Temporal Trends in Spatial Access to Pharmacies that Sell Over-the-Counter Syringes in New York City Health Districts: Relationship to Local Racial/Ethnic Composition and Need

Abstract

Pharmacies that sell over-the-counter (OTC) syringes are a major source of sterile syringes for injection drug users in cities and states where such sales are legal. In these cities and states, however, black injectors are markedly less likely to acquire syringes from pharmacies than white injectors. The present analysis documents spatial and temporal trends in OTC pharmacy access in New York City health districts over time (2001)(2002)(2003)(2004)(2005)(2006) and investigates whether these trends are related to district racial/ ethnic composition and to local need for OTC pharmacies. For each year of the study period, we used kernel density estimation methods to characterize spatial access to OTC pharmacies within each health district. Higher values on this measure indicate better access to these pharmacies. "Need" was operationalized using two different measures: the number of newly diagnosed injection-related AIDS cases per 10,000 residents (averaged across 1999-2001), and the number of drug-related hospital discharges per 10,000 residents (averaged across 1999-2001). District sociodemographic characteristics were assessed using 2000 US decennial census data. We used hierarchical linear models (HLM) for descriptive and inferential analyses and investigated whether the relationship between need and temporal trajectories in the Expanded Syringe Access Demonstration Program access varied by district racial/ethnic composition, controlling for district poverty rates. HLM analyses indicate that the mean spatial access to OTC pharmacies across New York City health districts was 12.71 in 2001 and increased linearly by 1.32 units annually thereafter. Temporal trajectories in spatial access to OTC pharmacies depended on both need and racial/ethnic composition. Within high-need districts, OTC pharmacy access was twice as high in 2001 and increased three times faster annually, in districts with higher proportions of non-Hispanic white residents than in districts with low proportions of these residents. In low-need districts, "whiter" districts had substantially greater baseline access to OTC pharmacies than districts with low proportions of non-Hispanic white residents. Access remained stable thereafter in low-need districts, regardless of racial/ethnic composition. Conclusions were consistent across both measures of "need" and persisted after controlling for local poverty rates. In both high-and low-need districts, spatial access to OTC pharmacies was greater in "Whiter" districts in 2001; in high-need 929districts, access also increased more rapidly over time in "whiter" districts. Ensuring equitable spatial access to OTC pharmacies may reduce injection-related HIV transmission overall and reduce racial/ethnic disparities in HIV incidence among injectors.

Retail Redlining in New York City: Racialized Access to Day-to-Day Retail Resources

“…Yet, spatial regressions revealed that as percent Black increased, the distance to the nearest clothing store, shoe store (general and athletic), pharmacy, health supplement store, electronics store, office supply store, and video game store increased. Cooper et al 10 surmised that perhaps chain pharmacies have less coverage of urban communities with low percentages of White residents. Our data support this assertion for several pharmacy chains.…”

“…Moreover, while racial and ethnic composition accounted for 43 % of spatial variation in access, adding poverty to the model had a negligible effect. 10 Why is the proportion of Black residents consistently inversely related to resources important for promoting and maintain health? Small and McDermott 37 contend that business operation is not based solely on customers' pockets-political and economic conditions such as government incentives and entrepreneurship grants play a key role in where and how businesses operate.…”

“…From a health perspective, retail redlining contributes to racialized risk environments. Cooper et al 10 articulate a racialized risk environment as one in which health-related features occur in spatial pockets of risk or protection based on the race and ethnicity neighborhood populations.…”

Residential Racial Composition, Spatial Access to Care, and Breast Cancer Mortality among Women in Georgia

“…15 Spatial access to care may also mediate the relationship between residential segregation and local racial composition and breast cancer outcomes. 15,22 Predominately Black/AfricanAmerican neighborhoods tend to have poorer spatial access to health care services, [23][24][25][26][27] and increased distance and travel time to healthcare providers may be associated with less cancer treatment uptake and poorer cancer outcomes. [28][29][30][31] Here, we advance this line of inquiry by exploring the relationships between residential racial composition (RRC) and disparities in breast cancer survival in 15 metropolitan areas in Georgia.…”

Factors Associated with Presence of Pharmacies and Pharmacies that Sell Syringes Over-the-Counter in Los Angeles County

“…In New York, Cooper and colleagues conducted kernel density estimates to detect that neighborhoods with a high proportion of African American residents between 2001 and 2006 had fewer OTC syringe-selling outlets than neighborhoods with a high proportion of white residents. 31 However, little research has been conducted on the demographic and socioeconomic status (SES) factors associated with pharmacy availability and OTC syringe availability on the local level in the Western USA.…”