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Interventions focused on overdose risk behaviors may offer opportunities to reduce overdose, but little research has addressed racial and ethnic differences in risk behaviors. We explored differences in risk behaviors among Black, Latino, and White individuals who used opioids and had a history of prior overdose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used cross-sectional baseline data from REBOOT 2.0 (the REpeated dose Behavioral intervention to reduce Opioid Overdose Trial) based in Boston, MA, and San Francisco, CA, which enrolled people with opioid use disorder and a history of opioid overdose. We used the Andersen behavioral model to inform covariate selection for a multivariable logistic regression analysis examining associations between race\/ethnicity (Black, Latino, and White) and three individual overdose risk behaviors (using opioids alone, not using a tester dose, and using alcohol and\/or benzodiazepines on the same day as opioids).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 247 participants, 19% were Black, 16% were Latino and 66% were White. More than 20% in each group reported each risk behavior. In unadjusted analyses, Black participants had higher odds of using alone (OR\u2009=\u20092.17, 95% CI 1.08\u20134.36) and lower odds of not using a tester dose (OR\u2009=\u20090.48, 95% CI 0.24\u20130.93), indicating greater tester dose use. After adjusting for age, gender and structural determinants of health (e.g., housing, incarceration, education, opioid use disorder treatment) the adjusted odds of Black participants using alone (aOR\u2009=\u20092.05, 95% CI 0.99\u20134.26) and a tester dose (aOR\u2009=\u20090.56, 95% CI 0.28\u20131.13) were no longer statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overdose risk behaviors were common among Black, Latino, and White overdose survivors in San Francisco and Boston. Overdose risk behaviors were not significantly different for Black or Latino compared to White overdose survivors after adjusting for age, gender, and structural determinants of health. For individuals at the highest risk of overdose, individual prevention efforts remain necessary but are not sufficient. Interventions should also address the social-structural factors shaping overdose risk, including housing, criminalization, and access to treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Details found at clinicaltrials.gov, NCT02093559.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12954-026-01451-9","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T07:05:51Z","timestamp":1776668751000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A comparison of opioid overdose risk behaviors by race and ethnicity among overdose survivors in Boston, MA, and San Francisco, CA"],"prefix":"10.1186","volume":"23","author":[{"given":"Gabriela E.","family":"Reed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa M.","family":"McMahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Shin Grace","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natrina L.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Y.","family":"Walley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip O.","family":"Coffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam T. 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