Contextual Determinants of Drug Use Risk Behavior: a Theoretic Framework

Galea, Sandro; Ahern, Jennifer; Vlahov, David

doi:10.1093/jurban/jtg082

Cited by 113 publications

(105 citation statements)

References 52 publications

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“…The literature on contextual determinants of illicit drug use is sparse (Galea et al, 2003c). We are aware of only one other empirical study that has assessed contextual determinants of alcohol, cigarette, and marijuana use in the same population sample (Galea et al, in press).…”

Section: Discussionmentioning

confidence: 99%

Education inequality and use of cigarettes, alcohol, and marijuana

Galea

Ahern

Tracy

et al. 2007

Drug and Alcohol Dependence

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Education inequality at the neighborhood-level may influence population health and health behavior. We assessed the relations between education inequality and substance use in 59 New York City (NYC) neighborhoods. We used Gini coefficients of education to describe neighborhood education inequality and data from a random-digit-dial phone survey of adult residents of NYC to assess use of substances. Among 1355 respondents (female=56.2%; white=35.7%; mean age=40.4), 23.9% (95% confidence interval [CI]=20.3-27.5) reported smoking, 39.4% (95% CI=35.3-43.4) drinking, and 5.4% (95% CI=3.6-7.3) using marijuana in the previous 30 days. In multilevel models controlling for neighborhood education, neighborhood income inequality, and individual covariates, living in a neighborhood with high education inequality was associated with a greater prevalence of drinking (p=0.02) and of smoking marijuana (p=0.004) but among current drinkers it was associated (p=0.03) with having fewer drinks. The odds of alcohol use (OR=1.70) and marijuana use (OR=3.49) were greater in neighborhoods in the 75 th percentile of education Gini compared to neighborhoods in the 25 th percentile of education Gini. Statisical interactions suggest that there may be a stronger relation between education inequality and marijuana use in neighborhoods with low mean education than in neighborhoods with higher mean levels of education. These findings, taken together, suggest a complex relation between education inequality and substance use; likelihood of the use of alcohol and marijuana was higher in areas with higher education inequality suggesting potential roles for substance use norms and availability, whereas quantity used among drinkers was higher in areas with low education inequality, suggesting potential roles for both disadvantage and norms.

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Section: Discussionmentioning

confidence: 99%

Education inequality and use of cigarettes, alcohol, and marijuana

Galea

Ahern

Tracy

et al. 2007

Drug and Alcohol Dependence

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“…20 Our findings lend support to the increasing recognition that broader structural or contextual factors can act as barriers to, or facilitators of, an individual's HIV risk behaviors. [21][22][23][24][25][55][56][57][58] More research is needed to understand race/ethnic differences in sexual behaviors and contexts of risk. African American men as well as Latinos appear to have a risk profile that differs from that of non-Hispanic Whites.…”

Section: -63mentioning

confidence: 99%

“…It is increasingly recognized that broader structural or contextual factors can facilitate or pose barriers to an individual's ability to avoid exposure to HIV or for HIV-positive individuals to avoid exposing others to infection. [19][20][21][22][23][24][25] As contexts and situations may change over time, we use a repeated measures approach to examine social and service contexts, as well as individual attributes, as correlates of unsafe sex.…”

Section: Introductionmentioning

confidence: 99%

HIV-Positive Men Sexually Active with Women: Sexual Behaviors and Sexual Risks

Aidala

Lee

Howard³

et al. 2006

J Urban Health

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This study examines patterns of sexual behavior, sexual relating, and sexual risk among HIV-positive men sexually active with women. A total of 278 HIV-positive men were interviewed every 6-12 months between 1994 and 2002 and reported considerable variability in sexual behaviors over time. Many were not sexually active at all for months at a time; many continued to have multiple female and at times male partners. Over one-third of the cohort had one or more periods when they had engaged in unprotected sex with a female partner who was HIV-negative or status unknown (unsafe sex). Periods of unsafe sex alternated with periods of safer sex. Contextual factors such as partner relations, housing status, active drug use, and recently exchanging sex showed the strongest association with increased odds of unsafe sex. A number of predictors of unsafe sex among African American men were not significant among the Latino sub-population, suggesting race/ethnic differences in factors contributing to heterosexual transmission. Implications for prevention interventions are discussed.

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“…Such adverse built environmental features may lead to locations and circumstances that foster participation in HIV risk behaviors. Galea et al (2003), suggest that in areas characterized by adverse characteristics (e.g., poverty, substantial social disorder and lack of safety) people engage in disproportionately more risk behaviors, which influences the risk of transmission of HIV and of STDs (Galea et al 2003). There is evidence supporting a relationship between these types of ecologic stressors and HIV and STDs (Cohen et al 2000;Friedman et al 2005;Zierler et al 2000).…”

Section: Introductionmentioning

confidence: 99%

“…Mental health has been shown to increase HIV/AIDS risk through changes in sexual and drug use risk behaviors (Blumberg and Dickey 2003;Sterk et al 2006;Stevens et al 2003;Stiffman et al 1992). Factors such as poverty, substantial social disorder and lack of safety may lead to an increase in risk behaviors that enhance transmission of HIV and of STDs (Galea et al 2003).…”

Section: Introductionmentioning

confidence: 99%

Population Levels of Psychological Stress, Herpesvirus Reactivation and HIV

2008

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Nearly 40,000 Americans are newly infected with Human Immunodeficiency Virus (HIV) each year. Recently, studies have demonstrated associations between group-level characteristics and the prevalence and incidence of HIV/Acquired Immune Deficiency Syndrome (AIDS) and other sexually transmitted diseases. Two mechanisms previously posited to explain these associations are neighborhood effects on risk behaviors and social or institutional policies. In this paper, we hypothesize that adversity at the population level, such as neighborhood poverty, also influences HIV risk through stress-mediated aberrations in immunological susceptibility by reviewing existing data examining each of these pathways. In particular, we review the evidence showing that: (1) Neighborhood ecologic stressors influence neighborhood-and individual-levels of mental health, psychosocial stress, and HIV/AIDS risk, (2) Individual-level psychosocial stressors influence progression from HIV to AIDS through stress-related hormonal changes, and (3) Individual-level psychosocial stressors influence HIV acquisition via stress-related reactivation of latent herpesviruses, specifically EBV and HSV-2. Our review indicates that further studies are needed to examine the joint pathways linking neighborhood-level sources of psychosocial stress, stress-related reactivation of HSV-2 and EBV, and increased acquisition rates of HIV. We suggest using a multi-level framework for targeting HIV prevention efforts that address not only behavioral risk factors, but structural, political, and institutional factors associated with neighborhood disadvantage, levels of psychosocial stress, and prevention or treatment of HSV-2 and EBV.

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Contextual Determinants of Drug Use Risk Behavior: a Theoretic Framework

Cited by 113 publications

References 52 publications

Education inequality and use of cigarettes, alcohol, and marijuana

Education inequality and use of cigarettes, alcohol, and marijuana

HIV-Positive Men Sexually Active with Women: Sexual Behaviors and Sexual Risks

Population Levels of Psychological Stress, Herpesvirus Reactivation and HIV

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