Neighbourhood structural characteristics and crack cocaine use: Exploring the impact of perceived neighbourhood disorder on use among African Americans

Abstract

Background Crack cocaine use and associated negative social and health consequences remain a significant public health problem. Research that expands beyond the individual by considering the environmental context as a determinant of cocaine use is growing. The main objectives of this paper are to examine the effects of perceived neighbourhood disorder as an independent correlate of the frequency of recent crack cocaine use and whether its impact is mediated by use-related practices and social context of use among an African American adult sample in Atlanta (GA). Methods Cross-sectional data were collected from 461 respondents who were recruited through active and passive community outreach from 70 disadvantaged urban neighbourhoods across Atlanta. Multivariable negative binomial regression was performed to assess the independent association of perceived neighbourhood disorder with crack cocaine use frequency and to explore potential mediation by use-related practices and social context of use. Results Perceived neighbourhood disorder did not remain statistically significant after accounting for use-related practices and social context of use. Involvement in drug distribution and having traded sex were associated with increases in frequency of drug use, while using in safer places and using alone were associated with decreases in frequency of use. Conclusion The results show that perceived neighbourhood disorder is associated with frequency of crack cocaine use independently of socio-demographics. However, its significance was eliminated when controlling for use-related practices and the social context of use. Such practices and the social context of use may mediate the relationship between neighbourhood disorder and crack cocaine use. Future research is needed to more fully elucidate the links between individual and neighbourhood characteristics that are related to crack cocaine use and strategies to reduce use must consider the salience of use-related practices and the social context of use.

Powder cocaine and crack use in the United States: An examination of risk for arrest and socioeconomic disparities in use

“…Our finding that racial minority adults are at low risk for crack use is somewhat inconsistent with the literature suggesting that young African American males are more likely to use crack (Beaver, 2010; Smart, 1991; Sterk et al, 2013; Wallace, 2014). However, the reader must keep in mind that while (unadjusted) rates tend to be presented in the policy literature, our multivariable models reduced confounding by SES variables such as income and educational attainment.…”

Revisão sistemática da literatura sobre crack: análise do seu uso prejudicial nas dimensões individual e contextual

“…Outro resultado importante foi a baixa utilização dos serviços sociais e de saúde de UC. Essa baixa utilização pode estar associada às dificuldades de acesso a esses serviços devido tanto à distância por causa de meios de transporte quanto ao horário de funcionamento desses serviços e ao estigma dos UC pelos profissionais de saúde (PAIM KESSLER ET AL., 2012;STERK;ELIFSON;DEPADILLA, 2014;ZAVASCHI ET AL., 2014).…”

Integrating place into research on drug use, drug users’ health, and drug policy

“…Sterk, Elifson and DePadilla (2014) take the important step of investigating some of the pathways linking a particularly potent place-based exposure – perceived neighborhood disorder – to the frequency of crack use in a sample of African-American adults living in Atlanta, Georgia (USA). They find that this relationship may be mediated by trading sex for drugs and by characteristics of drug use networks.…”

“…Identifying these pathways, however, is important for bolstering arguments that these relationships are causal; helps build conceptual frameworks; and can identify key points for intervention. We hope that future quantitative analyses build on the efforts of Sterk and colleagues (2014) by seeking to identify the mechanisms that link place characteristics to health.…”