Background:
Stigma is a fundamental determinant of drug-related harms. Measures of drug use stigma are critical for the design and evaluation of stigma reduction interventions, but few have been validated for people who inject drugs. We evaluated the psychometric properties of an adapted version of the Substance Use Stigma Mechanisms Scale (SU-SMS) to measure drug use stigma among people with a history of injection drug use in Baltimore, Maryland.
Methods:
During January 2023-June 2024, 869 participants of the AIDS Linked to the IntraVenous Experience (ALIVE) cohort of community-recruited people with a history of injection drug use in Baltimore completed an interviewer-administered survey, which included 18 items adapted from the SU-SMS (includes five subscales of enacted and anticipated stigma from two sources [family/healthcare workers] and internalized stigma). Confirmatory factor analysis (CFA) was performed via WLSMV estimation. Associations of stigma subscale scores were assessed with related psychosocial and behavioral constructs (e.g., perceived social support [MOS-SS], depressive symptoms [CESD³23], and past 6-month drug use practices) via age- and sex-adjusted modified Poisson regressions.
Results:
The median participant age was 59 years (range=22-81), 34% were female, and 73% were Black. CFA supported the 5-factor scale structure of enacted family stigma, enacted healthcare stigma, anticipated family stigma, anticipated healthcare stigma, and internalized stigma (RMSEA=0.062; CFI=0.991; TLI=0.989; SRMR=0.036). All subscales had high internal consistency (w=0.86-0.94). For each subscale, greater stigma was significantly associated with lower perceived social support and a greater probability of depressive symptoms. Greater anticipated family stigma and internalized stigma were also significantly associated with active non-injection and injection drug use.
Conclusion:
This adapted drug use stigma scale had excellent psychometric properties and evidence of construct validity in a sample of people with a history of injection drug use, suggesting it may be a valuable tool for characterizing stigma burden and informing stigma reduction efforts. |