Neighbourhood structural characteristics and crack cocaine use: exploring the impact of perceived neighbourhood disorder on use among African Americans.
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 environmental 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. Multivariable 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.


CONCLUSIONS
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.
Emory University, Rollins School of Public, Department of Behavioral Sciences and Health Education, United States.
Claire E
CE
Sterk
Emory University, Rollins School of Public, Department of Behavioral Sciences and Health Education, United States.
Kirk W
KW
Elifson
Emory University, Rollins School of Public, Department of Behavioral Sciences and Health Education, United States. Electronic address: ldepadi@emory.edu.
Lara
L
DePadilla
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D016578:Crack Cocaine; D003430:Cross-Sectional Studies; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012931:Social Environment; D014505:Urban Population / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000706:statistics & numerical data
D016578:Crack Cocaine
Crack cocaine; Ecological model; Mediation