Social Capital and Beyond: A Qualitative Analysis of Social Contextual and Structural Influences on Drug-Use Related Health Behaviors
Kirst, Maritt J., Journal of Drug Issues
Using a social capital framework, this study explores how aspects of social relationships within the social networks of injection drug users (IDUs) and crack smokers (CSs) influence their drug use-related risk and protective health behaviors. Interviews were conducted with a quota sample of 80 socioeconomically marginalized drug users in Toronto, Canada, and qualitative data were extracted from 77 of these interviews. Analysis of the interview transcripts revealed themes indicating that social capital, in the form of collective norms, trust, and exchange of safer drug use information, within users' drug networks encouraged risk and/or protective behaviors within particular contexts. The analysis also highlighted the influence of social structural factors, such as harm reduction and health service delivery on the users' health behaviors. The implications of these findings for harm-reduction services are discussed.
Drug use-related risk behaviors, such as needle-sharing, drug sharing, and other drug use equipment sharing (e.g., drug preparation receptacles like cookers and filters), are associated with an increased risk of blood-borne disease infection such as HIV, Hepatitis B and Hepatitis C (Des Jaríais et al., 2003; Grund, Friedman, Stern et al., 1996). The prevalence of such drug use-related harms continues to be high among injection drug users (IDUs) in many Canadian cities, presenting significant individual and public health problems (Public Health Agency of Canada, 2006).
While IDUs are at high risk for blood-borne disease infection and other health problems (e.g., skin abscess, endocarditis, fatal and nonfatal overdose) (Broadhead, Kerr, Grund, & Altice, 2002; Des Jaríais, Friedman, & Ward, 1 993), other drug users, such as crack smokers (CSs), have also been found to be at risk for drug-use-related harms (Clatts, Welle, Goldsamt, et al, 2002; Erickson & Cheung, 1999; Ward, Pallecaros, Green, & Day, 2000). Recent research has indicated that individuals who smoke crack often have open cuts and burns on their lips from smoking crack in heated glass or metal pipes, and that these cuts/burns may contribute to the risk of infectious disease transmission through risky sex behaviors and pipe-sharing (Fischer et al., 2008; Wong, 2001; Porter, Bonilla, & Drucker, 1997; Ward et al., 2000).
As drug use often occurs as a social activity, the social environment in which it occurs logically influences related risk behaviors (Grund, 1993; Lovell, 2002; Rhodes & Quirk, 1998). The analysis of users' interpersonal relationships is therefore important to understand why they engage in such risky behaviors. This knowledge can subsequently assist in breaking down barriers to risk reduction that occur within the context of drug use (Lovell, 2002; Rhodes, 2002; Weeks, Clair, Borgatti, Radda, & Schensul, 2002), and is thus instrumental for informing harm-reduction strategies that promote protective behaviors related to drug use. Studies exploring the social context of drug use have found that types of social network structure, such as network size, density/connectedness, and location (Friedman, Curtis, Neaigus, Jose, & Des Jaríais, 1999; Hoffman, Su, & Pach, 1997; Latkin et al., 1995a, b; Neaigus, Friedman, Curtis et al., 1994), and aspects of social network relationships, such as trust and reciprocity, information exchange, and norms and rules, can contribute to the risk of blood-borne disease transmission and other health problems among drug users (Power, Jones, Kearns, Ward, Perera, 1995; Treloar & Abelson 2005; Weeks et al., 2002; Friedman, Fürst, Jose et al., 1 998). However, both of these types of studies have focused primarily on the networks of IDUs, and have focused on the relationship between their social networks and risk behavior. Other groups of drug users whose health is also at risk, such as CSs, are often excluded. Studies have recently noted an increased prevalence of crack use among socioeconomically marginalized populations in various Canadian cities (Fischer et al. …