Drug and Alcohol Dependence 77 (2005) 227–233 Prevalence and correlates of crack-cocaine injection among young injection drug users in the United States, 1997–1999 Scott S. Santibanez a,* , Richard S. Garfein a , Andrea Swartzendruber a , Peter R. Kerndt b , Edward Morse c , Danielle Ompad d , Steffanie Strathdee e , Ian T. Williams f , Samuel R. Friedman g , Lawrence J. Ouellet h a Division of HIV/AIDS, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA b Los Angeles County Health Department, Los Angeles, CA 90012, USA c Tulane University, New Orleans, LA 70117, USA d Center for Urban Epidemiological Studies, New York Academy of Medicine, New York City, NY 10029-5293, USA e University of California, San Diego School of Medicine, La Jolla, CA 92093-0622, USA f The Division of Viral Hepatitis, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA g National Development and Research Institutes Inc., New York, NY 10010, USA h University of Illinois at Chicago, Chicago, IL 60617, USA Received 20 October 2003; received in revised form 9 August 2004; accepted 13 August 2004 Abstract Objectives: We estimated prevalence and identified correlates of crack-cocaine injection among young injection drug users in the United States. Methods: We analyzed data from the second Collaborative Injection Drug Users Study (CIDUS II), a 1997–1999 cohort study of 18–30-year- old, street-recruited injection drug users from six US cities. Results: Crack-cocaine injection was reported by 329 (15%) of 2198 participants. Prevalence varied considerably by site (range, 1.5–28.0%). No participants injected only crack-cocaine. At four sites where crack-cocaine injection prevalence was greater than 10%, recent (past 6 months) crack-cocaine injection was correlated with recent daily injection and sharing of syringes, equipment, and drug solution. Lifetime crack-cocaine injection was correlated with using shooting galleries, initiating others into drug injection, and having serologic evidence of hepatitis B virus and hepatitis C virus infection. Conclusions: Crack-cocaine injection may be a marker for high-risk behaviors that can be used to direct efforts to prevent HIV and other blood-borne viral infections. © 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Epidemiology; HIV/AIDS; Hepatitis; Drugs; Urban health; Substance abuse 1. Introduction Over the past 25 years, the United States has experienced a rapid succession of cocaine-use epidemics. At the peak of the powder-cocaine epidemic in 1985, 25 million Americans reported that they had used cocaine at some point during their lifetime (Gay et al., 1973; Van Dyke and Byck, 1982; * Corresponding author. Tel.: +1 404 639 5384; fax: +1 404 639 8629. E-mail address: ssantibanez@cdc.gov (S.S. Santibanez). Hatsukami and Fischman, 1996; Karch, 1999). As powder- cocaine use declined after the mid-1980s, the popularity of free-basing or processing cocaine with ether became more widespread. Shortly thereafter, a new epidemic emerged: use of crack-cocaine. This extremely addictive, base-form could be extracted from cocaine powder using only baking soda, water, and heat and smoked. Doses of crack-cocaine were of- ten packaged in very inexpensive units, compared with those of the more costly powdered cocaine, leading to the diffusion of cocaine use into poor, minority communities (Washton 0376-8716/$ – see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.drugalcdep.2004.08.020