Cooper Hannah L F, Bossak Brian, Tempalski Barbara, Des Jarlais Don C, Friedman Samuel R
Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road, NE, Room 568, Atlanta, GA 30322, USA.
Int J Drug Policy. 2009 May;20(3):217-26. doi: 10.1016/j.drugpo.2008.08.008. Epub 2008 Oct 28.
The concept of the "risk environment"--defined as the "space ... [where] factors exogenous to the individual interact to increase the chances of HIV transmission"--draws together the disciplines of public health and geography. Researchers have increasingly turned to geographic methods to quantify dimensions of the risk environment that are both structural and spatial (e.g., local poverty rates). The scientific power of the intersection between public health and geography, however, has yet to be fully mined. In particular, research on the risk environment has rarely applied geographic methods to create neighbourhood-based measures of syringe exchange programmes (SEPs) or of drug-related law enforcement activities, despite the fact that these interventions are widely conceptualized as structural and spatial in nature and are two of the most well-established dimensions of the risk environment. To strengthen research on the risk environment, this paper presents a way of using geographic methods to create neighbourhood-based measures of (1) access to SEP sites and (2) exposure to drug-related arrests, and then applies these methods to one setting (New York City [NYC]). NYC-based results identified substantial cross-neighbourhood variation in SEP site access and in exposure to drug-related arrest rates (even within the subset of neighbourhoods nominally experiencing the same drug-related police strategy). These geographic measures--grounded as they are in conceptualizations of SEPs and drug-related law enforcement strategies--can help develop new arenas of inquiry regarding the impact of these two dimensions of the risk environment on injectors' health, including exploring whether and how neighbourhood-level access to SEP sites and exposure to drug-related arrests shape a range of outcomes among local injectors.
“风险环境”的概念——被定义为“个体外部因素相互作用以增加艾滋病毒传播几率的空间”——将公共卫生和地理学这两个学科结合在一起。研究人员越来越多地转向地理方法,以量化风险环境中具有结构性和空间性的维度(例如当地贫困率)。然而,公共卫生与地理学交叉领域的科学力量尚未得到充分挖掘。特别是,尽管注射器交换计划(SEP)和与毒品相关的执法活动在本质上被广泛认为具有结构性和空间性,并且是风险环境中两个最成熟的维度,但关于风险环境的研究很少应用地理方法来创建基于社区的注射器交换计划或与毒品相关执法活动的衡量指标。为了加强对风险环境的研究,本文提出了一种利用地理方法创建基于社区的衡量指标的方法,用于衡量(1)SEP站点的可达性和(2)与毒品相关逮捕的暴露程度,然后将这些方法应用于一个环境(纽约市[NYC])。基于纽约市的结果表明,SEP站点可达性和与毒品相关逮捕率在不同社区之间存在显著差异(即使在名义上实施相同毒品相关警察策略的社区子集中也是如此)。这些基于SEP和与毒品相关执法策略概念化的地理衡量指标,有助于开拓关于风险环境的这两个维度对注射者健康影响的新研究领域,包括探索社区层面SEP站点的可达性以及与毒品相关逮捕的暴露程度是否以及如何影响当地注射者的一系列结果。