AIDS and Behavior

, Volume 5, Issue 4, pp 379–386 | Cite as

Impact of Needle Exchange Programs on Adolescent Perceptions About Illicit Drug Use

  • Melissa A. Marx
  • Heena Brahmbhatt
  • Peter Beilenson
  • Ronald S. Brookmeyer
  • Steffanie A. Strathdee
  • Cheryl Alexander
  • David Vlahov
Article

Abstract

The objective of this study was to examine the association between adolescent exposure to and understanding of needle exchange programs (NEPs) and their perceptions of the impact of NEP on the decision to use illicit drugs. From November 1998 to February 1999, 9th and 10th grade students from 4 Baltimore City high schools completed surveys reporting perceptions of the effect of NEP and other factors on adolescents' decisions regarding illicit drug use. The perceived effect of NEP was compared to that of other factors, using the Wilcoxon signed rank test. The impact of seeing drug users attend NEPs on adolescents' decisions to use drugs was modeled using multiple linear regression. Among 1,110 students, 88% were African American, 58% were female, and the mean age was 15 years. The percentage of students who thought the specified factors promoted drug use follows: peer drug use, 49.9%; parents drug use, 43.5%; seeing drug users attend NEP, 11.1%; school drug education, 6.6%; and anti-drug TV advertisements, 6.1%. The percentage viewing these factors as having no influence on illicit drug use was 21.7, 19.1, 42.4, 36.9, and 29.8% respectively. Students of African American race, female gender, and those with medium/high knowledge about NEP were significantly less likely to consider NEP a promoter of drug use. These data suggest that the influence of NEPs on promoting illicit drug use among adolescents appears to be neutral compared to other factors known to be influential to this population group.

HIV prevention needle exchange substance abuse substance abuse prevention adolescent health 

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REFERENCES

  1. American Psychiatric Association. (1996). Policy statement on needle exchange programs. American Journal of Psychiatry, 153, 1660.Google Scholar
  2. Bauman, K., and Ennett, S. (1994). Peer influence on adolescent drug use. American Psychologist, 49, 820–822.Google Scholar
  3. Bauman, K., and Ennett, S. (1996). On the importance of peer influence for adolescent drug use: Commonly neglected considerations. Addiction, 91, 185–198.Google Scholar
  4. Bluthenthal, R. N., Kral, A. H., Gee, L., Erringer, E. A., and Edlin, B. R. (2000). The effect of syringe exchange use on high-risk injection drug users: A cohort study. AIDS, 14, 605–611.Google Scholar
  5. Brooner, R., Kidorf, M., King, V., Beilenson, P., Svikis, D., and Vlahov,D. (1998). Drug abuse treatment success among needle exchange participants. Public Health Reports, 113, 129–139.Google Scholar
  6. Bruneau, J., Lamothe, F., Franco, E., Lachance, N., Desy, M., Soto, J., and Vincelette, J. (1997). High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: Results of a cohort study. American Journal of Epidemiology, 146, 994–1002.Google Scholar
  7. Caudill, B. D., Hoffman, J. A., Hubbard, R. L., Flynn, P. M., and Luckey, J. W. (1994). Parental history of substance abuse as a risk factor in predicting crack smokers' substance use, illegal activities, and psychiatric status. American Journal of Drug and Alcohol Abuse, 20, 341–354.Google Scholar
  8. CDC. (1998). HIV/AIDS Surveillance Report. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  9. Chassin, L., Presson, C., Sherman, S., Montello, D., and McGrew, J. (1986). Changes in peer and parent influence during adolescence: Longitudinal versus cross-sectional perspectives on smoking initiation. Developmental Psychology, 22, 327–334.Google Scholar
  10. Des Jarlais, D. C., Marmor, M., Paone, D., Titus, S., Shi, Q., Perlis, T., Jose, B., and Friedman, S. R. (1996). HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet, 348, 987–991.Google Scholar
  11. Doherty, M., Garfein, R., Vlahov, D., Junge, B., Rathouz, P., Galai, N., Anthony, J., and Beilenson, P. (1997). Discarded needles do not increase soon after the opening of a needle exchange program. American Journal of Epidemiology, 145, 730–737.Google Scholar
  12. Doherty, M. C., Junge, B., Rathouz, P., Garfein, R. S., Riley, E., and Vlahov, D. (2000). The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up. American Journal of Public Health, 90, 936–939.Google Scholar
  13. Drucker, E., Lurie, P., Wodak, A., and Alcabes, P. (1998). Measuring harm reduction: The effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV. AIDS, 12, S217-S230.Google Scholar
  14. Fisk, S. N. (1998). The Association of Nurses in AIDS Care. Position paper on harm reduction and HIV care for drug users: Integrating harm-reduction methods and HIV care. Journal of the Association of Nurses AIDS Care, 9, 19–24.Google Scholar
  15. Friedman, S. R., Curtis, R., Jose, B., Flom, P. L., Neaigus, A., and Des Jarlais, D. C. (1999). The message not heard: Myth and reality in discussions about syringe exchange. AIDS, 13, 738–739.Google Scholar
  16. Goodlatte, R., Armey, R., and Tiahrt, T. (1999). Send the right message to our children: Just say NO to free needles for drug addicts! Letter: Congress of the United States of America.Google Scholar
  17. Gutierres, S. E., Molof, M., and Ungerleider, S. (1994). Relationship of “risk” factors to teen substance use: A comparison of abstainers, infrequent users, and frequent users. The International Journal of Addictions, 29, 1559–1579.Google Scholar
  18. Guydish, J., Bucardo, J., Clark, G., and Bernheim, S. (1998). Evaluating needle exchange: A description of client characteristics, health status, program utilization, and HIV risk behavior. Substance Use and Misuse, 33, 1173–1196.Google Scholar
  19. Guydish, J., Bucardo, J., Young, M., Woods, W., Grinstead, O., and Clark, W. (1993). Evaluating needle exchange: Are there negative effects? AIDS, 7, 871–876.Google Scholar
  20. Hagan, H., McGough, J. P., Thiede, H., Weiss, N. S., Hopkins, S., and Alexander, E. R. (1999). Syringe exchange and risk of infection with hepatitis B and C viruses. American Journal of Epidemiology, 149, 203–213.Google Scholar
  21. Hahn, J. A., Vranizan, K. M., and Moss, A. R. (1997). Who uses needle exchange?A study of injection drug users in treatment in San Francisco, 1989-1990. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 15, 157–164.Google Scholar
  22. Hart, G. J., Carvell, A. L., Woodward, N., Johnson, A. M., Williams, P., and Parry, J. V. (1989). Evaluation of needle exchange in central London: Behaviour change and anti-HIV status over one year. AIDS, 3, 261–265.Google Scholar
  23. Hartgers, C., van Ameijden, E. J., van den Hoek, J. A., and Coutinho, R. A. (1992). Needle sharing and participation in the Amsterdam Syringe Exchange program among HIV-seronegative injecting drug users. Public Health Reports, 107, 675–681.Google Scholar
  24. Hawkins, J. D., Catalano, R. F., and Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64–105.Google Scholar
  25. Hawkins, J. D., Lishner, D. M., and Catalano, R. F. (1985). Childhood predictors and the prevention of adolescent substance abuse. National Institute on Drug Abuse: Research Monograph Series, 56, 75–126.Google Scholar
  26. Health and Human Service Department. (1996). National admissions to substance abuse treatment services, the treatment episode data set (TEDS). Substance Abuse and Mental Health Services Administration (SAMHA), Office of Applied Studies.Google Scholar
  27. Heimer, R. (1998). Can syringe exchange serve as a conduit to substance abuse treatment? Journal of Substance Abuse Treatment, 15, 183–191.Google Scholar
  28. Heimer, R., Kaplan, E. H., Khoshnood, K., Jariwala, B., and Cadman, E. C. (1993). Needle exchange decreases the prevalence of HIV-1 proviral DNA in returned syringes in New Haven, Connecticut. American Journal of Medicine, 95, 214–220.Google Scholar
  29. Hurley, S. F., Jolley, D. J., and Kaldor, J. M. (1997). Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet, 349, 1797–1800.Google Scholar
  30. Lopez, J., Redondo, L., and Martin, A. (1989). Influence of family and peer group on use of drugs by adolescents. The International Journal of the Addictions, 24, 1065–1082.Google Scholar
  31. Marx, M. A., Crape, B., Brookmeyer, R. S., Junge, B., Latkin, C., Vlahov, D., and Strathdee, S. A. (2000). Trends in crime and the introduction of a needle exchange program. American Journal of Public Health, 90, 1933–1936.Google Scholar
  32. Mirzaee, E., Kingery, P. M., Pruitt, B. E., Heuberger, G., and Hurley, R. S. (1991). Sources of drug information among adolescent students. Journal of Drug Education, 21, 95–106.Google Scholar
  33. National Institutes of Health. (1997). Interventions to prevent HIV risk behaviors, National Institutes of Health Consens Statement, 15, 1–41.Google Scholar
  34. Paone, D., Des Jarlais, D. C., Gangloff, R., Milliken, J., and Friedman, S. R. (1995). Syringe exchange: HIV prevention, key findings, and future directions. The International Journal of Addictions, 30, 1647–1683.Google Scholar
  35. Paone, D., Des Jarlais, D. C., and Shi, Q. (1998). Syringe exchange use and HIV risk reduction over time. AIDS, 12, 121–123.Google Scholar
  36. Peak, A., Rana, S., Maharjan, S. H., Jolley, D., and Crofts, N. (1995). Declining risk for HIV among injecting drug users in Kathmandu, Nepal: The impact of a harm-reduction programme. AIDS, 9, 1067–1070.Google Scholar
  37. Public Health Service of the United States. (1997). HIV prevention bulletin: Medical advice for persons who inject illicit drugs. Rockville, MD: CDC National AIDS Clearinghouse.Google Scholar
  38. Quinn, S. C. (1999). Public attitudes towards needle exchange programs. AIDS, 13, 1428–1429.Google Scholar
  39. Rogers, D. E., and Osborn, J. E. (1993). AIDS policy. Two divisive issues. JAMA, 270, 494–495.Google Scholar
  40. Schechter, M. T., Strathdee, S. A., Cornelisse, P. G., Currie, S., Patrick, D. M., Rekart, M. L., and O'shaughnessy, M. V. (1999). Do needle exchange programmes increase the spread of HIV among injection drug users?: An investigation of the Vancouver outbreak. AIDS, 13, F45-F51.Google Scholar
  41. Schoenbaum, E. E., Hartel, D. M., and Gourevitch, M. N. (1996). Needle exchange use among a cohort of injecting drug users. AIDS, 10, 1729–1734.Google Scholar
  42. Strathdee, S., Celentano, D., Shah, N., Lyles, C., Stambolis, V., Macalino, G., Nelson, K., and Vlahov, D. V. (1999). Needle exchange attendance and health care utilization promote entry into detoxification. Journal of Urban Health, 76, 448–460.Google Scholar
  43. Strathdee, S. A., Patrick, D. M., Currie, S. L., Cornelisse, P. G., Rekart, M. L., Montaner, J. S., Schechter, M. T., and O'shaughnessy, M. V. (1997). Needle exchange is not enough: Lessons from the Vancouver injecting drug use study. AIDS, 11, F59-F65.Google Scholar
  44. Sussman, S., Dent, C. W., Stacy, A. W., and Craig, S. (1998). One year outcomes of project towards no drug abuse. Preventive Medicine, 27, 632–642.Google Scholar
  45. Swadi, H., and Zeitlin, H. (1988). Peer influence and adolescent substance abuse: A promising side? British Journal of Addiction, 83, 153–157.Google Scholar
  46. Swadi, H. S. (1988). Adolescent drug taking: Role of family and peers. Drug Alcohol Dependence, 21, 157–160.Google Scholar
  47. Thomas, S. B., and Quinn, S. C. (1993). The burdens of race and history on Black Americans' attitudes toward needle exchange policy to prevent HIV disease. Journal of Public Health Policy, 14, 320–347.Google Scholar
  48. U.S. Census Bureau. (1997). 1990 Census: 1997 update. Retrieved from http://www.census.gov/population/estimates/country/co-97-1/97C1 24Google Scholar
  49. van Ameijden, E., van den Hoek, J., Mientjes, F., and Coutinho, R. (1993). A longitudinal study on the incidence and transmission patterns of HIV, HBV, and HCV infection among drug users in Amsterdam. European Journal of Epidemiology, 9, 255–262.Google Scholar
  50. Vertefeuille, J., Marx, M. A., Tun, W., Huettner, S., Strathdee, S. A., and Vlahov, D. (2000). Decline in self-reported high risk injection-related behaviors among HIV seropositive participants in the Baltimore Needle Exchange program. AIDS and Behavior, 4, 381–388.Google Scholar
  51. Vlahov, D., Flynn, C., Brookmeyer, R., Junge, B., Safaeian, M., Beilenson, P., and Nelson, K. E. (1998, June 28-July 3). Lower risk of HIV infection with continued regular participation in needle exchange program. Paper presented at the 12th World AIDS Conference, Geneva.Google Scholar
  52. Vlahov, D., Junge, B., Brookmeyer, R., Cohn, S., Riley, E., Armenian, H., and Beilenson, P. (1997). Reductions in highrisk drug use behaviors among participants in the Baltimore needle exchange program. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 16, 400–406.Google Scholar
  53. Vlahov, D., Munoz, A., Anthony, J. C., Cohn, S., Celentano, D. D., and Nelson, K. E. (1990). Association of drug injection patterns with antibody to human immunodeficiency virus type 1 among intravenous drug users in Baltimore, Maryland. American Journal of Epidemiology, 132, 847–856.Google Scholar
  54. Watters, J. K., Estilo, M. J., Clark, G. L., and Lorvick, J. (1994). Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA, 271, 115–120.Google Scholar
  55. Westerholm, B. (1998). Needle exchange programs: An international report shows reduced transmission of HIV infections. Lakartidningen, 95(7), 614–615.Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Melissa A. Marx
    • 1
  • Heena Brahmbhatt
    • 2
  • Peter Beilenson
    • 3
  • Ronald S. Brookmeyer
    • 4
  • Steffanie A. Strathdee
    • 1
  • Cheryl Alexander
    • 2
  • David Vlahov
    • 1
    • 5
  1. 1.Department of EpidemiologyJohns Hopkins School of Hygiene and Public HealthBaltimore
  2. 2.Department of Population and Family Health SciencesJohns Hopkins School of Hygiene and Public HealthBaltimore
  3. 3.Baltimore City Department of HealthBaltimore
  4. 4.Department of BiostatisticJohns Hopkins School of Hygiene and Public HealthBaltimore
  5. 5.Center for Urban Epidemiological StudiesNew York Academy of MedicineNew York

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