Editorial
Integrating place into research on drug use, drug users’ health, and drug policy

https://doi.org/10.1016/j.drugpo.2014.03.004Get rights and content

Introduction

Over the past 15 years, place has become increasingly prominent in research on drug use, drug users’ health, and drug policy. This line of inquiry, however, is not new. Interest in the ways in which place characteristics shape drug use and drug users’ health has varied over time, often in tandem with paradigm shifts in the extent to which contextual factors have figured as possible determinants of health and well-being. The 1800s witnessed an intensification of interest in how place characteristics and other contextual factors shaped health in general and substance misuse in particular. In 1826, for example, Villerme analyzed tax and death records in Parisian arondissements and concluded that mortality rates were highest in impoverished neighborhoods (Susser & Stein, 2009). Twenty years later, Virchow attributed the typhus epidemic in Upper Silesia (Prussia) to the local confluence of several sociopolitical factors, including the rise of the plutocracy and the immiseration of the working class (Brown & Fee, 2006). Likewise, physicians in the 1880s–1890s commonly ascribed opiate misuse among affluent White men in US cities to the strains of constructing civilization in the midst of rapid industrialization (Cooper, 2004).

This focus on context and place diminished between World War I and the 1960s, and was replaced by an emphasis on individual-level factors. During these decades, hysteria about communism made it difficult to propose that social factors (e.g., poverty) shaped any form of health-related outcome (Krieger, 2000), and the rise of successful biomedical interventions (e.g., widespread access to antibiotics) and the ascendance of psychology and psychiatry rendered individual-level frameworks attractive (Ellen, 1995). During this period, for example, physicians attributed opiate addiction to individual psychopathology, rather than to broader social factors (Cooper, 2004).

Contextual factors were restored to etiologic frameworks in the latter decades of the 20th century. This restoration was prompted in part by widespread social movements that highlighted the power of social structures and by the challenges that HIV/AIDS posed to exclusively individual-level frameworks (Fee & Krieger, 1993). During this period, place moved to the foreground of research on drug use, drug users’ health, and drug policy (Cooper et al., 2009, Strathdee et al., 2010, Thomas et al., 2008, Tempalski and McQuie, 2009), most notably with the formulation of Rhodes’ Risk Environment Model, which defined the risk environment as the “space … [where] factors exogenous to the individual interact to increase the chances of HIV transmission” (Rhodes, Singer, Bourgois, Friedman, & Strathdee, 2005, p. 1027).

Though a focus on place is not new in research on drug use, drug users’ health, and drug policy, major challenges remain. Key challenges include theorizing place and place-making processes; defining place and measuring place characteristics; and delineating causal processes that link place characteristics to relevant outcomes. Additionally, work in this content area has been largely limited to specific countries (e.g., the US, Canada, Australia) and to specific subpopulations within these countries. This special issue has been designed to strengthen the resurgence of work on place, drug use, users’ health, and drug policy by responding to these challenges.

Section snippets

Mapping activity spaces

The papers published in this special issue have generated several advances in the conceptualization and measurement of “place” in research on drug use and health. The majority of past geospatial research on the risk environment has located people using their home address and has operationalized “place” using administratively defined boundaries (e.g., census tracts, ZIP codes). Many people, however, actively avoid acquiring drugs near their homes, given the stigmatized nature of substance use;

Encompassing multiple scales and histories in conceptualizations of place

Rosenblum, Castrillo, Bourgois, Mars, et al. (2014) offer an expansive and enriching conceptualization of “place” that encompasses history and recognizes the interactions of global and local scales. This team integrated ethnographic methods with social epidemiological methods to study the relationship between Puerto Rican residential segregation in US cities to the diffusion of Columbian-sourced heroin. Quantitative findings indicate that cities with larger and more segregated Puerto Rican

Describing micro-environments

While most research has considered macro-environments as places of risk, Knight, Lopez, Comfort, Shumway, et al. (2014), Smoyer and Blankenship (2014), and Siegler, Tuazon, O’Brien, and Paone's (2014) papers describe interior micro-environments that may foster or diminish risk. Knight et al.’s (2014) research, for example, analyzes the role of single room occupancy (SRO) hotel rooms in exacerbating and ameliorating negative mental health outcomes for substance using, poor women in San Francisco

Placing new populations

While some papers in this special issue have focused on identifying and describing new “places” of risk, several papers have extended the line of research on place characteristics and substance use to encompass new populations. Noting that HIV prevalence among Malaysian fisherman is ten times that found in the general population, West, Choo, El-Bassel, Gilbert, et al. (2014) studied the ways in which boats, as physical and social spaces, shape the drug scene and HIV risk among Malaysian

Delineating causal pathways

While several papers have identified statistical relationships between place-based exposures and drug- and HIV-related outcomes, the mechanisms underlying these statistical associations have rarely been explored in quantitative analyses. Sterk, Elifson, and DePadilla (2014) take the important step of investigating some of the pathways linking a particularly potent place-based exposure – perceived neighborhood disorder – to the frequency of crack use in a sample of African-American adults living

Describing place-making processes

“Not-In-My-Backyard” (NIMBY) responses to harm reduction programs, drug treatment facilities, and drug-using clients have become common. Research by Davidson and Howe (2014) deepens our understanding of how characteristics of “place” affect whether particular areas adopt harm reduction services or other unpopular services. This study highlights how different experiences and meanings ascribed to a “place” shape local debates about the location of harm reduction services. Their study examined the

Developing theory: place, power, agency & drug users’ health

Theoretical contributions in this issue articulate the ways in which “place” plays a key role in organizing and structuring our social and physical lives; “place” is a key element for understanding our identity and creates “context and meaning” (Cresswell, 2004) for our lived experiences, behaviors, and actions. Context and experience of “place” can differ for people who use drugs, compared with non-drug users. Duff's (2014) critical discourse of “contexts” as an assemblage of spaces, bodies,

Reflection and summation

The papers in this special issue provide several methodological, conceptual, and theoretical advances that we hope will inspire and guide future research on place, drug use, and drug users’ health. Moving beyond the traditional method of linking people to places via their home addresses, several papers in this special issue consider activity spaces, and seek to describe the nature of these spaces and the predictors and outcomes of engaging in specific behaviors in these spaces. One possible

Conflict of interest

The authors have no conflict of interest to report.

Acknowledgements

The creation of this editorial and special issue was supported by the following NIH grants: Community Vulnerability and Response to IDU-Related HIV (R01 DA13336); Place characteristics & disparities in HIV in IDUs: A multilevel analysis of NHBS (R01 DA035101); a CFAR03 grant awarded by the Emory Center for AIDS Research (P30 AI050409); Public Housing Relocations: Impact on Healthcare Access, Drug Use & Sexual Health (R21DA027072); and Public Housing Relocations: Impact on HIV and Drug Use (

References (31)

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