Journal of Urban Health

, Volume 95, Issue 1, pp 83–90 | Cite as

Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico

  • Amen Ben Hamida
  • Claudia Rafful
  • Sonia Jain
  • Shelly Sun
  • Patricia Gonzalez-Zuniga
  • Gudelia Rangel
  • Steffanie A. Strathdee
  • Dan Werb


Although most people who inject drugs (PWID) report receiving assistance during injection initiation events, little research has focused on risk factors among PWID for providing injection initiation assistance. We therefore sought to determine the influence of non-injection drug use among PWID on their risk to initiate others. We used generalized estimating equation (GEE) models on longitudinal data among a prospective cohort of PWID in Tijuana, Mexico (Proyecto El Cuete IV), while controlling for potential confounders. At baseline, 534 participants provided data on injection initiation assistance. Overall, 14% reported ever initiating others, with 4% reporting this behavior recently (i.e., in the past 6 months). In a multivariable GEE model, recent non-injection drug use was independently associated with providing injection initiation assistance (adjusted odds ratio [AOR] = 2.42, 95% confidence interval [CI] = 1.39–4.20). Further, in subanalyses examining specific drug types, recent non-injection use of cocaine (AOR = 9.31, 95% CI = 3.98–21.78), heroin (AOR = 4.00, 95% CI = 1.88–8.54), and methamphetamine (AOR = 2.03, 95% CI = 1.16–3.55) were all significantly associated with reporting providing injection initiation assistance. Our findings may have important implications for the development of interventional approaches to reduce injection initiation and related harms. Further research is needed to validate findings and inform future approaches to preventing entry into drug injecting.


Injection initiation Injection drug use People who inject drugs Non-injection drug use Tijuana Border health Prevention 



Dan Werb is supported by a grant to the PRIMER study from the National Institute on Drug Abuse (NIDA DP2-DA040256-01) and by the Canadian Institutes of Health Research via a New Investigator Award. El Cuete IV is also supported by NIDA via a MERIT Award (R37 DA019829). C. Rafful was supported by a UC-MEXUS/CONACyT scholarship grant number 209407/313533, the UC MEXUS Dissertation grant number DI 15-42, and R25 DA026401.


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Copyright information

© The New York Academy of Medicine 2017

Authors and Affiliations

  • Amen Ben Hamida
    • 1
    • 2
  • Claudia Rafful
    • 1
    • 2
  • Sonia Jain
    • 3
  • Shelly Sun
    • 3
  • Patricia Gonzalez-Zuniga
    • 1
  • Gudelia Rangel
    • 4
    • 5
  • Steffanie A. Strathdee
    • 1
  • Dan Werb
    • 1
    • 6
    • 7
  1. 1.Division of Global Public HealthUniversity of California San DiegoSan DiegoUSA
  2. 2.Graduate School of Public HealthSan Diego State UniversitySan DiegoUSA
  3. 3.Department of Family Medicine and Public Health, Biostatistics Research CenterUniversity of California San DiegoSan DiegoUSA
  4. 4.Secretariat of HealthMexico CityMexico
  5. 5.Mexico-United States Border Health CommissionEl PasoUSA
  6. 6.Centre for Urban Health Solutions, St. Michael’s HospitalTorontoCanada
  7. 7.University of California School of MedicineLa JollaUSA

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