Neighbourhood social participation and women's use of anxiolytic-hypnotic drugs: a multilevel analysis.
OBJECTIVE
To identify and quantify a hypothesised collective effect of the neighbourhood on individual use of anxiolytic-hypnotic drugs (AHD). To analyse the general impact of neighbourhood social participation on use of AHD, adjusting for individual characteristics.


METHODS
Cross sectional analysis performed by multilevel logistic regression with women at the first level and neighbourhoods at the second level.


METHODS
Malmö (250 000 inhabitants), Sweden.


METHODS
15 456 women aged 45 to 73, residing in 95 neighbourhoods in Malmö, who took part in the Malmö diet and cancer study (1991-1996).


RESULTS
The prevalence of AHD use was 5.5% in the study sample. Overall, 1.7% of the total individual differences in the propensity for using AHD were explained by the neighbourhood level. This percentage, however, differed between different individuals. Low level of social participation in the neighbourhood was associated with higher probability of AHD use (OR = 3.10 (95% CI 1.51 to 6.41)), independently of individual age, low social participation, low educational level, and living alone. This association was reduced (OR = 2.01 (95% CI 0.97 to 4.14)) after the additional accounting for individual disability pension, low self rated health, stress, and medication for somatic disorders.


CONCLUSIONS
The neighbourhood level of social participation seems to affect individual use of AHD, possibly through individual characteristics. However, neighbourhood boundaries play a minor part in understanding individual AHD use in the city of Malmö.
Johnell
K
K
Family Medicine Stockholm, Karolinska Institutet, Huddinge, Sweden. Kristina.Johnell@klinvet.ki.se
Merlo
J
J
Lynch
J
J
Blennow
G
G
D000368:Aged; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D016015:Logistic Models; D008875:Middle Aged; D011446:Prospective Studies; D012931:Social Environment; D012944:Social Support; D013548:Sweden
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives