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In addition, the direct observation of behaviors to determine the impact of the environment on behavior constitutes a primary methodology for health ecological studies. Some of these studies have targeted the results of prevention or behavioral change programs and culturally competent interventions in risk taking behavior. A linked series of studies of needle sharing and needle hygiene practices supported by the National Institute on Drug Abuse exemplifies midrange theory combined with observational methods in a cultural ecological context. The component studies of this project focus on context specific uses of injection equipment among drug users in the United States, as part of HIV risk reduction efforts for drug injectors. Descriptive observations in this realm (Koester 1994; Page 1990; Page et al. 1990) explore both the meaning and the processes of injection drug use, needle sharing, and the public health consequences of drug paraphernalia laws (laws that restrict the possession of syringes that might be used for drug abuse). Later studies (Clatts et al. 1996; Singer et al. 1995) explore the micro-environmental consequences of needle hygiene and needle sharing in depth. One example of the latter approach is the Needle Hygiene Project, conducted by the National Institutes on Drug abuse Cooperative Agreement Program (Needle et al ND, Koester 1994). These studies have led to changes in the recommended messages and training processes for HIV risk reduction among injection drug users.