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J Urban Health. 2018 Feb;95(1):83-90. doi: 10.1007/s11524-017-0188-4.

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico.

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Division of Global Public Health, University of California San Diego, San Diego, CA, USA.
Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
Department of Family Medicine and Public Health, Biostatistics Research Center, University of California San Diego, San Diego, CA, USA.
Secretariat of Health, Mexico City, Mexico.
Mexico-United States Border Health Commission, El Paso, TX, USA.
Division of Global Public Health, University of California San Diego, San Diego, CA, USA.
Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.
University of California School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093-0507, USA.


Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39-4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98-21.78), heroin (AOR = 4.00, 95% CI = 1.88-8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16-3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.


Border health; Injection drug use; Injection initiation; Non-injection drug use; People who inject drugs; Prevention; Tijuana

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