Geographical clustering of cannabis use: results from the New Zealand Mental Health Survey 2003-2004

Enclaves of Isolation and Neglect in Rural Areas. Evidence from North-Eastern Poland

This article focuses on the specificity of present enclave structures in rural areas that were created decades ago as a result of decisions to establish housing estates for employees, and which acquired negative features as a result of the liquidation of the monopolistic employer. An attempt has been made to answer if workers' housing complexes can turn into permanent enclaves of isolation and neglect after the liquidation of a monopolistic workplace, especially if they are located in rural areas? The aim of the paper is to picture the process of social exclusion emergence in the rural areas, which results from the still unresolved socio-economic problem of the existence of such enclaves of isolation and neglect in Polish rural areas in the 21st century. Despite almost 30 years passing, the areas with spatially and socially isolated settlements have very high unemployment rates, a low level of technical and social infrastructure and a widespread sense of injustice among the people who live there. The empirical basis for the analysis was four cases. The presented stories took place against the historical background of the Warmińsko-Mazurskie Voivodship and the socio-economic background. Studies were conducted in the selected villages with a free-form interview and photographic documentation was prepared. In the result, a close picture of the enclaves was drawn. The examples presented in this article proved that workers' settlements, located around large economic entities distant from existing settlement networks can develop into enclaves of isolation and neglect.

Immigrant enclaves and risk of drug involvement among asylum-seeking immigrants in Sweden: A quasi-experimental study

BACKGROUND

Sweden is a major host nation for asylum-seeking immigrants, and residential placement of these immigrants is an important policy concern. This quasi-experimental study estimated of the impact of being placed into an "immigrant enclave" on risk of officially-recognized drug involvement (ORDI) among asylum-seeking immigrants over a 15-year period.

METHODS

All data come from Swedish registries. The sample consisted of (a) asylum-seeking immigrants aged 5-35 years old at arrival (N = 51,017) that were subject to a nationwide policy (enforced 1987-1991) that dispersed asylum-seeking immigrants across municipalities, and (b) native-born Swedes aged 15 and older during this same period (N = 1,040,311). Neighborhood immigrant composition was quantified using the Reardon Index; residents of "immigrant enclave" neighborhoods (n = 960) were compared to residents of all other neighborhoods (n = 2,471). Cox proportional hazards models assessed the relationship between living in an enclave and risk of ORDI, identified by national registries, through 2015.

RESULTS

Overall, 29.7% of immigrants were assigned to, and 25.5% of Swedes lived in, an enclave. Cumulative incidence of ORDI in enclaves was 6.34% as compared to 6.89% in other neighborhoods. Immigrants living in an enclave had lower risk of ORDI (Hazard ratio (HR): 0.86, 95% Confidence Interval (CI): 0.77 - 0.96). This protective association was marginally stronger in lower poverty areas. Native-born Swedes living in an enclave had higher risk of ORDI (HR: 1.05, 95% CI: 1.03-1.08), a relationship that was exacerbated by neighborhood poverty.

CONCLUSIONS

Neighborhood immigrant composition is associated with risk of ORDI, with differential associations for immigrants and native-born populations.

Sample size estimation for alternating logistic regressions analysis of multilevel randomized community trials of under-age drinking

Under-age drinking is an enormous public health issue in the USA. Evidence that community level structures may impact on under-age drinking has led to a proliferation of efforts to change the environment surrounding the use of alcohol. Although the focus of these efforts is to reduce drinking by individual youths, environmental interventions are typically implemented at the community level with entire communities randomized to the same intervention condition. A distinct feature of these trials is the tendency of the behaviours of individuals residing in the same community to be more alike than that of others residing in different communities, which is herein called 'clustering'. Statistical analyses and sample size calculations must account for this clustering to avoid type I errors and to ensure an appropriately powered trial. Clustering itself may also be of scientific interest. We consider the alternating logistic regressions procedure within the population-averaged modelling framework to estimate the effect of a law enforcement intervention on the prevalence of under-age drinking behaviours while modelling the clustering at multiple levels, e.g. within communities and within neighbourhoods nested within communities, by using pairwise odds ratios. We then derive sample size formulae for estimating intervention effects when planning a post-test-only or repeated cross-sectional community-randomized trial using the alternating logistic regressions procedure.

The social norms of birth cohorts and adolescent marijuana use in the United States, 1976-2007

AIMS

Studies of the relationship between social norms and marijuana use have generally focused on individual attitudes, leaving the influence of larger societal-level attitudes unknown. The present study investigated societal-level disapproval of marijuana use defined by birth cohort or by time-period.

DESIGN

Combined analysis of nationally representative annual surveys of secondary school students in the United States conducted from 1976 to 2007 as part of the Monitoring the Future study.

SETTING

In-school surveys completed by adolescents in the United States.

PARTICIPANTS

A total of 986 003 adolescents in grades 8, 10 and 12.

MEASUREMENTS

Main predictors included the percentage of students who disapproved of marijuana in each birth cohort and time-period. Multi-level models with individuals clustered in time-periods of observation and birth cohorts were modeled, with past-year marijuana use as the outcome.

FINDINGS

Results indicated a significant and strong effect of birth cohort disapproval of marijuana use in predicting individual risk of marijuana use, after controlling for individual-level disapproval, perceived norms towards marijuana and other characteristics. Compared to birth cohorts in which most (87-90.9%) adolescents disapproved of marijuana use, odds of marijuana use were 3.53 times higher in cohorts where fewer than half (42-46.9%) disapproved (99% confidence interval: 2.75, 4.53).

CONCLUSIONS

Individuals in birth cohorts that are more disapproving of marijuana use are less likely to use, independent of their personal attitudes towards marijuana use. Social norms and attitudes regarding marijuana use cluster in birth cohorts, and this clustering has a direct effect on marijuana use even after controlling for individual attitudes and perceptions of norms.

Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses

OBJECTIVE

In recent years cohort studies have examined childhood attention-deficit/hyperactivity disorder (ADHD) as a risk factor for substance use disorders (SUDs) in adolescence and young adulthood. The long-term risk is estimated for development of alcohol, cannabis, combined alcohol and psychoactive SUDs, combined SUDs (nonalcohol), and nicotine use disorders in children with ADHD.

METHOD

MEDLINE, CINHAL, PsycINFO, and EMBASE were searched through October 2009; reference lists of included studies were hand-searched. Prospective cohort studies were included if they compared children with ADHD to children without, identified cases using standardized criteria by mean age of 12 years, followed participants until adolescence (nicotine use) or young adulthood (psychoactive substance use disorder, with and without alcohol, alcohol use disorder, cannabis use disorder), and reported SUD outcomes. Two independent reviewers examined articles and extracted and cross-checked data. Effects were summarized as pooled odds ratios (ORs) in a random effects model.

RESULTS

Thirteen studies were included. Only two of five meta-analyses, for alcohol use disorder (N = 3,184) and for nicotine use (N = 2,067), estimated ORs showing stability when evaluated by sensitivity analyses. Childhood ADHD was associated with alcohol use disorder by young adulthood (OR = 1.35, 95% confidence interval = 1.11-1.64) and with nicotine use by middle adolescence (OR = 2.36, 95% confidence interval = 1.71-3.27). The association with drug use disorder, nonalcohol (N = 593), was highly influenced by a single study.

CONCLUSIONS

Childhood ADHD is associated with alcohol and drug use disorders in adulthood and with nicotine use in adolescence.

Early cannabis use and estimated risk of later onset of depression spells: Epidemiologic evidence from the population-based World Health Organization World Mental Health Survey Initiative

Early-onset cannabis use is widespread in many countries and might cause later onset of depression. Sound epidemiologic data across countries are missing. The authors estimated the suspected causal association that links early-onset (age <17 years) cannabis use with later-onset (age > or =17 years) risk of a depression spell, using data on 85,088 subjects from 17 countries participating in the population-based World Health Organization World Mental Health Survey Initiative (2001-2005). In all surveys, multistage household probability samples were evaluated with a fully structured diagnostic interview for assessment of psychiatric conditions. The association between early-onset cannabis use and later risk of a depression spell was studied using conditional logistic regression with local area matching of cases and controls, controlling for sex, age, tobacco use, and other mental health problems. The overall association was modest (controlled for sex and age, risk ratio = 1.5, 95% confidence interval: 1.4, 1.7), was statistically robust in 5 countries, and showed no sex difference. The association did not change appreciably with statistical adjustment for mental health problems, except for childhood conduct problems, which reduced the association to nonsignificance. This study did not allow differentiation of levels of cannabis use; this issue deserves consideration in future research.

Development of a clinically relevant liquid chromatography tandem mass spectrometry assay for 13 drugs of abuse in urine, designed to meet the needs of the service users

Background

The clinical requirements of the users of assay results must be at the centre of assay development. We aimed to develop a single liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for drugs of abuse in urine that would meet the needs of our service users and replace the multiple screening and confirmatory techniques previously in use.

Methods

After discussion with our users, it was decided that 13 drugs and metabolites should be measured in our panel: morphine, codeine, norcodeine, dihydrocodeine, 6-monoacetylmorphine, acetyl codeine, methadone and its metabolite, buprenorphine and its metabolite, amphetamine, benzoylecgonine and cotinine. Urine samples were prepared by the addition of internal standard, enzymatic hydrolysis and solid-phase extraction. Chromatography conditions were optimized so that the analytes were separated within a run time of 6 min. Optimal parent to daughter m/z ion transitions were chosen for all drugs and daughter ion ratios were used.

Results

The LC-MS/MS assay was successfully validated with acceptable precision and lower limits of quantification for all drugs. No matrix effects were seen. The results produced by the LC-MS/MS assay compared well with the previous combination of techniques in use.

Conclusions

We have developed and validated a fit-for-purpose LC-MS/MS assay for 13 drugs of abuse in urine that obviates the need for multiple screening and confirmatory analytical techniques.

Prevalence of cannabis use in Brazil: data from the I Brazilian National Alcohol Survey (BNAS)

AIMS

To estimate the prevalence of cannabis use in the last 12 months in the Brazilian population and to examine its association with individual and geographic characteristics.

DESIGN

Cross-sectional survey with a national probabilistic sample.

PARTICIPANTS

3006 individuals aged 14 to 65 years.

MEASUREMENTS

Questionnaire based on well established instruments, adapted to the Brazilian population.

FINDINGS

The 12-month prevalence of cannabis use was 2.1% (95%CI 1.3-2.9). Male gender, better educational level, unemployment and living in the regions South and Southeast were independently associated with higher 12-month prevalence of cannabis use.

CONCLUSION

While the prevalence of cannabis use in Brazil is lower than in many countries, the profile of those who are more likely to have used it is similar. Educational and prevention policies should be focused on specific population groups.

Geographic clustering of underage drinking and the influence of community characteristics

The aim of this paper was to examine the extent to which underage drinking clusters geographically in a sample of communities, and to investigate the manner in which community-level contexts are related to this process. We used data from a randomized community trial of underage drinking to provide the first quantitative estimates of the magnitude of the geographic clustering of underage drinking based upon pairwise odds ratios (PWORs). The Enforcing Underage Drinking Laws Randomized Community Trial provided data from repeated cross-sectional samples of youth aged 14-20 from 68 communities surveyed in 2004, 2006, and 2007 (n=18,730). Past 30-day drinking, binge drinking, getting drunk, experiencing non-violent consequences as a result of drinking and making a purchase attempt all significantly clustered within-communities with PWORs ranging from 1.05 to 1.21. After adjustment for individual-level characteristics, results remained relatively unchanged. However, there was evidence that the magnitude of the clustering varied as a function of neighborhood disadvantage, neighborhood disorder, and family structure. Clustering of drunkenness and experiencing non-violent consequences as a result of drinking was greatest in the least economically disadvantaged and least disordered communities with the greatest percentage of married-couple families. The clustering of making a purchase attempt, however, was greatest in more disordered communities, specifically the largest communities with the highest degree of residential mobility and housing density. These findings that clustering of underage drinking behaviors varies by community context has the potential for identifying the types of communities to target for underage drinking behavior-specific preventive interventions.