Galea Sandro, Ahern Jennifer, Tracy Melissa, Vlahov David
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan 48104-2548, USA.
Am J Prev Med. 2007 Jun;32(6 Suppl):S195-202. doi: 10.1016/j.amepre.2007.04.003.
Evidence about the relationship between contextual variables and substance use is conflicting. Relationships between neighborhood income and income distribution and the prevalence and frequency of substance use in 59 New York City (NYC) neighborhoods were assessed while accounting for individual income and other socio-demographic variables. Measures of current substance use (in the 30 days prior to the survey) were obtained from a random-digit-dial phone survey of adult residents of NYC and data from the 2000 U.S. Census to calculate median neighborhood income and income distribution (assessed using the Gini coefficient). Among 1355 respondents analyzed (female=56.2%, mean age=40.4), 23.9% reported cigarette, 40.0% alcohol, and 5.4% marijuana use in the previous 30 days. In ecologic assessment, neighborhoods with both the highest income and the highest income maldistribution had the highest prevalence of drinking alcohol (69.0%) and of smoking marijuana (10.5%) but not of cigarette use; there was no clear ecologic association between neighborhood income, income distribution, and cigarette use. In multilevel multivariable models adjusting for individual income, age, race, sex, and education, high neighborhood median income and maldistributed neighborhood income were both significantly associated with a greater likelihood of alcohol and marijuana use but not of cigarette use. Both high neighborhood income and maldistributed income also were associated with greater frequency of alcohol use among current alcohol drinkers. These observations suggest that neighborhood income and income distribution may play more important roles in determining population use of alcohol and marijuana than individual income, and that determinants of substance use may vary by potential for drug dependence. Further research should investigate specific pathways that may explain the relationship between neighborhood characteristics and use of different substances.
关于环境变量与物质使用之间关系的证据相互矛盾。在考虑个人收入和其他社会人口变量的情况下，评估了纽约市（NYC）59个社区的邻里收入与收入分配以及物质使用的流行率和频率之间的关系。当前物质使用情况（调查前30天内）的测量数据来自对NYC成年居民的随机数字拨号电话调查，以及2000年美国人口普查数据，以计算邻里收入中位数和收入分配情况（使用基尼系数评估）。在分析的1355名受访者中（女性占56.2%，平均年龄40.4岁），23.9%的人报告在过去30天内吸烟，40.0%饮酒，5.4%使用大麻。在生态评估中，收入最高且收入分配最不均衡的社区饮酒（69.0%）和吸食大麻（10.5%）的流行率最高，但吸烟情况并非如此；邻里收入、收入分配与吸烟之间没有明显的生态关联。在调整了个人收入、年龄、种族、性别和教育程度的多层次多变量模型中，邻里收入中位数高和收入分配不均衡均与饮酒和使用大麻的可能性增加显著相关，但与吸烟无关。邻里高收入和收入分配不均衡也与当前饮酒者的饮酒频率增加有关。这些观察结果表明，邻里收入和收入分配在决定人群酒精和大麻使用方面可能比个人收入发挥更重要的作用，而且物质使用的决定因素可能因药物依赖潜力而异。进一步的研究应调查可能解释邻里特征与不同物质使用之间关系的具体途径。
