Prevention Science

, Volume 12, Issue 2, pp 173–180 | Cite as

Individual, Social, and Environmental Factors Associated with Initiating Methamphetamine Injection: Implications for Drug Use and HIV Prevention Strategies

  • Brandon DL. Marshall
  • Evan Wood
  • Jean A. Shoveller
  • Jane A. Buxton
  • Julio SG. Montaner
  • Thomas Kerr


The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study’s commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study’s conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95–0.98), female sex (aHR: 0.58, 95%CI: 0.41–0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18–2.23), using drugs in Vancouver’s drug scene epicentre (aHR: 2.15 95%CI: 1.49–3.10), homelessness (aHR: 1.43, 95%CI: 1.01–2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36–3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03–6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city’s open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.


Methamphetamine Injection drug use Risk behavior Initiation HIV 



We would particularly like to thank the VIDUS participants for their willingness to be included in the study as well as current and past VIDUS investigators and staff. We would specifically like to thank Dr. Thomas Patterson, Deborah Graham, Peter Vann, Caitlin Johnston, Steve Kain, and Calvin Lai for their research and administrative assistance. This work was supported by the US National Institutes of Health (NIH) [R01 DA011591] and the Canadian Institutes of Health Research (CIHR) [RAA-79918]. Thomas Kerr is supported by the Michael Smith Foundation for Health Research (MSFHR) and the CIHR. Brandon Marshall is supported by senior graduate trainee awards from MSFHR and CIHR.


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Copyright information

© Society for Prevention Research 2011

Authors and Affiliations

  • Brandon DL. Marshall
    • 1
    • 2
  • Evan Wood
    • 1
    • 3
  • Jean A. Shoveller
    • 2
  • Jane A. Buxton
    • 2
    • 4
  • Julio SG. Montaner
    • 1
    • 3
  • Thomas Kerr
    • 1
    • 3
  1. 1.British Columbia Centre for Excellence in HIV/AIDSSt. Paul’s HospitalVancouverCanada
  2. 2.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  3. 3.Department of MedicineUniversity of British Columbia, St. Paul’s HospitalVancouverCanada
  4. 4.Division of EpidemiologyBritish Columbia Centre for Disease ControlVancouverCanada

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