Background
Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs.
Methods
This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure.
Results
Presence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = − 3.81, − 0.22; crack-cocaine: p < 0.001, 95% CI = − 7.40, − 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = − 2.57, − 0.14) remained independent predictors of early age of crack-cocaine initiation.
Conclusions
Early onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.
Inicialmente gostaria de agradecer ao meu orientador, Prof. Dr. Siqueira, por sua temperança, equilíbrio e paciência comigo. Além disso, também sou muito agradecido ao senhor por ter me apresentado a um tema que só com o tempo fui entendendo algumas de suas mensagens iniciais: importante, interessante e pouco estudado (ao menos no Brasil). Agradeço, também, à CAPES pelo financiamento da pesquisa. Poderia ficar lembrando e agradecendo vários amigos e familiares, mas, desta vez, gostaria de fazer algo diferente. Pelo fato de ainda não ter tido a oportunidade de conhecê-los pessoalmente, uma vez que eles moram no Japão, dedico a minha Tese especialmente aos meus dois sobrinhos queridos que sempre estiveram em meus pensamentos: Raquel Megume Oikawa e Rafael Eidi Oikawa.
Não posso me esquecer, aqui, de agradecer duas grandes mulhems que, corajosamente, me aceitaram em suas vidas e que, quase certamente, não sabem o quanto me fazem bem: Vem Lúcia e Dona MbKcelina. Também à minha mãe, minha avó e ao meu tio Naco.Agradecimentos especiais à minha orientadom Silvia coisas, me ajudar a mcuperar um pouco de autoconfiança.Aos meus colegas da Unicapital: marina, José Roberto e demais professores e também ao meu colega Sidney Miranda pela ajuda de última hom.
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