# Contextual factors of the risk environment surrounding injection drug use: A real-time approach

> **NIH NIH R21** · KAISER FOUNDATION RESEARCH INSTITUTE · 2022 · $233,484

## Abstract

Project Summary
Amidst the current opioid crisis in the U.S., overdose (OD) rates among people who inject drugs (PWID) are
high and many PWID continue to be at risk for viral (HIV, HCV) and bacterial infections (e.g., skin infections,
endocarditis). Select high-risk drug and injection practices (“risk practices”), such as sharing injection
equipment or using multiple drugs in combination (e.g., opioids and alcohol), have been shown to increase risk
for these health outcomes. However, much of the past work on risk practices has been cross-sectional,
retrospective, and/or focuses on individual-level behaviors, limiting the ecological validity of findings. One
methodology that could mitigate limitations associated with past studies is ecological momentary assessment
(EMA). EMA allows for data collection in real-time, in a person's natural environment, using mobile devices.
One advantage when considering this methodology is that it can capture momentary information as the
individual's context, location, or affect changes. This convergent parallel mixed methods study will apply both
qualitative methods and EMA to the “risk environment” framework proposed by Rhodes (2002, 2009). The
risk environment model suggests that complex environmental factors (subtypes: physical, policy, economic,
social) interact with varying levels of micro- (individual and his/her immediate context) and macro-level
(system) influence to produce drug-related harm. Few studies have examined multiple components of the risk
environment model in combination or within the real-world context. This mixed-methods study has two
primary goals: 1) conduct exploratory qualitative interviews with PWID to better inform the literature on
micro- and macro-level (“contextual,” i.e., exogenous to the person) factors that may not have been previously
identified, and 2) use EMA to examine relationships between risk practices and individual and contextual
factors, thus providing real-time information on predictors of risk that have only been examined previously in
cross-sectional studies or not at all, in the participant's natural environment. Street outreach will be used to
recruit ethnically diverse PWID (N = 75) in Honolulu, HI to participate in a qualitative interview, baseline
assessment, and 2-week EMA. The findings from this study will inform a larger project powered to examine
complex relationships between contextual and individual-level factors with risk practices. The long-term
objective of this line of work is to develop a comprehensive model of the risk environment that can be used to
inform the delivery of harm reduction services and interventions for PWID, as well as impact policy decisions
that affect people who use drugs.

## Key facts

- **NIH application ID:** 10471359
- **Project number:** 5R21DA052877-02
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** Kristina T. Phillips
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $233,484
- **Award type:** 5
- **Project period:** 2021-09-01 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10471359

## Citation

> US National Institutes of Health, RePORTER application 10471359, Contextual factors of the risk environment surrounding injection drug use: A real-time approach (5R21DA052877-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10471359. Licensed CC0.

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