title: Area-Level Deprivation and Adverse Consequences in People With Substance Use Disorders: Findings From the Psychiatric and Addictive Dual Disorder in Italy (PADDI) Study.
abstract: Environmental factors may operate with individual ones to influence the risk of substance use. Research has focused on severe adverse consequences influenced by contextual variables. However, the literature on community level factors influencing substance use behaviors is relatively limited across Europe so far.
  
  
  
  We capitalized on data from a National survey, exploring individual and contextual characteristics, to study adverse consequences among people with substance use disorders.
  
  
  
  The impact of area-level deprivation on nonfatal overdose, hepatitis C or B infections, and major involvement with the criminal justice system, was explored. Logistic regression models with cluster-robust errors, modeling subject-level and area-level effects, were used.
  
  
  
  Living in deprived and intermediate areas, as compared with affluent ones, was associated with greater likelihood of both nonfatal overdose and jail sentences longer than 6 months, though not of active viral hepatitis.
  
  
  
  Area-level deprivation may play an important role in determining adverse consequences in people with substance use disorders, also after controlling for individual-level characteristics. More research is needed to understand the aspects of social and physical environments that matter for drug outcomes before effective policy and research interventions can be developed.
authors.affiliation: a Division of Psychiatry , University College London , London , United Kingdom.|b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carrà
authors.affiliation: b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.|c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Crocamo
authors.affiliation: c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Borrelli
authors.affiliation: b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Tabacchi
authors.affiliation: b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bartoli
authors.affiliation: c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy.
authors.forename: Ioana
authors.initials: I
authors.lastname: Popa
authors.affiliation: c Department of Public Health, Experimental and Forensic Medicine , University of Pavia , Pavia , Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Montomoli
authors.affiliation: b Department of Medicine and Surgery , University of Milano Bicocca , Monza , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Clerici
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003415:Crime / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000191:economics / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012307:Risk Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Substance use disorder; hepatitis; overdose; prison; socioeconomic status