Neighborhood Effects on Drug Use Among African American Adults

描述（由申请人提供）：社区的结构特征、物理基础设施和社会进程越来越被认为是健康的重要决定因素。虽然健康状况在很大程度上取决于个人行为，但人们居住的地方可能会影响个人行为之外的健康结果。具体而言，我们建议调查社区环境损害或促进其居民健康的程度。这项拟议中的研究主要针对佐治亚州亚特兰大市的非裔美国成年人，同时对使用者和非使用者、男性和女性、年轻人和老年人进行了比较。使用毒品的定义是使用可卡因、海洛因和/或甲基苯丙胺。本研究的目的是：(1)探讨社区环境、个体特征和社区认知与吸毒的关系；(2)在吸毒者中，研究社区环境、个人特征（包括情境使用相关属性）和社区感知与吸毒频率的关系；(3)识别空间格局，探讨与空间格局相关的社区特征和个体特征。指导性概念模型建立在邻里社会生态组织理论，特别是社会解体理论的基础上。该项目包括四个不同的数据来源，即1,600个个人访谈、2000年美国人口普查数据、第一部分犯罪数据和亚特兰大警察局的毒品逮捕数据，这些数据将结合起来评估社区结构特征，并对社区物质基础设施和社会过程进行系统观察。人口普查街区组将被用作社区的代表。研究区域将涵盖100个人口普查街区群体，我们的试点数据显示，这些群体因关键结构特征而异。我们的分析方法将结合层次线性模型（HLM）和空间“热点”分析来探索关键假设。拟议的研究具有重要意义，因为其重点是非洲裔美国人，这一人口受到非法药物使用及其社会和健康后果（包括艾滋病毒/艾滋病）的不成比例的影响。通过采用多层次、分层的方法，将重点从吸毒的个人层面因素扩大到社区影响的影响，从而增强了其重要性。此外，该研究具有理论和研究意义，因为其研究结果将为决策者、城市设计师、社会和卫生服务提供者以及更广泛的研究界提供有用的信息。最重要的是，这些发现有可能对未来针对非法药物使用及其社会和健康后果的多层次干预作出重大贡献，这些后果受到个人层面和社区背景因素的综合影响。公共卫生相关性：本研究提出在非裔美国成年人中调查社区对药物使用的影响，超出个人水平。尽管对影响药物使用的个人层面特征有重要的见解，但我们对环境因素及其影响的了解有限。这项研究的发现可能对许多其他健康挑战产生影响，包括性传播感染，包括艾滋病毒/艾滋病、肥胖、癌症和心血管疾病。

DESCRIPTION (provided by applicant): The structural characteristics, physical infrastructure, and social processes of a neighborhood increasingly are recognized as salient determinants of health. Although health conditions largely depend on individual behaviors, the place where people live may impact health outcomes over and beyond individual actions. Specifically we propose to investigate the extent to which the neighborhood context harms or promotes the health of its residents. The proposed study focuses on African American adults in Atlanta, Georgia, while comparing users and non-users, men and women, and younger and older persons. Drug use is defined as the use of cocaine, heroin and/or methamphetamine. The proposed study aims are: (1) to investigate the association between neighborhood context, individual characteristics and neighborhood perceptions with drug use; (2) among drug users, to examine the association between neighborhood context, individual characteristics, including situational use-related attributes, and neighborhood perceptions with the frequency of drug use; and (3) to identify the spatial patterns and to investigate neighborhood characteristics and individual-level characteristics associated with these spatial patterns. The guiding conceptual model builds on theories of neighborhood social and ecological organization, specifically social disorganization theory. This project comprises four distinct data sources, namely 1,600 individual interviews, data from the 2000 U.S. Census, Part 1 crime data and drug arrest data from the Atlanta Police Department which will be combined into an assessment of neighborhood structural characteristics, and systematic observations of neighborhood physical infrastructure and social processes. Census block groups will be used as proxy for neighborhoods. The study area will cover 100 census block groups and our pilot data show these to vary according to key structural characteristics. Our analytical approach will combine hierarchical linear modeling (HLM) and spatial "hot spot" analyses to explore the key hypotheses. The proposed study is significant because of its focus on African Americans, a population that is shown to be disproportionately impacted by illicit drug use and its social and health consequences, including HIV/AIDS. Its significance is enhanced by applying a multilevel, hierarchical approach that expands the focus from individual-level factors on drug use to the impact of neighborhood influences. In addition, the study has theoretical and research significance as its findings will provide useful information for policy-makers, urban designers, social and health service providers and the wider research community. Most importantly, the findings have the potential to make major contributions to future multi-level interventions targeting illicit drug use and its social and health consequences that are impacted by a mix of individual-level and neighborhood contextual factors. PUBLIC HEALTH RELEVANCE: This study proposes to investigate the neighborhood effects on drug use among African American adults over and beyond those at the individual level. Despite significant insights about individual-level characteristics found to influence drug use, our knowledge regarding contextual factors and their impact is limited. The findings from the study can have implications for many other health challenges including sexually transmitted infections, including HIV/AIDS, obesity, cancer, and cardiovascular disease.