Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 2400 - 515 W Hasting St, Vancouver, BC V6B 5K3, Canada.
BMC Health Serv Res. 2013 Dec 28;13:536. doi: 10.1186/1472-6963-13-536.
Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18-24 years), marginalized crack users in Brazil.
N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants' drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011.
The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important.
The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users' social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.
在整个美洲，包括巴西的边缘化城市街头吸毒者中，都普遍存在吸食 Crack 的现象。 Crack 用户通常存在多种身心健康问题，而这些人群中接受帮助服务的比例较低，且存在明显的障碍。本研究调查了巴西两个城市年轻（18-24 岁）、边缘化 Crack 用户的社会和健康服务利用情况及其未满足的服务需求，并分析了其特征和决定因素。
通过社区为基础的方法，从里约热内卢（n = 81）和萨尔瓦多（n = 79）的贫困社区招募了 160 名研究参与者。使用混合方法方案。通过匿名访谈者管理的问卷在社区环境中评估参与者的药物使用、健康状况以及社会和健康服务利用特征；计算了感兴趣变量的描述性统计数据。通过与研究人群进行几次焦点小组讨论进一步评估服务需求和障碍；对叙事数据进行了定性分析。研究方案得到了机构伦理审查委员会的批准；数据收集于 2010 年 11 月至 2011 年 6 月进行。
大多数参与者为男性，没有稳定的住房，并且使用其他药物（如酒精、大麻）。约有一半的参与者报告存在身体和心理健康问题，但大多数人并未因这些问题接受过医疗护理。只有很小一部分人利用了当地可用的社会或卫生服务；在两个地点，服务的利用似乎都受到性别、种族和住房特征的影响。参与者提到服务资源有限、缺乏针对特定需求的专业技能、官僚障碍和污名化是更好地获得服务的障碍。然而，大多数受访者表示强烈的兴趣和需求，希望为研究人群提供一般的社会、健康和治疗服务，他们强调了各种关键特征的重要性。
本研究为当前关于巴西 Crack 使用的健康和治疗干预措施的制定和利用的讨论提供了实质性证据。根据我们的数据，Crack 用户的社会和服务需求在很大程度上未得到满足；这些差距似乎部分源于现有服务获取方面的系统障碍，同时也需要为目标人群提供改进的针对性服务。
