNYCN services, controlling for their distance to service providers. Along with strong housing market performance, the concentration of Black/African-Americans in a neighborhood is likely to contribute to less successful client outcomes.

Havens of risks or resources? A study of two Latino neighborhoods in New York City.

Research has been mixed on the potential risks and resources that ethnic enclaves may confer upon residents: whereas some authors characterize racial and ethnic minority neighborhoods through the lens of segregation and risk, others argue that these minority neighborhoods are ethnic enclaves that can improve the availability of resources to residents. In this study, we sought to assess two predominantly Latino New York City neighborhoods (one enclave neighborhood and one comparison) in the areas of structural resources (e.g., grocers, parks), cultural resources (e.g., botanicas, hair salons), and risks (e.g., empty lots, bars) by street-level coding in 20 census tracts (streets N = 202). We used Poisson generalized linear models to assess whether enclave status of a neighborhood predicted the numbers of risks and resources on streets within those neighborhoods. Enclave status did not predict the number of risks (Rate ratio = 1.08(0.83, 1.42), χ (2)(1, N = 202) = 0.35, p = n. s.) or cultural resources (Rate ratio = 0.87(0.54, 1.40), χ (2)(1, N = 202) = 0.34, p = n. s.), yet it was associated with a higher number of structural resources (Rate ratio = 1.90(1.48, 2.43), χ (2)(1, N = 202) = 25.74, p < 0.001). The results suggest that while living in an ethnic enclave may not reduce risks, it may help residents cope with those risks through an increased number of structural resources. These findings support theories that conceptualize ethnic enclaves as neighborhoods where greater resources are available to residents. The focus on resources within this work was instrumental, as no difference would have been found if a solely risk-focused approach had been employed.

Community Impact of Pharmacy-Randomized Intervention to Improve Access to Syringes and Services for Injection Drug Users.

In an effort to reduce HIV transmission among injection drug users (IDUs), New York State deregulated pharmacy syringe sales in 2001 through the Expanded Syringe Access Program by removing the requirement of a prescription. With evidence suggesting pharmacists' ability to expand their public health role, a structural, pharmacy-based intervention was implemented to determine whether expanding pharmacy practice to include provision of HIV risk reduction and social/medical services information during the syringe sale would (a) improve pharmacy staff attitudes toward IDUs (b) increase IDU syringe customers, and (c) increase prescription customer base in New York City neighborhoods with high burden of HIV and illegal drug activity. Pharmacies (n = 88) were randomized into intervention (recruited IDU syringe customers into the study and delivered intervention activities), primary control (recruited IDU syringe customers only) and secondary control (did not recruit IDUs or deliver intervention activities) arms. Pharmacy staff in the intervention versus secondary control pharmacies showed significant decreases in the belief that selling syringes to IDUs causes community loitering. Structural interventions may be optimal approaches for changing normative attitudes about highly stigmatized populations.

Health, Community, and Spirituality

The purpose of this study was to evaluate Fine, Fit, and Fabulous (FFF), a faith-based diabetes prevention program for black and Latino congregants at churches in low-income New York City neighborhoods. FFF includes nutrition education and fitness activities while incorporating Bible-based teachings that encourage healthy lifestyles. FFF is a 12-week, bilingual program developed by the Bronx Health REACH coalition, a Centers for Disease Control and Prevention-funded Center of Excellence for the Elimination of Disparities. This program has been implemented in 15 Bronx and Harlem churches, engaging a primarily black and Latino overweight and obese urban population. Pre-post surveys, nutrition tests, and weight logs were collected to assess knowledge, attitudes, and behaviors regarding healthy eating and physical activity. Participants (n = 183) reported statistically significant improvements in knowledge and healthy behaviors from baseline. Increased numbers of participants reported exercising in the past 30 days, eating fruit daily, being able to judge portion sizes, and reading food labels. Statistically significant numbers reported that they ate less fast food and were less likely to overeat at follow-up. The average weight loss across churches was 4.38 lbs or 2% of participants' initial body weight. Significant differences were observed when stratifying by race/ethnicity. Evaluation results show FFF's success at engaging overweight adults in behavior changes related to healthy eating and exercise. FFF demonstrates the potential of faith-based health interventions to address obesity and diabetes risk in high-need communities of color.

The Net Men and the Anglers: A Case Study in the Conflicts over Recreational and Commercial Fishing

New York History Winter 2014© 2014 by The New York State Historical Association 70 The Net Men and the Anglers: A Case Study in the Conflicts over Recreational and Commercial Fishing Kevin Olsen, Montclair State University Conflicts over fishing rights are among the oldest and most common disputes in the maritime world. One conflict of this type is between commercial fishing and large-scale tourism. In many modern communities, the dispute has centered on the displacement of traditional fishing lifeways by waterfront development. Commercial Fisheries News reported that in twenty-first-century Maine, 84 percent of coastal communities are concerned about lack of shore access for working fishermen.1 Other disputes of this type center around the depletion of fish stocks and often feature competing stakeholders blaming the other side for declining catches.2 In the nineteenth century, an expanding New York City was one of the places where this type of conflict played out. Jamaica Bay had been a minor maritime center and home to isolated fishing and farming communities (see Figure 1). Over the course of the century, however, city dwellers came increasingly to rely on Jamaica Bay for recreation. Railroad transportation and a growing tourism infrastructure made the bay popular for swimming, boating, camping, and fishing. The bay was also home to a large fish-processing industry and commercial fishery. By the end of the 1800s, the city’s recreational needs focused new attention on commercial fishing practices and many people contended that the use of seines and other types of nets 1. “Working waterfront tools make Maine ballot,” Commercial Fisheries News 33 (2005). 2. Recent scholarship has explored the relationship between anthropogenic environmental impacts and changes to fishing communities. The historical consequences of overfishing in New England is the subject of Jeffrey Bolster’s The Mortal Sea: Fishing the Atlantic in the Age of Sail (Cambridge: Harvard University Press, 2012). A similar discussion appears in Jeremy B.C. Jackson, Karen E. Alexander, and Enric Sala, eds., Shifting Baselines: The Past and the Future of Ocean Fisheries (Washington, D.C.: Island Press, 2011). The United Nations Food and Agriculture Organization issued a report in 2000 about the demographic changes in the developing world’s traditional fishing communities that explored how these communities perceived oceanic pollution. Uwe Tietze, George Groenewold, and Alain Marcoux, Demographic Change in Coastal Fishing Communities and its Implications for the Coastal Environment, no. 403 (Rome: United Nations Food & Agriculture Org., 2000), 81–89. Olsen Conflicts over Recreational and Commercial Fishing 71 was wasteful. To preserve game fish and tourist dollars, New York State passed laws that effectively closed the bay to all commercial fishing that employed any type of net. Some historians have argued that the conflict between recreational and commercial fishing was ultimately counterproductive. The historian Elizabeth Pillsbury contended that, after 1870, an alliance based on mutual interests between the commercial and recreational fishing interests in the New York City region began to break down. Pillsbury concluded that this failure to cooperate delayed implementation of regulations and management practices that would have protected commercial fisheries.3 Modern environmental managers will recognize the problem of conflicting stakeholder demands played out against a backdrop of changing circumstances. A system of local control over Jamaica Bay’s resources was incapable of addressing the declining fishery. The influx of recreational 3. Elizabeth Pillsbury, “An American Bouillabaisse: The Ecology, Politics and Economics of Fishing around New York City, 1870-present” (PhD diss., Columbia University, 2009). Figure 1. Jamaica Bay is a twenty-square mile, shallow tidal estuary on the south shore of Long Island. Most of the New York City neighborhoods shown on this map were originally independent townships. Map courtesy of author. 72 ■ NEW YORK HISTORY anglers changed the economy of the bay and created a threat to the existing management system. The result was a conflict between stakeholders that was ultimately resolved because of financial concerns rather than ecological considerations. The larger issue of habitat destruction was not part of the resolution. Jamaica Bay Located entirely within the boundaries of New York City, Jamaica Bay is a shallow tidal estuary on the southern shore of Long Island. The western portion of the bay is in Brooklyn...

“I didn't think I could get out of the fucking park.” Gay men's retrospective accounts of neighborhood space, emerging sexuality and migrations

Young, African American and Latino gay, bisexual and other men who have sex with men (MSM) are disproportionately represented among new HIV cases according to the most recent national surveillance statistics. Analysts have noted that these racial/ethnic disparities in HIV among MSM exist within the wider context of sexual, mental and physical health disparities between MSM and heterosexuals. The intercorrelation of these adverse health outcomes among MSM, termed syndemics, has been theorized to be socially produced by a heterosexist social system that marginalizes lesbian, gay, bisexual, MSM and other sexual minorities. African American and Latino MSM experience overlapping systems of oppression that may increase their risk of experiencing syndemic health outcomes. In this paper, using data from twenty in-depth qualitative interviews with MSM living in four New York City (NYC) neighborhoods, we present accounts of neighborhood space, examining how space can both physically constitute and reinforce social systems of stratification and oppression, which in turn produce social disparities in sexual health outcomes. By analyzing accounts of emerging sexuality in neighborhood space, i.e. across time and space, we identify pathways to risk and contribute to our understanding of how neighborhood space is experienced by gay men, adding to our ability to support young men as they emerge in place and to shape the social topography of urban areas.

Revisiting the role of the urban environment in substance use: the case of analgesic overdose fatalities.

We examined whether neighborhood social characteristics (income distribution and family fragmentation) and physical characteristics (clean sidewalks and dilapidated housing) were associated with the risk of fatalities caused by analgesic overdose. In a case-control study, we compared 447 unintentional analgesic opioid overdose fatalities (cases) with 3436 unintentional nonoverdose fatalities and 2530 heroin overdose fatalities (controls) occurring in 59 New York City neighborhoods between 2000 and 2006. Analgesic overdose fatalities were less likely than nonoverdose unintentional fatalities to have occurred in higher-income neighborhoods (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.70, 0.96) and more likely to have occurred in fragmented neighborhoods (OR = 1.35; 95% CI = 1.05, 1.72). They were more likely than heroin overdose fatalities to have occurred in higher-income (OR = 1.31; 95% CI = 1.12, 1.54) and less fragmented (OR = 0.71; 95% CI = 0.55, 0.92) neighborhoods. Analgesic overdose fatalities exhibit spatial patterns that are distinct from those of heroin and nonoverdose unintentional fatalities. Whereas analgesic fatalities typically occur in lower-income, more fragmented neighborhoods than nonoverdose fatalities, they tend to occur in higher-income, less unequal, and less fragmented neighborhoods than heroin fatalities.

Comparing Sugary Drinks in the Food Retail Environment in Six NYC Neighborhoods

Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke® or Pepsi®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.

Comparing Nutrition Environments in Bodegas and Fast-Food Restaurants

Many small grocery stores or “bodegas” sell prepared or ready-to-eat items, filling a niche in the food environment similar to fast-food restaurants. However, little comparative information is available about the nutrition environments of bodegas and fast-food outlets. This study compared the nutrition environments of bodegas and national chain fast-food restaurants using a common audit instrument, the Nutrition Environment Measures Study in Restaurants (NEMS-R) protocol. The analytic sample included 109 bodegas and 107 fast-food restaurants located in New York City neighborhoods in the upper third and lower third of the census tract poverty rate distribution. Inter-rater reliability was evaluated in 102 food outlets, including 31 from the analytic sample and 71 from a supplementary convenience sample. The analysis compared scores on individual NEMS-R items, a total summary score, and subscores indicating healthy food availability, nutrition information, promotions of healthy or unhealthy eating, and price incentives for healthy eating, using t tests and χ2 statistics to evaluate differences by outlet type and neighborhood poverty. Fast-food restaurants were more likely to provide nutrition information, and bodegas scored higher on healthy food availability, promotions, and pricing. Bodegas and fast-food restaurants had similar NEMS-R total scores (bodegas 13.09, fast food 14.31; P=0.22). NEMS-R total scores were higher (indicating healthier environments) in low- than high-poverty neighborhoods among both bodegas (14.79 vs 11.54; P=0.01) and fast-food restaurants (16.27 vs 11.60; P<0.01). Results imply different policy measures to improve nutrition environments in the two types of food outlets.

Substance Use and Other Mental Health Disorders Among Veterans Returning to the Inner City: Prevalence, Correlates, and Rates of Unmet Treatment Need

Estimates of substance use and other mental health disorders of veterans (N = 269) who returned to predominantly low-income minority New York City neighborhoods between 2009 and 2012 are presented. Although prevalences of posttraumatic stress disorder, traumatic brain injury, and depression clustered around 20%, the estimated prevalence rates of alcohol use disorder, drug use disorder, and substance use disorder were 28%, 18%, and 32%, respectively. Only about 40% of veterans with any diagnosed disorder received some form of treatment. For alcohol use disorder, the estimate of unmet treatment need was 84%, which is particularly worrisome given that excessive alcohol use was the greatest substance use problem.

A note on the ‘food paradox’: some contradictory evidence

A sample of 200 households in one New York City neighborhood in 1904 shows constant per capita food consumption as households grow in size, holding constant per capita expenditure. Logan (Econ Inq 49(4):1008–1028, 2011) presents US historical evidence that per capita food consumption declines as households grow, replicating contemporary cross-national evidence reported by Deaton and Paxson (J Political Econ 106(5):897–930, 1998), which they describe as a ‘paradox’. Possible reasons for the contradictory evidence include minimal price variation within a city, greater homogeneity of household units, more being spend on rent leading to greater benefits of sharing living space, and application of the unitary household model to a more appropriate setting. Time series estimates of US price and income elasticity of food demand show constant or increasing per capita consumption, which also contradicts the received literature.

Overweight and obesity: Can we reconcile evidence about supermarkets and fast food retailers for public health policy?

The aim of this study is to determine whether access to fast food outlets and supermarkets is associated with overweight and obesity in New York City neighborhoods. We use a Bayesian ecologic approach for spatial prediction. Consistent with prior research, we find no association between fast food density and overweight or obesity. Consistent with prior research, we find that supermarket access has a salutary impact on overweight and obesity. Given the lack of empirical evidence linking fast food retailers with adverse health outcomes, policymakers should be encouraged to adopt policies that incentivize the establishment of supermarkets and the modification of existing food store markets and retailers to offer healthier choices. Reaching within neighborhoods and modifying the physical environment and public health prevention and intervention efforts based on the characteristics of those neighborhoods may play a key role in creating healthier communities.

Association of neighborhood-level factors with hospitalization for community-associated methicillin-resistant Staphylococcus aureus, New York City, 2006: a multilevel observational study

BackgroundHospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined.MethodsTo explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression.ResultsThe CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR]Q5 vs. Q1 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AORQ4 vs. Q1 1.7, 95% CI: 1.1, 2.7; females: AORQ4 vs. Q1 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AORQ5 vs. Q1 1.2, 95% CI: 0.76, 1.8; females: AORQ5 vs. Q1 1.5, 95% CI: 0.82, 2.7).ConclusionsNeighborhood-level characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.

Availability of Over-the-Counter Emergency Contraception in 2 Disparate New York City Neighborhoods

We conducted a telephone survey of pharmacies in 2 New York City neighborhoods on same-day availability, type, and cost of over-the-counter emergency contraception. There was no difference in availability of over-the-counter emergency contraception between Upper East Side and East Harlem pharmacies (93% vs 94%; P = .71). Average cost of medication was less in East Harlem than in the Upper East Side ($45.16 vs $51.64; P < .001). Efforts should accentuate overcoming cost and knowledge barriers associated with the use of emergency contraception.

INFORMAL SOCIAL CONTROL OF INTIMATE PARTNER VIOLENCE AGAINST WOMEN: RESULTS FROM A CONCEPT MAPPING STUDY OF URBAN NEIGHBORHOODS

How the neighborhood environment relates to intimate partner violence against women has been studied using theories applied originally to general violence. Extending social disorganization and collective efficacy theories, they apply a traditional measure informal social control that does not reflect behaviors specific to partner violence. We conducted a concept mapping study in two New York City neighborhoods, to understand what behaviors neighborhood residents might enact to prevent partner violence and how feasible and effective residents believed them to be. Results revealed a range of “preventive intervention behaviors.” Cluster analysis revealed that these behaviors grouped into four general areas, corresponding to the victim, perpetrator, community, and formal systems. Preventive intervention behaviors rated by participants as most feasible focused on the victim, whereas those rated most effective involved formal systems. Results have theoretical and practical implications for future research and programs to engage neighbors and neighborhoods in intimate partner violence prevention.

Affiliation or appropriation? Crossing and the politics of race among children in New York City

Based on ethnographic research in a diverse New York City neighborhood, this article examines issues surrounding the practice of crossing from children’s perspectives. Crossing refers to the use of language varieties to which one does not have conventional access, practices that could be disparaging or affiliative. The author explores how children distinguished the two types through the principle of authenticity, itself derived by means that went beyond the usual determinants of blood, birth and bodies. While playful, the author argues that crossings were one way for children to participate in the everyday politics of difference and critique the existing racial order.

Resources and Interest Among Faith Based Organizations for Influenza Vaccination Programs

In the United States, annual influenza vaccination rates are suboptimal and are well below the national health objectives. Project VIVA mobilized community members and organizations to implement an influenza vaccination program in Harlem by administering vaccines in "non-traditional" venues, such as community-based organizations, pharmacies, and faith-based organizations (FBOs). FBOs have been recognized as important venues for health promotion initiatives within medically underserved communities. However, data regarding the extent of resources and interest in health promotion programs among FBOs are sparse. We conducted a telephone survey among 115 FBOs in three New York City neighborhoods with histories of low influenza immunization rates to identify the congregation's health concerns, interest in serving as a community-based venue for influenza vaccinations, and existing resources for health programming. Twenty-six percent of the FBOs had an established health ministry, while 45% expressed interest in developing one. Seven percent included nurses among their health activities and 16.5% had contact with the local health department. Most FBOs expressed interest in common health promotions programs; 60% expressed interest in providing on-site influenza vaccination programs within their organization. Health programs within FBOs can be a point of access that may improve the health of their congregants as well as the larger community.

Retrospective accounts of injection initiation in intimate partnerships

BackgroundThe influence of family members, peers and sexual partners on initiation to injection drug use is well established. Furthermore, research on gender differences in injection initiation has recognized the increased vulnerability of women, in particular, to injection-related health risks, and the gendered nature of the injection initiation experience. Yet more research is needed on the interpersonal and structural dynamics that shape injection initiation within intimate partnerships. MethodsThis paper draws on narrative data from semi-structured ethnographic interviews with 25, relatively stable, drug-using couples from two New York City neighbourhoods. The study was conducted between 2007 and 2009. Our analyses focus on retrospective accounts of injection initiation from IDUs who were initiated to injection (or initiated their partners) in current or former intimate partnerships. In particular we analyse narratives of injection initiation events where both partners participated as initiates or initiators. ResultsTransition to injection within intimate partnerships was common, especially for women, and occurred in specific contexts. Structural and interpersonal dynamics, including the ubiquity of drugs in poor communities and the gendered nature of drug acquisition and use strategies, as well as the problem of increased drug tolerance, situational impediments to drug access, and the perceived cost–benefit of injecting, all influenced the process of initiation to injection drug use within couples. The data also suggest that, even when risks associated with injection initiation were understood, both pragmatic and emotional considerations within relationships tended to offset concerns about potential dangers. ConclusionThe findings suggest the need for a broad range of interventions (including couples-focussed interventions) to minimize rates of injection initiation within intimate partnerships.