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Racialized environments and syringe services program implementation: County-level factors.

Ricky N Bluthenthal1, Jamie L Humphrey2, Claire N Strack2

  • 1Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

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|August 31, 2024
PubMed
Summary

Racialized environments influence the presence of syringe service programs (SSPs), but not their distribution scope. Addressing community factors is key to preventing substance use harms and improving access to vital harm reduction services.

Keywords:
Dissimilarity indexDivergence indexHarm reduction servicesNaloxone distributionNational studyOverdose mortalityPolitical determinants of healthRacial residential segregationRacialized environmentsSyringe distributionSyringe service programs

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Area of Science:

  • Public Health
  • Health Equity
  • Substance Use Research

Background:

  • Racialized health inequities in substance use-related harms may stem from unequal access to syringe service programs (SSPs).
  • Understanding the link between racialized environments and SSP access is crucial for addressing these disparities.

Purpose of the Study:

  • To examine the association between county-level racialized environments and the presence of SSPs.
  • To investigate factors associated with per capita syringe and naloxone distribution by SSPs.
  • To explore how racial residential segregation impacts SSP implementation and service scope.

Main Methods:

  • Utilized 2021 US National Survey of SSP data, including SSP presence and distribution volumes (syringes, naloxone) in 2020 by county.
  • Measured racial residential segregation (RRS) using divergence and dissimilarity indexes for Black:Non-Hispanic White and Hispanic:Non-Hispanic White comparisons.
  • Employed logistic Generalized Estimating Equations and zero-inflated negative binomial regression models to analyze associations with SSP presence and distribution.

Main Results:

  • SSPs were present in 9% of US counties, associated with higher RRS, urban/suburban settings, higher opioid overdose mortality, and lower Republican vote share.
  • Per capita syringe distribution correlated with lower RRS, smaller proportions of racialized minority populations, and rural counties.
  • Per capita naloxone distribution was linked to lower proportions of Hispanic and "other" populations, and rural counties.

Conclusions:

  • Racialized environments are associated with the presence of SSPs, but not the scale of their operations.
  • Effective prevention of HIV, HCV, and overdose deaths necessitates addressing community-level determinants of SSP implementation and accessibility.
  • Equitable access to harm reduction services requires targeted strategies that consider the influence of racialized environments.