International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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C.E. Sterk et al. / International Journal of Drug Policy 25 (2014) 616–623 617 by residents, often racial/ethnic minorities, with limited options for upward social mobility (Lipton & Johnson, 1998), providing a historical context for the link between place and crack use intensity. Studies examining the effects of neighbourhood char- acteristics on drug use are increasing (Boardman, Finch, Ellison, Williams, & Jackson, 2001; Crum, Lillie-Blanton, & Anthony, 1996; Galea, Rudenstine, & Vlahov, 2005), including those that focus on the neighbourhood socio-economic status (Duncan, Duncan, & Strycker, 2002; Fuller et al., 2005; Karriker-Jaffe, 2011; Wilson, Syme, Boyce, Battistich, & Selvin, 2005). Neighbourhood disadvan- tage has been associated with drug-related behaviors (Boardman et al., 2001). Research has also shown that social exclusion, relative deprivation and lack of economic resources more gen- erally create environmental risk for illicit drug use (Fothergill, Ensminger, Green, Robertson, & Hee Soon, 2009; Karriker-Jaffe, 2011). The lack of sufficient economic and social resources results in a weakening of social controls, thereby creating a place characterized by physical disorder (e.g., vacant buildings, graf- fiti, vandalism) as well as social disorder (e.g., crime, drug use and drug sales) (Lambert, Brown, Phillips, & Ialongo, 2004; Ziersch, Baum, MacDougall, & Putland, 2005). Neigh- bourhood disorder may act through other individual or social processes in influencing health or drug use behavior (Galea, Ahern, & Vlahov, 2003). For example, research shows that the association between neighbourhood disadvantage and health might be mediated when perceived neighbourhood social dis- order and associated fear were included (Ross & Mirowsky, 2001). Perceived neighbourhood disorder, the meso-system and crack cocaine use Perceived neighbourhood disorder has been associated with illicit drug use, controlling for individual factors and other neigh- bourhood characteristics (Sunder, Grady, & Wu, 2007). Perceived neighbourhood condition may also be antecedent of drug use as part of a system. Bronfenbrenner's (1979) ecological model dif- ferentiates between the exo-, meso- and micro-systems. Place may be considered a facet of the exo-system and the meso- and micro-system are then processes embedded within it. In this study, place is conceptualized as neighbourhood disorder. The process of micro-system features such as family, friends, and acquaintances relating to one another is the meso-system, which in this study includes crack cocaine use-related practices and the social context of use. Neighbourhood disorder may increase crack cocaine use through norms that are supportive of use, while marginalizing those who disapprove of local drug scenes (Sterk, Elifson, & Theall, 2007). Moreover, neighbourhood disor- der may allow for use in public places, public distribution and sales, and activities to support ones drug habit, ranging from pan- handling to trading sex (Latkin et al., 2007; Schönnesson et al., 2008; Sterk, 1999b; Sterk, Elifson, & German, 2000; Werb et al., 2010). In neighbourhoods with high levels of disorder, places likely will emerge that facilitate use (Sterk-Elifson & Elifson, 1993). These range from private settings (e.g., crack houses and private res- idential settings), to semi-public (e.g., abandoned house or car) and public places (e.g., park or street corner). Use patterns vary by place of use. For example, in private settings, users are more likely to share the drug, maybe even buy their supply together or cook rocks from powdered cocaine, and have forms of infor- mal social control that curtail the frequency of use. Conversely, in public settings, use and sales tend to occur at the same time, group cohesion is limited, and norms are largely undefined (Hamid, 1992; Fig. 1. Conceptual model. Mieczkowski, 1990; Ribeiro et al., 2010; Sterk-Elifson & Elifson, 1993). The place or setting of use and the network of people with whom one uses and other associates tend to be linked. However, some studies that have included neighbourhood disadvantage in multi- variate models predicting drug use still found a significant effect for neighbourhood when controlling for social resources (Boardman et al., 2001), opinions about friends' use (Gibbons et al., 2004) or friend's acceptance of use (Sunder et al., 2007), suggesting that place influences drug use regardless of social network character- istics. For example, one study found that seeing the drug and other people using (Ehrman, Robbins, Childress, & O'Brien, 1992; Epstein et al., 2009) may lead one to use or use more often or that being at a place where the person has used or been exposed to use trig- gers the desire to get high (Bradizza & Stasiewicz, 2003; Crum et al., 1996). Although some researchers found that users may prefer to use alone as a means to have more control, a number also reported isolated use to reduce the negative aspects of getting high, such as paranoia (Inciardi, 1995; Ribeiro et al., 2010; Sterk-Elifson & Elifson, 1993). At the micro-level, socio-demographic characteristics influence the social context of crack cocaine use. For example, those who are older and those who initiated use at an older age tend to be more marginalized and face more challenges in acquiring the drug and supporting their habit than those who are younger and who became socialized into the drug world at a younger age (Johnson & Sterk, 2003; Sterk, 1999a). The present study The resource poor environment that characterizes many areas of high crack cocaine use may exacerbate frequency of use patterns. In Atlanta, GA, where this study took place, crack cocaine users are primarily African Americans living in resource poor neighbour- hoods (DePadilla & Wolfe, 2012). The objectives of this paper are (1) to determine if the exo-system characteristic of perceived neigh- bourhood disorder and the meso-system characteristics of crack cocaine use-related practices and social context of crack cocaine use are independently associated with frequency of use and (2) to examine whether the impact of the exo-system characteris- tic of neighbourhood disorder on frequency of use is mediated by the meso-system characteristics of crack cocaine use-related practices and social context of use. Given the paucity of litera- ture about the practices and social context among non-treatment populations (Malchy, Bungay, & Johnson, 2008; Ribeiro et al., 2010), we seek to understand how these meso-system character- istics impact frequency of use from an ecological perspective that incorporates the concept of place among African American adults (Fig. 1).

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