Racialized environments and syringe services program implementation: County-level factors

Abstract

Objective: Racialized health inequities in substance use-related harms might emerge from differential access to syringe service programs (SSPs). To explore this, we examined the association between county-level racialized environments, other factors, and (1) SSP presence, and (2) per capita syringe and (3) naloxone distribution.

Methods: 2021 US National Survey of SSP data (n=295/412;72 % response rate) was used to identify SSP presence and the sum of syringes and naloxone doses distributed in 2020 by county. Study measures included racial residential segregation (RRS; i.e., divergence and dissimilarity indexes for Black:Non-Hispanic White & Hispanic:Non-Hispanic White) and covariates (i.e., demographic proportions, urban/suburban/rural classifications, 2020 US presidential Republican vote share, and overdose mortality from 2019). We used logit Generalized Estimating Equations to determine factors associated with county-level SSP presence, and zero inflated negative binomial regression models to determine factors associated with per capita syringe and naloxone distribution.

Results: SSPs were reported in 9 % (283/3106) of US counties. SSP presence was associated with higher divergence and dissimilarity indexes, urban and suburban counties, higher opioid overdose mortality, and lower 2020 Republican presidential vote share. Per capita syringes distributed was associated with lower RRS (divergence and Hispanic:White dissimilarity), lower racially minoritized population proportions and rural counties, while per capita naloxone distribution was associated with lower Hispanic and "other" population proportions, and rural counties.

Conclusions: Racialized environments are associated with SSP presence but not the scope of those programs. Preventing HIV and HCV outbreaks, and overdose deaths requires addressing community level factors that influence SSP implementation and accessibility.

Keywords: Dissimilarity index; Divergence index; Harm reduction services; Naloxone distribution; National study; Overdose mortality; Political determinants of health; Racial residential segregation; Racialized environments; Syringe distribution; Syringe service programs.

Figure 1.

Racial Residential Segregation, Proportional Composition and Syringe service program Presence (SSP) aOR = adjusted odds ratio; LCL=95% lower confidence limit; UCL=95% upper confidence limit; NH = non-Hispanic; Each racial residential segregation measure and the proportional racial composition measure was modeled separately. Each model adjusted for urbanicity, the percent of county residents that voted for the Republican presidential candidate in 2020, and the rate of opioid-related overdose mortality.

Figure 2.

Racial Residential Segregation, Proportional Composition, and per Capita Syringe Distribution aIRR = adjusted incident rate ratio; LCL=95% lower confidence limit; UCL=95% upper confidence limit; NH = non-Hispanic; Each racial residential segregation measure and the proportional racial composition measure was modeled separately. Each model adjusted for urbanicity, the percent of county residents that voted for the Republican presidential candidate in 2020, and the rate of opioid-related overdose mortality.

Figure 3.

Racial Residential Segregation, Proportional Composition and per Capita Naloxone Distribution aIRR = adjusted incident rate ratio; LCL=95% lower confidence limit; UCL=95% upper confidence limit; NH = non-Hispanic; Each racial residential segregation measure and the proportional racial composition measure was modeled separately Each model adjusted for urbanicity, the percent of county residents that voted for the Republican presidential candidate in 2020, and the rate of opioid-related overdose mortality.