Stephen K Koester

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Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the "risk environment" of injection drug users (IDUs) provides an opportunity to apply structural thinking(More)
BACKGROUND Previous research has demonstrated associations between substance use and sexual risk behavior in men who have sex with men (MSM). Recent trends in substance use show increasing use of prescription medications (e.g., Vicodin) without a physician's prescription, yet associations between the nonmedical use of prescription drugs (NMUPD) and HIV risk(More)
In addition to the numerous heroin users who voluntarily enter methadone treatment as a way to free themselves from illicit drug addiction and those ordered to do so by the courts, there are a large number of opioid users who enter methadone treatment with other objectives in mind. These include shorter-term goals that users do not necessarily equate with(More)
In recent years, the non-medical use of prescription drugs (without a doctor's prescription) has increased dramatically, particularly in young adults. Previous work has noted associations between the non-medical use of prescription drugs and the use of illicit drugs, and associations between the use of illicit drugs and sexual risk behavior. Investigations(More)
Qualitative and quantitative findings from the baseline survey of a longitudinal, socially-focused blood-borne disease intervention study among 611 heroin IDU in Denver indicate that high risk injection practices—the sharing of contaminated drug solution in particular—often occur as a consequence of how heroin is obtained, the quantity obtained and the(More)
OBJECTIVE To identify factors influencing pharmacists' decisions about selling syringes to injection drug users (IDUs). DESIGN Audiotaped interviews. SETTING Denver, Colorado. PARTICIPANTS Thirty-two pharmacists at 24 pharmacies. INTERVENTION One-hour semistructured interviews. MAIN OUTCOME MEASURES Practices regarding syringe sales to IDUs and(More)
BACKGROUND AND OBJECTIVES Methamphetamine use has been strongly associated with high-risk sexual behaviors, and its use has been increasing among men who have sex with men (MSM). Although the behavioral implications of methamphetamine use and sexual risk have been broadly examined, fewer studies have examined attitudes about methamphetamine use. METHODS(More)
OBJECTIVE To determine the availability of syringes for injection drug users (IDUs) from pharmacies in Denver. DESIGN Single-group, uncontrolled, noncomparative study. SETTING Denver, Colorado. PATIENTS OR OTHER PARTICIPANTS 23 randomly selected pharmacies in the Denver metropolitan area and 3 additional pharmacies located near drug-buying locations.(More)