Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis
Abstract Background Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects o...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-023-00892-w |
| _version_ | 1797453401650364416 |
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| author | April M. Ballard Dylan Falk Harris Greenwood Paige Gugerty Judith Feinberg Peter D. Friedmann Vivian F. Go Wiley D. Jenkins P. Todd Korthuis William C. Miller Mai T. Pho David W. Seal Gordon S. Smith Thomas J. Stopka Ryan P. Westergaard William A. Zule April M. Young Hannah L. F. Cooper |
| author_facet | April M. Ballard Dylan Falk Harris Greenwood Paige Gugerty Judith Feinberg Peter D. Friedmann Vivian F. Go Wiley D. Jenkins P. Todd Korthuis William C. Miller Mai T. Pho David W. Seal Gordon S. Smith Thomas J. Stopka Ryan P. Westergaard William A. Zule April M. Young Hannah L. F. Cooper |
| author_sort | April M. Ballard |
| collection | DOAJ |
| description | Abstract Background Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states. Methods PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use. Results Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]). Conclusion This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs. |
| first_indexed | 2024-03-09T15:22:17Z |
| format | Article |
| id | doaj.art-475ccf58e84b4373aa55de1c5110e723 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-03-09T15:22:17Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-475ccf58e84b4373aa55de1c5110e7232023-11-26T12:44:37ZengBMCHarm Reduction Journal1477-75172023-10-0120111310.1186/s12954-023-00892-wHouselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysisApril M. Ballard0Dylan Falk1Harris Greenwood2Paige Gugerty3Judith Feinberg4Peter D. Friedmann5Vivian F. Go6Wiley D. Jenkins7P. Todd Korthuis8William C. Miller9Mai T. Pho10David W. Seal11Gordon S. Smith12Thomas J. Stopka13Ryan P. Westergaard14William A. Zule15April M. Young16Hannah L. F. Cooper17Rollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversityRollins School of Public Health, Emory UniversitySchool of Medicine, West Virginia UniversityOffice of Research, University of Massachusetts Chan Medical School-BaystateGillings School of Global Public Health, University of North Carolina at Chapel HillSchool of Medicine, Southern Illinois UniversityDepartment of Medicine, Oregon Health & Science UniversityCollege of Public Health, The Ohio State UniversityDepartment of Medicine, University of ChicagoSchool of Public Health and Tropical Medicine, Tulane UniversitySchool of Medicine, West Virginia UniversitySchool of Medicine, Tufts UniversitySchool of Medicine and Public Health, University of Wisconsin-MadisonRTI InternationalCollege of Public Health, University of KentuckyRollins School of Public Health, Emory UniversityAbstract Background Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states. Methods PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use. Results Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]). Conclusion This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs.https://doi.org/10.1186/s12954-023-00892-wHouselessnessSyringe service programsHarm reductionRural areasHealthcare access |
| spellingShingle | April M. Ballard Dylan Falk Harris Greenwood Paige Gugerty Judith Feinberg Peter D. Friedmann Vivian F. Go Wiley D. Jenkins P. Todd Korthuis William C. Miller Mai T. Pho David W. Seal Gordon S. Smith Thomas J. Stopka Ryan P. Westergaard William A. Zule April M. Young Hannah L. F. Cooper Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis Harm Reduction Journal Houselessness Syringe service programs Harm reduction Rural areas Healthcare access |
| title | Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis |
| title_full | Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis |
| title_fullStr | Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis |
| title_full_unstemmed | Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis |
| title_short | Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis |
| title_sort | houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the usa a cross sectional analysis |
| topic | Houselessness Syringe service programs Harm reduction Rural areas Healthcare access |
| url | https://doi.org/10.1186/s12954-023-00892-w |
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