Health behaviors of young adult heroin injectors in the Seattle area.
Abstract
Background Recent indicators point to substantial increases in the number of young heroin users across much of the United States as well as across Washington State. This study characterizes this younger generation of heroin injectors in order to inform public health responses.Methods A cross-sectional analysis was conducted using street-intercept surveys at King County, WA syringe exchange programs in 2013. Survey responses were restricted to heroin injectors (n=389) and then categorized by the participant's age (<30 and ≥30) for a descriptive epidemiological analysis. A manual stepwise logistic regression tested the independent relationship of user characteristics with being under the age of 30.Results In regression analyses, adjusting for other characteristics, young adults were significantly (p<0.05) more likely to: re-use syringes 2-4 times (OR=2.28 compared to those who used a syringe once), share syringes (OR=2.92), report they were "hooked on" prescription-type opioids prior to using heroin (OR=2.54), have had a sexual partner in the prior year (opposite sex OR=7.37, same sex OR=23.29, both genders OR=22.04), and report powder cocaine use in the prior 3 months (OR=2.49) compared to those ages 30 and older. Young adults were significantly less likely to report using pain medicines (OR=0.33), having an abscess in the prior year (OR=0.33) or having tested positive for hepatitis C (OR=0.22) than older adults adjusting for other variables.Conclusions Younger heroin injectors engage in risky injection practices more than older heroin injectors. Along with other significant differences, these findings have implications for outreach programs and medical care for younger heroin injectors.
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(1990) · Choice Reviews Online · doi:10.5860/choice.27-3338 · Cited by 35,305 · see citing works
Hosmer, D. W., & Lemeshow, S. (2000) · doi:10.1002/0471722146 · Cited by 20,302 · see citing works
The Changing Face of Heroin Use in the United States
Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.366 · Cited by 1,169 · see citing works
Walley, A. Y., Xuan, Z., Hackman, H. H., Quinn, E., Doe-Simkins, M., Sorensen-Alawad, A., Ruiz, S., & Ozonoff, A. (2013) · BMJ · doi:10.1136/bmj.f174 · Cited by 999 · see citing works
Binswanger, I. A., Blatchford, P. J., Mueller, S. R., & Stern, M. F. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-9-201311050-00005 · Cited by 598 · see citing works
Jones, C. M. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.01.007 · Cited by 517 · see citing works
Sharing of drug preparation equipment as a risk factor for hepatitis C
Hagan, H., Thiede, H., Weiss, N. S., Hopkins, S. G., Duchin, J. S., & Alexander, E. R. (2001) · American Journal of Public Health · doi:10.2105/ajph.91.1.42 · Cited by 501 · see citing works
Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal
Coffin, P. O., & Sullivan, S. D. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-1-201301010-00003 · Cited by 347 · see citing works
Bacterial Infections in Drug Users
Gordon, R. J., & Lowy, F. D. (2005) · New England Journal of Medicine · doi:10.1056/nejmra042823 · Cited by 329 · see citing works
WODAK, A. D., & Cooney, A. (2006) · Substance Use & Misuse · doi:10.1080/10826080600669579 · Cited by 311 · see citing works
Acute risk of drug‐related death among newly released prisoners in England and Wales
Farrell, M., & Marsden, J. (2008) · Addiction · doi:10.1111/j.1360-0443.2007.02081.x · Cited by 298 · see citing works
Injection drug use and right sided endocarditis
Moss, R. M., & Munt, B. (2003) · Heart · doi:10.1136/heart.89.5.577 · Cited by 266 · see citing works
Assessment of the Trends in Medical Use and Misuse of Opioid Analgesics from 2004 to 2011
Atluri, S. L. (2014) · Pain Physician · doi:10.36076/ppj.2014/17/e119 · Cited by 220 · see citing works
Identifying Injection Drug Users at Risk of Nonfatal Overdose
Coffin, P. O., Tracy, M., Bucciarelli, A., Ompad, D. C., Vlahov, D., & Galea, S. (2007) · Academic Emergency Medicine · doi:10.1197/j.aem.2007.04.005 · Cited by 161 · see citing works
The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting?
Zabal, C., Attie, F., Rosas, M., Buendía-Hernández, A., & García-Montes, J. A. (2002) · Heart · doi:10.1136/heart.89.1.77 · Cited by 154 · see citing works
Problematic use of prescription-type opioids prior to heroin use among young heroin injectors
Pollini, R. A., Garfein, Banta‐Green, C. J., Cuevas-Mota, Metzner, & Teshale (2011) · Substance Abuse and Rehabilitation · doi:10.2147/sar.s24800 · Cited by 134 · see citing works
Self-citationPeavy, K. M., Banta‐Green, C. J., Kingston, S., Hanrahan, M. T., Merrill, J. O., & Coffin, P. O. (2012) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2012.704591 · Cited by 128 · see citing works
Self-citationKral, A. H., Lorvick, J., & Edlin, B. R. (2000) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/00126334-200006010-00011 · Cited by 105 · see citing works
Heroin overdose among young injection drug users in San Francisco
Ochoa, K. C., Davidson, P. J., Evans, J. L., Hahn, J. A., Page, K. A., & Moss, A. R. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.04.012 · Cited by 101 · see citing works
Trends and Geographic Patterns in Drug-Poisoning Death Rates in the U.S., 1999–2009
Rossen, L. M., Khan, D., & Warner, M. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2013.07.012 · Cited by 95 · see citing works
Bailey, S. L., Ouellet, L. J., Mackesy‐Amiti, M. E., Golub, E. T., Hagan, H., Hudson, S., Latka, M. H., Gao, W., & Garfein, R. S. (2007) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2007.02.014 · Cited by 86 · see citing works
Darke, S. G., Williamson, A., Ross, J. E., Mills, K. L., Havard, A., & Teesson, M. (2007) · Journal of Urban Health · doi:10.1007/s11524-006-9156-0 · Cited by 82 · see citing works
Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges
Jenkins, L. M., Banta‐Green, C. J., Maynard, C. C., Kingston, S., Hanrahan, M. T., Merrill, J. O., & Coffin, P. O. (2011) · Journal of Urban Health · doi:10.1007/s11524-010-9525-6 · Cited by 81 · see citing works
Self-citationStrang, J., Bird, S. M., & Parmar, M. (2013) · Journal of Urban Health · doi:10.1007/s11524-013-9803-1 · Cited by 79 · see citing works
Distributive syringe sharing among young adult injection drug users in five U.S. cities
Golub, E. T., Strathdee, S. A., Bailey, S. L., Hagan, H., Latka, M. H., Hudson, S., & Garfein, R. S. (2007) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2007.02.013 · Cited by 65 · see citing works
Thorpe, L. E., Bailey, S. L., Huo, D., Monterroso, E. R., & Ouellet, L. J. (2001) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/00126334-200105010-00012 · Cited by 56 · see citing works
Tassiopoulos, K., Bernstein, J., & Bernstein, E. (2013) · Addiction Science & Clinical Practice · doi:10.1186/1940-0640-8-20 · Cited by 25 · see citing works
Adolescent Abuse of Pharmaceutical Opioids Raises Questions About Prescribing and Prevention
Banta‐Green, C. J. (2012) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpediatrics.2012.590 · Cited by 5 · see citing works
Self-citationLópez‐Pelayo, H., Vallejo, M. V., & Solé, A. G. (2013) · Addiction Science & Clinical Practice · doi:10.1186/1940-0640-8-s1-a43 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Heroin and Methamphetamine Injection: An Emerging Drug Use Pattern
Al-Tayyib, A., Koester, S., Langegger, S., & Raville, L. (2017) · Substance Use & Misuse · doi:10.1080/10826084.2016.1271432 · Cited by 203 · see citing works
Increasing methamphetamine injection among non-MSM who inject drugs in King County, Washington
Glick, S. N., Burt, R. D., Kummer, K., Tinsley, J., Banta‐Green, C. J., & Golden, M. R. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.10.011 · Cited by 99 · see citing works
Self-citationFedick, P. W., Bills, B. J., Manicke, N. E., & Cooks, R. G. (2017) · Analytical Chemistry · doi:10.1021/acs.analchem.7b02798 · Cited by 89 · see citing works
Glick, S. N., Klein, K. S., Tinsley, J., & Golden, M. R. (2020) · American Journal on Addictions · doi:10.1111/ajad.13115 · Cited by 81 · see citing works
Principles of Harm Reduction for Young People Who Use Drugs
Kimmel, S. D., Gaeta, J. M., Hadland, S. E., Hallett, E., & Marshall, B. D. L. (2021) · PEDIATRICS · doi:10.1542/peds.2020-023523g · Cited by 74 · see citing works
Barocas, J. A., Yazdi, G. E., Savinkina, A. A., Nolen, S., Savitzky, C., Samet, J. H., Englander, H. L., & Linas, B. P. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1346 · Cited by 60 · see citing works
Winer, J. M., Yule, A. M., Hadland, S. E., & Bagley, S. M. (2022) · Annals of Medicine · doi:10.1080/07853890.2022.2104922 · Cited by 65 · see citing works
Geospatial Analysis of Drug Poisoning Deaths Involving Heroin in the USA, 2000–2014
Stewart, K., Cao, Y., Hsu, M. H., Artigiani, E., & Wish, E. D. (2017) · Journal of Urban Health · doi:10.1007/s11524-017-0177-7 · Cited by 52 · see citing works
Management of Opioid Misuse and Opioid Use Disorders Among Youth
Robinson, C. A., & Wilson, J. D. (2020) · PEDIATRICS · doi:10.1542/peds.2019-2056c · Cited by 48 · see citing works
Ivsins, A., Fleming, T., Barker, A., Mansoor, M., Thakarar, K., Sue, K. L., & McNeil, R. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2022.103791 · Cited by 46 · see citing works
Gunn, C. M., Maschke, A., Harris, M. T. H., Schoenberger, S. F., Sampath, S., Walley, A. Y., & Bagley, S. M. (2020) · Addiction · doi:10.1111/add.15305 · Cited by 34 · see citing works
Mackesy-Amiti, M. E., & Boodram, B. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2018.03.016 · Cited by 32 · see citing works
Jawa, R., Tin, Y., Nall, S. K., Calcaterra, S. L., Savinkina, A. A., Marks, L. R., Kimmel, S. D., Linas, B. P., & Barocas, J. A. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.7888 · Cited by 25 · see citing works
Economic Evaluation of Extended-Release Buprenorphine for Persons With Opioid Use Disorder
Flam-Ross, J. M., Marsh, E., Weitz, M., Savinkina, A., Schackman, B. R., Wang, J., Madushani, R. W. M. A., Morgan, J. R., Barocas, J. A., Walley, A. Y., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.29583 · Cited by 21 · see citing works
Sex work, injection drug use, and abscesses: Associations in women, but not men
Wurcel, A. G., Burke, D. J., Skeer, M. R., Landy, D. M., Heimer, R., Wong, J. B., Chui, K. K. H., & Stopka, T. J. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.12.028 · Cited by 21 · see citing works
Faryar, K. A., Freeman, C. L., Persaud, A. K., Furmanek, S. P., Guinn, B. E., Mattingly, W. A., Wiemken, T. L., Buckner, K., & Huecker, M. R. (2017) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2017.08.066 · Cited by 20 · see citing works
Adams, J. W., Savinkina, A. A., Hudspeth, J. C., Gai, M. J., Jawa, R., Marks, L. R., Linas, B. P., Hill, A., Flood, J., Kimmel, S. D., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.0541 · Cited by 15 · see citing works
Meylakhs, P. A., Friedman, S. R., Meylakhs, A. Y., Mateu‐Gelabert, P., Ompad, D. C., Alieva, A., & Dmitrieva, A. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02489-6 · Cited by 13 · see citing works
Uusküla, A., Raag, M., Marsh, K., Talu, A., Vorobjov, S., & Jarlais, D. D. (2017) · PLoS ONE · doi:10.1371/journal.pone.0170956 · Cited by 12 · see citing works
Savinkina, A. A., Madushani, R. W. M. A., Yazdi, G. E., Wang, J., Barocas, J. A., Morgan, J. R., Assoumou, S. A., Walley, A. Y., Linas, B. P., & Murphy, S. M. (2022) · Addiction · doi:10.1111/add.15879 · Cited by 12 · see citing works
Zinsli, K. A., Banta‐Green, C. J., Whiteside, L., Hood, J. E., Kingston, S., Tinsley, J., Moreno, C., & Glick, S. N. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.104272 · Cited by 10 · see citing works
Self-citationKlein, K. S., Glick, S. N., & Mauro, P. M. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108121 · Cited by 9 · see citing works
Opioid Use Disorders and Offending Patterns Among Local Jail Inmates
Raggio, A. L., Kopak, A. M., & Hoffmann, N. G. (2017) · Corrections · doi:10.1080/23774657.2017.1310003 · Cited by 7 · see citing works
Harm reduction interventions for AYA who use opioids: A scoping review
Noyes, E. A., Hausman, E. S., Yeo, E. J., Bain, P. A., Bannister, M. H., Lopez, I. B., Rajakumar, B., Wang, G., & Chatterjee, A. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112677 · Cited by 6 · see citing works
Shealey, J., Hall, E. W., Pigott, T., & Bradley, H. M. (2022) · medRxiv · doi:10.1101/2022.02.18.22271192 · Cited by 5 · see citing works
Health and Economic Outcomes of Addressing Encampments of Individuals Using Opioids
Zwick, H. C., O’Dea, R., Barocas, J. A., Flam-Ross, J. M., Chatterjee, A., Walley, A. Y., Harris, R. A., Schackman, B. R., White, L. F., Chrysanthopoulou, S. A., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.17095 · Cited by 7 · see citing works
Broady, T. R., Brener, L., Caruana, T., Cama, E. J., & Treloar, C. (2023) · Drug and Alcohol Review · doi:10.1111/dar.13606 · Cited by 4 · see citing works
Bakhshaie, J., Fishbein, N. S., Redmond, B., & Zvolensky, M. J. (2024) · Springer eBooks · doi:10.1007/978-981-97-0821-5_36-1 · Cited by 4 · see citing works
Archambault, L., Goyer, M.-È., Sabetti, J., & Perreault, M. (2022) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2022.2040007 · Cited by 3 · see citing works
Shealey, J., Hall, E. W., Pigott, T., Rosmarin, L., Carter, A., Cade, C., Luisi, N., & Bradley, H. M. (2024) · medRxiv · doi:10.1101/2024.08.14.24310813 · Cited by 3 · see citing works
Shakya, P., Jangra, J., Rao, R., Mishra, A. K., & Bhad, R. (2024) · Drug and Alcohol Review · doi:10.1111/dar.13890 · Cited by 2 · see citing works
Sherman, N. (2018) · Cureus · doi:10.7759/cureus.3332 · Cited by 2 · see citing works
Dhanda, A., O’Connor, S. S., McGuire, H., Knox, E., & Ruth, E. (2018) · American Journal on Addictions · doi:10.1111/ajad.12767 · Cited by 1 · see citing works
Kervran, C. (2019) · doi:10.70675/775165e4z1890z478az8729zd5d1975119b8
- Authors
- Cedarbaum, E. R., & Banta-Green, C. J.
- Affiliations
- University of Washington (US)
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 158
- Pages
- 102-109
- ISSN
- 0376-8716 (ISSN-L)
- OpenAlex
- W2175108478
- Cited by
- 34
- References
- 29
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 4 · 2022: 6 · 2021: 1 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 7
- FWCI
- 2.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- heroin injection, syringe reuse, needle sharing, prescription opioid use, sexual partners, cocaine use, hepatitis C, health behavior, needle exchange programs, age differences in drug use, Seattle
- MeSH terms
- Adolescent, Adult, Age Factors, Cross-Sectional Studies, Female, Heroin Dependence, Humans, Male, Surveys and Questionnaires, Syringes, Washington, Cohort Studies, Health Behavior, Substance Abuse, Intravenous, Needle-Exchange Programs, Young Adult, Self Report
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