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Shannon Blaney, MPH, Crystal Fuller, PhD, Danielle C. Ompad, PhD, David Vlahov, PhD, and Sandro Galea, MD, MPH, DrPH. Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-4193541, sblaney@nyam.org
Impoverished, urban, and minority communities shoulder disproportionately large burdens of substance abuse. We posited that community social cohesion might prevent initiation of hard drug use among youth in vulnerable communities. We recruited illicit drug users through street outreach in the East Harlem, Central Harlem, and South Bronx neighborhoods in New York City. Participants were interviewed regarding demographic characteristics, drug use behavior and personal history (n=437). The outcome, age of hard drug use initiation, was defined as the youngest age that participants first used heroin, crack or cocaine. Zipcode was the neighborhood-level unit of analysis. Collective efficacy was measured through a random digit dial survey of 754 residents of the aforementioned neighborhoods. Individual scores on the collective efficacy scale were aggregated at the zipcode-level. 2000 US Census data provided zipcode-level measures of disadvantage, educational attainment, and segregation. After adjustment for individual-level factors, collective efficacy (p = .03) was the only zipcode-level factor significantly associated with younger drug use initiation. In the full model, the only individual-level factor that remained a significant predictor of younger initiation was ever having been in juvenile detention; race and ethnicity no longer significantly predicted age of first hard drug use. These findings emphasize the importance of community social factors over race and ethnicity in explaining disparities in hard drug use in New York City. They also indicate that juvenile detainees are particularly vulnerable to early substance use and suggest that they might benefit from specialized interventions to address hard drug use.
Learning Objectives: At the conclusion of the session, the learner will be able to
Keywords: Underserved Populations, Drug Abuse
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.