Social Networks and Health Workshop 2019: Alia Al-Tayyib, Assistant Professor, Epidemiology, University of Colorado

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Social Networks of Youth and Young
Adults who Misuse Prescription
Opioids and Heroin
Alia Al-Tayyib, PhD
Social Networks and Health Workshop
May 13, 2019

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Prescription Opioids
 Misuse of prescription opioids is prevalent among youth
 Among 12 to 17 year olds, past year nonmedical use of prescription opioids
ranges from 4%-11%
 In the United States, 44 people die as a result of prescription
opioid overdose every day.
 For every unintentional overdose related to an opioid pain reliever:
9 persons admitted to substance abuse treatment
35 emergency department visits
161 report drug abuse or dependence
461 report nonmedical use of prescription opioids
??? transition to injection drug use
J Adolesc Health 2012;51(1):6-17; CDC NVSS mortality data 2015; MMWR, 2012:61(1):10-13

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Injection Drug Use
 Injection drug use is a major risk factor for acquiring HIV and HCV
infection
 Estimated per-act probability of acquiring HIV from infected source via
needle sharing is 67 per 10,000 exposures
 HCV is a hearty virus and is easily transmitted via infected needles and drug
preparation equipment (can survive up to 3 weeks in bottled water)
 Social networks influence pathways into injecting drugs, and youth
are particularly vulnerable to the influence of their social networks
http://www.cdc.gov/hiv/policies/law/risk.html ; JID 2013; 207:281-7

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Social Network Analysis (SNA)
 SNA models human relations, which allows researchers to
examine how attributes of a social network influence behavior
 Attributes can be related to:
 Structure: homogeniety, strength of ties, numbers and size of
components
 Exposure: high-risk peers, infected peers
 Network-based measures can be used to examine how
relationships between, and among, network members influence
behavior
 Can yield more meaningful measures of social integration
 Collection of network data in unbounded populations is difficult

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Example of a network
AJPH 2012; 102(1):141-7

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Respondent Driven Sampling (RDS)
 RDS, a peer-referral sampling methodology, is an efficient
method to recruit hard-to-reach populations
 Initial “seed” participants are identified and recruited for
participation, seeds are then asked to recruit persons from
their networks using referral coupons
 Employs a dual incentive structure
 Behaviorally documented ties, survey data from all nodes of
network

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Example of RDS Recruitment Chains

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SNA + RDS

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Social Networks of Abused Prescription Pills
in Youth Study

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Study Eligibility
 Between the ages of 15 and 24
If under 18, must be able to consent for self
 Living separate or apart from legal guardian and managing own
financial affairs
 Seeking exam or treatment for STI or HIV
 Seeking medical care and treatment for addiction to or use of drugs
 Currently misusing prescription opioids OR using heroin
after a period of prescription opioid misuse
 “Currently misusing” defined as at least once in the past 3 months
 “After a period of misusing” defined as being “hooked” on
prescription opioids before first time injected or used heroin
 Willing to provide information about their social network

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SNAPPY Study Procedures
 Provide informed consent to participate in research
 Complete an interviewer-administered behavioral survey
 Complete a social network interview and sociograms
 HIV and HCV test and counseling
 Participants receive 5 referral coupons to give to others
 Participants receive $70 for their participation and $20-$60* for
each person they refer who participates
 Those not eligible to participate receive $10 for their time

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SNAPPY Screening
 Between October 1, 2015 and April 25, 2017, a total of 217
persons were screened for SNAPPY participation.
 Of 136 non-participants:
 15 (11%) were ineligible due to age
 91 (67%) because the person reported no recent prescription opioid or
heroin use
 30 (10%) were unresponsive to our multiple contact attempts
 Identifying potential participants was challenging due to the
fact that the population of interest is not bound by specific
venues and RDS was not particularly effective in recruitment.

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SNAPPY Recruitment
81 participants: 54 seeds and 27 referrals

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SNAPPY Sample
 These 80 participants have provided information on 537 alter
namings
 Predominately male (73%), white (68%), and homeless in the
past 12 months (60%), mean age 21.4 (SD=2.3)
 Drug use transition
 Prescription opioid only – 11 (14%)
 Non-injection heroin – 5 (6%)
 Injection drug use – 64 (80%)
 53% describe growing up as middle or upper class
 20% identified as LGBTQ

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Creating Sociomatrix
 Of the 537 named alters, 34 (6%) were names of ego
participants which represented 24 unique persons
 Of the remaining 503 alter namings, 26 (5%) were actually 12
unique persons, cross-linked by more than one ego participant
 Thus, if these networks were analyzed as a collection of 80
egocentric networks, there would appear to be 617 persons (80
egos plus 537 alters)
 The matching process for creating a sociometric network
allowed us to unduplicate these 617 nodes to 569 persons (80
egos and 489 unique non-respondent alters)

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Egos
n (%)
Alters
n (%)
TOTAL 80 489
Mean Age (SD) 21.4 (2.3) 27.2 (10.2)
Gender
Male 58 (73) 326 (67)
Female 22 (27) 162 (33)
Race/Ethnicity
White, non-Hispanic 54 (68) 311 (64)
Hispanic 20 (25) 123 (26)
Other 6 (7) 51 (10)
Homeless past 12 months 48 (60) 180 (37)
Ever injected 64 (80) 226 (46)
HCV antibody positive 22 (28) -----
Injected with ----- 194 (40)

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Network Analysis
 Social network prompt: “Think about people you have contact
with, who have been involved in your life in a significant way
during the past month.”
 Location prompt: “Where does [this person] hang out?”
 With respect to transition, we examined k-plexes, subgroups of
size n where each node connects to at least n-k other nodes.
(n≥3; k=2 for our analysis)
 example: a 2-plex of size 5
 respondents ranked against each other
 larger & more numerous k-plexes rank more highly
 Visualized with Pajek; ego sizes proportional to k-plex rank

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Challenges and Implications
 This is a very difficult population to recruit
 Limited number of participants who hadn’t already transitioned to
injection drug use
 RDS might not be the ideal recruitment method for young PWID
 Scheduling interview required multiple attempts
 Persons who have transitioned to injection drug use are in
denser network regions (larger, more frequent k-plexes).
 Prevention efforts that target youth and young adults who
misuse prescription drugs before they have transitioned to
injection drug use are urgently needed.

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Big THANK YOUS!
 Social Networks and Health
Fellowship and Jim Moody
 National Institute on Drug Abuse
(K01DA036452)
 Stephen Q Muth
 Paula Riggs
 Eric Rice
 Carl Latkin
 Sam Friedman
 Jesse Carlson
 Participants

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Questions?
DenverPublicHealth.org | @DenverPublicHealth | @DenPublicHealth
Alia.Al-Tayyib@dhha.org
303-602-3601