School of Social and Community Medicine, University of Bristol, Bristol, UK.
Addiction. 2013 Apr;108(4):743-50. doi: 10.1111/add.12056. Epub 2012 Dec 21.
To investigate childhood influences on onset of injection drug use.
Matched case-control study.
Edinburgh, Scotland.
A total of 432 individuals presenting at a community health facility with injection drug use and 432 age- and sex-matched non-injecting controls recruited through the same facility.
Main exposures considered were family structure and experience of public care, carer substance use, physical and sexual victimization and conduct problems, all measured at personal interview. The outcome was history of adult injection drug use recorded in medical records corroborated at personal interview.
Compared to two-parent families all other family structures were associated with increased risk of injection drug use, the greatest increased risk being associated with public care. Violence, criminality and financial problems in the family were also associated with increased risk, as were all types of carer substance use. The greatest increased risk was associated with markers of early conduct problems, particularly school exclusion and childhood contact with the criminal justice system. In multivariable analyses the strongest risk factors for later injecting were always having lived with a relative or family friend (not always a parent) and in care/adopted/foster home at any point [odds ratio (OR) = 2.66, 95% confidence interval (CI): 1.02-6.92 and OR = 2.17, 95% CI: 0.91-5.17, respectively], experienced violence from parent or carer (OR = 2.06, 95% CI: 1.26, 3.38) and early evidence of conduct problems [ever excluded from school (OR = 2.73, 95% CI: 1.68, 4.45); childhood criminality (ever arrested by police pre-adult OR = 3.05, 95% CI: 1.90, 4.89, ever been in borstal/young offenders/list D school OR = 4.70, 95% CI: 2.02, 10.94)]. After adjustment for family structure and conduct problems, sexual victimization was associated weakly with injecting onset (OR = 1.29, 95% CI: 0.76-2.19). More than 70% of injection drug use onset appeared attributable to the risk factors identified.
Injection drug use in adults is associated strongly with prior childhood adversity, in particular not living with both parents and early conduct problems. Prevention initiatives should also consider these risk factors.
探讨儿童时期对注射吸毒起始的影响。
匹配病例对照研究。
苏格兰爱丁堡。
共纳入 432 名在社区卫生机构就诊时存在注射吸毒的个体和 432 名年龄和性别匹配的非注射吸毒对照者，均通过同一机构招募。
主要考虑的暴露因素为家庭结构和公共照护经历、照料者的物质使用、身体和性侵害以及行为问题，均通过个人访谈进行测量。结果为病历记录的成年后注射吸毒史，并在个人访谈中进行核实。
与双亲家庭相比，所有其他家庭结构均与注射吸毒风险增加相关，而公共照护与最大的风险增加相关。家庭中的暴力、犯罪和经济问题也与风险增加相关，所有类型的照料者物质使用也与风险增加相关。行为问题的早期标志物与风险增加最相关，尤其是学校退学和儿童期与刑事司法系统的接触。在多变量分析中，与后来的注射吸毒相关的最强风险因素始终是与亲戚或家庭朋友（不一定是父母）共同生活和（无论是否是父母）在任何时候都在寄养家庭/收养家庭/领养家庭中生活（比值比 [OR] = 2.66，95%置信区间 [CI]：1.02-6.92 和 OR = 2.17，95% CI：0.91-5.17），曾遭受父母或照料者的暴力（OR = 2.06，95% CI：1.26-3.38）以及早期行为问题的证据[曾被学校开除（OR = 2.73，95% CI：1.68-4.45）；儿童期犯罪（成年前被警方逮捕的次数 OR = 3.05，95% CI：1.90-4.89，曾被教养院/少年犯/名单 D 学校收容 OR = 4.70，95% CI：2.02-10.94）]。在调整家庭结构和行为问题后，性侵害与注射吸毒起始相关较弱（OR = 1.29，95% CI：0.76-2.19）。超过 70%的注射吸毒起始归因于确定的风险因素。
成年人的注射吸毒与儿童时期的逆境强烈相关，尤其是与父母双方都不住在一起和早期行为问题有关。预防措施也应考虑这些风险因素。
