The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64242

Carl A Latkin, PhD, Chyvette T Williams, MPH, and Jian Wang. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 737, Baltimore, MD 21205

BACKGROUND: Neighborhood environment is increasingly recognized as a contextual determinant of health, behavior and disease; however, the pathways through which neighborhood characteristics impact health behaviors are poorly understood. This paper examines pathways to elucidate how neighborhood disorder may lead to the transmission of HIV among urban injection drug users. METHODS: Data were from a sample of 700 drug injectors from the SHIELD Study, an experimental HIV prevention intervention targeting behavior change among drug users in Baltimore, MD. Structural Equation Modeling was used to examine psychological distress as an intervening mechanism between neighborhood disorder and drug injection behaviors. Study questionnaire items tapping physical decay and social incivilities were used to measure neighborhood disorder. Psychological distress was measured using items from the Centers for Epidemiology – Depression Scale. Drug injection behaviors examined were frequency of injection and sharing injection equipment. RESULTS: The relationship between neighborhood disorder and injection behaviors in all models tested suggest that psychological distress is higher in more disordered neighborhoods, that distress leads to greater injection frequency and equipment sharing, and that injection frequency predicts equipment sharing. CONCLUSION: Structural interventions such as neighborhood revitalization projects and increased access to sterile syringes might have more widespread effectiveness in reducing HIV risk than more traditional individual-focused behavioral interventions.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Recognize the importance of neighborhood context on HIV risk behaviors
• Apply structural equation modeling techniques to the study of HIV risk

Keywords: Injection Drug Users, HIV Risk Behavior

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.