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Crystal M. Fuller, PhD, Luisa N. Borrell, DDS, PhD, Carl A. Latkin, PhD, Sandro Galea, MD, DrPH, Danielle C. Ompad, PhD, Steffanie A. Strathdee, PhD and David Vlahov, PhD

Crystal M. Fuller and Luisa N. Borrell are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Crystal M. Fuller is also with the Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York. Carl A. Latkin is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Sandro Galea and Danielle C. Ompad are with the Center for Urban Epidemiologic Studies, New York Academy of Medicine. Steffanie A. Strathdee and David Vlahov are with the Infectious Disease Program, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. David Vlahov is also with the Center for Urban Epidemiologic Studies, New York Academy of Medicine, and the Department of Epidemiology, Mailman School of Public Health.

Correspondence: Requests for reprints should be sent to Crystal M. Fuller, PhD, Center for Infectious Disease Epidemiologic Research, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, 4th Floor, Room R422, New York, NY 10032 (e-mail: cf317{at}columbia.edu).

Objectives. We investigated individual- and neighborhood-level factors associated with adolescent initiation of injection drug use.

Methods. Injection drug users (IDUs) who had been injecting 2 to 5 years underwent HIV testing and completed a sociobehavioral risk survey. Modeling techniques accounting for intraneighborhood correlations were used in data analyses.

Results. Adolescent-initiating IDUs were less likely than adult-initiating IDUs to report high-risk sex and injection behaviors and more likely to report high-risk networks. African American IDUs from neighborhoods with large percentages of minority residents and low adult educational levels were more likely to initiate injection during adolescence than White IDUs from neighborhoods with low percentages of minority residents and high adult education levels.

Conclusions. Racial segregation and neighborhood-level educational attainment must be considered when drawing inferences about age at initiation of injection drug use and related high-risk behaviors.

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