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Author Notes:

Correspondence should be sent to Hannah Cooper, Dept of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Rd NE, Room 526, Atlanta, GA, 30322 (e-mail: hcoope3@sph.emory.edu). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints/Eprints” link.

Peer Reviewed

Contributors H. L. F. Cooper conceptualized and conducted all statistical analyses and was the primary author of the article. D. C. Des Jarlais and S. R. Friedman conducted the risk factors study, which provided all individual-level data for the analyses. D. C. Des Jarlais, B. Tempalski, and S. R. Friedman, helped to conceptualize the analyses and to write the article. Z. Ross created all measures of spatial access to syringe exchange programs and to over the counter pharmacies. B. Bossak created all other district-level measures.


Research Funding:

This research was supported by the National Institute on Drug Abuse (grants 5R21DA023391, 5R01DA013336, and 5R01DA003574).

Spatial Access to Syringe Exchange Programs and Pharmacies Selling Over-the-Counter Syringes as Predictors of Drug Injectors' Use of Sterile Syringes


Journal Title:

American Journal of Public Health


Volume 101, Number 6


, Pages 1118-1125

Type of Work:

Article | Post-print: After Peer Review


Objectives. We examined relationships of spatial access to syringe exchange programs (SEPs) and pharmacies selling over-the-counter (OTC) syringes with New York City drug injectors’ harm reduction practices. Methods. Each year from 1995 to 2006, we measured the percentage of 42 city health districts’ surface area that was within 1 mile of an SEP or OTC pharmacy. We applied hierarchical generalized linear models to investigate relationships between these exposures and the odds that injectors (n = 4003) used a sterile syringe for at least 75% of injections in the past 6 months. Results. A 1-unit increase in the natural log of the percentage of a district's surface area within a mile of an SEP in 1995 was associated with a 26% increase in the odds of injecting with a sterile syringe; a 1-unit increase in this exposure over time increased these odds 23%. A 1-unit increase in the natural log of OTC pharmacy access improved these odds 15%. Conclusions. Greater spatial access to SEPs and OTC pharmacies improved injectors’ capacity to engage in harm reduction practices that reduce HIV and HCV transmission.

Copyright information:

© American Public Health Association 2011

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