International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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International Journal of Drug Policy 25 (2014) 616–623 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Neighbourhood structural characteristics and crack cocaine use: Exploring the impact of perceived neighbourhood disorder on use among African Americans Claire E. Sterk, Kirk W. Elifson, Lara DePadilla ∗ Emory University, Rollins School of Public, Department of Behavioral Sciences and Health Education, United States a r t i c l e i n f o Article history: Received 18 April 2013 Received in revised form 11 September 2013 Accepted 6 December 2013 Keywords: Crack cocaine Ecological model Mediation a b s t r a c t 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 envi- ronmental 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. Multi- variable 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. © 2013 Elsevier B.V. All rights reserved. Introduction Crack cocaine use and its health and social consequences remain significant public health problems since their initial introduction in the mid-1980s in the United States. For example, cocaine was the most commonly reported illicit drug for emergency depart- ment visits in 2011 (Substance Abuse and Mental Health Services Administration, 2013) and for arrests in 2009 (Motivans, 2011). Health consequences associated with crack cocaine use include a range of psychiatric, neurological, and cardiovascular problems (Cornish & O'Brien, 1996; Falck, Wang, & Carlson, 2008) as well as the increased risk for sexually transmitted infections, most notably HIV/AIDS (DeBeck et al., 2009; Harzke, Williams, & Bowen, 2009; ∗ Corresponding author at: 1518 Clifton Road, 5th Floor, Atlanta, GA 30322, United States. Tel.: +1 404 727 8749. E-mail address: (L. DePadilla). Latkin, Curry, Hua, & Davey, 2007; Logan, Cole, & Leukefeld, 2003; Sterk-Elifson & Elifson, 1993). Drug-related violence has also been related to high mortality and morbidity rates (Brewer et al., 2006; Siegal, Falck, Wang, & Carlson, 2000). Negative personal and social consequences include social degradation and economic marginal- ization (Bourgois, 1995; Cross, Johnson, Davis, & Liberty, 2001; Sterk, 1999a), chaotic residential circumstances (Substance Abuse and Mental Health Services Administration, 2010; Wechsberg et al., 2003), unhealthy personal relationships (Golub, Dunlap, & Benoit, 2010), decreased personal safety (Falck, Wang, Carlson, & Siegal, 2001; Ribeiro, Sanchez, & Nappo, 2010) and increased criminal jus- tice involvement (Sterk, Theall, & Elifson, 2005). Crack cocaine use from an ecological perspective: neighbourhood disorder Crack cocaine largely has been marketed in resource-poor neighbourhoods characterized by social disorder and populated 0955-3959/$ – see front matter © 2013 Elsevier B.V. All rights reserved.

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