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) 616–623 621 Table 3 Mediation analyses. Variable Paths from neighbourhood disorder to mediators Paths from neighbourhood disorder and mediators to frequency of use Perceived neighbourhood disorder a , b 1.07 (1.02, 1.12) * Crack cocaine use-related practices Involvement in drug distribution c 1.04 (0.99, 1.10) Having traded sex a 1.05 (1.01, 1.10) * 1.32 (1.19, 1.47) *** Perceived neighbourhood disorder a , b 1.05 (1.00, 1.11) + Perceived neighbourhood disorder b , c 1.06 (1.01, 1.12) * Social context of crack use Setting: only at home, home of relatives and home of friends a , d 0.97 (0.94, 1.00) + People use with c , e 0.96 (0.93, 0.99) ** People use with: alone only c , f 0.59 (0.48, 0.74) *** People use with: alone or personal connections only c , f 0.80 (0.69, 0.92) ** Perceived neighbourhood disorder b , c 1.05 (0.99, 1.11) a Controlling for age and age at first use. b IRR is for a one standard deviation change in neighbourhood disorder (5.60). c Controlling for age, age at first use and income. d Reference group is any (semi-)public places. e Sorted descending from ever with acquaintances to alone only. f Reference group is ever with acquaintances. + p < .10. * p < .05. ** p < .01. *** p < .001. Jang and Johnson (2001) in their examination of neighbour- hood disorder discuss the difference between objective measures of disadvantage and the perception of neighbourhood disorder, describing the former as the presence of the phenomena and the latter as an interpretation of it. Their study found an associa- tion between perceived disorder and illicit drug use but other studies that used census data to create indices of neighbourhood disadvantage, largely grounded in different indicators of socioeco- nomic status, have also found associations between these objective measures and illicit drug use (Boardman et al., 2001; Karriker- Jaffe, 2011). However, this finding is not consistent across studies (Karriker-Jaffe, 2011). Additionally, a study of low-income women that used both an objective census measure and a measure of per- ceived disorder found that the objective measure indicated less disorder was associated with more drug use when comparing only the least disadvantaged neighbourhoods while perceived disorder was associated with drug use in the anticipated direction (Sunder et al., 2007). It could be that when people are experiencing similar levels of disadvantage based on income, it is the interpretation or experience of the surrounding disorder that makes them more vul- nerable to drug use. In this study, we applied perception of disorder as our measure of place in order to examine the effect of peoples' experience of where they live on frequency of crack cocaine use. It makes sense, therefore, that the inclusion of measures of use that are more proximal to the experience of drug use such as setting may be more salient or may mediate the impact of neighbourhood disorder. Strengths and limitations This study is subject to a number of limitations. The data are cross-sectional and preclude any causal inferences. The sample is non-probability and therefore may not be representative of crack cocaine users in the area under study. As participants were asked about neighbourhood disorder where they reside, it's possible that if they work or purchase drugs elsewhere, the conditions of those environments may have additive or differential impact on crack cocaine use. Respondents self-reported sensitive information about drug use and illegal activities and their responses may have been subject to social desirability bias. However, the interviewers were trained to be sensitive to potential bias and we have no reason believe that there would be misreporting for reasons other than recall bias. Using a brief time period of 90 days was intended to mitigate this issue. The sample is relatively small and purposive and generalizability is limited to resource poor urban neighbour- hoods. A strength of the study is that the population is not limited to those seeking treatment, thus providing understanding of a hard- to-reach group of users. Additionally, this study elaborates on the on the meso-system and links it to the exo-system as it applies to crack cocaine users, thereby enhancing a specific application of the ecological model. Conclusion The foci of this study address crack cocaine use among African Americans at two ecological levels: the exo-system and the meso- system by examining perceived neighbourhood disorder, crack cocaine use-related practices and the social context of crack cocaine use. Given that a higher percentage of African Americans report the use of illicit drugs nationally than other races/ethnicities (Substance Abuse and Mental Health Services Administration, 2012) and a higher percentage of public drug treatment admissions for crack cocaine specifically in Atlanta, GA (DePadilla & Wolfe, 2012), an understanding of the effect of place on crack cocaine use in this population is important. The findings show that although perceived neighbourhood disorder as a characteristic of place is independently associated with frequency of use when controlling for socio-demographics, the practices related to use and the specific circumstances of use defined by setting and people, may be more salient correlates. People engaging in practices that are embedded within the drug economy may need different resources than those who are not. It may be that some users are already attempting to mitigate the negative consequences of crack cocaine use (Ribeiro et al., 2010) and those who cannot may indicate disparities in access to safer settings among crack cocaine users (German & Sterk, 2002) that highlight other needs, such as stable housing or social sup- port from people who are not users (Sterk, 1999a). Assistance such as this, however, will be more complicated to provide in places that foster sex trading or using drugs in groups through physical and social disorder. In turn, interventions that aim to address the impact of disorder on drug use may well benefit from understand- ing heterogeneity in the use-related practices and the social context

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