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The Chief Medical Officers for the UK recommend that if you're pregnant or planning to become pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink, the greater the risk. When you drink, alcohol passes from your blood through the placenta and to your baby. A baby's liver is one of the last organs to develop and doesn't mature until the later stages of pregnancy. Your baby cannot process alcohol as well as you can, and too much exposure to alcohol can seriously affect their development. Drinking alcohol, especially in the first three months of pregnancy, increases the risk of miscarriage, premature birth and your baby having a low birth weight. Drinking after the first three months of your pregnancy could affect your baby after they're born. The risks are greater the more you drink. The effects include learning difficulties and behavioural problems. Drinking heavily throughout pregnancy can cause your baby to develop a serious condition called foetal alcohol syndrome FAS. Children with FAS have:. Drinking less heavily, and even drinking heavily on single occasions, may be associated with lesser forms of FAS. The risk is likely to be greater the more you drink. It may not be as difficult as you think to avoid alcohol completely for nine months, as many women go off the taste of alcohol early in pregnancy. Most women do give up alcohol once they know they're pregnant or when they're planning to become pregnant. Women who find out they're pregnant after already having drunk in early pregnancy should avoid further drinking. However, they should not worry unnecessarily, as the risks of their baby being affected are likely to be low. If you do decide to drink when you're pregnant, it's important to know how many units you are consuming. One UK unit 10 millilitres ml - or eight grams - of pure alcohol. This is equal to:. You can find out how many units there are in different types and brands of drinks with the Drinkaware unit and calorie calculator. It allows you to keep a drinks diary and get feedback on your drinking. Click here to read more about alcohol units. If you have difficulty cutting down what you drink, talk to your midwife, GP or pharmacist. Confidential help and support is also available from local counselling services:. Read more advice on cutting down your drinking here. Using illegal or street drugs during pregnancy, including cannabis , ecstasy, cocaine and heroin, can have potentially serious effects on your unborn baby. If you regularly use drugs, it's important to tackle this now you're pregnant. It's best not to stop abruptly without first seeking medical advice as there may be withdrawal problems or other side effects. If you took a drug without realising you were pregnant on a one-off occasion, try not to worry - it's very unlikely to have affected your baby. However, if illegal drugs are part of your life, getting help can really improve the outlook for you and your baby. If you use drugs, it's important to seek help straight away so you can get the right advice and support. You can get help from:. They won't judge you and can help you access a wide range of other services, such as antenatal and family support. You can also contact FRANK for friendly, confidential drugs advice, including information on the different types of help available. Skip to main content Skip to navigation. Experts are still unsure exactly how much - if any - alcohol is completely safe for you to have while you're pregnant, so the safest approach is not to drink at all while you're expecting. Is it safe to drink alcohol when pregnant? How does alcohol affect my unborn baby? Children with FAS have: poor growth facial abnormalities learning and behavioural problems Drinking less heavily, and even drinking heavily on single occasions, may be associated with lesser forms of FAS. How to avoid alcohol in pregnancy It may not be as difficult as you think to avoid alcohol completely for nine months, as many women go off the taste of alcohol early in pregnancy. If you're concerned, talk to your midwife or GP. What is a unit of alcohol? This is equal to: half a pint of beer, lager or cider at 3. Alcohol support services If you have difficulty cutting down what you drink, talk to your midwife, GP or pharmacist. Confidential help and support is also available from local counselling services: Drinkline is the national alcohol helpline, If you're worried about your own or someone else's drinking, call this free helpline on weekdays 9am to 8pm, weekends 11am to 4pm Addaction is a UK-wide treatment agency that helps individuals, families and communities manage the effects of alcohol and drug misuse. Alcoholics Anonymous AA is a free self-help group. Its 'step' programme involves getting sober with the help of regular support groups. Find your nearest alcohol support services here. Illegal drugs in pregnancy Using illegal or street drugs during pregnancy, including cannabis , ecstasy, cocaine and heroin, can have potentially serious effects on your unborn baby. What if I took drugs before I knew I was pregnant? Getting help If you use drugs, it's important to seek help straight away so you can get the right advice and support. You can get help from: your maternity teams your GP specialist treatment services They won't judge you and can help you access a wide range of other services, such as antenatal and family support. Show accessibility tools. Accessibility tools Text size: Increase text size Decrease text size Reset text size. Frank Ltd. Planning for pregnancy. Congratulations on your pregnancy. Who will look after me? Antenatal Screening. Digital Maternity Records. Congenital diaphragmatic hernia CDH. Cytomegalovirus CMV in pregnancy. Congenital pulmonary airway malformation CPAM. Cystic Hygroma. Exomphalos omphalocele. Multi cystic dysplastic kidney MCDK. Multiple pregnancy. Parvovirus in pregnancy. Raised NT 3. Spina bifida. Suspected heart abnormality. Do you have pre existing health problems? Asthma and pregnancy. Congenital heart disease. Diabetes prior to pregnancy. Epilepsy in pregnancy. Raised BMI in pregnancy. 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Different types of birth. Induction of Labour. Tears during childbirth. Vitamin K for newborn babies. Worried about a previous birth experience? After you have had your baby After you have had your baby Early days. Feeding your baby in the first six months. Caring for your newborn baby. Safer Sleep. Your body after the birth. Going home from hospital or after home birth. Blood loss — what to expect after birth. Caring for your stitches. Care and advice after a caesarean section. Screening for Infection in Newborn Babies. What to watch for as a new parent. Newborn Screening Wales. Coping with a lack of sleep. Changing relationships. Sex after childbirth. Helping your body recover after birth. Iron supplements. Postpartum psychosis. Making new friends in your area app download. Feeding your baby in the first six months Feeding your baby in the first six months The best start for your baby. Why early skin contact matters. Learning to Breastfeed your Baby - The first few days. 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The food: Coto, konro soup (or the grilled version), sup saudara, palubasa, palubutung, and go try the seafood at Bambu Kuning on Andalas.
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Official websites use. Share sensitive information only on official, secure websites. Understanding the experience of initiating injection drug use and its social contexts is crucial to inform efforts to prevent transitions into this mode of drug consumption and support harm reduction. We systematically reviewed and synthesized existing qualitative scientific literature to identify the socio-structural contexts for, and experiences of, the initiation of injection drug use. Peer-reviewed studies were included if they qualitatively explored experiences of or socio-structural contexts for injection drug use initiation. A thematic synthesis approach was used to identify descriptive and analytical themes across studies. From initial results, 41 studies reporting data from participants were included. We developed eight descriptive themes and two analytical higher order themes. The first analytical theme focused on injecting initiation resulting from a social process enabled and constrained by socio-structural factors: social networks and individual interactions, socialization into drug-using identities, and choices enabled and constrained by social context all combine to produce processes of injection initiation. The second analytical theme addressed pathways that explore varying meanings attached to injection initiation and how they link to social context: seeking pleasure, responses to increasing tolerance to drugs, securing belonging and identity, and coping with pain and trauma. Qualitative research shows that injection drug use initiation has varying and distinct meanings for individuals involved and is a dynamic process shaped by social and structural factors. Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation, rather than solely prioritizing the reduction of individual harms through behavior change. Keywords: Systematic review, qualitative synthesis, thematic synthesis, injection drug use, injection initiation, drug use, trajectories, transitions. Twelve million people inject drugs globally 1 and, with limited access to harm reduction services 2 , face vulnerability to poor health and social outcomes 3 — 5. Patterns of drug injecting are evolving: injection drug use is increasing in some areas and populations that have historically reported low prevalence e. There has long been interest in preventing transitions to drug injecting 9 , 10 , though the effectiveness of interventions has been limited according to scientific evaluations conducted to date There is therefore a need to further develop understanding of injection drug use initiation to inform interventions and policy responses. Quantitative studies of injection drug use initiation have explored a range of factors linked to injection initiation, including shifts in the drug supply, drugs used, unemployment, family disruption, homelessness, incarceration and social networks 12 — Qualitative research offers unique complementary insights by enabling in-depth exploration of how injection initiation is experienced, for example: the meanings and identities it can bring, and how initiation is shaped by contextual factors A synthesis of this qualitative literature would help elucidate the frequently complex pathways by which individual experiences, discrete factors and contexts combine 21 , We aimed to systematically review and synthesize qualitative literature on the experience of, and social context for, injection initiation. What role do family, friends and others play in influencing the context of injection initiation? Thus, we understand injection initiation as arising from interactions between individual agency and the constraints and opportunities afforded within these overlapping environments 22 , which can vary across populations due to the intersection of individual characteristics and social-structural inequities. We used this overarching theoretical framing - of social and structural factors forming pathways with individual agency to produce injection initiation — to explore and elucidate the empirical findings of qualitative research in this area. We employed a thematic synthesis approach in order to develop concepts and theory of relevance to policy and intervention development 27 — We combined database and manual searches to ensure a comprehensive review see search record in supplementary file 2. Searches for relevant studies were conducted in March We manually searched selected journals to ensure recent publications were included, searched Google Scholar and hand-searched institutional webpages of key authors in the field, identified through our familiarity with the literature. For each included study, we also checked reference lists in other papers. Inclusion criteria were: scientific peer-reviewed literature; English language; analysis drawing on qualitative research design, including mixed-methods approaches; and analyses addressing the experiences, processes or contexts of injection initiation. Exclusion criteria included grey literature, quantitative research; opinion articles, commentaries, and editorials i. We reviewed the titles and abstracts for citations found in the database and manual searches. Full references were then checked against inclusion criteria. We assessed the quality of included studies to support interpretation and development of the analysis, rather than as the basis for inclusion. This approach is consistent with previous qualitative syntheses and debates on the merits of judging quality and the likelihood of lower quality studies contributing less to review results Thematic synthesis develops descriptive and analytical themes through coding of original studies. Descriptive themes translate the findings from original studies into one another to identify common areas of focus Analytical themes seek a novel synthesis of the literature and to explain and explore the descriptive themes After familiarizing ourselves with the included studies a coding framework was developed iteratively. We focused this process of translation on second order constructs i. We undertook this approach owing to the limitations on understanding the context of primary data presented in each study and the consequent risk of misinterpreting isolated data fragments. The coding and analysis process was iterative and ongoing, and focused on discussion across the team to refine our translation of concepts, comparing the coded data within codes, and grouping codes into categories. We used the theoretical framing discussed above to categorize the codes, using core areas of focus from the risk environment such as micro-social environment and agency 23 — Codes were grouped into descriptive themes representing large code categories e. The structural framework we used oriented the development of these descriptive and analytical themes towards understanding relationships between individual experiences and environmental factors. We identified unique articles through the search, of which 41 met inclusion criteria Figure 1 ; Table 1. Many papers we classified as medium rather than high quality owing to limitations in study reporting, primarily due to restrictions on article length and disciplinary conventions rather than weakness in study design. The included studies frequently addressed experiences of initiation in depth or the social contexts for this; fewer studies explored specific theoretical relationships between these experiences and their contexts. We therefore characterize the literature as frequently in-depth and conceptually diverse, although with less emphasis on developing theoretical relationships between constructs. We developed eight descriptive themes grouped into two analytical themes. The first analytical theme explores injection initiation as a dynamic process produced over time, involving individuals interacting with socio-structural factors. The second analytical theme then further delineates pathways to, and contexts of, injection initiation events. These pathways explore how individuals experience and ascribe meaning to injection initiation within specific social contexts Figure 2. The first injection of drugs is often embedded in long-term processes of change in self and identity within the context of social interactions and structural factors. Social connections and networks were reported as fundamental to drug injecting initiation. Friends 41 , 44 , 47 , 48 , 50 , 51 , 55 , 56 , 60 , 68 , 70 , 73 , 77 , family 41 , 43 , 44 , 51 , 52 , 55 , 68 , 70 — 73 , intimate partners 42 , 48 , 49 , 52 , 57 , 59 , 60 , 64 , 68 , 70 — 72 , 77 , acquaintances 37 , 43 , 77 , gang members 63 , elders 65 and drug dealers 41 , 42 were all described as influential. Different types of social interactions shaped injection initiation. Studies suggested that people who already inject may encourage injection initiation, enthusing about the benefits of drug injection linked to pleasure or cost-efficiency 37 , 47 , 48 , 51 , 52 , 70 , 72 , 73 e. Encouragement by people who already inject could extend to peer pressure 37 , 66 , 68 and more direct coercion 38 , 52 , By contrast, people who already inject drugs also actively discouraged potential injectors 43 , 66 , Studies suggested a strong reluctance or refusal to assist injection initiation, reflecting group norms on the unacceptability of facilitating injection initiation 51 , 53 , 66 , 71 , 72 , However, this convention to refuse the facilitation of first injection events was reportedly frequently ignored, for a range of logics, including the desire to reduce potential harms experienced by initiates or to access drugs 53 , 66 , 71 , 72 , Both those assisting and those seeking to inject described processes of help-seeking, extending to persistent and pressuring requests to be initiated 48 , 51 , 53 , 66 , 72 , This process was described as the erosion of social norms against drug injecting among individuals through their own actions and those of others. Injection initiation involved crossing boundaries of morality, stigma 50 , 66 or risk 61 , where fears or negative social norms are displaced or replaced 48 , 72 with new social roles and identities bound to injecting This shift can be influenced by other people 48 linking to the interactions described above and through increased participation in social networks centered around injection drug use 50 , 52 , 58 , This active role is also indicated in persistent requests for help, as described above. A core theme across studies, however, was of limited agency. This occurred whether through accounts of limited autonomy 42 or in how experiences of, and claims to, active choice and autonomy with respect to injection initiation that were, in fact, constrained and enabled by environmental factors 42 , 47 , 50 , 61 , 66 , 67 , Conversely, some people emphasized a dominant role for context in shaping their initiation of injecting drug use. Recognizing the potential for constraint on an individual from environmental factors also served to help individuals rebuild an identity in response to drug use, which they may regret or be seeking to overcome Meso-level environments i. Homelessness also led to an immersion in street scenes or shelters where injecting was visible and encouraged 38 , 44 , Linked to this concentrated disadvantage were constrained socio-economic opportunities stemming from structural vulnerability that amplify the risk of drug injection initiation: working in distributing or selling drugs leading to proximity to drugs 37 , 39 , 42 or unemployment leading to injecting drug use as a way to manage boredom 65 , gain prestige 63 or manage poverty and increasing tolerance Within prison environments, injection drug use is potentially visible and encouraged 58 , identified as a way to cope with misery 52 , or as a focus for coercion from others Changes in drug supply linked to intensive police action 47 or policy shifts in the specific context of prescription opioid availability 58 may increase the viability of injecting from an economic perspective, given contexts of poverty and economic survival 47 , 65 , or the potential for higher quality drugs 62 , Overarching economic changes, whether short-term cycles interacting with poverty and vulnerability to foster the economic appeal of injection 47 or long-term transitions linked to shifting norms and social ties around drug use 66 , 67 , are also linked to initiation. In this second analytical theme we explore four overlapping descriptive themes reflecting meanings associated with injection initiation, and delineate pathways linking these individual experiences to specific social and structural factors. Boredom and a need for excitement was also linked to a concern for pleasure and self-fulfillment 41 , Seeking pleasure is bound up within specific social-structural factors. An increased high associated with drug injecting was described as emerging from engagement in social networks that include people who already inject drugs 51 , 52 , 56 , 60 , 73 , where the high is witnessed 48 or encouraged 47 , 73 and curiosity generated 44 , Seeking pleasure can be enabled by such social environments 66 , whilst experiences of homelessness and marginalization can push people in to social networks and street scenes where injecting is witnessed and people become curious about its effects 42 , Shifts in the drug supply to purer or more easily injectable forms also create incentives for injecting given the decreased pleasure associated with less potent drugs or a greater difficulty in purchasing drugs 62 , Accounts referenced increasing tolerance to a drug 37 , 40 , 41 , 47 , 48 , 52 , 55 , 58 , 60 , 68 , 70 , 71 , 76 , withdrawals 47 , 48 , 56 , 58 , 61 , 70 and economic pressures or recognition of the economic efficiency of injecting 37 , 41 , 46 — 48 , 51 , 52 , 55 , 58 , 60 — 63 , 65 , 68 , 70 — 73 , 76 , 77 as linked to injection initiation. A recognition of the increased efficiency of injection drug use can occur within social networks of people already injecting who can encourage this understanding 47 , 48 , 52 or be a rationale for coercing others in to injecting 77 , and thereby reflect economic pressures generated by poverty, marginalization 47 , 61 , and shifts in drug supply Injection initiation can secure belonging to particular groups and identities. I saw them enjoying drugs and I felt lonely and always left out. A need to belong or adopt certain identities was structured by gender. Drug injecting can function to manage, or respond to, violence, abuse or neglect. Injection initiation was identified as a response to grief, misery and stress 37 , 52 ; as an aid in coping with mental illness including depression 46 , 50 , 55 , or to manage physical pain I went through the windshield. Injecting was also described as a response to the stress of deportation 64 , guilt 68 and assault and rape 39 , 41 , The nature of crises and trauma and the capacity to manage them can be bound up in social and structural factors. Specific neighbourhoods and street scenes for drug use can be a place people seek refuge in after traumatic experiences 69 , or be settings in which crises are more prevalent, for example violence in poor neighbourhoods 71 , and where social contacts that can enable drug injection are present 50 , This qualitative systematic review synthesized concepts, experiences and pathways linked to injection initiation. Using a socio-structural framework 22 , we developed two analytical themes that comprise eight descriptive themes: injection initiation as a dynamic process produced over time, involving individuals interacting with social-structural factors; and, injection initiation stemming from specific pathways to and contexts of injection initiation events. In seeking to bring clarity to a large qualitative literature through our theoretical framing, we have demonstrated the extensive empirical evidence for injection initiation as a multi-dimensional phenomenon involving individual, social and structural factors. We have also highlighted the importance of concepts of socialization, identity and an approach exploring dynamic pathways of enacted and constrained individual agency occurring in relation to environmental contexts framed by larger structural vulnerabilities. We consider these concepts and pathways potentially generalizable to a range of contexts, although more study is needed to fully support this. The review provides insight into the range of pathways by which socio-structural contexts shape individual and group capacities and behaviors. There is also need to further elaborate the theoretical relationships by which agency interacts with specific contextual factors 22 ; as we noted, studies often provided insight to meanings and experiences or to contextual factors, although there is less emphasis on exploring specific theoretical relationships between factors. Future research should respond to this multi-dimensional understanding of injection initiation and develop more insight in to the specific pathways shaping injecting initiation in diverse contexts, building on the conceptual clarity developed in this review. Future research should address the underrepresentation of experiences of particular ethnic, sexual, and gender identities in current research; the role of particular drugs; and identify additional specific pathways linking social and structural factors to individual experiences of injection initiation Policy and interventions to address the needs of people who use drugs and respond to injection drug use should orientate to a dynamic, multi-level understanding of injection initiation. Recent emphasis on structural approaches to reduce the risk of initiation 78 has built on lessons gained from individual level approaches seeking to alter behavior, which may be constrained in their capacity to effectively reduce the potential for initiation This review seeks to develop this emphasis further and we, therefore, explored the emergence of injecting within constraining and enabling contexts. Recognizing this, interventions and policy should seek to create socio-structural environments in which vulnerable individuals have alternative, attractive choices to initiating injection drug use 42 , rather than solely prioritizing the reduction of individual harms through behavior change. Whilst implementing and scaling up such structural approaches to health carry challenges, our recommendations respond to evidence for how discrete structural modifications such as supervised consumption facilities can change social environments and so disrupt specific harmful drug-using practices 79 — Such socio-structural approaches would need to respond to the multiple meanings attached to injection initiation and its multiple contexts, whether someone injecting under pressure from an intimate partner 57 or driven by curiosity and pleasure The centrality of pleasure in our analysis, commonly not highlighted in drug policy research 82 , also has implications for considering the feasibility and acceptability of strategies to prevent individuals from initiating injection drug use, as it suggests that currently conceptualized prevention efforts have limits and that allied efforts to support safer injecting are needed This review has limitations. First, we were limited to English language studies, explaining the dominance of North American, Western European and Australian literature on our findings although the search did not return any non-English language studies. Second, the methodology of thematic synthesis has been criticized for decontextualizing findings, which is often understood as the foundation and inherent value of qualitative research However, thematic synthesis is valuable in its capacity to highlight broad themes in the literature that can be developed and explored for their relevance to policy or intervention development Third, all qualitative research, including the products of a thematic synthesis, have limits on generalizability; the findings from this review should therefore be understood as potentially theoretically generalizable to other contexts 84 , with future research needed to further explore the relevance of these concepts and refine their applicability in specific contexts. We reviewed the existing qualitative literature to delineate experiences and contexts for drug injection initiation. The available qualitative literature suggests injection initiation has varying and distinct meanings and is a dynamic process shaped by social and structural factors. Research and interventions need to adapt to this multi-dimensional understanding of injection initiation as both behavioral and social, and should seek to understand and target socio-structural change. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Published in final edited form as: Addiction. Find articles by Andy Guise. Find articles by Danielle Horyniak. Find articles by Jason Melo. Find articles by Ryan McNeill. Find articles by Dan Werb. Issue date Dec. PMC Copyright notice. The publisher's version of this article is available at Addiction. Open in a new tab. Medium 2 Briggs et al. UK: London and Bristol In-depth interviews. Medium 3 Carbone-Lopez et al. USA: Missouri In-depth interviews. High 4 Dertadian et al. Australia: Sydney Life history interviews. Low 5 Draus et al. High 6 Fast et al. Canada: Vancouver, Downtown district with long-established drug market In-depth interviews and ethnographic observation. High 7 Finlinson et al. Puerto Rico: Bayamon In-depth interviews. Medium 8 Firestone et al. Canada: Toronto Qualitative study using in-depth interviews. Medium 9 Fitzgerald et al. Australia Qualitative study using semi-structured interviews. High 10 Giddings et al. UK Qualitative study using in-depth interviews. Low 11 Guise et al. Kenya: Nairobi and coastal region Qualitative studies using in-depth interviews, observation and ethnographic interviews. Medium 12 Harocopos et al. Medium 13 Higgs et al. Australia: Melbourne Qualitative study using semi-structured interviews. Medium 14 Horyniak et al. Australia: Melbourne Semi-structured interviews. High 15 Kermode et al. India: Nagaland and Manipur, northeastern states with proximity to Golden Triangle Semi-structured interviews. High 16 Khobzi et al. High 17 Kolla et al. Canada: Toronto Semi-structured interviews. High 18 Lankenau et al. Medium 19 Lankenau et al. Medium 20 Lankenau et al. High 21 Lazuardi et al. Medium 22 Mars et al. High 23 Martin 59 Explore social conditions under which women become vulnerable to injecting initiation. Australia: Melbourne In-depth interviews. Medium 24 Mateu-Gelabert et al. Ireland: Dublin, poor inner city community Longitudinal ethnography with interviews, focus groups and participation. Medium 26 McCurdy et al. Tanzania: Dar es Salaam Semi-structured interviews. Medium 27 Nasir et al. Indonesia: Makassar, slums In-depth interviews. High 28 Ojeda et al. Mexico: Tijuana In-depth interviews. Medium 29 Razani et al. Iran: Tehran Focus groups and key informant interviews. Medium 30 Rhodes et al. Moldova: Balti Semi-structured interviews. High 31 Rhodes et al. High 32 Robertson et al. Medium 33 Roy et al. Canada: Montreal In-depth interviews. High 34 Sherman et al. USA: Baltimore In-depth interviews. High 35 Simmons et al. Medium 36 Small et al. High 37 Tuchman 73 Explore the social, contextual, and behavioral dimensions of injecting practices of women who inject drugs. Low 38 Wagner et al. Low 39 Wenger et al. Medium 40 Witteveen et al. The Netherlands: Amsterdam In-depth interviews. Medium 41 Wright et al. Declarations of competing interest: We have no competing interests. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Andrade et al. Explore shifts in New York heroin markets, and impacts on non-injecting heroin users. Briggs et al. Within a study on speedball injection, aims to explore how homeless hostel environments shape injecting drug use and related harms. Carbone-Lopez et al. Dertadian et al. Draus et al. Describes contextual factors contributing to heroin injection initiation. Fast et al. Canada: Vancouver, Downtown district with long-established drug market. In-depth interviews and ethnographic observation. Finlinson et al. Explores polydrug use history of recent initiators of drug injecting. Firestone et al. Responding to prescription opioid and crack use amongst street drug users, aims to describe behaviors and preferences as well as social and structural contexts for use of these drugs. Fitzgerald et al. Qualitative study using semi-structured interviews. Giddings et al. Explores what differentiates drug injecting from other methods. Guise et al. Combines studies to explore the social context for transitions to injecting heroin. Qualitative studies using in-depth interviews, observation and ethnographic interviews. Harocopos et al. Describes social contexts for injecting initiation. Longitudinal qualitative study using repeated in-depth interviews. Higgs et al. Horyniak et al. Understand injecting drug use exposure and preferences among young people from culturally diverse backgrounds. Kermode et al. Increase understanding of contextual factors associated with initiation to injection drug use. India: Nagaland and Manipur, northeastern states with proximity to Golden Triangle. Khobzi et al. Exploration of biological, psychosocial, socio-cultural and socio-structural processes in injection initiation. Kolla et al. Examine initiation events from the perspective of the initiators, in order to understand their roles and motivations. Lankenau et al. Describe the circumstances surrounding the first injection of Ketamine. Describes how drug type used at first injection relates to characteristics of the initiate, risk behaviors, and future drug use trajectories. Survey integrating qualitative data collection. Describe initiation in to prescription opioid misuse. Lazuardi et al. Mars et al. Understand process by which heroin injectors had initiated heroin use and injecting. Martin Explore social conditions under which women become vulnerable to injecting initiation. Mateu-Gelabert et al. Explores drug use and sexual risks of non-medical prescription opioid users. Mayock Longitudinal ethnography with interviews, focus groups and participation. McCurdy et al. Explore the rules and organization of drug use. Nasir et al. Examines the influence of the social context on initiation of injecting drug use in slum areas. Ojeda et al. Describes illicit drug use behaviors in diverse settings of Mexican born deportees from the USA. Razani et al. Explore risk behaviors of people using drugs in context of harm reduction efforts. Rhodes et al. Explore accounts of people who inject drugs who initiate others in to drug injecting. Explores how narratives of drug transitions relate to broader social and economic transitions. Robertson et al. Examine the correlates and contexts of US injection initiation among undocumented migrants. Roy et al. Examine social contexts and processes influencing transition to drug injection among street youth. Sherman et al. Explores the influences on the transition from sniffing to injecting heroin. Simmons et al. Explore the interpersonal and structural dynamics that shape injection initiation within intimate partnerships. Small et al. Investigate the initiation of injection drug use among street involved youth. Tuchman Explore the social, contextual, and behavioral dimensions of injecting practices of women who inject drugs. Wagner et al. Wenger et al. Examine the injection initiation process from the perspective of established people who inject drugs. Witteveen et al. Elucidate injection initiation and risky injection practices among young drug users. Wright et al. Explore women drug users experiences of abuse from intimate partners when being injected with illicit drugs.
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Interventions should therefore respond to the socio-structural influences on injecting drug use initiation by seeking to modify the contexts for initiation.
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This qualitative study examines the experience of young people in a slum area (lorong) in Makassar, eastern Indonesia, who use drugs but are not drug dependent.
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