Evan Wood


Research Classification

Community Health / Public Health

Research Interests

Substance Use
injection drug use
Population health
urban health

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Graduate Student Supervision

Doctoral Student Supervision (Jan 2008 - Nov 2019)
Injection career trajectories among illicit drug users in Vancouver, Canada (2013)

Background: Though vast resources have been allocated toward the prevention of illicit drug use, the prevalence of injection drug use remains high globally. This thesis therefore sought to identify factors that influence the natural history of injection drug use by: systematically reviewing the epidemiologic literature on the prevention of injecting initiation; identifying the role of drug-related and personality-based risk factors in increasing the risk of injecting initiation; and evaluating the role of harm reduction interventions in potentially modifying the likelihood of injecting cessation among injection drug users (IDU). Methods: Street-involved youth and IDU participating in ongoing prospective observational cohorts in Vancouver, Canada, completed semi-annual interviewer-administered questionnaires. Longitudinal epidemiologic methods were applied to assess the association between selected drug-related, personality-based (e.g., sensation seeking level), and structural factors on the outcomes of interest, while controlling for a variety of potential sociodemographic and behavioural confounders.Results: The systematic review found that a limited set of interventions to prevent injecting has been scientifically evaluated and implemented. A longitudinal analysis of injecting initiation found that non-injection crystal methamphetamine use was significantly associated with injecting initiation among street-involved youth. The adaptation of a sensation seeking scale for use in a related longitudinal analysis found that higher sensation seeking was associated with injecting and risk factors for injection initiation. Finally, in a longitudinal analysis conducted over a span of 15 years, rates of injecting cessation among a cohort of IDU increased significantly despite a substantial expansion in needle and syringe program (NSP) implementation.Conclusions: This thesis identified gaps in current responses to preventing injection drug use. A set of drug-related and personality-based factors associated with increased risk of injecting initiation among street-involved youth was also identified, including non-injection crystal methamphetamine use and higher sensation seeking. Further, an increase in the rate of injecting cessation among IDU occurred during a period of substantial expansion of NSP sites in Vancouver. These results suggest that resources should be allocated towards the development of interventions to prevent injection initiation, and that harm reduction interventions should be considered complementary to broader efforts to reduce both injection drug use and related harms.

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Social and structural barriers to effective antiretroviral therapy for HIV infection among injection drug users (2012)

Background: Despite the development of antiretroviral therapy (ART), injection drug users (IDU) continue to have high levels of HIV-related morbidity and mortality. This thesis sought to apply the risk environment conceptual framework on patterns of HIV treatment outcomes by: Systematically reviewing the epidemiologic literature on HIV disease progression among illicit drug users; examining the incidence of viral rebound among IDU on ART; evaluating the role of homelessness on the suppression of plasma HIV RNA viral load; and assessing the role of incarceration on the likelihood of non-adherence to ART.Methods: HIV-seropositive IDU participating in an ongoing prospective observational cohort completed biannual interviewer-administered questionnaires. This data was confidentially linked to comprehensive records on HIV treatment and related clinical outcomes held by a clinical monitoring laboratory and antiretroviral dispensary. A variety of longitudinal analytic techniques were used to estimate the independent relationships between selected social- and structural-level exposures and the outcomes of interest while controlling for relevant sociodemographic, clinical and behavioural factors.Results: The systematic review found that only a minority of studies included social- and structural-level measures in analyses of disease progression and treatment outcomes. Longitudinal analysis of viral rebound found that incarceration and sex trade involvement were significantly associated with higher rates. Among individuals initiating ART, homelessness was a significant structural barrier to suppression. Among individuals prescribed ART, we observed a dose-dependent relationship between non-adherence and the number of incarceration episodes. Conclusions: In this setting of free and universal access to HIV care and ART, sub-optimal treatment outcomes were common among IDU. Consistent with an application of the HIV risk environment, a number of prevalent social- and structural-level exposures were associated with higher risks of non-adherence to treatment and poorer treatment outcomes, including homelessness, sex trade involvement and incarceration. Interventions to reduce elevated levels of preventable HIV-related morbidity and mortality among IDU should consider the role played by modifiable aspects of the HIV risk environment.

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Master's Student Supervision (2010 - 2018)
Understanding conventional and novel approaches used to advance evidence-based illicit drug policy (2014)

A considerable amount of research has shown traditional illicit drug policies represent a critical source of inequity and ongoing health-related harms on a global scale. The harms associated with these policies have spurred several calls for “evidence-based” policy reform whereby policies that criminalize drug users be replaced with public health approaches. These calls for policy reform, and the persistence of criminal justice based approaches, have raised questions about the strategies and tools scientists, researchers, academics and/or health practitioners may mobilize to support this objective (herein referred to collectively as scientists). In this context, the primary objectives of this thesis were to: 1) synthesize what is known about conventional activities and strategies scientists use to advance evidence-based drug policies and 2) to describe and evaluate in detail the Vienna Declaration campaign, the largest scientist-led mobilization to support evidence-based illicit drug policy to date, and 3) to generate insights into strategies that may support the advancement of evidence-based illicit drug policy, especially as they related to public and political discourse.This work reveals scientist-led efforts to promote evidence-based drug policy have not traditionally made use of the Internet and related tools. Findings from an analysis of the Vienna Declaration campaign reveal that the Internet and social media are important dissemination tools that support science-based efforts to advance evidence-based drug policy. Given the deficit of research in this area and long-standing limitations to scientists’ proficiency engaging the public, media, and policymakers, the thesis concludes additional research is needed to better understand the tools and strategies available to scientists working in this area. It speculates that such a research agenda may also serve as a culturally appropriate way of engaging scientists and influencing their future knowledge translation efforts.

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