摘要：Objectives. We sought to determine whether contextual factors shape injection drug use among Black adolescents and adults. Methods. For this longitudinal study of 95 US metropolitan statistical areas (MSAs), we drew annual MSA-specific estimates of the prevalence of injection drug use (IDU) among Black adolescents and adults in 1993 through 2007 from 3 surveillance databases. We used existing administrative data to measure MSA-level socioeconomic status; criminal justice activities; expenditures on social welfare, health, and policing; and histories of Black uprisings (1960–1969) and urban renewal funding (1949–1974). We regressed Black IDU prevalence on these predictors by using hierarchical linear models. Results. Black IDU prevalence was lower in MSAs with declining Black high-school dropout rates, a history of Black uprisings, higher percentages of Black residents, and, in MSAs where 1992 White income was high, higher 1992 Black income. Incarceration rates were unrelated. Conclusions. Contextual factors shape patterns of drug use among Black individuals. Structural interventions, especially those that improve Black socioeconomic security and political strength, may help reduce IDU among Black adolescents and adults. Contextual factors are increasingly prominent in studies of illegal drug use in the United States. Studies suggest, for example, that neighborhood economic disadvantage predicts illegal drug use, 1–4 and that local social disorder and unemployment rates predict the prevalence of injection drug use (IDU) in metropolitan areas. 5 Contextual factors may be especially important to understanding patterns of illicit and licit substance use among Black adolescents and adults. 6–8 Individual-level characteristics, including psychological states, predict less variance in alcohol and other drug use among Black adolescents and adults than among Whites. 6–8 Contextual factors may play a stronger role in shaping vulnerability to drug use among Black individuals for at least 2 reasons. First, the United States’ racialized social system 9 amplifies Black individuals’ exposure to adverse contextual factors that create vulnerability to drug use (e.g., high violent crime rates) and diminishes access to protective resources (e.g., high-quality schools). 10–12 Second, the magnitudes of relationships between contextual factors and drug use may be greater for Black individuals than for Whites. 13 Jones-Webb et al., for example, found that local poverty rates were stronger predictors of harmful alcohol use for Black men than for White men. 14 This longitudinal, area-based analysis investigates relationships between contextual factors and the prevalence of IDU among Black individuals (aged 15–64 years) in large US metropolitan areas (MSAs) over time (1993–2007). We focused on determinants of IDU among Black individuals because IDU prevalence appears to be higher in this racial/ethnic group than in others, 15,16 and because Black injectors are at high risk for HIV and hepatitis C infection and overdose. 17–19 This analysis was guided by the Political Ecology of Health, which posits, in part, that social and economic contexts, resources, and collective agency (e.g., social movements to advance racial equality) intersect over time to shape variations in distributions of health and disease across time, space, and populations. 20–23 On the basis of this model and past research about determinants of drug use among Black adults and other populations, 1–5,24–28 we studied predictors within the following domains: socioeconomic factors, criminal justice activities, and public expenditures on social welfare and policing. Drawing on sociological research about Black uprisings in the 1960s, 29–31 we examined relationships of Black uprisings, a form of collective agency, to Black IDU prevalence. Guided by Fullilove, 32–34 we posited that urban renewal programs in 1949 through 1974 might have created long-term vulnerability to IDU in Black communities by disrupting protective social networks and undermining social and political capital.
