Using geographic information systems to assess spatial patterns of drug use, selection bias and attrition among a sample of injection drug users

This study sought to assess whether frequency and type of drug use are geographically located within the city of Baltimore independent of neighborhood characteristics. The second goal was to assess geographic factors associated with sample selection and attrition. The sample consisted of 597 inner-city injection drug users who were enrolled in a HIV prevention study. The residential locations were plotted using Geographic Information Systems (GIS) software. Three patterns of drug use in the prior 6 months were examined: daily use of injection heroin, daily use of injection cocaine and any use of crack cocaine. Daily use of cocaine and any use of crack were found to be statistically associated with residing in the western portion of the city and distance from the western district sexually transmitted disease clinic. After adjusting for individual level characteristics and neighborhood level variables, as measured by 1990 census tract data, daily use of cocaine was found to be associated with residing in a more southern area of the city and distance from the western district sexually transmitted disease clinic, and any crack use was found to be associated with residing in a more western area of the city and distance from the western district sexually transmitted disease clinic. Men and younger participants were more likely to reside further away from the study clinic as were individuals who dropped out of the intervention condition. The results of this study suggest that type and frequency of drug use is associated with specific geographic areas, independent of neighborhood characteristics. These results have implications for the location of drug prevention, needle exchange and other HIV prevention activities.