Family structure is one factor that can help explain drug use among adolescents. In 2005 a study was conducted with 255 ninth-grade students from an urban, predominantly Latino Los Angeles area high school. Students were 83% Latino, 58% female, and from mostly low SES households. Half of all students reported having ever used alcohol, 30% had ever smoked a cigarette, and 18% had ever used marijuana. Family structure was measured using a single open-ended question and logistic regression was employed to determine the effects of various family structures on the use of alcohol, cigarettes, and marijuana. The presence of older siblings in the home was associated with alcohol and marijuana use, and living with a cousin was associated with marijuana use. Results suggest that influential others, including siblings and cousins, should be included in measures of family structure. Study limitations are noted.
drug use; adolescents; acculturation; family structure; siblings; peer influence; Latino; Hispanic
To examine perceived discrimination and substance use among Latino high school students.
Latino 9th graders (N=1332) completed self-report measures of perceived discrimination and substance use behavior.
Perceived discrimination was associated with lifetime use measures of smoking (OR=1.73, P<0.01), alcohol (OR=1.53, P<0.01), marijuana (OR=1.70, P<0.01), and inhalants (OR=1.50, P<0.05); and past 30 day measures of smoking (OR=2.54, P<0.01), alcohol (OR=1.63, P<0.01), marijuana (OR=1.95, P<0.01), and inhalants (OR=1.64, P<0.01), and binge drinking (OR=1.84, P<0.01).
Latino adolescents who have higher perceptions of discrimination are at risk for substance use. Interventions to help Latino adolescents cope with feelings of discrimination may be a useful addition to substance use prevention programs.
Latino; adolescent; substance use; discrimination
To ascertain the effects of parent-adolescent acculturation gaps, perceived discrimination, and perceived negative context of reception on adolescent cigarette smoking, alcohol use, sexual activity, and sexual risk taking. We used an expanded, multidimensional model of acculturation.
A sample of 302 recently immigrated parent-adolescent dyads (152 from Miami and 150 from Los Angeles) completed measures of acculturation (Hispanic and American practices and identifications, and individualist and collectivist values) and parent-adolescent communication. Adolescents completed measures of recent cigarette smoking, alcohol use, sexual behavior, and sexual risk taking.
Parent-adolescent gaps in American practices and ethnic identity, and perceptions of a negative context of reception, predicted compromised parent-adolescent communication. In Miami only, adolescent-reported communication negatively predicted odds of cigarette smoking, occasions of drunkenness, and number of sexual partners. Also in Miami only, parent-reported communication positively predicted these outcomes, as well as occasions of adolescent binge drinking, drunkenness, number of sexual partners, and odds of unprotected sex. The only significant findings in Los Angeles were protective effects of parent-reported communication on frequency of alcohol use and of binge drinking. Mediational effects emerged only in the Miami sample.
Effects of parent-adolescent acculturation gaps vary across Hispanic groups and receiving contexts. The especially strong parental control in many Mexican families may account for these differences. However, other important differences between Hispanic subgroups and communities of reception could also account for these differences. Prevention efforts might encourage Hispanic youth both to retain their culture of origin and to acquire American culture.
Hispanic; acculturation; discrimination; alcohol use; recent immigrants
Given the important contextual function of family dynamics and traditional gender roles in Latino cultures, parental influences on substance use among Latino adolescents may differ across genders. This study examined associations between family factors (parental monitoring, parent–child communication, family cohesion, and familism) and marijuana use among 1,369 Latino adolescents in Southern California. Students from seven schools completed surveys in 9th and 11th grades. Longitudinal hierarchical linear regression analyses evaluated the associations between family factors in 9th grade and lifetime marijuana use in 11th grade, as well as gender differences in these associations. Girls reported higher levels of parental monitoring, parental communication, and familism than boys did, but there were no gender differences in family cohesiveness. In a regression model controlling for covariates and previous marijuana use, parent–child communication and family cohesion in 9th grade were each uniquely predictive of lower levels of marijuana consumption in 11th grade. Gender was a statistical moderator, such that higher levels of parent–child communication predicted lower marijuana use among boys, whereas girls’ use was relatively low regardless of parent–child communication levels. Results are discussed in the light of the concurrent socialization processes of family and gender in Latino culture and its relation to preventing delinquent behaviors such as marijuana use.
adolescents; family; gender; Hispanic; Latino; longitudinal; marijuana; parents
Hispanic youth are at risk for experiencing depressive symptoms and smoking cigarettes, and risk for depressive symptoms and cigarette use increase as Hispanic youth acculturate to U.S. culture. The mechanism by which acculturation leads to symptoms of depression and cigarette smoking is not well understood. The present study examined whether perceived discrimination explained the associations of acculturation with depressive symptoms and cigarette smoking among 1,124 Hispanic youth (54% female). Youth in Southern California completed surveys in 9th–11th grade. Separate analyses by gender showed that perceived discrimination explained the relationship between acculturation and depressive symptoms for girls only. There was also evidence that discrimination explained the relationship between acculturation and cigarette smoking among girls, but the effect was only marginally significant. Acculturation was associated with depressive symptoms and smoking among girls only. Perceived discrimination predicted depressive symptoms in both genders, and discrimination was positively associated with cigarette smoking for girls but not boys. These results support the notion that, although Hispanic boys and girls experience acculturation and discrimination, their mental health and smoking behaviors are differentially affected by these experiences. Moreover, the results indicate that acculturation, gender, and discrimination are important factors to consider when addressing Hispanic youth’s mental health and substance use behaviors.
Acculturation; Gender; Perceived discrimination; Depression; Cigarette smoking; Hispanic youth
Theories of acculturation predict that discrepancies in cultural orientation between adolescents and their parents will increase the adolescents’ risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1772 Hispanic 9th grade students in Southern California. Parent–child discrepancy in U.S. orientation (defined as the difference between the child’s U.S. orientation and the child’s perception of the parents’ U.S. orientation) was a risk factor for past-month smoking, lifetime and past-month alcohol use, and lifetime and past-month marijuana use. Parent–child discrepancy in Hispanic orientation (defined as the difference between the child’s Hispanic orientation and the child’s perception of the parents’ Hispanic orientation) was a risk factor for lifetime and past-month alcohol and marijuana use. The adolescents’ own Hispanic orientation was protective against lifetime and past-month smoking and marijuana use, but not alcohol use. In an analysis of mediation, U.S. acculturation discrepancy was associated with lower levels of family cohesion, which in turn was associated with higher levels of substance use. Results suggest that family-based interventions for acculturating and bicultural Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.
Acculturation; Hispanic; Adolescence; Tobacco; Alcohol; Drugs
Acculturation discrepancy theory predicts that conflicting cultural preferences between adolescents and their parents will increase the adolescents’ risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1683 Hispanic students in Southern California who completed surveys in 9th and 10th grade. Measures included the students’ own cultural orientations and their perceptions of their parents’ preference for their cultural orientations (“Perceived Parental Cultural Expectations”—PPCE). Hispanic PPCE in 9th grade was a risk factor for lifetime, but not past-month, cigarette, alcohol, and marijuana use in 10th grade. The adolescents’ own Hispanic orientation in 9th grade was protective against lifetime and past-month smoking and marijuana use and lifetime alcohol use in 10th grade. The effects of the acculturation variables did not vary according to generation in the U.S. Change in acculturation between 9th and 10th grade was statistically significant but small in magnitude. Increases in parent-child Hispanic acculturation discrepancy (i.e., the difference between the adolescents’ own cultural orientations and their PPCE, with adolescents perceiving that their parents wanted them to be more Hispanic oriented than they actually were) from 9th to 10th grade were associated with an increased risk of substance use. Family-based interventions for acculturating Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.
Acculturation; Hispanic; Adolescence; Cigarette smoking; Tobacco; Alcohol; Drugs
The intergenerational transmission (IGT) of violence has been a main theoretical consideration to explain the link between interparental aggression in the family of origin and intimate partner violence (IPV) in subsequent intimate relationships. Studies have examined this theoretical link based on self-reports of interparental violence witnessed during childhood and adolescence. However, no study has examined whether emerging adults who currently witness interparental violence are more likely to exhibit violence in their own intimate relationships. Data were analyzed from undergraduate students (N = 223) attending an ethnically diverse Southern California university. Multivariate linear regression analyses were used to examine the impact of witnessing interparental violence on the physical and psychological IPV experienced in emerging adult relationships. The joint effects of witnessing both forms of interparental violence were also tested. Support for the intergenerational transmission of violence was identified for specific types of violence. Future directions of study and implications for prevention and treatment are offered.
intimate partner violence; interparental violence; social cognitive theory; intergenerational transmission; emerging adulthood
Cultural values can shape people’s attitudes toward substance use and influence their risk of experimentation with drugs. This article examines the relationships between cultural values (familism, respeto, and machismo), fatalism (a culturally encouraged personality disposition), and substance use among Hispanic adolescents. In 2005, cross-sectional data were collected from 1,616 Hispanic ninth grade students in Los Angeles. Each cultural value was associated with lifetime substance use; however, these relationships depended on the type of substance and gender. Our findings suggest that it might be useful to incorporate the cultural values and address the personality trait of fatalism in prevention programs for Hispanic adolescents. The study’s limitations are noted.
cultural values; familism; respeto; fatalism; machismo; substance use; Hispanic; adolescence; bicultural competence
This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the “immigrant paradox,” whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning.
acculturation; immigrant; cultural practices; cultural values; cultural identifications
Immigration to a nation with a stronger anti-smoking environment has been hypothesized to make smoking less common. However, little is known about how environments influence risk of smoking across the lifecourse. Research suggested a linear decline in smoking over the lifecourse but these associations, in fact, might not be linear. This study assessed the possible nonlinear associations between age and smoking and examined how these associations differed by environment through comparing Koreans in Seoul, South Korea and Korean Americans in California, United States. Data were drawn from population based telephone surveys of Korean adults in Seoul (N=500) and California (N=2,830) from 2001–2002. Locally weighted scatterplot smoothing (lowess) was used to approximate the association between age and smoking with multivariable spline logistic regressions, including adjustment for confounds used to draw population inferences. Smoking differed across the lifecourse between Koreans and Korean Americans, with these patterns also differing between men and women. The association between age and smoking peaked around 35 years among Korean and Korean American men. From 18 to 35 the probability of smoking was 57% higher (95%CI, 40 to 71) among Korean men versus 8% (95%CI, 3 to 19) higher among Korean American men. A similar difference in age after 35, from 40 to 57 years of age, was associated with a 2% (95%CI, 0 to 10) and 20% (95%CI, 16 to 25) lower probability of smoking among Korean and Korean American men. A nonlinear pattern was also observed among Korean American women. Social role transitions provide plausible explanations for the decline in smoking after 35. Investigators should be mindful of nonlinearities in age when attempting to understand tobacco use.
South Koreans' Health; Korean Americans' Health; Age; Tobacco Control; Immigration; Smoking
Extant twin research on the depression–smoking association in adolescents has been conducted in U.S. and European samples and considered depression as a unitary phenotype. This study explored genetic and environmental influences on covariation between smoking initiation and 4 depressive symptom dimensions (positive affect [PA], negative affect [NA], somatic features [SF], and interpersonal problems [IP]) in adolescent Chinese twins.
Questionnaires measuring current depressive symptoms and lifetime smoking initiation were administered to 602 twin pairs (M [SD] age = 12.2 (1.93) years, range 9–16 years). Cholesky bivariate decomposition models examined influences on each depressive symptom dimension, smoking initiation, and their covariation using age- and sex-adjusted threshold variables.
Within-twin correlations between smoking initiation and each depressive symptom dimension were significant (|r|s = .29–.61). Bivariate twin modeling showed significant genetic effects on overall depressive symptoms (55% variance), shared environment effects on NA (36%) and PA (53%), and shared environment effects on smoking initiation (46%) unique from PA. No other familial influences on the individual phenotypes (apart from those accounting for smoking–depression covariance) were significant. Relations of smoking initiation to overall depressive symptoms and IP were influenced by familial (shared environment and/or genetic) factors and nonshared environmental factors. The SF–smoking initiation relation was influenced mostly by familial factors. Only shared environment significantly influenced the association of lower PA and higher NA to smoking initiation.
Relations between each symptom dimension and smoking initiation are of sizeable magnitude in Chinese adolescents. Genetic and environmental factors underlying depression–smoking comorbidity may vary across different depressive symptom dimensions.
Fotonovelas—small booklets that portray a dramatic story using photographs and captions—represent a powerful health education tool for low-literacy and ethnic minority audiences. This study evaluated the effectiveness of a depression fotonovela in increasing depression knowledge, decreasing stigma, increasing self-efficacy to recognize depression, and increasing intentions to seek treatment, relative to a text pamphlet. Hispanic adults attending a community adult school (N = 157, 47.5 % female, mean age = 35.8 years, 84 % immigrants, 63 % with less than high school education) were randomly assigned to read the fotonovela or a low-literacy text pamphlet about depression. They completed surveys before reading the material, immediately after reading the material, and 1 month later. The fotonovela and text pamphlet both produced significant improvements in depression knowledge and self-efficacy to identify depression, but the fotonovela produced significantly larger reductions in antidepressant stigma and mental health care stigma. The fotonovela also was more likely to be passed on to family or friends after the study, potentially increasing its reach throughout the community. Results indicate that fotonovelas can be useful for improving health literacy among underserved populations, which could reduce health disparities.
Hispanic; Depression; Fotonovela; Stigma; Knowledge; Attitudes; Intentions; Health disparities; Health literacy; Narrative
To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals’ cognitive attributions for smoking were associated with subsequent smoking development and through which pathways.
Middle and high school students in seven large cities in China (N=12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008).
Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity (β=0.11, p<0.001) and autonomy (β=0.08, p=0.019) were associated with smoking initiation among baseline non-smokers. Coping (β=0.07, p<0.001) and social image (β=0.10, p=<.0001) were associated with smoking progression among baseline lifetime smokers. Social image (β=0.05, p=0.043), engagement (β=0.07, p=0.003), and mental enhancement (β=0.15, p<0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%.
This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.
Attributions; Smoking; Attribution Theory; Adolescents; China
Using a network analytic framework, this study introduces a new method to measure peer influence based on adolescents’ affiliations or two-mode social network data. Exposure based on affiliations is referred to as the “affiliation exposure model.” This study demonstrates the methodology using data on young adolescent smoking being influenced by joint participation in school-based organized sports activities with smokers. The analytic sample consisted of 1260 American adolescents from age 10 to 13 in middle schools, and the results of the longitudinal regression analyses showed that adolescents were more likely to smoke as they were increasingly exposed to teammates who smoke. This study illustrates the importance of peer influence via affiliation through team sports.
Culture; acculturation; ethnicity; race; measurement; minority; disparities
A brief motivational interviewing (MI) intervention may be a viable adjunct to school-based substance abuse prevention programs. This article describes the development and implementation of a brief MI intervention with 573 adolescents (mean age 16.8; 40.3% female, 68% Latino) enrolled in eight continuation high schools in Southern California. Study participants were assigned to the MI condition in a randomized controlled trial of Project Toward No Drug Abuse. Data are provided on dosage, topics discussed, and quality of MI determined with the Motivational Interviewing Skill Code (MISC). Results suggest that the protocol was feasible and implemented with adequate fidelity. The study’s limitations are noted.
adolescent; motivational interviewing; substance use; prevention; intervention; telephone; school-based; booster
Focus groups were conducted with adolescents and parents as part of a larger study to understand the connection between acculturation and Hispanic/Latino adolescent substance use. Parents (n = 18) were all mothers and had an average age of 42 years. Students (n = 16) were 62% female and had an average age of 14 years. Results are summarized in five categories: culture/ethnic identity, acculturation, parent-child conflict/relationships, gender, and adolescent substance use. Parents and adolescents held similar views in some areas (e.g., pride in ethnic identity and changes in language use), but diverged in others (e.g., indicators of acculturation, gender differences in parenting, and ideas of freedom and independence). Participants in the focus groups did not endorse the association between acculturation and substance use that has been detected in quantitative studies. Implications for substance use prevention and treatment programs are discussed.
Acculturation; adolescents; Latino/Hispanic; qualitative methods; substance use
Socioeconomic status (SES) has been associated with smoking among adolescents, but it is not known which attributes of SES are responsible for the added risk, or whether these associations are consistent in ethnically diverse samples.
This study investigated the associations between SES variables and smoking behavior among an ethnically diverse sample of 1847 8th-grade adolescents in Southern California in 2002. Several aspects of SES were examined: an objective composite measure of family and neighborhood SES, the adolescent’s spending money, and the adolescent’s perception of SES (family’s ability to afford basic necessities, wealth relative to others, and wealth relative to last year).
After controlling for demographic characteristics, smoking behavior of parents and friends, and parental monitoring, low scores on the objective SES index and large amounts of pocket money were associated with an increased risk of smoking.The subjective measures of perceived SES were not associated with smoking.
Results indicate that increased smoking prevention efforts are needed in low-SES areas, and that limiting adolescents’ pocket money may be an effective strategy for preventing smoking.
smoking; adolescence; socioeconomic status
Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens through receptive syringe sharing (RSS) and receptive paraphernalia sharing (RPS). Research into the influence of the perceived risk of HIV infection on injection risk behavior has yielded mixed findings. One explanation may be that consequences other than HIV infection are considered when IDUs are faced with decisions about whether or not to share equipment. We investigated the perceived consequences of refusing to share injection equipment among 187 IDUs recruited from a large syringe exchange program in Los Angeles, California, assessed their influence on RSS and RPS, and evaluated gender differences. Two sub-scales of perceived consequences were identified: structural/external consequences and social/internal consequences. In multiple linear regression, the perceived social/internal consequences of refusing to share were associated with both RSS and RPS, after controlling for other psychosocial constructs and demographic variables. Few statistically significant gender differences emerged. Assessing the consequences of refusing to share injection equipment may help explain persistent injection risk behavior, and may provide promising targets for comprehensive intervention efforts designed to address both individual and structural risk factors.
Injection drug use; HIV; gender; perceived consequences; syringe sharing
To investigate the impact of worries on weight concerns and emotional eating and body mass index (BMI) percentile in an ethnically diverse sample of female youth.
This study uses baseline and follow-up data from a brief school-based physical activity intervention trial in minority female youth. Partial correlations adjusted for intervention status, age, and ethnicity were used to assess the relationship among emotional eating, weight concerns, and BMI percentile at follow-up. Multi-level modeling was used to analyze the relationships between baseline worries and follow-up emotional eating, weight concerns, and BMI percentile. Additional analysis assessed whether emotional eating mediated and/or moderated the relationship between baseline worries and follow-up BMI. Data were analyzed using SAS v9.1.
The sample consisted of 404 minority females (67.1% Latina; mean age 12.5±0.6; 60.6% normal weight). Weight concerns were positively correlated with emotional eating and BMI percentile (p< 0.001 for both). Baseline worries significantly predicted emotional eating (p= 0.027) and weight concerns (p< 0.001) but not BMI percentile (p= 0.183) at follow-up. Emotional eating did not mediate the relationship between baseline worries and follow-up BMI percentile; however it did moderate the relationship between baseline worries and follow-up BMI percentile (p= 0.003).
Worries were associated with psychosocial variables but not BMI percentile in this sample. Reducing worries in those with high emotional eating scores may influence future weight gain in Latina females.
psychosocial; minority; youth; BMI; weight concerns; emotional eating; mediation; moderation
Although previous investigations have indicated a role for genetic factors in smoking initiation, the underlying genetic mechanisms are still unknown. In 2,339 adolescents from a Chinese Han population in the Wuhan Smoking Prevention Trial (Wuhan, China, 1998–1999), the authors explored the association of 57 genes in the dopamine pathway with smoking initiation. Using a conservative approach for declaring significance, positive findings were further examined in an independent sample of 603 Caucasian adolescents followed for up to 10 years as part of the Children's Health Study (Southern California, 1993–2009). The authors identified 1 single nucleotide polymorphism (rs2298122) in the calcyon neuron-specific vesicular protein gene (CALY) that was positively associated with smoking initiation in females (odds ratio = 2.21, 95% confidence interval: 1.49, 3.27; P = 8.4 × 10−5) in the Wuhan Smoking Prevention Trial cohort, and they replicated the association in females from the Children's Health Study cohort (hazard rate ratio = 2.05, 95% confidence interval: 1.27, 3.31; P = 0.003). These results suggest that the CALY gene may influence smoking initiation in adolescents, although the potential roles of underlying psychological characteristics that may be components of the smoking-initiation phenotype, such as impulsivity or novelty-seeking, remain to be explored.
adolescent; dopamine; genetic association studies; smoking
Purpose: Compulsive Internet Use (CIU) has increasingly become an area of research among process addictions. Largely based on data from cross-sectional studies, a positive association between CIU and substance use has previously been reported. This study presents gender and country-specific longitudinal findings on the relationships between CIU and substance use. Methods: Data were drawn from youth attending non-conventional high schools, recruited into two similarly implemented trials conducted in China and the USA. The Chinese sample included 1,761 students (49% male); the US sample included 1,182 students (57% male) with over half (65%) of the US youth being of Hispanic ethnicity. Path analyses were applied to detect the concurrent and predictive relationships between baseline and one-year follow-up measures of CIU level, 30-day cigarette smoking, and 30-day binge drinking. Results: (1) CIU was not positively related with substance use at baseline. (2) There was a positive predictive relationship between baseline CIU and change in substance use among female, but not male students. (3) Relationships between concurrent changes in CIU and substance use were also found among female, but not male students. (4) Baseline substance use did not predict an increase in CIU from baseline to 1-year follow-up. Conclusions: While CIU was found to be related to substance use, the relationship was not consistently positive. More longitudinal studies with better measures for Internet Addiction are needed to ascertain the detailed relationship between Internet addiction and substance use.
compulsive internet use; internet addiction; youth; cigarette smoking; binge drinking; addiction syndrome; addiction specificity
Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world’s current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts.
The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation.
Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program × Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation.
This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition × Social Environmental Influences may be important when developing future effective prevention programming.
Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens via syringe and paraphernalia sharing, and women are at elevated risk. Consequences of injection risk behavior such as the risk of becoming infected with HIV have been relatively well studied, though less is known about the consequences of refusing to share injection equipment. We conducted in-depth qualitative interviews with 26 IDUs recruited from a syringe exchange program in Los Angeles, California, USA to understand the consequences that IDUs associate with refusing to share injection equipment and to determine whether these perceived consequences differ by gender. Perceived consequences were organized into four domains using a Social Ecological framework: microsystem (perceived risk of HIV, drug withdrawal or forgoing drug use), exosystem (trust and social norms), mesosystem (precarious housing and shelter policies), and macrosystem (syringe access/inconvenience, economic and legal consequences). Gender differences were identified in some, but not all areas. Effective public health interventions among IDUs will benefit from a holistic perspective that considers the environmental and social rationality (Kowalewski et al., 1997) of decisions regarding injection risk behavior, and assists individuals in addressing the consequences that they perceive to be most salient.
HIV; injection drug use; gender; qualitative methods; perceived consequences; behavioral theory