RESUMO
The objectives of the current study were to determine the incidence and prevalence of hard-core drug (HCD) use and to explore the predictors of HCD use in a three-wave longitudinal study of women ages 18-35 living in urban areas of high drug traffic in Puerto Rico. Prevalence of HCD use was determined by positive self-report or positive toxicological tests for crack, cocaine, or heroine at baseline and follow-up periods. Incidence density was calculated using Poisson methods. Predictors of HCD use were identified using the generalized estimating equation (GEE) approach. Prevalence rates fluctuated between 16.3 at baseline and 12.6 and 14.6 at subsequent waves. Incidence of crack/cocaine or heroine ranged from 7.4 to 6.3 per 100 person years. Low education, unemployment, current alcohol use, and severe partner violence predict incident HCD use. Therefore, prevention programs for HCD use must consider strategies to promote social mobility and empowerment and to mitigate violence against women.
Assuntos
Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack , Violência Doméstica/estatística & dados numéricos , Escolaridade , Feminino , Dependência de Heroína/epidemiologia , Humanos , Incidência , Estudos Longitudinais , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Desemprego/estatística & dados numéricosRESUMO
BACKGROUND: Latino children have persistent low rates of mental health service use. Understanding the factors that influence caregivers' decisions about whether to use mental health care for their children can help explain why. OBJECTIVE: The objective of this study was to investigate the factors reported by the primary caregiver that could help classify Puerto Rican children into users versus nonusers of mental health services and mental health versus school sector care, among users. SUBJECTS: Data were collected from a random Puerto Rican community sample of caregiver-child dyads. MEASURES: Version-IV of the Computerized Diagnostic Interview for Children (DISC) was used to assess psychiatric disorders in children. The Service Assessment for Children and Adolescents (SACA) was used to examine the types of services used for mental health problems. STATISTICAL METHODS: The Classification and Regression Tree (CART) approach was used to develop a simple model simulating caregivers' decision-making around taking children for mental health care and the setting for care. RESULTS: The classification model of use versus no use of mental health service suggested 3 significant predictors: child's level of impairment, parental concern, and child's difficulty in performing schoolwork. The classification model of sector of care, mental health versus school setting, identified 1 significant predictor, any disruptive disorder diagnosis. CONCLUSION: : Assisting caregivers in linking a child's impairment with need for mental health care might be a mechanism to reduce children's unmet need. Approaches such as CART, used to identify factors predicting consumer choices in marketing, might be useful to select strategies for social campaigns targeted toward decreasing unmet need.