Do actions speak louder than words? Perceived peer influences on needle sharing and cleaning in a sample of injection drug users.

Past research (Dielman, Butchart, Shope, & Miller, 1990; Kandel, 1980) has found peer influence, perceived peer norms and perceived peer behavior as the strongest predictors of drug use in adolescent and young adult populations. The purpose of this study was to investigate whether verbal persuasion (peer norms) and/or observation of peer behavior (modeling) were significantly associated with the injection practices of unclean needle sharing and needle cleaning of 642 high risk for HIV infection active injection drug users in Baltimore, Maryland, in 1991 and 1992. Using regression analyses to examine interview reports of infection practices, it was determined that subjects who reported observing more peer protective HIV-related behavior were also more likely to report lower frequencies of HIV risk behavior (unclean needle sharing) and increased frequencies of HIV protective behavior (always cleaning needles). Reports of verbalizations of peer norms about reducing risk were not associated with decreased HIV risk behavior. Reports of "encouragement by peers to engage in cleaning needles" was paradoxically related to increased risk of sharing unclean needles. In conclusion, peer behavior rather than verbal persuasion appears to influence injection practices.