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COMPETING RISKS: THE ROLE OF THE PERCEIVED CONSEQUENCES OF REFUSING TO SHARE INJECTION EQUIPMENT AMONG INJECTION DRUG USERS by Karla Dawn Wagner A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (PREVENTIVE MEDICINE: HEALTH BEHAVIOR) December 2009 Copyright 2009 Karla Dawn Wagner
|Title||Competing risks: the role of the perceived consequences of refusing to share injection equipment among injection drug users|
|Author||Wagner, Karla Dawn|
|Author firstname.lastname@example.org; email@example.com|
|Degree||Doctor of Philosophy|
|Degree program||Preventive Medicine (Health Behavior)|
|School||Keck School of Medicine|
|Advisor (committee chair)||
Unger, Jennifer B.
Richardson, Jean L.
|Advisor (committee member)||
Lankenau, Stephen E.
Palinkas, Lawrence A.
|Abstract||Background: Injection drug users (IDUs) are at risk for HIV and other bloodborne pathogens. Though reductions in injection risk behavior have been observed, residual risk behavior persists. Female IDUs are at elevated risk compared to their male counterparts, and this elevated risk appears to be grounded in the social and environmental context. The perceived consequences of refusing to share injection equipment have yet to be investigated as a factor that may help explain persistent injection risk behavior.; Methods: The current study used a two-phase, mixed-methods design to identify the perceived consequences of refusing to share injection equipment, assess the relationship between perceived consequences and injection risk behavior, and explore whether perceived consequences moderate the effects of other correlates of injection risk behavior in a sample of IDUs recruited from a large syringe exchange program. In addition, the study assessed gender differences in the both the qualitative and quantitative data.; Results: Findings from the qualitative analysis suggest that perceived consequences of refusing to share can be organized into four domains: individual, social, physical, and economic/policy. Gender differences were particularly evident in the social domain. Findings from the first quantitative analysis suggest that the consequences can be assessed using two sub-scales: perceived social/internal and structural/external consequences. In multiple linear regression perceived social/internal consequences were associated with greater frequency of reported injection risk behavior, even when controlling for other correlates of injection risk behavior. The perceived structural/external consequences were not associated with injection risk behavior. Few gender differences emerged in the quantitative results. Findings from the second quantitative analysis suggested that perceived consequences moderated the association between peer norms and injection risk behavior, and also moderated the associations amongst other correlates of injection risk behavior. Moderation results suggest that the associations between some theoretical correlates of behavior may be stronger in individuals who report greater influence of perceived consequences.; Conclusion: Assessing the perceived consequences of refusing to share injection equipment may help explain some residual injection risk behavior. Addressing the individual, social, physical, and economic/policy-level consequences of safer behavior may help IDUs reduce injection risk behavior.|
|Keyword||injection drug use; HIV; hepatitis C virus; mixed-methods; qualitative methods; structural equation modeling; cognitive behavioral theory|
|Part of collection||University of Southern California dissertations and theses|
|Publisher (of the original version)||University of Southern California|
|Place of publication (of the original version)||Los Angeles, California|
|Publisher (of the digital version)||University of Southern California. Libraries|
|Provenance||Electronically uploaded by the author|
|Legacy record ID||usctheses-m2652|
|Rights||Wagner, Karla Dawn|
|Repository name||Libraries, University of Southern California|
|Repository address||Los Angeles, California|
|Full text||COMPETING RISKS: THE ROLE OF THE PERCEIVED CONSEQUENCES OF REFUSING TO SHARE INJECTION EQUIPMENT AMONG INJECTION DRUG USERS by Karla Dawn Wagner A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (PREVENTIVE MEDICINE: HEALTH BEHAVIOR) December 2009 Copyright 2009 Karla Dawn Wagner|