Community Ment Health J DOI 10.1007/s10597-015-9860-x
BRIEF COMMUNICATION
Socio-demographic Characteristics of Individuals with History of Crack Cocaine Use in the US General Population Andriy Yur’yev1 • Evaristo Akerele1
Received: 9 November 2014 / Accepted: 14 March 2015 Ó Springer Science+Business Media New York 2015
Abstract This study explores socio-demographic characteristics of individuals with history of crack cocaine use. Data from the 29th Round of General Social Survey was used. Respondents with history of crack cocaine use were compared to respondents without such history. T test was applied to identify differences between groups. Approximately 6 % of respondents reported lifetime history of crack cocaine use. Groups with and without history of crack cocaine use differed significantly in gender, marital status, education, income distribution, employment, health perception, family and financial satisfaction, criminal history, happiness, sexual history, history of injection drug use, and HIV testing. There were no significant differences for race. The study provides insights that could improve identification and prevention of substance use disorders. Keywords Crack Cocaine General population Sociodemographic USA General Social Survey
Introduction Substance use disorder is a global public health issue (UNODC 2013). Recent data from the National Survey on Drug Use and Health indicate that approximately 22 million Americans aged 12 or older abuse illicit drugs and 1.4 million of them abuse cocaine (NSDUH 2011). Crack & Andriy Yur’yev [email protected] Evaristo Akerele [email protected] 1
Psychiatry Department, Harlem Hospital Center, Columbia University, 506 Lenox Ave., New York, NY 10037, USA
cocaine use is associated with medical (Epstein 1994; Goodkin et al. 1998; Pechansky et al. 2003; Shannon et al. 2008), psychiatric (Akerele and Nahar 2015; E. O. Akerele and Levin 2002; Haasen et al. 2005; Nnadi et al. 2005), family (Boyd and Mieczkowski 1990; Compton et al. 2002; Henderson et al. 1994; Pinheiro et al. 2006), occupational (Donlin et al. 2008; Zwerling et al. 1990), and criminal issues (Inciardi and Surratt 2001; Kasarabada et al. 2000; Pottieger and Tressell 2000; Saum et al. 2007). Data on prevalence of crack cocaine use and its socio-demographic characteristics are primarily based on qualitative studies. These studies tend to focus only individuals diagnosed with substance use disorders who present to healthcare providers for treatment. There is a dearth of more comprehensive data on prevalence of cocaine use disorder that includes all segments of the population. Analysis of more inclusive data sets is essential for the development of preventive strategies and treatment interventions. In this study a comprehensive data set is analyzed. The goal is to identify trends in socio-demographic characteristics of individuals with history of crack cocaine trends which may be used to enhance prevention and treatment of cocaine use disorder.
Method Data from the General Social Survey was selected for the purpose of this study. The General Social Survey (GSS) is a major US social survey which aims to monitor social change and the growing complexity of American society. It is the largest project funded by the Sociology Program of the National Science Foundation and one of the most frequently analyzed sources of information in the social sciences (GSS 2010).
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Community Ment Health J
A total 1708 respondents representing general population of the USA participated in 29th round of GSS. A group of respondents who answered ‘‘Yes’’ to the question ‘‘Have you ever, even once, used ‘‘crack’’ cocaine in chunk or rock form?’’ was selected (N = 103) and compared to the group of respondents who answered ‘‘No’’ to the same question (N = 1605). General demographic characteristics of respondents with and without history of crack cocaine use including gender, marital status, and race and education level were explored. The following questions representing a number of socio-demographic and health indicators were selected for comparison between the groups: A.
B.
C.
D.
E.
F.
G.
H.
I. J.
At any time during the last 10 years, have you been unemployed and looking for work for as long as a month? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Have you ever, even once, taken any drugs by injection with a needle (like heroin, cocaine, amphetamines, or steroids) Interviewer’s comment: do not include anything you took under a doctor’s orders (Score: 1— ‘‘Yes’’; 2—‘‘No’’) Would you say your own health, in general, is excellent, good, fair, or poor? (Score: 1—‘‘Excellent’’; 2—‘‘Good’’; 3—‘‘Fair’’; 4—‘‘Poor’’) All things considered, how satisfied are you with your family life? (Score: 1—‘‘Completely satisfied’’; 2— ‘‘Very satisfied’’; 3—‘‘Fairly satisfied’’; 4—‘‘Neither satisfied nor dissatisfied’’; 5—‘‘Fairly dissatisfied’’; 6—‘‘Very dissatisfied’’; 7—‘‘Completely dissatisfied’’) We are interested in how people are getting along financially these days. So far as you and your family are concerned, would you say that you are pretty well satisfied with your present financial situation, more or less satisfied, or not satisfied at all? (Score: 1— ‘‘Satisfied’’; 2—‘‘More or less satisfied’’; 3—‘‘Not at all satisfied’’) On the whole, how satisfied are you with the work you do—would you say you are very satisfied, moderately satisfied, a little dissatisfied, or very dissatisfied? (Score: 1—‘‘Very satisfied’’; 2—‘‘Moderately satisfied’’; 3— ‘‘A little dissatisfied’’; 4—‘‘Very dissatisfied’’) Were you ever picked up or charged by the police, for any other reason whether or not you were guilty? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Not counting minor traffic offenses, have you ever been convicted of a crime? (Score: 1—‘‘Yes’’; 2— ‘‘No’’) Have you ever spent any time in prison or jail? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Taken all together, how would you say things are these days—would you say that you are very happy, pretty happy or not too happy? (Score: 1—‘‘Very happy’’; 2—‘‘Pretty happy’’; 3—‘‘Not too happy’’)
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K.
L.
Thinking about the time since your 18th birthday, have you ever had sex with a person you paid or who paid you for sex? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Have you ever been tested for HIV? Interviewer’s comment: Do not count tests you may have had as part of a blood donation. Include oral test (where they take a swab from your mouth.) (Score: 1—‘‘Yes’’; 2— ‘‘No’’)
Answers were aggregated according to the groups (individuals with history of crack cocaine use vs. individuals without such history). T test was used to determine significance of difference between groups. The study was evaluated by the Biomedical Research Alliance of New York and met criteria for IRB exemption.
Results Among all respondents 6 % reported lifetime history of crack cocaine use (8.1 % males and 4.4 % females). Lifetime history of crack cocaine use was reported by 5.9 % of white respondents, and 5.7 % of black respondents. Among respondents who have history of crack cocaine use proportion of men was higher compared to respondents without cocaine use history (60.2 vs. 43.9 %). Proportion of individuals who were never married or divorced was higher among cocaine users compared to those who never used crack cocaine (never married: 40.8 vs. 27.2 %; divorced: 22.3 vs. 15.9 %) and proportion of married individuals was lower (29.1 vs. 46.4 %). There was no significant difference in race distribution between those two groups. Proportion of individuals with history of crack cocaine use was higher among respondents with low education level and lower among respondents with bachelor or graduate degree compared to population without history of crack cocaine use (less then high school: 21.4 vs. 11.8 %; high school: 56.3 vs. 49.8 %; bachelor: 10.7 vs. 18.9 %; graduate: 3.9 vs. 11.6 %). Proportion of individuals with history of crack cocaine use was higher among respondents with low annual income compared to population without crack cocaine abuse history (\$15,000: 40.6 vs. 20.8 %; $75,000 and more: 5.8 vs. 21.5 %). Analysis of social indicators revealed remarkable differences between groups. A proportion of individuals who reported being unemployment for some time during last 10 years was significantly higher among individuals with history of cocaine use (Question A: 43.7 vs. 24 %). More than 20 % of individuals with crack cocaine use history reported also a history of intravenous drug use (Question B). Crack cocaine users ranked their subjective health perception significantly lower compared to those who never used cocaine (Question C: mean score 2.31 vs. 2.03;
Community Ment Health J
p \ 0.05). They were also significantly less satisfied with their family (Question D: mean score 3.04 vs. 2.29; p \ 0.001) and financial life (Question E: mean score 2.30 vs. 2.01; p \ 0.001). Satisfaction with their job did not differ significantly between groups (Question F: mean score 1.80 vs. 1.65; p = 0.11). Significantly higher proportion of individuals with history of crack cocaine use reported history of legal (Question G: mean score 1.28 vs. 1.82; p \ 0.001) and criminal problems (Question H: mean score 1.54 vs. 1.90; p \ 0.001 and Question I: mean score 1.41 vs. 1.88; p \ 0.001) compared to those who never used crack cocaine. Cocaine users were also ranking themselves significantly less happy compared to individuals without cocaine history (Question J: mean score 2.06 vs. 1.82; p \ 0.001). Significantly higher proportion of respondents with history of crack cocaine use reported history of having paid sex including either buying or selling (Question K: mean score 1.80 vs. 1,92; p \ 0.001). Significantly more respondents with history of crack cocaine use reported been tested for HIV compared to individuals without crack cocaine use history (Question L: mean score 1.40 vs. 1.60; p \ 0.001).
Discussion Approximately 6 % of respondents reported lifetime history of crack cocaine use in our analysis. This outcome is similar to the results from the European countries (United Kingdom 5.2 % in 2001; Germany 4 % in 2000; Spain 4.8 % in 1999; Haasen et al. 2004). These results suggest a trend of increased rates of cocaine abuse among male population compared to females which is consistent with what exists in the literature (Kosten et al. 1993; McKay et al. 1996; Najavits and Lester 2008; Weiss et al. 1997). Cocaine use disorder seemed to have a negative impact on family and marital relationship. In our study proportion of individuals with history of crack cocaine use that were divorced or never married was higher and proportion of married individuals was lower compared to those without history of cocaine use. This is consistent with data from existing literature. (Boyd and Mieczkowski 1990; Hidalgo Carmona et al. 2008; Pinheiro et al. 2006). Similar factors probably contribute to lower level of family satisfaction reported by respondents with history of crack cocaine use. There were no significant race differences in history of cocaine use. This supports the hypothesis of Lillie-Blanton (Lillie-Blanton et al. 1993) that, given similar social and environmental conditions, crack use does not strongly depend on race-specific personal factors (Adebimpe 1993; Gfroerer et al. 1993). Lower education level among respondents with history of crack cocaine use compared to individuals without such history confirms a tendency of
drugs abuse being more prevalent in the lower as compared to the upper social strata (Miech et al. 2005). Finding of higher unemployment history and low satisfaction with financial situation among respondents with history of cocaine use is not surprising considering association between cocaine abuse and adverse employment outcomes (Zwerling et al. 1990). Surprisingly satisfaction with job did not differ significantly between groups. An interesting finding in our study is proportion (20 %) of intravenous drug abusers among individuals with history of crack cocaine use. This finding suggests that screening for injection drug abuse among individuals with cocaine use history may play a significant role in the management of comorbid medical conditions such as HIV, Hepatitis C, bacterial endocarditis, sepsis etc. (Joe and Simpson 1995; Shannon et al. 2008; van der Meer et al. 1992). It is not surprising that respondents with history of crack cocaine use rank their subjective health perception significantly lower compared to respondents without such history. Higher involvement in risky sex behavior should be also mentioned at this point. Our results show significantly higher engagement in paid sex (either buying or selling sex) among respondents with crack cocaine use history which may be a target for another intervention prevention policy. In our analysis, respondents with history of crack cocaine use reported significantly more criminal and legal problems which supports findings of other scholars who report higher rates of criminal involvement and illegal activity among cocaine abusers (Inciardi and Surratt 2001; Kasarabada et al. 2000; Pottieger and Tressell 2000). These factors probably culminate in the overall low perception of happiness among cocaine using respondents. There are some significant limitations in this analysis. First, the study is based on self-reported data which may be less reliable compared to the studies where drug abuse was confirmed using additional laboratory analysis (e.g. urine toxicology screen). Second, underreporting or inconsistency in reporting drug use is a known limitation in majority of survey-based drug abuse studies (Fendrich and Mackesy-Amiti 1995; Fendrich and Vaughn 1994). Third, this is a retrospective study with all its inherent limitations.
Conclusions Clearly, the current data suggest that the key factors in substance use disorder are related to socioeconomic factors rather than race. However more studies are needed to confirm this. Furthermore, there is a need to identify modalities in which socioeconomic factors and injection drug use impact on drug use disorders. This knowledge will assist in the development of more effective socioeconomic
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interventions for the treatment and prevention of substance use disorder.
References Adebimpe, V. R. (1993). Race and crack cocaine. JAMA, 270(1), 45. author reply 46. Akerele, E. O., & Levin, F. R. (2002). Substance abuse among patients with schizophrenia. Journal of Psychiatric Practice, 8(2), 70–80. Akerele, E., & Nahar, N. (2015). Cocaine. In R. J. Frances, S. I. Miller, & A. H. Mack (Eds.), Clinical textbook of addictive disorders (4th ed.). New York, NY: The Guilford Press. Boyd, C. J., & Mieczkowski, T. (1990). Drug use, health, family and social support in ‘‘crack’’ cocaine users. Addictive Behaviors, 15(5), 481–485. Compton, W. M., Cottler, L. B., Ridenour, T., Ben-Abdallah, A., & Spitznagel, E. L. (2002). The specificity of family history of alcohol and drug abuse in cocaine abusers. The American Journal on Addictions, 11(2), 85–94. Donlin, W. D., Knealing, T. W., Needham, M., Wong, C. J., & Silverman, K. (2008). Attendance rates in a workplace predict subsequent outcome of employment-based reinforcement of cocaine abstinence in methadone patients. Journal of Applied Behavior Analysis, 41(4), 499–516. Epstein, R. (1994). Cocaine and HIV prevalence in an alcohol treatment center. JAMA, 272(6), 435. Fendrich, M., & Mackesy-Amiti, M. E. (1995). Inconsistencies in lifetime cocaine and marijuana use reports: Impact on prevalence and incidence. Addiction, 90(1), 111–118. Fendrich, M., & Vaughn, C. M. (1994). Diminished lifetime substance use over time: An inquiry into differential underreporting. Public Opinion Quarterly, 58(1), 96–123. Gfroerer, J., Flewelling, R., Rachal, J. V., & Folsom, R. (1993). Race and crack cocaine. JAMA, 270(1), 45–46. Goodkin, K., Shapshak, P., Metsch, L. R., McCoy, C. B., Crandall, K. A., Kumar, M., et al. (1998). Cocaine abuse and HIV-1 infection: Epidemiology and neuropathogenesis. Journal of Neuroimmunology, 83(1–2), 88–101. GSS (2010). General social survey (http://www3.norc.org/GSS?Web site/). Haasen, C., Prinzleve, M., Gossop, M., Fischer, G., & Casas, M. (2005). Relationship between cocaine use and mental health problems in a sample of European cocaine powder or crack users. World Psychiatry, 4(3), 173–176. Haasen, C., Prinzleve, M., Zurhold, H., Rehm, J., Guttinger, F., Fischer, G., et al. (2004). Cocaine use in Europe—A multi-centre study. Methodology and prevalence estimates. European Addiction Research, 10(4), 139–146. Henderson, D. J., Boyd, C., & Mieczkowski, T. (1994). Gender, relationships, and crack cocaine: A content analysis. Research in Nursing & Health, 17(4), 265–272. Hidalgo Carmona, C. G., Santis Barros, R., Rodriguez Tobar, J., Hayden Canobra, V., & Anselmo Montequin, E. (2008). Family functioning of out-of-treatment cocaine base paste and cocaine hydrochloride users. Addictive Behaviors, 33(7), 866–879. Inciardi, J. A., & Surratt, H. L. (2001). Drug use, street crime, and sex-trading among cocaine-dependent women: Implications for public health and criminal justice policy. Journal of Psychoactive Drugs, 33(4), 379–389. Joe, G. W., & Simpson, D. D. (1995). HIV risks, gender, and cocaine use among opiate users. Drug and Alcohol Dependence, 37(1), 23–28.
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Kasarabada, N. D., Anglin, M. D., Stark, E., & Paredes, A. (2000). Cocaine, crime, family history of deviance-are psychosocial correlates related to these phenomena in male cocaine abusers? Substance Abuse, 21(2), 67–78. Kosten, T. A., Gawin, F. H., Kosten, T. R., & Rounsaville, B. J. (1993). Gender differences in cocaine use and treatment response. Journal of Substance Abuse Treatment, 10(1), 63–66. Lillie-Blanton, M., Anthony, J. C., & Schuster, C. R. (1993). Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. JAMA, 269(8), 993–997. McKay, J. R., Rutherford, M. J., Cacciola, J. S., KabasakalianMcKay, R., & Alterman, A. I. (1996). Gender differences in the relapse experiences of cocaine patients. The Journal of Nervous and Mental Disease, 184(10), 616–622. Miech, R. A., Chilcoat, H., & Harder, V. S. (2005). The increase in the association of education and cocaine use over the 1980s and 1990s: Evidence for a ‘historical period’ effect. Drug and Alcohol Dependence, 79(3), 311–320. Najavits, L. M., & Lester, K. M. (2008). Gender differences in cocaine dependence. Drug and Alcohol Dependence, 97(1–2), 190–194. Nnadi, C. U., Mimiko, O. A., McCurtis, H. L., & Cadet, J. L. (2005). Neuropsychiatric effects of cocaine use disorders. Journal of the National Medical Association, 97(11), 1504–1515. NSDUH (2011). Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services (http://www.samhsa.gov/data/nsduh/2k11results/ nsduhresults2011.htm). Pechansky, F., von Diemen, L., Kessler, F., Hirakata, V., Metzger, D., & Woody, G. E. (2003). Preliminary estimates of human immunodeficiency virus prevalence and incidence among cocaine abusers of Porto Alegre, Brazil. Journal of Urban Health, 80(1), 115–126. Pinheiro, R. T., Pinheiro, K. A., Magalhaes, P. V., Horta, B. L., da Silva, R. A., Sousa, P. L., et al. (2006). Cocaine addiction and family dysfunction: A case-control study in southern Brazil. Substance Use and Misuse, 41(3), 307–316. Pottieger, A. E., & Tressell, P. A. (2000). Social relationships of crime-involved women cocaine users. Journal of Psychoactive Drugs, 32(4), 445–460. Saum, C. A., Hiller, M. L., Leigey, M. E., Inciardi, J. A., & Surratt, H. L. (2007). Predictors of substance abuse treatment entry for crime-involved, cocaine-dependent women. Drug and Alcohol Dependence, 91(2–3), 253–259. Shannon, K., Rusch, M., Morgan, R., Oleson, M., Kerr, T., & Tyndall, M. W. (2008). HIV and HCV prevalence and gender-specific risk profiles of crack cocaine smokers and dual users of injection drugs. Substance Use and Misuse, 43(3–4), 521–534. UNODC (2013). World Drug Report. Vienna: United Nations Office on Drugs and Crime (http://www.unodc.org/unodc/secured/wdr/ wdr2013/World_Drug_Report_2013.pdf). van der Meer, J. T., Thompson, J., Valkenburg, H. A., & Michel, M. F. (1992). Epidemiology of bacterial endocarditis in The Netherlands. I. Patient characteristics. Archives of Internal Medicine, 152(9), 1863–1868. Weiss, R. D., Martinez-Raga, J., Griffin, M. L., Greenfield, S. F., & Hufford, C. (1997). Gender differences in cocaine dependent patients: A 6 month follow-up study. Drug and Alcohol Dependence, 44(1), 35–40. Zwerling, C., Ryan, J., & Orav, E. J. (1990). The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome. JAMA, 264(20), 2639–2643.
BRIEF COMMUNICATION
Socio-demographic Characteristics of Individuals with History of Crack Cocaine Use in the US General Population Andriy Yur’yev1 • Evaristo Akerele1
Received: 9 November 2014 / Accepted: 14 March 2015 Ó Springer Science+Business Media New York 2015
Abstract This study explores socio-demographic characteristics of individuals with history of crack cocaine use. Data from the 29th Round of General Social Survey was used. Respondents with history of crack cocaine use were compared to respondents without such history. T test was applied to identify differences between groups. Approximately 6 % of respondents reported lifetime history of crack cocaine use. Groups with and without history of crack cocaine use differed significantly in gender, marital status, education, income distribution, employment, health perception, family and financial satisfaction, criminal history, happiness, sexual history, history of injection drug use, and HIV testing. There were no significant differences for race. The study provides insights that could improve identification and prevention of substance use disorders. Keywords Crack Cocaine General population Sociodemographic USA General Social Survey
Introduction Substance use disorder is a global public health issue (UNODC 2013). Recent data from the National Survey on Drug Use and Health indicate that approximately 22 million Americans aged 12 or older abuse illicit drugs and 1.4 million of them abuse cocaine (NSDUH 2011). Crack & Andriy Yur’yev [email protected] Evaristo Akerele [email protected] 1
Psychiatry Department, Harlem Hospital Center, Columbia University, 506 Lenox Ave., New York, NY 10037, USA
cocaine use is associated with medical (Epstein 1994; Goodkin et al. 1998; Pechansky et al. 2003; Shannon et al. 2008), psychiatric (Akerele and Nahar 2015; E. O. Akerele and Levin 2002; Haasen et al. 2005; Nnadi et al. 2005), family (Boyd and Mieczkowski 1990; Compton et al. 2002; Henderson et al. 1994; Pinheiro et al. 2006), occupational (Donlin et al. 2008; Zwerling et al. 1990), and criminal issues (Inciardi and Surratt 2001; Kasarabada et al. 2000; Pottieger and Tressell 2000; Saum et al. 2007). Data on prevalence of crack cocaine use and its socio-demographic characteristics are primarily based on qualitative studies. These studies tend to focus only individuals diagnosed with substance use disorders who present to healthcare providers for treatment. There is a dearth of more comprehensive data on prevalence of cocaine use disorder that includes all segments of the population. Analysis of more inclusive data sets is essential for the development of preventive strategies and treatment interventions. In this study a comprehensive data set is analyzed. The goal is to identify trends in socio-demographic characteristics of individuals with history of crack cocaine trends which may be used to enhance prevention and treatment of cocaine use disorder.
Method Data from the General Social Survey was selected for the purpose of this study. The General Social Survey (GSS) is a major US social survey which aims to monitor social change and the growing complexity of American society. It is the largest project funded by the Sociology Program of the National Science Foundation and one of the most frequently analyzed sources of information in the social sciences (GSS 2010).
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Community Ment Health J
A total 1708 respondents representing general population of the USA participated in 29th round of GSS. A group of respondents who answered ‘‘Yes’’ to the question ‘‘Have you ever, even once, used ‘‘crack’’ cocaine in chunk or rock form?’’ was selected (N = 103) and compared to the group of respondents who answered ‘‘No’’ to the same question (N = 1605). General demographic characteristics of respondents with and without history of crack cocaine use including gender, marital status, and race and education level were explored. The following questions representing a number of socio-demographic and health indicators were selected for comparison between the groups: A.
B.
C.
D.
E.
F.
G.
H.
I. J.
At any time during the last 10 years, have you been unemployed and looking for work for as long as a month? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Have you ever, even once, taken any drugs by injection with a needle (like heroin, cocaine, amphetamines, or steroids) Interviewer’s comment: do not include anything you took under a doctor’s orders (Score: 1— ‘‘Yes’’; 2—‘‘No’’) Would you say your own health, in general, is excellent, good, fair, or poor? (Score: 1—‘‘Excellent’’; 2—‘‘Good’’; 3—‘‘Fair’’; 4—‘‘Poor’’) All things considered, how satisfied are you with your family life? (Score: 1—‘‘Completely satisfied’’; 2— ‘‘Very satisfied’’; 3—‘‘Fairly satisfied’’; 4—‘‘Neither satisfied nor dissatisfied’’; 5—‘‘Fairly dissatisfied’’; 6—‘‘Very dissatisfied’’; 7—‘‘Completely dissatisfied’’) We are interested in how people are getting along financially these days. So far as you and your family are concerned, would you say that you are pretty well satisfied with your present financial situation, more or less satisfied, or not satisfied at all? (Score: 1— ‘‘Satisfied’’; 2—‘‘More or less satisfied’’; 3—‘‘Not at all satisfied’’) On the whole, how satisfied are you with the work you do—would you say you are very satisfied, moderately satisfied, a little dissatisfied, or very dissatisfied? (Score: 1—‘‘Very satisfied’’; 2—‘‘Moderately satisfied’’; 3— ‘‘A little dissatisfied’’; 4—‘‘Very dissatisfied’’) Were you ever picked up or charged by the police, for any other reason whether or not you were guilty? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Not counting minor traffic offenses, have you ever been convicted of a crime? (Score: 1—‘‘Yes’’; 2— ‘‘No’’) Have you ever spent any time in prison or jail? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Taken all together, how would you say things are these days—would you say that you are very happy, pretty happy or not too happy? (Score: 1—‘‘Very happy’’; 2—‘‘Pretty happy’’; 3—‘‘Not too happy’’)
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K.
L.
Thinking about the time since your 18th birthday, have you ever had sex with a person you paid or who paid you for sex? (Score: 1—‘‘Yes’’; 2—‘‘No’’) Have you ever been tested for HIV? Interviewer’s comment: Do not count tests you may have had as part of a blood donation. Include oral test (where they take a swab from your mouth.) (Score: 1—‘‘Yes’’; 2— ‘‘No’’)
Answers were aggregated according to the groups (individuals with history of crack cocaine use vs. individuals without such history). T test was used to determine significance of difference between groups. The study was evaluated by the Biomedical Research Alliance of New York and met criteria for IRB exemption.
Results Among all respondents 6 % reported lifetime history of crack cocaine use (8.1 % males and 4.4 % females). Lifetime history of crack cocaine use was reported by 5.9 % of white respondents, and 5.7 % of black respondents. Among respondents who have history of crack cocaine use proportion of men was higher compared to respondents without cocaine use history (60.2 vs. 43.9 %). Proportion of individuals who were never married or divorced was higher among cocaine users compared to those who never used crack cocaine (never married: 40.8 vs. 27.2 %; divorced: 22.3 vs. 15.9 %) and proportion of married individuals was lower (29.1 vs. 46.4 %). There was no significant difference in race distribution between those two groups. Proportion of individuals with history of crack cocaine use was higher among respondents with low education level and lower among respondents with bachelor or graduate degree compared to population without history of crack cocaine use (less then high school: 21.4 vs. 11.8 %; high school: 56.3 vs. 49.8 %; bachelor: 10.7 vs. 18.9 %; graduate: 3.9 vs. 11.6 %). Proportion of individuals with history of crack cocaine use was higher among respondents with low annual income compared to population without crack cocaine abuse history (\$15,000: 40.6 vs. 20.8 %; $75,000 and more: 5.8 vs. 21.5 %). Analysis of social indicators revealed remarkable differences between groups. A proportion of individuals who reported being unemployment for some time during last 10 years was significantly higher among individuals with history of cocaine use (Question A: 43.7 vs. 24 %). More than 20 % of individuals with crack cocaine use history reported also a history of intravenous drug use (Question B). Crack cocaine users ranked their subjective health perception significantly lower compared to those who never used cocaine (Question C: mean score 2.31 vs. 2.03;
Community Ment Health J
p \ 0.05). They were also significantly less satisfied with their family (Question D: mean score 3.04 vs. 2.29; p \ 0.001) and financial life (Question E: mean score 2.30 vs. 2.01; p \ 0.001). Satisfaction with their job did not differ significantly between groups (Question F: mean score 1.80 vs. 1.65; p = 0.11). Significantly higher proportion of individuals with history of crack cocaine use reported history of legal (Question G: mean score 1.28 vs. 1.82; p \ 0.001) and criminal problems (Question H: mean score 1.54 vs. 1.90; p \ 0.001 and Question I: mean score 1.41 vs. 1.88; p \ 0.001) compared to those who never used crack cocaine. Cocaine users were also ranking themselves significantly less happy compared to individuals without cocaine history (Question J: mean score 2.06 vs. 1.82; p \ 0.001). Significantly higher proportion of respondents with history of crack cocaine use reported history of having paid sex including either buying or selling (Question K: mean score 1.80 vs. 1,92; p \ 0.001). Significantly more respondents with history of crack cocaine use reported been tested for HIV compared to individuals without crack cocaine use history (Question L: mean score 1.40 vs. 1.60; p \ 0.001).
Discussion Approximately 6 % of respondents reported lifetime history of crack cocaine use in our analysis. This outcome is similar to the results from the European countries (United Kingdom 5.2 % in 2001; Germany 4 % in 2000; Spain 4.8 % in 1999; Haasen et al. 2004). These results suggest a trend of increased rates of cocaine abuse among male population compared to females which is consistent with what exists in the literature (Kosten et al. 1993; McKay et al. 1996; Najavits and Lester 2008; Weiss et al. 1997). Cocaine use disorder seemed to have a negative impact on family and marital relationship. In our study proportion of individuals with history of crack cocaine use that were divorced or never married was higher and proportion of married individuals was lower compared to those without history of cocaine use. This is consistent with data from existing literature. (Boyd and Mieczkowski 1990; Hidalgo Carmona et al. 2008; Pinheiro et al. 2006). Similar factors probably contribute to lower level of family satisfaction reported by respondents with history of crack cocaine use. There were no significant race differences in history of cocaine use. This supports the hypothesis of Lillie-Blanton (Lillie-Blanton et al. 1993) that, given similar social and environmental conditions, crack use does not strongly depend on race-specific personal factors (Adebimpe 1993; Gfroerer et al. 1993). Lower education level among respondents with history of crack cocaine use compared to individuals without such history confirms a tendency of
drugs abuse being more prevalent in the lower as compared to the upper social strata (Miech et al. 2005). Finding of higher unemployment history and low satisfaction with financial situation among respondents with history of cocaine use is not surprising considering association between cocaine abuse and adverse employment outcomes (Zwerling et al. 1990). Surprisingly satisfaction with job did not differ significantly between groups. An interesting finding in our study is proportion (20 %) of intravenous drug abusers among individuals with history of crack cocaine use. This finding suggests that screening for injection drug abuse among individuals with cocaine use history may play a significant role in the management of comorbid medical conditions such as HIV, Hepatitis C, bacterial endocarditis, sepsis etc. (Joe and Simpson 1995; Shannon et al. 2008; van der Meer et al. 1992). It is not surprising that respondents with history of crack cocaine use rank their subjective health perception significantly lower compared to respondents without such history. Higher involvement in risky sex behavior should be also mentioned at this point. Our results show significantly higher engagement in paid sex (either buying or selling sex) among respondents with crack cocaine use history which may be a target for another intervention prevention policy. In our analysis, respondents with history of crack cocaine use reported significantly more criminal and legal problems which supports findings of other scholars who report higher rates of criminal involvement and illegal activity among cocaine abusers (Inciardi and Surratt 2001; Kasarabada et al. 2000; Pottieger and Tressell 2000). These factors probably culminate in the overall low perception of happiness among cocaine using respondents. There are some significant limitations in this analysis. First, the study is based on self-reported data which may be less reliable compared to the studies where drug abuse was confirmed using additional laboratory analysis (e.g. urine toxicology screen). Second, underreporting or inconsistency in reporting drug use is a known limitation in majority of survey-based drug abuse studies (Fendrich and Mackesy-Amiti 1995; Fendrich and Vaughn 1994). Third, this is a retrospective study with all its inherent limitations.
Conclusions Clearly, the current data suggest that the key factors in substance use disorder are related to socioeconomic factors rather than race. However more studies are needed to confirm this. Furthermore, there is a need to identify modalities in which socioeconomic factors and injection drug use impact on drug use disorders. This knowledge will assist in the development of more effective socioeconomic
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interventions for the treatment and prevention of substance use disorder.
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