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Risk Factors for Progression to Regular Injection Drug Use among Street-Involved Youth in a Canadian… DeBeck, Kora; Kerr, Thomas; Marshall, Brandon David Lewis; Simo, Annick; Montaner, Julio; Wood, Evan Jul 30, 2013

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Risk Factors for Progression to Regular Injection Drug Useamong Street-Involved Youth in a Canadian SettingKora DeBeck1,2, Thomas Kerr1,3, Brandon DL Marshall4, Annick Simo1, Julio Montaner1,3,and Evan Wood1,31British Columbia Centre for Excellence in HIV/AIDS2School of Public Policy, Simon Fraser University3Division of AIDS, Department of Medicine, University of British Columbia4Department of Epidemiology, Public Health Program, Brown UniversityAbstractBackground—Street-involved youth are at high risk for experimenting with injection drug use;however, little attention has been given to identifying the factors that predict progression to on-going injecting.Methods—Logistic regression was used to identify factors associated with progression toinjecting weekly on a regular basis among a Canadian cohort of street-involved youth.Results—Among our sample of 405 youth who had initiated injecting at baseline or during studyobservation, the median age was 22 years (interquartile range [IQR] = 21 – 24), and 72% (293)reported becoming a regular injector at some point after their first injection experience. Of these,the majority (n=186, 63%) reported doing so within a month of initiating injection drug use. Inmultivariate analysis, the drug used at the first injection initiation event (opiates vs. cocaine vs.methamphetamine vs. other; all p > 0.05) was not associated with progression; however, youngerage at first injection (adjusted odds ratio [AOR] =1.13), a history of childhood physical abuse(AOR =1.81), prior regular use of the drug first injected (AOR =1.77), and having a sexual partnerpresent at the first injection event (AOR =2.65) independently predicted progression to regularinjecting.Conclusion—These data highlight how quickly youth progress to become regular injectors afterexperimentation. Findings indicate that addressing childhood trauma and interventions such asevidence-based youth focused addiction treatment that could prevent or delay regular non-injection drug use, may reduce progression to regular injection drug use among this population.© 2013 Elsevier Ireland Ltd. All rights reserved.Send correspondence to: Kora DeBeck, BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C.,CANADAV6Z 1Y6, Tel: 604-682-2344 ext:66784, uhri-kd@cfenet.ubc.ca.Authors Contributions: The specific contributions of each author are as follows: KD and EW designed the study and wrote theprotocol, KD managed the literature searches and prepared the first draft of the analysis; AS conducted the statistical analyses withinput from KD, EW and BM; all authors contributed to the main content and provided critical comments on the final draft. All authorsapproved the final manuscript.Competing Interests: All other authors declare that they have no conflicts of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to ourcustomers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review ofthe resulting proof before it is published in its final citable form. Please note that during the production process errors may bediscovered which could affect the content, and all legal disclaimers that apply to the journal pertain.NIH Public AccessAuthor ManuscriptDrug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.Published in final edited form as:Drug Alcohol Depend. 2013 December 1; 133(2): . doi:10.1016/j.drugalcdep.2013.07.008.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptKeywordsinjection drug use; injection initiation; street-involved youth; injection prevention; physical abuse1. INTRODUCTIONInjection drug use is a significant public health problem and is associated with a range ofadverse health and social outcomes, including blood-borne disease transmission, fataloverdose, and engagement in criminal activity (DeBeck et al., 2007; Marshall et al., 2011;Miller et al., 2009; Werb et al., 2008). Among young people, the use of drugs via injection isof particular concern, since youth have been found to be more likely to share contaminatedsyringes (Kipke et al., 1996; Lloyd-Smith et al., 2008) and drug injection has been shown tobe an independent predictor of mortality among street-involved youth (Roy et al., 1998).Preventing youth from initiating injection drug use remains a key public health priority;however, little information is available on the frequency of experimentation with injectingand whether this translates into high rates of sustained injection drug use. We undertook thisstudy to assess experimentation with injecting and factors associated with progression toregular injection drug use among a Canadian cohort of drug-using street-involved youth.2. METHODSData for this study was obtained from the At-Risk Youth Study (ARYS), an openprospective cohort of street-involved youth who use illegal drugs in Vancouver, Canada.The study methods have been described in detail previously (Wood et al., 2006). In brief,study recruitment involved extensive street-based outreach and snowball sampling of street-involved youth. Street-involved was defined as being absolutely, periodically or temporallyat risk of being homeless, or using services for vulnerable youth and spending a substantialamount of time on the street or heavily involved in the street economy (Daly, 1998; Marlattet al., 2011; Marshall et al., 2009). To be eligible, participants at baseline must have beenage 14 to 26, reported use of illegal drugs (other than or in addition to marijuana) in the last30 days, and provided written informed consent. At enrollment and on a biannual basis,participants complete an interviewer-administered questionnaire and provide a blood samplefor serologic testing. All participants are compensated with a nominal stipend ($20 CDN)for their time.To assess progression to regular injection drug use after injection initiation, the presentanalysis included participants who reported ever having injected illicit drugs at baseline or atsome point during study follow-up (between September 2005 and November 2012), definedas a affirmative response to the question, Have you ever used a needle to chip, fix, or muscleeven once? Study participants who were injection naïve at baseline and remained injectionnaïve throughout the entire study period were excluded from the analysis. Since a number ofvariables of interest were based on the circumstances of youth’s first injection event, datafrom the first study visit that included a report of injection drug use was used in our analysisto minimize potential recall issues. The primary outcome of interest was progression tobecoming a regular injector after the first injection event. Specifically, participants wereasked to indicate how much time had passed after the first time they injected beforebecoming a regular injector, defined as injecting at least once a week on average on aregular basis. Potential response categories included: never, next day to less than one week,more than one week but less than one month, one month to one year, longer than one year.Explanatory variables of interest included the following sociodemographic factors: age atfirst injection (per year older); gender (female vs. male); and Aboriginal ancestry (selfidentify as Inuit, Métis, First Nations vs. others). To assess the potential role of drug types,DeBeck et al. Page 2Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptwe also considered the drug used at the first injection event. The most common drug typeused was opiates, so it was defined as the reference category; this approach is consistentwith previous studies of street-involved youth in other settings (Steensma et al., 2005). The‘opiate’ category included reports of the following drugs used at first injection: heroin;heroin mixed with methamphetamine; heroin mixed with cocaine; Dilaudid(hydromorphone); morphine; and codeine. Other mutually exclusive categories were:‘cocaine’, which included reports of cocaine and crack; ‘methamphetamine’, which includedreports of crystal methamphetamine, methamphetamine, and speed; and ‘other’ whichincluded Talwin (pentazocine), Ritalin (methylphenidate), steroids, adrenaline, alcohol,dimethyltryptamine (DMT), MDMA (ecstasy), ketamine, and phencyclidine (PCP). Othervariables of interest included five forms of childhood maltreatment, derived from theChildhood Trauma Questionnaire (CTQ), which has been shown to be valid and reliableamong substance-using youths (Bernstein et al., 2003; Fink et al., 1995). The CTQ is a 28-item survey that measures the following five forms of maltreatment: physical abuse, sexualabuse, emotional abuse, physical neglect, and emotional neglect. Five subscales on the CTQsurvey with predetermined cut-off scores are thus used to define trauma levels for each formof maltreatment. The four levels of trauma are: none (to minimal), low (to moderate),moderate (to severe), and severe (to extreme). As in previous work, we have collapsed thetrauma levels into two categories, ‘none/low’ and ‘moderate/severe’ (Kerr et al., 2009;Stoltz et al., 2007). Lastly, other factors considered relate to the circumstances of the firstinjection event and include: prior regular use of drug first injected, defined as at least weeklyuse of the drug in the month preceding injection initiation (yes vs. no; note: if the firstinjection event was reported as poly-drug use, regular use of any one of the drugs that wasinjected was considered prior regular use of drug first injected); duration of illicit hard druguse prior to first injection event, defined as the number of years between the age at injectioninitiation and the age at first non-injection hard drug use (‘hard’ drugs defined as heroin,cocaine, crack, or crystal methamphetamine) per additional year; being alone at firstinjection event (yes vs. no); having a family member present at first injection event, familymembers included parent(s), sibling, or other family members (yes vs. no); having a sexualpartner present at first injection event (yes vs. no); having older people present at firstinjection event (yes vs. no); and requiring assistance to inject at first injection event (yes vs.no).Logistic regression was used to determine factors associated with progression to regularinjection drug use. In bivariable analysis, categorical explanatory variables were analyzedusing Pearson’s chi-square test and continuous variables were analyzed using the Mann-Whitney test. To evaluate factors independently associated with our outcome of interest, allvariables with p-values that were p <0.1 in bivariable analyses were considered in amultivariate logistic regression. The model selection procedure was done based on theAkaike Information Criterion (AIC) with the best subset selection procedure (Shtatland etal., 2001). All statistical analyses were performed using SAS software version 9.2 (SAS,Cary, NC). All p-values are two sided.3. RESULTSOver our study period, 1029 individuals were enrolled, among whom 405 (39%) participantsexperimented with injection drug use, either before study enrollment or over the studyfollow-up, and completed all items on the CTQ and other measures of interest. Among thissample, 131 (32%) were female, the median age was 22 years (interquartile range [IQR] =21 – 24), and the median number of years since their first injection experience was 4.0 (IQR= 1.0 – 7.0). Subsequent to their first injection, 293 (72%) participants progressed to becomea regular injector. Among this group, after the first injection experience, 151 (51%) wereregular injectors within one week, and a cumulative total of 186 (63%) were regularDeBeck et al. Page 3Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptinjectors within a month, and 253 (86%) were regular injectors within a year; only 40 (14%)of participants took longer than one year to transition to regular injection.As shown in Table 1, opiates were the most common category of drug used at injectioninitiation (49%, n=197), followed by methamphetamine (24%, n=97), cocaine (21%, n=85),and other (6%, n=26). Bivariate and multivariate results are also displayed in Table 1. Asshown, factors associated with progression to regular injection drug use in bivariableanalysis included age at first injection, female gender, moderate to severe childhoodphysical abuse, moderate to severe childhood emotional neglect, prior regular use of drugfirst injected, duration of illicit hard drug use prior to first injection event, and having asexual partner present at the first injection event (all p < 0.05; Table 1). Factors found to beindependently associated with progression to regular injection drug use in the finalmultivariable model included: younger age at first injection (adjusted odds ratio [AOR] =1.13, 95% confidence interval [CI]: 1.05 – 1.22); a history of childhood physical abuse(AOR = 1.81, 95% CI: 1.07 – 3.07); prior regular use of drug first injected (AOR = 1.77,95% CI: 1.07 – 2.93) and having a sexual partner present at first injection event (AOR =2.65, 95% CI: 1.16 – 6.04).4. DISCUSSIONWe found that 72% of street-involved youth who experimented with injecting progressed toregular injection drug use, and the majority transitioned in less than one week. Although thetype of drug first used to inject was not associated with progression, younger age at firstinjection, prior regular use of the drug first injected, a history of childhood physical abuse,and having a sexual partner present at injection initiation all significantly increased the oddsof becoming a regular injector.The frequency and speed with which youth in our study transitioned to regular injectiondrug use is alarming and confirms the importance of early interventions for at-risk youth(Novelli et al., 2005; Roy et al., 2007; Vlahov et al., 2004). Delaying injection initiation alsoappears to have a protective influence on whether youth become a regular injector. Thishighlights a potential role for secondary prevention efforts for youth who have alreadyinitiated hard drug use but have not progressed to injection. Recent studies among street-involved youth suggest that structural factors, such as a lack of housing, play a role infacilitating injection initiation among youth who use illicit hard street drugs (Feng et al.,2013). Our findings suggest that if interventions such as housing are able to prevent or evendelay injection initiation, this could have a significant impact on preventing regular injectiondrug use among vulnerable youth.The association between childhood physical abuse and drug injecting has been reportedelsewhere (Fergusson et al., 2008). A prior study in our setting found that childhoodphysical abuse was the only form of childhood maltreatment independently associated withprevalent injection drug use (Kerr et al., 2009). Building on this previous finding, the currentstudy indicates that physical abuse is not only associated with experimenting with risky druguse practices, but is also an independent predictor of becoming a regular injection drug user.Although specific drug types have previously been associated with injection initiation(Wood et al., 2008), our analysis suggests that the properties and characteristics of aparticular drug do not appear to be associated with transitions to sustained injection druguse. While drug use patterns, such as prior frequent use of the drug first injected andyounger age at injection initiation, predicted subsequent regular injection, no single drugtype resulted in more problematic drug use patterns. Rather, our analysis indicates that inaddition to drug use patterns, social factors, such as having a sexual partner present at thefirst injection, and early life factors, such as particular forms of childhood trauma, appear toDeBeck et al. Page 4Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author Manuscriptbe salient factors in transitioning to regular injection drug use. These findings are supportedby a growing body of literature indicating that distal familial, social and structural factorsare key determinants of high risk drug use (Fergusson et al., 2008; Hadland et al., 2012;Kerr et al., 2009; Ompad et al., 2005; Westermeyer et al., 2001; Wu et al., 2010). This hasimplications for current drug use prevention efforts as it underscores the importance of earlyinterventions, including the provision of early childhood support for children whoexperience abuse (Toumbourou et al., 2007). In addition, our study highlights the pressingneed to expand evidence-based addiction treatment and other secondary prevention efforts,and suggests that greater attention should be given to developing innovative addictiontreatments for youth that can alter drug use trajectories.This study has a number of limitations. First, ARYS is not a random sample and thereforeour findings may not generalize well to other populations of drug-using street-involvedyouth. Secondly, since our study included participants who had recently initiated injectiondrug use and thus may not have had sufficient observed time to progress to become a regularinjector, our findings may underestimate the true prevalence of progression to regularinjection drug use among novice street-involved injectors. Among participants who did notreport progressing to become regular injectors, the median number of years at the time ofinterview since injection initiation was 2.9 (IQR =1.3–5.8); among regular injectors themedian number of years was 4.0 (IQR 1.0 – 7.0). Despite these differences, given that 86%of regular injectors report having transitioned to regular injection within a year, we expectthe effect of this potential misclassification to be relatively minor. Thirdly, our measuresrelied on self-report, which is vulnerable to response bias. Finally, an ideal sample wouldhave been to follow injection naïve youth forward to assess for subsequent injectingpatterns. Unfortunately, we do not currently have adequate follow-up post injectioninitiation among youth who initiated injecting during the study period to allow for this typeof analysis with the ARYS cohort.In sum, our study found that a high proportion of street-involved youth experimenting withdrug injecting progressed to become regular injectors in a relatively short period of time.While specific drugs used at the time of first injection were not predictive of subsequentregular use, drug use patterns, specifically prior regular use of the drug first injected andyounger age at first injection, as well as having a history of childhood physical abuse andhaving a sexual partner present at the first injection event were. These data highlight theimportance of expanding evidence-based primary and secondary drug use prevention andtreatment options for youth, and imply that efforts to support children who experience abusemay be more important than focusing on specific illicit substances.AcknowledgmentsRole of Funding Sources: The study was supported by the US National Institutes of Health (R01-DA028532) andthe Canadian Institutes of Health Research (MOP–102742). This research was undertaken, in part, thanks tofunding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine,which supports Dr. Evan Wood. Dr. Kora DeBeck is supported by a MSFHR/St. Paul’s Hospital - ProvidenceHealth Care Career Scholar Award. Dr. Julio Montaner has received an Avant-Garde award (DP1DA026182) fromthe National Institute of Drug Abuse, US National Institutes of Health. Funding sources had no further role in studydesign; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submitthe paper for publication.The authors thank the ARYS study participants for their contribution to the research, as well as current and pastresearchers and staff. We would specifically like to thank CodyCallon, Jennifer Matthews, Deborah Graham, PeterVann, Steve Kain, Tricia Collingham, and CarmenRock for their research and administrative assistance.DeBeck et al. Page 5Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptReferencesBernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Handelsman L,Medrano M, Desmond D, Zule W. Development and validation of a brief screening version of theChildhood Trauma Questionnaire. Child Abuse Negl. 2003; 27:169–190. [PubMed: 12615092]Daly G. Homeless. Policies, strategies, and lives on the street. Capital Class. 1998; 22:167–169.DeBeck K, Shannon K, Wood E, Li K, Montaner J, Kerr T. Income generating activities of peoplewho inject drugs. Drug Alcohol Depend. 2007; 91:50. [PubMed: 17561355]Feng C, DeBeck K, Kerr T, Mathias S, Montaner J, Wood E. Homelessness independently predictsinjection drug use initiation among street-involved youth in a Canadian setting. J Adolesc Health.2013; 52:499–501. [PubMed: 23299006]Fergusson DM, Boden JM, Horwood LJ. The developmental antecedents of illicit drug use: evidencefrom a 25-year longitudinal study. Drug Alcohol Depend. 2008; 96:165–177. [PubMed: 18423900]Fink LA, Bernstein D, Handelsman L, Foote J, Lovejoy M. Initial reliability and validity of thechildhood trauma interview: a new multidimensional measure of childhood interpersonal trauma.Am J Psychiatry. 1995; 152:1329–1335. [PubMed: 7653689]Hadland SE, Werb D, Kerr T, Fu E, Wang H, Montaner JS, Wood E. Childhood sexual abuse and riskfor initiating injection drug use: a prospective cohort study. Prev Med. 2012; 55:500–504. [PubMed:22954518]Kerr T, Stoltz JA, Marshall BD, Lai C, Strathdee SA, Wood E. Childhood trauma and injection druguse among high-risk youth. J Adolesc Health. 2009; 45:300–302. [PubMed: 19699428]Kipke MD, Unger JB, Palmer RF, Edgington R. Drug use, needle sharing, and HIV risk amonginjection drug-using street youth. Subst Use Misuse. 1996; 31:1167–1187. [PubMed: 8853236]Lloyd-Smith E, Kerr T, Zhang R, Montaner JSG, Wood E. High prevalence of syringe sharing amongstreet involved youth. Addict Res Theory. 2008; 16:353–358.Marlatt, GA.; Larimer, ME.; Witkiewitz, K. Harm Reduction: Pragmatic Strategies for ManagingHigh-risk Behaviors. Guilford Press; New York: 2011.Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstablehousing associated with an increased risk of HIV and STI transmission among street-involvedyouth. Health Place. 2009; 3:753–60. [PubMed: 19201642]Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after theopening of North America’s first medically supervised safer injecting facility: a retrospectivepopulation-based study. Lancet. 2011; 377:1429–1437. [PubMed: 21497898]Miller CL, Kerr T, Fischer B, Zhang R, Wood E. Methamphetamine injection independently predictshepatitis C infection among street-involved youth in a Canadian setting. J Adolesc Health. 2009;44:302–304. [PubMed: 19237118]Novelli LA, Sherman SG, Havens JR, Strathdee SA, Sapun M. Circumstances surrounding the firstinjection experience and their association with future syringe sharing behaviors in young urbaninjection drug users. Drug Alcohol Depend. 2005; 77:303–309. [PubMed: 15734230]Ompad DC, Ikeda RM, Shah N, Fuller CM, Bailey S, Morse E, Kerndt P, Maslow C, Wu Y, VlahovD, Garfein R, Strathdee SA. Childhood sexual abuse and age at initiation of injection drug use.Am J Public Health. 2005; 95:703–709. [PubMed: 15798133]Roy E, Boivin JF, Haley N, Lemire N. Mortality among street youth. Lancet. 1998; 352:32. [PubMed:9800745]Roy E, Boudreau JF, Leclerc P, Boivin JF, Godin G. Trends in injection drug use behaviors over 10years among street youth. Drug Alcohol Depend. 2007; 89:170–175. [PubMed: 17258871]Shtatland, ES.; Cain, E.; Barton, MB. The Perils of Stepwise Logistic Regression and How to EscapeThem Using Information Criteria and the Output Delivery System. SUGI 2001 proceedings, paper222; 2001.Steensma C, Boivin JF, Blais L, Roy E. Cessation of injecting drug use among street-based youth. JUrban Health. 2005; 82:622–637. [PubMed: 16195471]Stoltz JA, Shannon K, Kerr T, Zhang R, Montaner JS, Wood E. Associations between childhoodmaltreatment and sex work in a cohort of drug-using youth. Soc Sci Med. 2007; 65:1214–1221.[PubMed: 17576029]DeBeck et al. Page 6Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptToumbourou JW, Stockwell T, Neighbors C, Marlatt GA, Sturge J, Rehm J. Interventions to reduceharm associated with adolescent substance use. Lancet. 2007; 369:1391–1401. [PubMed:17448826]Vlahov D, Fuller CM, Ompad DC, Galea S, Des Jarlais DC. Updating the infection risk reductionHierarchy: preventing transition into injection. J Urban Health. 2004; 81:14–19. [PubMed:15047779]Werb D, Kerr T, Li K, Montaner J, Wood E. Risks surrounding drug trade involvement among street-involved youth. Am J Drug Alcohol Abuse. 2008; 34:810–820. [PubMed: 19016187]Westermeyer J, Wahmanholm K, Thuras P. Effects of childhood physical abuse on course and severityof substance abuse. Am J Addict. 2001; 10:101–110. [PubMed: 11444153]Wood E, Stoltz JA, Montaner JS, Kerr T. Evaluating methamphetamine use and risks of injectioninitiation among street youth: the ARYS study. Harm Reduct J. 2006; 3:18. [PubMed: 16723029]Wood E, Stoltz JA, Zhang R, Strathdee SA, Montaner JS, Kerr T. Circumstances of first crystalmethamphetamine use and initiation of injection drug use among high-risk youth. Drug AlcoholRev. 2008; 27:270–276. [PubMed: 18368608]Wu NS, Schairer LC, Dellor E, Grella C. Childhood trauma and health outcomes in adults withcomorbid substance abuse and mental health disorders. Addict Behav. 2010; 35:68–71. [PubMed:19775820]DeBeck et al. Page 7Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 8Table 1Bivariable and multivariable analyses of factors associated with progression to regular injection drug use among street-involved youth in Vancouver,Canada (n=405).CharacteristicProgression to Regular InjectorYesn = 293,n (%)Non = 112,n (%)Odds Ratio, (95% CI*)p-valueAdjusted Odds Ratio, (95% CI)p-valueSociodemographic Factors Age at first inject.18a19a1.12 (1.05 – 1.21)0.0011.13 (1.05 – 1.22)0.002  Per year younger(16–20)b(17–21)b Gender  Female104 (79)27 (21)1.73 (1.06 – 2.84)0.0301.47 (0.87 – 2.48)0.154  Male189 (69)85 (31) Aboriginal ancestry  Yes69 (73)26 (27)1.02 (0.61 – 1.71)0.943  No224 (72)86 (28)Childhood Trauma: Physical abuse  Moderate/Severe102 (80)26 (20)1.77 (1.07 – 2.91)0.0261.81 (1.07 – 3.07)0.027  None/Low191 (69)86 (31) Sexual abuse  Moderate/Severe66 (80)17 (21)1.62 (0.91 – 2.91)0.104  None/Low227 (71)95 (29) Emotional abuse  Moderate/Severe152 (75)52 (25)1.24 (0.80 – 1.92)0.327  None/Low141 (70)60 (30) Physical neglect  Moderate/Severe90 (76)28 (24)1.33 (0.81 – 2.18)0.258  None/Low203 (71)84 (29) Emotional neglect  Moderate/Severe154 (77)46 (23)1.59 (1.02 – 2.47)0.039Drug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 9CharacteristicProgression to Regular InjectorYesn = 293,n (%)Non = 112,n (%)Odds Ratio, (95% CI*)p-valueAdjusted Odds Ratio, (95% CI)p-value  None/Low139 (68)66 (32)First Drug Injected: Opiates (Ref.)  Yes147 (75)50 (25)-REF-  No146 (70)62 (30) Cocaine  Yes58 (68)27 (32)0.73 (0.42 – 1.28)0.270  No235 (73)85 (27) Methamphetamines  Yes74 (76)23 (24)1.09 (0.62 – 1.93)0.756  No219 (71)89 (29) Other  Yes14 (54)12 (46)0.40 (0.17 – 0.92)0.030  No279 (74)100 (26)Circumstances of first injection: Prior regular use of drug first injected  Yes108 (79)29 (21)1.67 (1.03 – 2.71)0.0381.77 (1.07 – 2.93)0.027  No185 (69)83 (31) Duration of illicit hard drug use prior to first injection event Per additional year2a (1–5)b3a(2–5)b0.91 (0.85 – 0.98)0.013 Alone at first injection event  Yes26 (68)12 (32)0.81 (0.39 – 1.67)0.570  No267 (73)100 (27) Family member present at first injection event  Yes17 (68)8 (32)0.80 (0.34 – 1.91)0.617  No276 (73)104 (27) Sexual partner present at first injection eventDrug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.NIH-PA Author ManuscriptNIH-PA Author ManuscriptNIH-PA Author ManuscriptDeBeck et al. Page 10CharacteristicProgression to Regular InjectorYesn = 293,n (%)Non = 112,n (%)Odds Ratio, (95% CI*)p-valueAdjusted Odds Ratio, (95% CI)p-value  Yes49 (86)8 (14)2.61 (1.20 – 5.71)0.0162.65 (1.16 – 6.04)0.021  No244 (70)104 (30) Older people present at first injection event  Yes183 (73)67 (27)1.12 (0.72 – 1.75)0.626  No110 (71)45 (29) Required help injecting  Yes227 (74)79 (26)1.44 (0.88 – 2.35)0.147  No66 (67)33 (33)Note:*CI = Confidence Interval;a Median;b Interquartile RangeDrug Alcohol Depend. Author manuscript; available in PMC 2014 December 01.


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