The association of self-reported neighborhood disorganization and social capital with adolescent alcohol and drug use, dependence, and access to treatment
Introduction
Many adolescents will experiment with alcohol or drug (AOD) use before graduating high school. According to the 2005 Monitoring the Future Survey, 75% of high school seniors have tried alcohol and 50% have tried an illicit drug (Johnston et al., 2005). Adolescent AOD use is associated with negative consequences including criminal, health, and social problems (Hawkins et al., 1992, Brook et al., 2002, Green and Ensminger, 2006, Newcomb and Bentler, 1988). The negative consequences of adolescent AOD use may escalate as the teen transitions into adulthood. Early onset of AOD use is associated with a significant increased risk of later abuse or dependence (Schneider Institute for Health Policy, 2001), and late adolescence has been identified as a particularly high risk period for developing drug dependence (Anthony and Helzer, 2002). Consequently, theories and models of adolescent AOD use have focused on the initiation of AOD use and the transitions between the use of drugs with low dependence liability to drugs with a higher dependence liability (Kandel, 2002). More than 70 factors have been identified for adolescent AOD use (Swadi, 1999) and the majority of these fit into the categories of individual-, family- or peer-levels. A comprehensive review of adolescent risk factors (Hawkins et al., 1992, Swadi, 1999) and social-level factors for adults has been presented elsewhere (Galea et al., 2004). Within the field of public health, there has been a renewed interest in exploring the impact of environment- or community-level factors on various health conditions and research in this area has used census-based measurement of community effects, and census tracts may or may not reflect neighborhoods. This study will focus on two community factors, neighborhood disorganization and social integration, which in adult samples have been associated with AOD use and there has been a limited amount of research looking at this association in adolescent samples.
Sampson and Groves (1989) have defined social disorganization as the “inability of a community structure to realize the common values of its residents and maintain effective social control” (Sampson and Groves, 1989, p. 777) and defined as such it is referred to as neighborhood disorganization. There is no gold standard for the measurement of neighborhood disorganization and the measures of neighborhood disorganization are at times inconsistent. In the work of Crum et al. (1996) measures of neighborhood disorganization included subjects’ perceptions of areas to walk or play, safety outdoors, crime, racism or prejudice, litter, vandalism, publicly visible alcohol or drug use, abandoned buildings, poverty, church attendance, and sense of community. Other neighborhood characteristics that are indicators of neighborhood disorganization include: teenagers loitering, homeless persons, burglary, drug selling, robbery, and prostitution (Latkin and Curry, 2003, Hadley-Ives et al., 2000). Ennett et al. (1997) also included population density and high residential mobility, which are thought to erode social control and social integration within neighborhoods.
A community disorganization framework has been applied to studies of adolescent drug use. Studies of neighborhood characteristics and AOD use/dependence among adolescents have used several measures of neighborhood, with varying results. Using a perceived measure of neighborhood disorder, Jang and Johnson (2001) found that neighborhood disorder was associated with adolescent drug use, independent of social bonding and social learning. In an adolescent sample, Hadley-Ives et al. (2000) found that youth reported neighborhood characteristics, such as abandoned buildings and crime, were associated with AOD problems and mental health. Additionally, Duncan et al. (2002) using a multilevel model found results that support a community disorganization framework and in a study based in Oregon, lower social cohesion (as reported by neighborhood residents) was associated with higher rates of adolescent drug- and alcohol-related arrests. A contrary finding was reported by Ennett et al. (1997) who used a measure of neighborhood disorganization based on both parents’ reports of neighborhoods and census tract information. Ennett et al. (1997) found that lifetime rates of both alcohol and cigarette use were higher in neighborhoods with greater social advantages. So while there have been a number of studies that have examined adolescent drug use from a community disorganization framework, measures have varied as have the results.
The link between health conditions and social integration has been firmly established (House et al., 1988). Social capital is one indicator of social integration and at the collective level it refers to the “ features of social organizations, such as networks, norms, and trust that facilitate action and cooperation for mutual benefit” (Putnam, 2000, pp. 35 and 36). Much of the research on social capital and health in the past decade has used Putnam's definition of social capital as civic participation, which frequently occurs through involvement in community organizations or voluntary associations (Putnam, 1995). Weitzman et al. (1999) found that social capital, as measured by volunteerism, was associated with decreased rates of binge drinking and alcohol abuse among college students. A Swedish study found a weak association between individual-level social capital and cigarette use (Lindstrom et al., 2003). While social capital and AOD use have not been extensively studied in adult or adolescent samples, other indicators of social integration have been. Specifically, peer affiliation and social bonding have been associated with adolescent drug use (Hawkins et al., 1992, Ensminger et al., 2002). Low social bonding has been associated with early onset of drug use (Ellickson et al., 2001) and low social bonding in adolescence was found to predict adult drug use among females in a longitudinal study (Ensminger et al., 2002).
Given the pervasiveness of AOD use in adolescents, understanding the potential differences in factors associated with AOD use versus dependence are important to the design of targeted primary and secondary interventions. This distinction is particularly important given the significant unmet need for adolescent AOD treatment. Using a nationally representative sample, the National Survey on Drug Use and Health (NSDUH) 2000 found that only 11.4% of 12–17-year-old who needed treatment for illicit drug addiction received treatment (Epstein, 2002). Adolescent AOD treatment research usually recruits samples from treatment facilities. Therefore, participants include only the treatment-seeking population, which represents only one out of 10 adolescents who need treatment. Adolescent AOD treatment can be efficacious and effective (McLellan et al., 2000, Morral et al., 2004); however, the low rate of treatment utilization limits the potential benefits.
Few studies have identified factors associated with adolescent access to AOD treatment, and barely a handful of community indicators have been investigated. Aday and Andersen's emerging model of access to care (Andersen, 1995) has been extended to AOD treatment (Stiffman et al., 2000, Wu et al., 2001, Wu et al., 2002). Wu et al. (2003) focused on predisposing and need factors associated with adolescent access and found that age, gender, co-occurring mental health problems, and severity of drug problems were associated with access to drug treatment. The only community factor Wu et al. (2003) included was living in an urban area, which was unrelated to access to substance abuse treatment in the multivariable model.
The purpose of this study is to examine the influence of self-reported neighborhood disorganization and social capital as community factors for adolescent AOD use, dependence and access to treatment. While there is existing research to support an association between neighborhood disorganization and social capital and AOD use/addiction, the empirical evidence yields mixed results and few of these studies have utilized adolescent samples nor relied on subjective measures of the social context.
Based on the existing literature, it is hypothesized that higher levels of neighborhood disorganization and lower levels of social capital are associated with AOD use and dependence. In respect to access to treatment, we hypothesize that youth reporting high rates of neighborhood disorganization would be less likely to access AOD treatment and that youth with high social capital would be more likely to access AOD treatment. While there is limited literature on which to base our hypothesizes regarding access to AOD treatment, neighborhoods that are disorganized may lack adequate local resources, and it seems logical that AOD treatment facilities may be one of the resources lacking. In respect to social capital, social integration has been hypothesized to have a positive influence on physical and mental health in part because of the provision of health information through social ties. This is the first study to examine the association of neighborhood disorganization and social capital with adolescent AOD use, AOD dependence, and receipt of AOD treatment using a nationally representative sample.
Section snippets
Methods
This is a secondary data analysis of the 1999 and 2000 National Survey on Drug Use and Health (NSDUH). The NSDUH, funded by the Substance Abuse and Mental Health Services Administration, has been conducted annually since 1971, and it is a publicly available dataset. The NSDUH uses a multi-stage sampling design to achieve a probability sample of the non-institutionalized civilian population and is estimated to represent 98% of the United States population. The NSDUH is not generalizable to
Demographic characteristics
The sample was relatively evenly balanced in terms of gender and age. There were slightly more males (50.6%) than females (49.4%), and approximately one-third of the sample was in each age category. Sixty-seven percent of the sample was White, 13.5% was Black, 13.7% was Hispanic, and 5.9% was in the “other” racial category. Most youth reported either A or B grades (78%). Six percent (n = 2253) reported a family income of US$ 10,000 or less and 20.8% (n = 7937) reported a family income of US$ 75,000
AOD use/dependence and neighborhood disorganization
AOD use and dependence was found to be associated with neighborhood disorganization even after controlling for individual- and family-level characteristics. This finding is consistent with previous research (Hadley-Ives et al., 2000, Jang and Johnson, 2001, Duncan et al., 2002), although these studies used slightly different techniques to measure neighborhood disorganization. The data may suggest a positive linear relationship between AOD involvement and neighborhood disorganization given that
Conclusions
In conclusion, neighborhood disorganization and social capital are associated with adolescent AOD use, dependence, and access to treatment. These concepts have the potential to simultaneously address primary and secondary adolescent AOD prevention and may be worth incorporating into community-based interventions provided that future research demonstrates a causal association. The findings suggest that subjective measures of social context may be an important component of the complex
Conflicts of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
This dissertation research was supported by grants from the National Institute on Drug Abuse (DA019732) and the Substance Abuse and Mental Health Services Administration (OA00078-01).
Contributors: Dr. Winstanley designed the secondary analysis as part of her dissertation research. Dr. Winstanley conducted the literature review and Drs. Ensminger and Latkin provided summaries of previous related work. Drs. Winstanley and Steinwachs conducted the statistical analysis. Drs. Stitzer and Olsen
References (51)
- et al.
The effectiveness of Drug Abuse Resistance Education (project DARE): 5-year follow-up results
Prev. Med.
(1996) - et al.
Correlates of mental health service utilization and unmet need among a sample of male adolescents
Addict. Behav.
(2001) - et al.
Neighborhood environment and opportunity to use cocaine and other drugs in late childhood and early adolescence
Drug Alcohol Depend.
(1996) - et al.
Predictors of late-onset smoking and cessation over 10 years
J. Adolesc. Health
(2001) - et al.
The inner city and drug use: initial findings from an epidemiological study
Drug Alcohol Depend.
(1997) - et al.
Comorbidity between patterns of substance use dependence and psychiatric syndromes
Drug Alcohol Depend.
(2001) - et al.
Depression in Ontario: under-treatment and factors related to antidepressant use
J. Affect. Disord.
(1999) Individual risk factors for adolescent substance use
Drug Alcohol Depend.
(1999)Revisiting the behavioral model and access to medical care: does it matter?
J. Health Soc. Behav.
(1995)- et al.
Epidemiology of drug dependence