Table 3.
Association of place and participant characteristics with injection-related risk behavior among people who inject drugs from 19 US metro areas in 2009, stratified by race/ethnicity8,9,10
| Latino (N=1,593) | Black (N=4,537) | White (N=2,656) | ||||
|---|---|---|---|---|---|---|
|
| ||||||
| Odds ratio (95% Confidence interval) | Adjusted odds ratio11 (95% Confidence interval) | Odds ratio (95% Confidence interval) | Adjusted odds ratio (95% Confidence interval) | Odds ratio (95% Confidence Interval) | Adjusted odds ratio (95% Confidence interval) | |
| MSA variance (variance component) | 0.35 (0.10) | 0.30 (0.08) | 0.36 (0.10) | 0.25 (0.07) | 0.39 (0.10) | 0.36 (0.10) |
| County variance (variance component) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) |
| ZIP code variance (variance component) | 0.07 (0.02) | 0.06 (0.02) | 0.05 (0.01) | 0.03 (0.01) | 0.05 (0.01) | 0.02 (0.01) |
| Intercept | 1.86 (1.34, 2.57) | 1.24 (0.59, 2.61) | 1.29 (0.97, 1.71) | 0.61 (0.31, 1.21) | 2.07 (1.53, 2.81) | 2.50 (1.35, |
| Region | ||||||
| Northeast (Reference) | 1.00 | -- | 1.00 | 1.00 | 1.00 | -- |
| South | 1.90 (0.90, 4.01) | -- | 2.44 (1.37, 4.34)* | 2.24 (1.21, 4.17)* | 1.49 (0.70, 3.18) | -- |
| Midwest | 0.86 (0.27, 2.71) | -- | 1.14 (0.51, 2.55) | 1.14 (0.48, 2.73) | 0.91 (0.30, 2.74) | -- |
| West | 1.84 (0.91, 3.72)** | -- | 1.77 (0.94, 3.35) | 1.87 (0.95, 3.71) | 1.14 (0.52, 2.51) | -- |
| Metropolitan statistical area | ||||||
| Black isolation | 0.41 (0.08, 2.13) | -- | 0.68 (0.17, 2.77) | -- | 0.96 (0.21, 4.41) | -- |
| Latino isolation | 2.14 (0.30, 15.26) | -- | 0.76 (0.14, 4.13) | -- | 1.05 (0.17, 6.37) | -- |
| County | ||||||
| Percent of unaffordable rental units among low income households | 0.99 (0.95, 1.03) | -- | 1.03 (0.99, 1.06) | -- | 1.00 (0.96, 1.02) | -- |
| Average number of months on waiting lists for assisted housing | 1.00 (0.99, 1.02) | -- | 1.00 (0.98, 1.01) | -- | 1.00 (0.98, 1.01) | -- |
| Drug arrest rates per 1,000 residents | 1.00 (0.94, 1.06) | -- | 1.00 (0.97, 1.02) | -- | 1.00 (0.97, 1.03) | -- |
| ZCTA | ||||||
| Density per square mile of off-premise alcohol outlets | 0.99 (0.99, 1.00) | -- | 1.00 (0.99, 1.01) | -- | 1.00 (1.00, 1.01) | -- |
| Density per square mile of abandoned residential units | 1.00 (1.00, 1.00) | -- | 1.00 (1.00, 1.00) | -- | 1.00 (1.00, 1.00) | -- |
| Percent of housing units with >1.5 people per room | 1.01 (0.97, 1.05) | -- | 1.03 (0.99, 1.07) | -- | 0.98 (0.94, 1.02) | -- |
| Percent non-Hispanic black residents | 1.00 (1.00, 1.01) | -- | 1.00 (1.00, 1.00) | -- | 1.00 (1.00, 1.01) | -- |
| Economic deprivation | 1.00 (0.95, 1.06) | -- | 1.01 (0.97, 1.05) | -- | 1.03 (0.98, 1.08) | -- |
| Gentrification | 1.04 (0.96, 1.13) | -- | 0.98 (0.94, 1.03) | -- | 0.97 (0.91, 1.04) | -- |
| Spatial access to drug treatment | 1.00 (0.95, 1.05) | -- | 0.96 (0.91, 1.01) | -- | 1.00 (0.95, 1.05) | -- |
| Spatial access to syringe exchange programs | 1.05 (0.75, 1.47) | -- | 0.98 (0.79, 1.21) | -- | 1.00 (0.76, 1.30) | -- |
| Participant Characteristics | ||||||
| Current age | 0.97 (0.96, 0.99)* | 0.99 (0.97, 1.00)* | 0.98 (0.97, 0.99)* | 0.99 (0.98, 1.00) | 0.97 (0.96, 0.98)* | 0.97 (0.97, 0.99)* |
| Sex (1=male) | 0.92 (0.71, 1.18) | 0.84 (0.64, 1.12) | 1.20 (1.04, 1.38)* | 1.12 (0.96, 1.30) | 1.41 (1.17, 1.71)* | 1.24 (1.01, 1.53)* |
| Men who had sex with men | ||||||
| Men who had sex with men more than 1 year ago (Reference) | 1.00 | -- | 1.00 | -- | 1.00 | -- |
| Men who had sex with men in the past year | 0.83 (0.45, 1.54) | -- | 0.91 (0.60, 1.37) | -- | 1.40 (0.91, 2.13) | -- |
| Men who never had sex with men | 0.49 (0.30, 0.81)* | -- | 0.44 (0.32, 0.60)* | -- | 1.01 (0.71, 1.45) | -- |
| Currently married or living as married | 0.99 (0.74, 1.32) | 1.23 (0.91, 1.67) | 1.01 (0.84, 1.22) | 1.24 (1.02, 1.51)* | 1.08 (0.81, 1.43) | 1.19 (0.88, 1.61) |
| Annual income (5,000 USD vs. more) | 0.85 (0.68, 1.06) | 0.95 (0.74, 1.21) | 0.86 (0.75, 0.98)* | 1.02 (0.88, 1.17) | 0.83 (0.70, 0.99)* | 0.91 (0.75, 1.09) |
| Currently employed full-time | 0.55 (0.31, 0.98)* | 0.62 (0.34, 1.13) | 0.44 (0.32, 0.60)* | 0.51 (0.37, 0.71)* | 0.66 (0.46, 0.95)* | 0.70 (0.48, 1.03) |
| Incarceration | 1.81 (1.43, 2.29)* | 1.43 (1.11, 1.83)* | 1.32 (1.15, 1.52)* | 1.13 (0.98, 1.31) | 1.64 (1.37, 1.96)* | 1.24 (1.02, 1.50)* |
| Homelessness | 2.08(1.65, 2.61)* | 1.72 (1.35, 2.19)* | 1.85 (1.63, 2.11)* | 1.49 (1.29, 1.71)* | 1.97 (1.64, 2.37)* | 1.60 (1.31, 1.95)* |
| Daily injection drug use | 0.68 (0.51, 0.90)* | 0.72 (0.53, 0.97)* | 0.70 (0.59, 0.80)* | 0.62 (0.53, 0.73)* | 0.55 (0.45, 0.66)* | 0.59 (0.48, 0.72)* |
| Binge drinking | 1.85 (1.48, 2.31)* | 1.64 (1.30, 2.08)* | 1.96 (1.72, 2.23)* | 1.73 (1.51, 1.98)* | 1.77 (1.48, 2.12)* | 1.64 (1.35, 1.98)* |
| Non-injection drug use | 1.73 (1.36, 2.20)* | 1.49 (1.15, 1.92)* | 1.48 (1.29, 1.70)* | 1.27 (1.10, 1.47)* | 1.62 (1.28, 2.03)* | 1.40 (1.10, 1.79)* |
| Receipt of free clean syringes | 1.22 (0.94, 1.59) | 1.15 (0.87, 1.52) | 1.03 (0.89, 1.20) | 1.05 (0.90, 1.23) | 1.27 (1.02, 1.57)* | 1.11 (0.89, 1.40) |
| Exchanged sex for money or drugs | 2.14 (1.57, 2.92)* | 1.86 (1.34, 2.59)* | 2.73 (2.33, 3.20)* | 2.29 (1.95, 2.70)* | 2.63 (2.03, 3.39)* | 2.20 (1.68, 2.87)* |
| Result of most recent HIV test | ||||||
| Indeterminate result on most recent HIV test/or did not receive result (Reference) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Negative result on most recent HIV test | 0.92 (0.69, 1.23) | 0.95(0.70, 1.29) | 0.68 (0.57, 0.81)* | 0.73 (0.61, 0.88)* | 0.72(0.57, 0.92)* | 0.78 (0.60, |
| Positive result on most recent HIV test | 0.65 (0.36, 1.15) | 0.83 (0.46, 1.53) | 0.72 (0.53, 0.96)* | 0.88 (0.64, 1.19) | 0.50 (0.31, 0.78)* | 0.77 (0.47, |
Refer to table 1 for definitions of place characteristics measured at MSA, county, and ZIP code levels and participant characteristics
Note:
indicates significance at p<0.05 and
indicates significance at p<0.10; some estimates labeled as significant at p<0.05 include confidence intervals that include a value of 1.00 due to rounding of the confidence intervals.
Multilevel analysis was conducted to assess the associations of place and participant characteristics with injection-related risk behavior; random intercepts were included for MSAs and ZIP codes for each racial/ethnic group
“Plurality” guidelines from the Federal Office of Management and Budget were used to group Non-Hispanic biracial participants to the white and black racial categories. See the following citation for additional information: OMB. Provisional guidance on the implementation of the 1997 standards for federal data on race and ethnicity, Executive Office of the President, December 15. : U.S. Office of Management and Budget; 2000.
Adjusted models assessed the relationships of place-based characteristics significant in bivariate analysis (OR ≠ 1 and p-value ≤0.05 in bivariate analysis) to each outcome, controlling for the following individual-level confounders: age, sex, current marital status, annual income, currently employed, result from the most recent HIV test, and the following characteristics in the last 12 months, incarceration, homelessness, daily injection, binge drinking, non-injection drug use, receipt of free clean syringes, and exchanged sex for money or drugs