Galea Sandro, Ahern Jennifer, Vlahov David
Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029-5283, USA.
J Urban Health. 2003 Dec;80(4 Suppl 3):iii50-8. doi: 10.1093/jurban/jtg082.
Over the past two decades, public health research has emphasized the role of individual risk behaviors, primarily injection and sexual risk behaviors, in the spread of HIV infection. Much less emphasis has been given to understanding the determinants of these risk behaviors. Although individual characteristics are partly responsible for risky injection and sexual behaviors, they do not explain all the interpersonal variability in risk behavior. Contextual factors associated with HIV risk behavior may include structural factors (e.g., availability of services), social norms and attitudes (e.g., social trust), disadvantage (e.g., neighborhood socioeconomic status), and features of the physical environment (e.g., housing quality). This article presents a conceptual framework that incorporates some of the key contextual domains that may affect drug use behavior. It also presents data from a study of street-recruited drug users as an example of the relations between social contextual factors and frequency of injecting drug use, and discusses some methodological challenges in the study of contextual determinants of drug use behavior.
在过去二十年中，公共卫生研究强调了个人风险行为，主要是注射和性风险行为，在艾滋病毒感染传播中的作用。对于理解这些风险行为的决定因素则关注较少。虽然个人特征在一定程度上导致了危险的注射和性行为，但它们并不能解释风险行为在人际间的所有差异。与艾滋病毒风险行为相关的背景因素可能包括结构因素（如服务的可及性）、社会规范和态度（如社会信任）、不利条件（如社区社会经济地位）以及物理环境特征（如住房质量）。本文提出了一个概念框架，纳入了一些可能影响药物使用行为的关键背景领域。它还展示了一项针对街头招募的吸毒者的研究数据，以此为例说明社会背景因素与注射吸毒频率之间的关系，并讨论了在研究药物使用行为的背景决定因素时面临的一些方法学挑战。
