Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis

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

doi:10.1186/s12954-023-00892-w

Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis

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

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English
Article number	157
Journal	Harm Reduction Journal
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12954-023-00892-w
State	Published - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.

Funding

This work was supported by the National Institute on Drug Abuse [UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UG3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826] with co-funding from the Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA) and the Appalachian Regional Commission (ARC). Research presented in this manuscript is the result of secondary data harmonization and analysis and was supported by grant U24DA048538 from NIDA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, CDC, SAMHSA, the Department of Health and Human Services or ARC. This publication is based upon data collected as part of the Rural Opioid Initiative (ROI), a multi-site study developed by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The authors thank the other ROI investigators and their teams, community and state partners, and the participants of the individual ROI studies for their contributions. A full list of participating ROI institutions can be found at http://ruralopioidinitiative.org.

Funders	Funder number
Rural Opioid Initiative
National Institute on Drug Abuse	UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044826/UH3DA044826, UG3DA044823/UH3DA044823, UG3DA044831/UH3DA044831, UG3DA044822/UH3DA044822, UG3DA044830/UH3DA044830, UG3DA044825
National Institute on Drug Abuse
Centers for Disease Control and Prevention
Substance Abuse and Mental Health Services Administration
Appalachian Regional Commission	U24DA048538
Appalachian Regional Commission

Keywords

Harm reduction
Healthcare access
Houselessness
Rural areas
Syringe service programs

ASJC Scopus subject areas

Medicine (miscellaneous)
Public Health, Environmental and Occupational Health
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12954-023-00892-w

Cite this

Ballard, A. M., Falk, D., Greenwood, H., Gugerty, P., Feinberg, J., Friedmann, P. D., Go, V. F., Jenkins, W. D., Korthuis, P. T., Miller, W. C., Pho, M. T., Seal, D. W., Smith, G. S., Stopka, T. J., Westergaard, R. P., Zule, W. A., Young, A. M., & Cooper, H. L. F. (2023). 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, 20(1), Article 157. https://doi.org/10.1186/s12954-023-00892-w

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title = "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 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.",

keywords = "Harm reduction, Healthcare access, Houselessness, Rural areas, Syringe service programs",

author = "Ballard, {April M.} and Dylan Falk and Harris Greenwood and Paige Gugerty and Judith Feinberg and Friedmann, {Peter D.} and Go, {Vivian F.} and Jenkins, {Wiley D.} and Korthuis, {P. Todd} and Miller, {William C.} and Pho, {Mai T.} and Seal, {David W.} and Smith, {Gordon S.} and Stopka, {Thomas J.} and Westergaard, {Ryan P.} and Zule, {William A.} and Young, {April M.} and Cooper, {Hannah L.F.}",

note = "Publisher Copyright: {\textcopyright} 2023, BioMed Central Ltd., part of Springer Nature.",

year = "2023",

month = dec,

doi = "10.1186/s12954-023-00892-w",

language = "English",

volume = "20",

number = "1",

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Ballard, AM, Falk, D, Greenwood, H, Gugerty, P, Feinberg, J, Friedmann, PD, Go, VF, Jenkins, WD, Korthuis, PT, Miller, WC, Pho, MT, Seal, DW, Smith, GS, Stopka, TJ, Westergaard, RP, Zule, WA, Young, AM & Cooper, HLF 2023, '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, vol. 20, no. 1, 157. https://doi.org/10.1186/s12954-023-00892-w

TY - JOUR

T1 - Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA

T2 - a cross-sectional analysis

AU - Ballard, April M.

AU - Falk, Dylan

AU - Greenwood, Harris

AU - Gugerty, Paige

AU - Feinberg, Judith

AU - Friedmann, Peter D.

AU - Go, Vivian F.

AU - Jenkins, Wiley D.

AU - Korthuis, P. Todd

AU - Miller, William C.

AU - Pho, Mai T.

AU - Seal, David W.

AU - Smith, Gordon S.

AU - Stopka, Thomas J.

AU - Westergaard, Ryan P.

AU - Zule, William A.

AU - Young, April M.

AU - Cooper, Hannah L.F.

PY - 2023/12

Y1 - 2023/12

N2 - 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.

AB - 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.

KW - Harm reduction

KW - Healthcare access

KW - Houselessness

KW - Rural areas

KW - Syringe service programs

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U2 - 10.1186/s12954-023-00892-w

DO - 10.1186/s12954-023-00892-w

M3 - Article

C2 - 37880724

AN - SCOPUS:85174916771

SN - 1477-7517

VL - 20

JO - Harm Reduction Journal

JF - Harm Reduction Journal

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ER -

Houselessness and syringe service program utilization among people who inject drugs in eight rural areas across the USA: a cross-sectional analysis

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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