Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia.
School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
PLoS One. 2023 Mar 6;18(3):e0281107. doi: 10.1371/journal.pone.0281107. eCollection 2023.
Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana.
305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression.
Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001).
Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.
物质使用会导致健康状况不佳，并增加无家可归人群的死亡率。本研究评估了加纳阿克拉有庇护和无庇护的成年无家可归者中物质使用的流行率和风险水平，以及相关因素。
招募了 305 名年龄在 18 岁及以上、目前在阿克拉有庇护和无庇护的成年无家可归者。采用世界卫生组织（WHO）的酒精、吸烟和物质使用筛查测试（ASSIST）评估物质使用风险水平。使用逻辑回归评估高风险物质使用与社会人口统计学、移民、无家可归和健康特征的关联。
近四分之三（71%，n=216）的样本曾经使用过物质，几乎所有人都有 ASSIST 定义的中度风险（55%）或高风险（40%）使用。身体或情感暴力幸存者（AOR=3.54；95%置信区间[CI]1.89-6.65，p<.001）和性暴力幸存者（AOR=3.94；95%CI 1.85-8.39，p<.001）有更高的高风险物质使用的可能性，特别是酒精、可卡因和大麻。男性比女性（AOR=4.09；95%CI 2.06-8.12，p<.001）更有可能使用高风险物质，但与低收入相比，中等收入群体（AOR=3.94；95%CI 1.85-8.39，p<.001）则较低。
在阿克拉，无家可归的成年人中常见危险物质使用，并且与暴力受害、性别和收入水平密切相关。这些发现突显了在阿克拉和加纳及撒哈拉以南非洲其他同样有大量无家可归者的城市中，迫切需要采取有效的、有针对性的预防和降低健康风险策略，以解决无家可归人群中的危险物质使用问题。
