Determinants Of Drug Use Research Articles

Social determinants of drug use – barriers to translating research into policy

Our understanding of the causes of alcohol and other drug (AOD) use and harms has expanded in the past 20 years. In particular, aetiological theories have become substantially more complex, incorporating research on human development and social determinants of health. In this paper, factors that present challenges to the AOD sector translating this research into policy are considered. These include a) the complexity of social determinants, b) community attitudes, and c) governance and funding structures. It is concluded that the challenges are substantial, but not insurmountable. Research on social determinants of AOD use and harms is building an evidence base to inform policy. However, leadership is needed to transform funding priorities from single-issue, short-term projects focusing on individual-level changes to broader, longer-term approaches.

Impulsivity as a determinant and consequence of drug use: a review of underlying processes

Impulsive behaviors are closely linked to drug use and abuse, both as contributors to use and as consequences of use. Trait impulsivity is an important determinant of drug use during development, and in adults momentary 'state' increases in impulsive behavior may increase the likelihood of drug use, especially in individuals attempting to abstain. Conversely, acute and chronic effects of drug use may increase impulsive behaviors, which may in turn facilitate further drug use. However, these effects depend on the behavioral measure used to assess impulsivity. This article reviews data from controlled studies investigating different measures of impulsive behaviors, including delay discounting, behavioral inhibition and a newly proposed measure of inattention. Our findings support the hypothesis that drugs of abuse alter performance across independent behavioral measures of impulsivity. The findings lay the groundwork for studying the cognitive and neurobiological substrates of impulsivity, and for future studies on the role of impulsive behavior as both facilitator and a result of drug use.

Prevalence of drug use among students of vocational schools in Klaipėda city, Lithuania, in 2004–2006

The aim was to evaluate the prevalence and trends of drug use among students of vocational schools in Klaipeda city and to establish the relationships between psychosocial factors and drug abuse. Two cross-sectional questionnaire surveys were carried out among first-year students of vocational schools in Klaipeda. Random samples of 912 and 342 students aged 16-19 years (representatives of Western part of Lithuania) were questioned in 2004 and 2006, respectively. Questionnaires were filled out anonymously in the classroom. Questions have covered information on drugs such as marihuana, club drugs, injectable drugs, and other drugs. Logistic regression was used for evaluation of relationship between drug use and different psychosocial and behavioral determinants of drug use. In 2004, 56.0% of male respondents and 42.0% of female respondents have reported any drug use during their life. The analysis of standardized data (by the place of residence) showed an increase in the prevalence of drug use during 2004-2006: up to 65.5% in boys (P<0.05) and up to 44.0% in girls (P>0.05). Percentage of club drug users increased significantly in girls (from 21.5% to 29.8%; P=0.040) and exceeded the level of boys. The average number of drugs of different types used by boys changed slightly from 1.57 to 1.63 (P>0.05), but increased significantly in girls (from 1.49 to 1.88, P<0.001). The use of drugs was related to school location (graduates of Klaipeda schools used drugs more frequently), communication with friends who use drugs, participation in the parties where drugs are used, alcohol use, and smoking. In 2006 survey, more significant relationship between drug use and social and behavioral factors was observed. Several indicators of drug use showed a significant increase in drug abuse among students of vocational schools in Klaipeda during the period of 2004-2006. Multisectorial efforts and integrated preventive measures should be applied for the prevention of epidemics of drug use in Klaipeda city.

Sampling and Recruitment in Multilevel Studies among Marginalized Urban Populations: The IMPACT Studies

Illicit drug use in urban settings is a major public health problem. A range of individual level factors are known to influence drug use and its consequences, and a number of recent studies have suggested that the neighborhood in which an individual lives may also play a role. However, studies seeking to identify neighborhood-level determinants of drug use, particularly among marginalized urban populations, need to overcome significant challenges, particularly in the area of sampling and recruitment. One key issue is defining functional neighborhoods that are relevant to local residents. Another arises from the need to sample a representative or even a diverse population when studying marginalized groups such as illicit drug users. These are common problems that raise particular challenges when both need to be addressed in the same study. For example, many sampling approaches for neighborhood-level studies have included some form of random sample of households, but this may systematically overlook marginalized populations. On the other hand, the sampling approaches commonly used in studies of hidden populations such as chain referral, snow ball, and more recently, respondent-driven sampling, typically expand beyond a geographic "neighborhood." We describe the organization and rationale for the IMPACT Studies in New York City as a case illustration on how such issues may be addressed.

Indications for Propensity Scores and Review of their Use in Pharmacoepidemiology

Use of propensity scores to identify and control for confounding in observational studies that relate medications to outcomes has increased substantially in recent years. However, it remains unclear whether, and if so when, use of propensity scores provides estimates of drug effects that are less biased than those obtained from conventional multivariate models. In the great majority of published studies that have used both approaches, estimated effects from propensity score and regression methods have been similar. Simulation studies further suggest comparable performance of the two approaches in many settings. We discuss five reasons that favour use of propensity scores: the value of focus on indications for drug use; optimal matching strategies from alternative designs; improved control of confounding with scarce outcomes; ability to identify interactions between propensity of treatment and drug effects on outcomes; and correction for unobserved confounders via propensity score calibration. We describe alternative approaches to estimate and implement propensity scores and the limitations of the C-statistic for evaluation. Use of propensity scores will not correct biases from unmeasured confounders, but can aid in understanding determinants of drug use and lead to improved estimates of drug effects in some settings.

Physician decisions to discontinue long-term medications using a two-stage framework: the case of growth hormone therapy.

Physician decisions to discontinue prescription medications for chronic conditions are fundamental determinants of drug use but have been inadequately studied. The decision to stop growth hormone (GH) therapy is an important example because of high cost (approximately $26,000/y for a 48-kg child), complexity of treatment options, and expansion of patient populations. The aim of this study was to identify the factors that influence physician recommendations in the process of discontinuing therapy. A random sample of half of U.S. pediatric endocrinologists (n = 265) was mailed a survey that included case scenarios of GH-deficient adolescents. Decision options involved a 2-stage framework to 1) initiate change in ongoing GH therapy (by discussing discontinuing GH with the family but not yet stopping treatment), and 2) take action to discontinue ongoing GH therapy (by terminating GH or reducing the dose to adult maintenance level). Physician recommendations. The response rate was 83.8%. Physiological indices of growth potential (growth velocity, bone age) significantly influenced discontinuation decisions (both P < 0.001). However, family preference, child's height, and physician attitudes exerted independent effects (each P < 0.05). Treatment price had little influence. Together, these variables accounted for 60% to 70% of the variation in recommendations. Their relative influence differed by stage in the discontinuation process. The variables in our framework substantially explain discontinuation decisions. The data demonstrate the importance of both physiological and nonphysiological factors. The results suggest that physicians value even small gains as final height approaches, although an additional 20% expenditure may be needed to gain the last 1% to 3% of adult height.

Determinants of drug use in sport: a survey of Italian athletes

The aim of this survey was to study the socio-demographic determinants of drug use in sporting activities at an amateur level in Italy. In 2000 a cross-sectional study was carried out in two Italian regions (Latium and Campania). The participants were 1056 athletes (age range: 16-35 years; 660 males and 396 females). The results show that 28.3% thought “doping” was creatine, 14.7% said racemed amino-acids, 5.8% said proteins, 24.7% did not know and finally 35.7% correctly recognised it as growth hormone. When asked if using drugs was acceptable in order to improve sporting performance, significant results were associated with age (OR = 1.64 for 18-24 years old and OR = 2.22 for 25-30 years old); gender (males were more prone to consider them acceptable); type of sport undertaken (OR = 1.34 for athletes who practice team sport); educational level (athletes with an elementary level education are at higher risk), and knowledge of the effects of anabolic agents (OR = 0.6 for athletes with poor knowledge). The findings of our study confirm the need to implement preventive interventions, with a special focus on healthier behaviour, for reducing factors that encourage the use and the willingness to use licit and illicit drugs.

Further Evidence on the Labor Market Effects of Addiction: Chronic Drug Use and Employment in Metropolitan Miami

This study used data collected from 1996 to 1997 in low‐income and high‐crime neighborhoods in Miami, Florida, to analyze the effects of chronic drug use on employment. Given the significant gender differences in substance use patterns and labor market behavior, separate models were estimated for males and females. The analysis estimated univariate probit models of employment and bivariate probit models that allow for possible correlation among missing or unobserved determinants of drug use and employment. The key finding was that regardless of gender and specification, chronic drug use significantly reduced the probability of being employed. (JEL I12, J22, J24)

Drug prescribing patterns in Parkinson's disease: a pharmacoepidemiological survey in a cohort of ambulatory patients.

Drug treatment of idiopathic Parkinson's disease (IPD) is a difficult task, and comorbidity and comedication add to its complexity. Since in IPD there is little information about drug use, this study investigated drug prescribing and indications in IPD patients. From June 1997 to April 1998, a cross-sectional survey of IPD outpatients was performed and demographic and clinical data and information about drug treatments was collected and analysed. In the 130 IPD patients included in the study, anti-Parkinson drug (APD) prescriptions increased with disease duration and severity. Levodopa was most frequently used, followed by dopamine agonists and anticholinergic agents. Levodopa with other APDs was given to older patients with later IPD onset. Prescriptions of drugs for other indications (non-APDs) were given to 80.8% of the patients and their number increased with patient age. Non-APD prescriptions concerned mainly the circulatory system, mental disorders, the musculoskeletal system and the digestive system. Prescriptions for indications corresponding to secondary symptoms that often complicate IPD increased with patient age and also with IPD duration. In IPD patients, disease duration and severity and patient age seem to be major determinants of drug use. Indications for drug prescription suggest that main comorbidity includes neuropsychiatric, circulatory, musculoskeletal and digestive disorders. Analysis of prescribing patterns in IPD can provide a readily accessible indirect indicator of patient health status for both health services and epidemiologic research purposes.

Changes in Antipsychotic Drug Use Following Shifts in Policy

This case study of antipsychotic drug use in nursing homes illustrates the potential benefits and limits of multilevel hierarchical linear analysis in long-term care research. Multilevel (MLn) logistic regression models were used to assess changes in exposure and average daily dose and their associations with resident and facility characteristics following implementation of the 1987 Omnibus Budget Reconciliation Act regulations. Data were obtained for 8,158 elderly Oregon Medicaid residents residing in 128 facilities between July 1991 and December 1994. Findings support the general hypothesis that resident characteristics are the main determinants of drug use and that drug use decreased over time among some resident populations and some facility types. Although challenges were encountered in the use of the MLn software, hierarchical modeling has advantages that make it attractive for long-term care multilevel applications such as the drug use study reported here.

Angiotensin-converting enzyme inhibitor use in older patients with heart failure and renal dysfunction.

To examine the relationship between angiotensin-converting enzyme (ACE) inhibitor use and clinical outcomes among recently hospitalized patients with congestive heart failure (CHF) and coexisting renal insufficiency. A prospective cohort study. Ten community hospitals in upstate New York. A total of 1076 hospital survivors identified from a consecutive series of CHF inpatients. Patients were followed prospectively for 6 months after hospital discharge to track mortality, hospital readmission, and quality of life. Clinical outcomes were stratified by ACE inhibitor use among those with renal dysfunction, defined as serum creatinine > or = 2.0 mg/dL, and among the remaining patients, whose serum creatinine was < or = 1.9. ACE inhibitor use was lower among 187 patients with renal dysfunction than among 889 patients with preserved function (41 vs 69%, P < .001). Age and sex were among the significant determinants of drug use in both groups. After adjustment for covariables, ACE inhibitor use among those with abnormal renal function was not associated with a lower risk for death or readmission, or better quality of life. By comparison, ACE inhibition conferred meaningful clinical benefit among those whose creatinine was < or = 1.9 mg/dL. Convincing evidence of clinical benefit from ACE inhibitor use is not readily detectable among a sample of 187 unselected older patients with CHF and moderate or severe renal insufficiency. Further studies to identify subsets of this group who might benefit are warranted.

Determination of drug exposure using hair: application to child protective cases

The use of hair as a specimen for the determination of drug use remains controversial. Scientists disagree upon whether environmental drug contamination (e.g. smoke) can be differentiated from actual drug use. Children whose parents use drugs (particularly crack) at home are considered to be at risk. Using the hair of the children to determine exposure gives extra credibility to the child protective services and allows them to remove children from dangerous households. Children are tested when there are credible reasons for suspecting drug exposure. In Blackhawk County, Iowa, this program was implemented in late 1994, and since then many children have tested positively for drugs, the majority of the hair containing cocaine or methamphetamine. In some cases, cocaethylene and benzoylecgonine were also found in the hair of the children. While the presence of benzoylecgonine can be explained by exposure to crack smoke, the presence of cocaethylene suggests ingestion of cocaine and alcohol. Blackhawk County Juvenile Court have found the program to be so useful in helping children, that they have extended hair testing from Child Protective allegation investigations to ongoing court cases and even delinquency hearings.

Drug Use in Nepal: The View from the Street

This study uses qualitative research techniques to examine heroin use in Nepal. It explores the life histories of 16 heroin users in Kathmandu, the country's capital, emphasizing those who are street children or who are otherwise displaced. The cases document that the initiation of use in Nepal is a complex process which includes: certain personality traits; an early history of culturally acceptable use of alcohol, tobacco, marijuana, or hashish; peer influence; and the specific social setting of users. Outside (i.e., foreign) influences are included in the mix, but never as a single determinant of drug use. Factors specific to the Nepali scene include the traditional association of forms of marijuana with certain religious contexts and the availability of heroin. An additional factor is the poverty of the urban setting. The approach in Nepal to dealing with drugs primarily involves a realization of the role played by the interaction between personality and social setting in the fullest meaning of that term. [Translations are provided in the International s Section of this issue.]

Impact of Parent Monitoring on Initiation of Drug Use through Late Childhood

To examine whether parental supervision and monitoring in middle childhood might have a sustained impact on risk of drug use later in childhood and adolescence. An epidemiological sample of 926 urban-dwelling youths were individually interviewed annually, beginning in 1989 when the children were 8 to 10 years old, continuing through 1992. Standardized questions measured drug use, parenting behaviors, and other suspected determinants of drug use. Survival analysis estimates indicated that children in the lowest quartile of parent monitoring initiated drug use at earlier ages. The contrast in risk of initiating alcohol, tobacco, or other drug use across levels of parent monitoring was greatest when children were under 11 years old; at older ages there was no difference in risk. However, in analyses focused specifically on marijuana, cocaine, and inhalant drugs, we observed a sustained higher risk of starting to use these drugs among youths who had been monitored at the lowest levels in middle childhood. These results add to the chain of inference that effective supervision and monitoring in middle childhood by parents or guardians might induce a delay or prevent onset of drug use among youths living in urban areas, a hypothesis that now ought to be tested in rigorous field experiments.

Smoking outcome expectancies: factor structure, predictive validity, and discriminant validity.

Recent models of addiction posit that drug outcome expectancies are influential determinants of drug use. The current research examines the dimensional structure, predictive validity, and discriminant validity of expectancies for cigarette smoking in a prospective study. There was a good fit between the factor structure of the Smoking Consequences Questionnaire and the observed data. In addition, the internal consistency of each scale was satisfactory. Moreover, there was considerable evidence for the predictive and discriminant validity of expectancies. Expectancies of positive outcomes (positive reinforcement, negative reinforcement, and appetite-weight control) predicted withdrawal severity. Negative reinforcement expectancies and expectancies of negative consequences predicted cessation success. Predictive relations remained significant after controlling for related constructs: negative affect, stress, and dependence measures.

Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking

Objective. —To probe the meaning of reported racial and ethnic group differences in the prevalence of crack cocaine smoking and to estimate the degree to which crack cocaine smoking is associated with personal factors specific to race/ ethnicity. Design. —Through reanalysis of data from the 1988 National Household Survey of Drug Abuse (NHSDA), we compared racial/ethnic group differences in crack cocaine smoking. To hold constant social and environmental risk factors that might potentially confound racial comparisons, we used an epidemiologic strategy that involves poststratification of respondents into neighborhood risk sets. A conditional logistic regression model was used to estimate the relative odds of crack use by race/ethnicity. Patients or Other Participants. —The 1988 NHSDA interviewed 8814 individuals residing within households in the United States. Subjects were selected using a multistage area probability sampling of all residents aged 12 years and older. Results. —Once respondents were grouped into neighborhood clusters, the relative odds (RO) of crack use did not differ significantly for African Americans (RO, 0.85; 95% confidence interval [CI], 0.37 to 1.93) or for Hispanic Americans (RO, 0.88; 95% CI, 0.47 to 1.67) compared with white Americans. Conclusion. —Findings of race-associated differences are often presented as if a person's race has intrinsic explanatory power. This analysis provides evidence that, given similar social and environmental conditions, crack use does not strongly depend on race-specific (eg, biologic) personal factors. Although the study finding does not refute the previous analysis, it provides evidence that prevalence estimates unadjusted for social environmental risk factors may lead to misunderstanding about the role of race or ethnicity in the epidemiology of crack use. Future research should seek to identify which characteristics of the neighborhood social environment are important and potentially modifiable determinants of drug use. (JAMA. 1993;269:993-997)

Probing the Meaning of Racial/Ethnic Group Comparisons in Crack Cocaine Smoking

To probe the meaning of reported racial and ethnic group differences in the prevalence of crack cocaine smoking and to estimate the degree to which crack cocaine smoking is associated with personal factors specific to race/ethnicity. Through reanalysis of data from the 1988 National Household Survey of Drug Abuse (NHSDA), we compared racial/ethnic group differences in crack cocaine smoking. To hold constant social and environmental risk factors that might potentially confound racial comparisons, we used an epidemiologic strategy that involves poststratification of respondents into neighborhood risk sets. A conditional logistic regression model was used to estimate the relative odds of crack use by race/ethnicity. The 1988 NHSDA interviewed 8814 individuals residing within households in the United States. Subjects were selected using a multistage area probability sampling of all residents aged 12 years and older. Once respondents were grouped into neighborhood clusters, the relative odds (RO) of crack use did not differ significantly for African Americans (RO, 0.85; 95% confidence interval [Cl], 0.37 to 1.93) or for Hispanic Americans (RO, 0.88; 95% Cl, 0.47 to 1.67) compared with white Americans. Findings of race-associated differences are often presented as if a person's race has intrinsic explanatory power. This analysis provides evidence that, given similar social and environmental conditions, crack use does not strongly depend on race-specific (eg, biologic) personal factors. Although the study finding does not refute the previous analysis, it provides evidence that prevalence estimates unadjusted for social environmental risk factors may lead to misunderstanding about the role of race or ethnicity in the epidemiology of crack use. Future research should seek to identify which characteristics of the neighborhood social environment are important and potentially modifiable determinants of drug use.

Drug-utilization studies in the Netherlands

Drug-utilization research is a research area of increasing importance, both in the Netherlands and elsewhere. In this article an overview of the situation in the Netherlands is given. Three types of studies are distinguished: descriptive studies, studies of the determinants of drug use and studies of the impact of drug use. Descriptive studies are needed to understand the present situation and to detect problems. If these problems are to be solved it is important to understand the factors that determine drug use. In the Netherlands research in the latter area is focused on the influence of policy measures and of educational measures for physicians, as well as for the general public. The main body of research into the impact of drug use is the study of adverse effects, but increasingly attention is paid to the effect on quality of life in a broader sense. A number of data bases exist that enable drug-utilization research. At present one of the main problems concerning the data bases is the absence of adequate diagnosis-related drug-utilization data. Despite the existence of a number of shortcomings and problems, the general impression of drug-utilization research in the Netherlands is one of a flourishing field of study.

Bases of Power, Facilitation Effects, and Attitudes and Behavior: Direct, Indirect, and Interactive Determinants of Drug Use

Within the attitude-behavior literature, considerable disagreement exists as to when groups and institutions will influence attitudes, when they will influence behavior independently of attitudes, and when they will influence behavior by interacting with attitudes. By drawing on research on the bases of power, this paper attempts to specify the conditions that create each type of effect. Traditional classifications of the bases of power, however, cannot explain interactions. Attitude-behavior research suggests that interactions result from facilitation power. Facilitation power in part consists of the ability to influence behavior by providing social cooperation or by altering environmental circumstances. National survey data are used to examine how the bases of power available to schools, religious institutions, and peers influence drug use. The results generally support the hypotheses relating types of power to types of effects.

Determinants of drug use: A test of the coping hypothesis

This paper uses a national probability sample to examine major correlates of drug use among American adults. Demographic correlates of alcohol, cigarette, marijuana, tranquilizer, sleeping pill and stimulant use are explained in terms of a self medication or coping perspective of drug use. Two analysis procedures are used. In the first, respondents were asked to list strategies they use when they have problems. These responses are ‘broken down’ by drug use categories or ‘taking pills’. In the second procedure, attempts are made to interpret the correlations between age, sex, marital status, education and drug use by introducing variables which measure how respondents were experiencing fundamental aspects of their lives (role stress items) and mental health variables. A substantial portion of the variance in drug use that is explained by demographic variables appears to operate through social role and mental health variables, that is, these latter variables interpret the demographic/drug use relationships in a way that is consistent with a coping perspective. The authors conclude that these data and this analysis provided cautious support for a coping perspective.