Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys.
Toward a global view of alcohol, tobacco, cannabis, and cocaine use: findings from the WHO World Mental Health Surveys.
复制标题
朝着全球酒精，烟草，大麻和可卡因的使用：WHO世界心理健康调查的发现。
DOI：
10.1371/journal.pmed.0050141
复制
发表时间：
2008-07-01
期刊：
影响因子：
15.8
通讯作者：
Wells, J. Elisabeth
中科院分区：
文献类型：
--
作者：
Degenhardt, Louisa;Chiu, Wai-Tat;Sampson, Nancy;Kessler, Ronald C.;Anthony, James C.;Angermeyer, Matthias;Bruffaerts, Ronny;de Girolamo, Giovanni;Gureje, Oye;Huang, Yueqin;Karam, Aimee;Kostyuchenko, Stanislav;Lepine, Jean Pierre;Mora, Maria Elena Medina;Neumark, Yehuda;Ormel, J. Hans;Pinto-Meza, Alejandra;Posada-Villa, Jose;Stein, Dan J.;Takeshima, Tadashi;Wells, J. Elisabeth
酒精、烟草和非法药物的使用造成相当大的发病率和死亡率，但良好的跨国流行病学数据有限。本文描述了参与世界卫生组织（WHO）世界精神卫生调查倡议的首批17个国家的此类数据。在美洲（哥伦比亚、墨西哥、美国）、欧洲（比利时、法国、德国、意大利、荷兰、西班牙、乌克兰）、中东和非洲（以色列、黎巴嫩、尼日利亚、南非）、亚洲（日本、中华人民共和国）和大洋洲（新西兰）进行了家庭调查，总样本量为85,052人。世卫组织综合国际诊断访谈（CIDI）用于评估各种精神和物质障碍的患病率及其相关性。本文的重点是终身使用和年龄开始烟草，酒精，大麻和可卡因。美洲、欧洲、日本和新西兰的大多数人都使用酒精，中东、非洲和中国的比例较小。美国和新西兰的大麻使用率（均为42%）远远高于其他任何国家。在可卡因使用方面，美国也是一个异常值（16%）。男性比女性更有可能使用毒品；性别群体的相互作用被观察到，据此，不仅年轻的群体更有可能使用所有药物，而且在最近的群体中，男女之间的差距正在缩小。在最近的队列中，开始服用药物的危险期似乎也在延长，进入成年期的时间更长。与社会人口学变量的关联在各国是一致的，终身使用发生率曲线也是一致的。在全球范围内，药物使用的分布并不均匀，而且不仅仅与药物政策有关，因为实行严格的使用者非法药物政策的国家的使用水平并不比实行宽松政策的国家低。性别差异一直被记录下来，但在最近的队列中正在减少，这些队列也有更高的非法药物使用水平和开始风险期的延长。Louisa Degenhardt及其同事报告了一项对17个国家的国际调查，该调查发现世界不同地区在药物使用方面存在明显差异。了解某种特定疾病导致多少残疾和死亡（称为“疾病负担”）是很重要的。了解一个国家的疾病负担有助于通过指导针对该疾病的战略和政策来发展更健康的国家。直到1990年世界卫生组织（世卫组织）启动了一个特别项目——全球疾病负担项目，研究人员对不同国家的疾病负担的了解才开始零敲碎打。2002年，根据这个正在进行的项目的最新资料，世卫组织估计有9100万人受到酒精使用障碍的影响，1500万人受到药物使用障碍的影响。人们普遍认为，酒精、烟草和非法药物的使用与相当数量的疾病、残疾和死亡有关。然而，很少有高质量的数据来量化不同国家，特别是欠发达国家的数量。因此，研究人员开始收集不同国家使用酒精、烟草、大麻和可卡因的基本模式。他们记录了每个县终生使用这些物质的情况，重点是年轻人。他们还想检查开始使用毒品的年龄，以及使用的毒品类型是否受到一个人的社会和经济地位的影响。17个国家的54,069名调查参与者提供了关于吸毒的数据。这17个国家是根据合作者的可用性和调查的资金情况确定的。训练有素的非专业采访者进行了面对面的访谈（除了在法国，访谈是通过电话进行的），使用标准化的、结构化的精神疾病诊断访谈。参与者被问及是否曾经使用过(a)酒精、(b)烟草（香烟、雪茄或烟斗）、(c)大麻（大麻、哈希什）或(d)可卡因。如果他们使用过这些药物中的任何一种，他们会被问及开始使用每种药物的年龄。新西兰、日本、法国、德国、比利时、荷兰、意大利和西班牙没有对首次吸烟的年龄进行评估。采访者还记录了参与者的性别、年龄、受教育年限、婚姻状况、就业情况和家庭收入。研究人员发现，在美洲、欧洲、日本和新西兰，绝大多数调查参与者都饮酒，而在中东、非洲和中国，这一比例较小。毒品使用的全球分布是不均匀的，在所有接受调查的国家中，美国的合法和非法毒品使用水平最高。在不同的社会经济群体中，合法和非法药物的使用都存在差异。例如，男性比女性更有可能使用所有类型的药物；年轻人比老年人更有可能使用所有检查过的药物；高收入与各种药物使用有关。研究发现，婚姻状况只与非法药物使用有关——从未结过婚或有过婚史的人更有可能使用可卡因和大麻。吸毒似乎与毒品政策无关，因为政策较严格的国家（如美国）的非法吸毒水平并不比政策较宽松的国家（如荷兰）低。这些调查结果提供了来自代表世界所有区域的国家样本的关于药物使用模式的全面和有用的数据。这些数据将增进对全球疾病负担的了解，并应有助于政府和卫生组织制定与这些问题作斗争的政策。这项研究也有它的局限性，例如，它只调查了世界上17个国家，在这些国家里，有不同的参与率，也不清楚人们在接受采访时是否准确地报告了他们的吸毒情况。尽管如此，该研究确实发现了世界不同地区吸毒情况的明显差异，美国是所有被调查国家中合法和非法吸毒水平最高的国家之一。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.0050141访问这些网站。世界卫生组织提供了关于酒精的事实和数据，包括关于酒精造成的世界范围疾病负担的信息。世卫组织提供了关于药物滥用管理的信息，世卫组织还提供了来自澳大利亚新南威尔士大学和昆士兰大学联合主席的世卫组织研究人员提供的关于全球疾病负担项目的信息。《联合国世界毒品报告》可从联合国毒品和犯罪问题办公室获得。新南威尔士大学还管理着联合国艾滋病毒和注射吸毒问题参考小组秘书处
Alcohol, tobacco, and illegal drug use cause considerable morbidity and mortality, but good cross-national epidemiological data are limited. This paper describes such data from the first 17 countries participating in the World Health Organization's (WHO's) World Mental Health (WMH) Survey Initiative. Household surveys with a combined sample size of 85,052 were carried out in the Americas (Colombia, Mexico, United States), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), Middle East and Africa (Israel, Lebanon, Nigeria, South Africa), Asia (Japan, People's Republic of China), and Oceania (New Zealand). The WHO Composite International Diagnostic Interview (CIDI) was used to assess the prevalence and correlates of a wide variety of mental and substance disorders. This paper focuses on lifetime use and age of initiation of tobacco, alcohol, cannabis, and cocaine. Alcohol had been used by most in the Americas, Europe, Japan, and New Zealand, with smaller proportions in the Middle East, Africa, and China. Cannabis use in the US and New Zealand (both 42%) was far higher than in any other country. The US was also an outlier in cocaine use (16%). Males were more likely than females to have used drugs; and a sex–cohort interaction was observed, whereby not only were younger cohorts more likely to use all drugs, but the male–female gap was closing in more recent cohorts. The period of risk for drug initiation also appears to be lengthening longer into adulthood among more recent cohorts. Associations with sociodemographic variables were consistent across countries, as were the curves of incidence of lifetime use. Globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones. Sex differences were consistently documented, but are decreasing in more recent cohorts, who also have higher levels of illegal drug use and extensions in the period of risk for initiation. Louisa Degenhardt and colleagues report an international survey of 17 countries that finds clear differences in drug use across different regions of the world. Understanding how much disability and death a particular disease causes (known as the “burden of disease”) is important. Knowing the burden of a disease in a country contributes to the development of healthier nations by directing strategies and policies against the disease. Researchers' understanding of the burden of diseases across different countries was piecemeal until the 1990 launch of a special World Health Organization (WHO) project, the Global Burden of Disease Project. In 2002, on the basis of updated information from this ongoing project, the WHO estimated that 91 million people were affected by alcohol use disorders and 15 million by drug use disorders. It is widely accepted that alcohol, tobacco, and illegal drug use are linked with a considerable amount of illness, disability, and death. However, there are few high-quality data quantifying the amount across different countries, especially in less-developed countries. The researchers therefore set out to collect basic patterns of alcohol, tobacco, cannabis, and cocaine use in different countries. They documented lifetime use of these substances in each county, focusing on young adults. They also wanted to examine the age of onset of use and whether the type of drugs used was affected by one's social and economic status. Data on drug use were available from 54,069 survey participants in 17 countries. The 17 countries were determined by the availability of collaborators and on funding for the survey. Trained lay interviewers carried out face-to-face interviews (except in France where the interviews were done over the telephone) using a standardized, structured diagnostic interview for psychiatric conditions. Participants were asked if they had ever used (a) alcohol, (b) tobacco (cigarettes, cigars or pipes), (c) cannabis (marijuana, hashish), or (d) cocaine. If they had used any of these drugs, they were asked about the age they started using each type of drug. The age of first tobacco smoking was not assessed in New Zealand, Japan, France, Germany, Belgium, The Netherlands, Italy, or Spain. The interviewers also recorded the participants' sex, age, years of education, marital status, employment, and household income. The researchers found that in the Americas, Europe, Japan, and New Zealand, alcohol had been used by the vast majority of survey participants, compared to smaller proportions in the Middle East, Africa, and China. The global distribution of drug use is unevenly distributed with the US having the highest levels of both legal and illegal drug use among all countries surveyed. There are differences in both legal and illegal drug use among different socioeconomic groups. For example, males were more likely than females to have used all drug types; younger adults were more likely than older adults to have used all drugs examined; and higher income was related to drug use of all kinds. Marital status was found to be linked only to illegal drug use—the use of cocaine and cannabis is more likely in people who have never been married or were previously married. Drug use does not appear to be related to drug policy, as countries with more stringent policies (e.g., the US) did not have lower levels of illegal drug use than countries with more liberal policies (e.g., The Netherlands). These findings present comprehensive and useful data on the patterns of drug use from national samples representing all regions of the world. The data will add to the understanding of the global burden of disease and should be useful to government and health organizations in developing policies to combat these problems. The study does have its limitations—for example, it surveyed only 17 of the world's countries, within these countries there were different rates of participation, and it is unclear whether people accurately report their drug use when interviewed. Nevertheless, the study did find clear differences in drug use across different regions of the world, with the US having among the highest levels of legal and illegal drug use of all the countries surveyed. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050141. Facts and figures on alcohol are available from the World Health Organization, including information about the burden of disease worldwide as a result of alcohol Information on the management of substance abuse is available from WHO Information on the Global Burden of Disease Project is also available from WHO Researchers from the University of New South Wales, Australia and the University of Queensland co-chair, sponsors the Global Burden of Disease Mental Disorders and Illicit Drug Use Expert Group, which examines illicit drug use and disorders The UN World Drug Report is available from the UN Office on Drugs and Crime The University of New South Wales also runs the Secretariat for the Reference Group to the United Nations on HIV and Injecting Drug Use
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影响因子：
3.5
作者：
Bloomfield, Kim;Gmel, Gerhard;Mustonen, Heli
通讯作者：
Mustonen, Heli
DOI：
10.1111/j.1467-842x.2000.tb01605.x
发表时间：
2000-08-01
影响因子：
3.5
作者：
Degenhardt, L;Lynskey, M;Hall, W
通讯作者：
Hall, W
影响因子：
3.1
作者：
Alonso, J;Ferrer, M;Bruffaerts, R
通讯作者：
Bruffaerts, R
影响因子：
3.7
作者：
EFRON, B
通讯作者：
EFRON, B
影响因子：
4.4
作者：
Engels, RCME;Knibbe, RA;Drop, MJ
通讯作者：
Drop, MJ