A Cross-Sectional Analysis of the Association Between Houselessness Among People Who Inject Drugs and Using Syringe Service Programs in the Rural United States Open Access

Abstract

Background: Multiple studies conducted in urban areas have found that houselessness among people who inject drugs (PWID) reduces access to and utilization of health and harm reduction care services, including syringe service programs (SSPs). Given that both drug-related epidemics and houselessness are rising in rural areas, the present study seeks to extend this vital line of urban research about their inter-relationships to rural areas.

Methods: PWID (N=2587) in 8 rural sites across the United States took part in cross-sectional surveys that queried self-reported drug use, houselessness status over the past 6 months, SSP utilization over the past 30 days, and sociodemographic characteristics. We used multivariable logistic models to regress houselessness on SSP program use. We next limited the sample to the 933 PWID who had used an SSP in the previous month, and used a polytomous multivariable model to regress houselessness on the frequency of SSP use in the past month.

Results: The odds of SSP use were greater for those who experience houselessness than for those who do not (aOR = 1.27 [95% C.I. = 1.04, 1.55]). We found, however, that the odds of visiting an SSP weekly or more than weekly were lower (aOR = .55 [95% C.I. = .32, .94] ,aOR = .74 [95% C.I. = .46, 1.18], respectively) among PWID experiencing houselessness.

Conclusion: In this large sample of rural PWID, we found that experiencing houselessness is associated higher odds of using an SSP but with lower odds of frequent SSP use. PWID who experience houselessness are not receiving the same level of care from SSPs, since it is important to access naloxone, syringes, and the other services offered as often as possible.

Table of Contents

1.    Introduction………………………………………………..1

2.    Methods……………………………………………………3

3.    Results……………………………………………………..8

4.    Discussion…………………………………………………10

5.    Table 1a……………………………………………………18

6.    Table 1b……………………………………………………19

7.    Table 2……………………………………………………..20

8.    References………………………………………………….21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Social Epidemiology Health Care Access Regression Houselessness Syringe Exchange Rural Opioid Use Disorder Harm Reduction
Committee Chair / Thesis Advisor	Hannah Cooper, Emory University

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