A new study finds that, despite a very high prevalence of numerous, serious risk factors and structural and environmental challenges, the rate of substance use problems is low—and comparable to the general U.S. population—for a substantial proportion of African-American/Black and Latino adults residing in a high-risk urban community. Published in the open-access journal Frontiers in Public Health, the study identifies both risk factors for substance use problems, which include homelessness and incarceration, and protective 'resilience' factors that include support, education, and employment. The findings have the potential to pave the way for targeted intervention and prevention programs for communities most vulnerable to substance misuse.
"The many risk factors that can contribute to an increased likelihood of substance use problems by African-American and Latino adults living in a poor, urban community have been well documented, but protective factors are often ignored," says Dr. Charles Cleland, lead author of the study, based at the Center for Drug Use and HIV research, New York University Meyers College of Nursing, USA. "We wanted to address this knowledge gap and found that people with the highest rates of risk factors and least evidence of resilience were the most likely to suffer substance use problems."
Dr. Marya Gwadz, principal investigator of this study, also based at Meyers College of Nursing continues, "People hold stereotypes about those living in high-risk urban settings, for example, that these populations have elevated rates of unemployment, homelessness, and substance use problems. Yet we found a substantial proportion of participants had relatively low rates of risk factors, overcoming obstacles and thriving, even in difficult situations beyond their control, such as high local unemployment rates. We believe our study challenges some of the preconceptions people may hold about African-American/Black and Latino adults living in high-risk urban communities."
The researchers explored many factors believed to contribute to the risk for substance misuse, in nearly 3,000 African-American/Black and Latino adults from a community suffering high rates of poverty. Homelessness and incarceration were some of the 'risks', and 'resilience' was comprised of factors such as emotional and instrumental support (i.e. childcare or provision of transport), as well as education and employment. Participants were enrolled to the study by their peers, a recruitment method that engaged more isolated or vulnerable members of the target population, who may not typically want to take part in research.
"The individual risk and resilience factors of these thousands of people provided an almost overwhelming amount of information. To deal with this high level of complexity, we used a method that simplified and organized participants into a few groups with similar risk and resilience profiles," says Dr. Cleland. "This helped us to understand how these factors are related to substance use problems."
The study examined males and females separately and found both sexes could be described by three groups, with each comprised of a combination of factors. The groups were ranked according to their likelihood of substance misuse. Almost a third of women (27%) and 38% of men were in the lower risk groups, with the likelihood of substance use problems comparable to the general U.S. adult population. The profiles from the higher risk groups indicated that homelessness and incarceration were strongly associated with an increased probability of substance use problems, whereas education, as well as instrumental and emotional support, were protective factors. In fact, a lack of instrumental and emotional support, which may be indicative of social isolation and fractured social relationships, emerged as a serious concern for the functioning and wellbeing of these participants.
The study has potential to inform targeted treatment and intervention programs, including substance-use prevention programs, as well as helping individuals to maintain resilience and improve their lives.
"We need more effective interventions, with approaches tailored to individual risk and resilience," says Dr. Cleland. "Women and men in the highest-risk group may benefit from specialized outreach efforts and wrap-around clinical services, particularly because they lack emotional and instrumental support," says Dr. Gwadz.
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Charles M. Cleland et al, Syndemic Risk Classes and Substance Use Problems among Adults in High-Risk Urban Areas: A Latent Class Analysis, Frontiers in Public Health (2017). DOI: 10.3389/fpubh.2017.00237