Int J Health Geogr (2007) Baumann
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Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study,
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Sommaire
Résumé
- Contexte
- The aim was to assess the relationships between social and material deprivation and the use of tobacco, excessive alcohol and psychotropic drugs by both sexes and in various age groups. Greater knowledge concerning these issues may help public health policy-makers design more effective means of preventing substance abuse.
- Méthode
- The sample comprised 6,216 people aged ≥ 15 years randomly selected from the population in north-eastern France. Subjects completed a post-mailed questionnaire covering socio-demographic characteristics, occupation, employment, income, smoking habit, alcohol abuse and "psychotropic" drug intake (for headache, tiredness, nervousness, anxiety, insomnia). A deprivation score (D) was defined by the cumulative number of: low educational level, manual worker, unemployed, living alone, nationality other than western European, low income, and non-home-ownership. Data were analysed using adjusted odds ratios (ORa) computed with logistic models.
- Résultats
- Deprivation was common: 37.4% of respondents fell into category D = 1, 21.2% into D = 2, and 10.0% into D ≥ 3. More men than women reported tobacco use (30.2% vs. 21.9%) and alcohol abuse (12.5% vs. 3.3%), whereas psychotropic drug use was more common among women (23.8% vs. 41.0%). Increasing levels of deprivation were associated with a greater likelihood of tobacco use (ORa vs. D = 0: 1.16 in D = 1, 1.49 in D = 2, and 1.93 in D ≥ 3), alcohol abuse (1.19 in D = 1, 1.32 in D = 2, and 1.80 in D ≥ 3) and frequent psychotropic drug intake (1.26 in D = 1, 1.51 in D = 2, and 1.91 in D ≥ 3). These patterns were observed in working/other non-retired men and women (except for alcohol abuse in women). Among retired people, deprivation was associated with tobacco and psychotropic drug use only in men.
- Conclusion
- Preventive measures should be designed to improve work conditions, reduce deprivation, and help deprived populations to be more aware of risk and to find remedial measures.
Background
Worldwide, the use of tobacco, alcohol and psychotropic drugs results in substantial morbidity and mortality [1-6]. More than 400,000 people die from cigarette smoking every year, and one in every five deaths in the United States is believed to be smoking-related [7]. The consequences of smoking include respiratory and cardiovascular diseases, cancer, physical disabilities, mental disorders, injury, and death [1-8-14]. Among the effects of alcohol abuse are cirrhosis, cardiovascular disease, cancer, gastrointestinal problems, neurocognitive deficits, bone loss, emotional challenges, depression, deterioration in posture control and mobility, injury, job-loss and premature death [4-15-17]. Psychotropic drug intake is common in Europe [1-2-5-18] and alters health status, increases the risk of cancer, injury, and obesity, and deteriorates quality of life [3-13-19-22]. Substance abuse is associated with poor living conditions [2], and recent research has shown that its aetiology involves genetic, material, social and psychological factors [2]. Use of tobacco, alcohol or psychotropic drugs is widely recognised to be a strong, but controllable, risk factor for poor health and social disparities in health [1-3-5-8-23]. It is therefore necessary, from a pubic health perspective, to identify and help those individuals most at risk. Social and material deprivation affects a large number of people [24-27] and is multidimensional. Factors to consider include low educational level, poor employment status (manual worker, unemployed), living alone, ethnic background (other than western European) low income, and not being a home-owner [28-33]. Findings over recent decades have shown that, taken together, these characteristics result in very difficult living conditions, markedly deteriorated health status, premature death, and unsafe health-related behaviours [8-24-40], notably substance use [1-2-8-23-25-35-36].
Most studies in the literature were focused on one substance, but the patterns of risk may vary from substance to substance due to differences in their social acceptability and other factors. Greater understanding in this area would be expected to lead to improvements in the design of preventive measures. France is a vine growing country where alcohol consumption and psychotropic drug intake are higher than elsewhere, and smoking is prevalent[1-2-5].
Risk patterns may also differ between working and retired people and between the sexes. Many working people, particularly manual workers, use substances in order to cope with work-related difficulties [23-41], and occupations differ between men and women. On the whole, retired people have less good health status and more disability[26-42] than working people due to ageing itself and to having a longer history of working. Risk patterns also vary according to occupational group. Women suffer more from mental disorders than do men[25-42-43], and are more likely to take psychotropic drugs under medical supervision [1-17], to be given them following a medical consultation, to receive longer courses, and to renew the treatment [44].
Key questions in this context concern the relationships between deprivation and tobacco, alcohol and psychotropic drug use. Sex- and age-related differences among active and retired people are also of interest, as are the associations between various dimensions of deprivation and the use of specific substances. Knowledge about these patterns may be of use to professionals directly helping the people concerned, and to those responsible for designing and implementing public health policies intended to reduce social inequalities. Disparities in health are a burgeoning field in which debate is ongoing concerning the models used to explain inequality (particularly whether it is mediated by social, economic and lifestyle-related determinants of health) [29-39-45]. Although social disparities in mortality are greater in France than in other western European countries [34], inequalities in health are poorly documented there [46-48]. Research in recent decades has shed light on the impact of deprivation on health, but most of the work has focused on populations in specific geographic areas defined by neighbourhood deprivation indices [28-30]. Deprivation affects people in most parts of all countries, and epidemiological studies may need to look beyond the so-called "deprived areas" [24-25].
The present study looked at the relationship between social deprivation and substance use among people aged 15+ years in a French population. It investigated (1) the relationships between deprivation and tobacco, excessive alcohol and psychotropic drug use, (2) sex and age differences among working/other non-retired and retired people, and (3) the relationships between various aspects of deprivation, and tobacco, excessive alcohol and psychotropic drug use.
Materials and methods
The initial sample consisted of everyone aged 15 years or more living in 8,000 randomly selected households in the Lorraine region of north-eastern France (2.3 million inhabitants). Only households with a telephone were eligible.
Before the initial survey, a 3-month media campaign (television, print, and radio) was conducted in order to raise awareness. The investigation was approved by the Commission Nationale d'Informatique et Libertés, and written informed consent was obtained from respondents.
The study protocol included: (a) an application to participate that ascertained the number of people in the household, and (b) three standardized self-administered questionnaires with a covering letter and a pre-paid envelope for the reply. Mailings were made at 1-month intervals. When the number of individuals was unknown, two questionnaires were sent first, and another later. Questionnaires were completed by the subjects themselves, but adolescents were free to ask their parents about anything they did not understand. Questions covered: sex, date of birth, educational level, occupation (previous occupation for retired people) coded according to the Insee classification (Paris, 1983), smoking habit, alcohol abuse, nationality, family characteristics, unemployment, home-ownership, perceived income, and psychotropic drug use. Alcohol abuse was defined using the Deta questionnaire (at least two positive responses to four items: (i) consumption considered excessive by the subject; (ii) consumption considered excessive by people around the subject, (iii) subject wishes to reduce consumption, and (iv) consumption on waking)[8-25].With regard to perceived income, subjects were asked whether they considered themselves: comfortable or well off, earning just enough, coping but with difficulties, or getting into debt. Psychotropic drug use was determined by asking whether respondents had frequently taken medication (prescribed and/or non-prescribed) for headache, tiredness, nervousness or anxiety, or insomnia over the previous year (Yes/No)[8-18-43]].Deprivation was defined by the number of positive responses to the following seven criteria: low educational level (primary school), manual worker, unemployed, living alone, nationality other than western European, low income (coping, but with difficulties, or getting into debt), and not being a home-owner [28-30]. Of the 8,000 households included in the sample, mailings to 193 (2%) were lost (due to address error or death). Of 7,807 households contacted, 3,460 (44.3%) participated (all eligible members of the family took part in 86% of those). In total, 6,234 subjects filled in a questionnaire; 18 were of unknown sex or age, leaving 6,216 subjects who were similar in age and sex distribution to the Lorraine population (Table (Table11).
Statistical analyses
The χ2 independence test was used to compare the two sexes for various variables. The deprivation score (D) was defined by the number of the seven criteria considered above and classified into four groups: D = 0, D = 1, D = 2, and D ≥ 3. We also used the principal component analysis in order to define a score as a linear combination of the previous criteria but this was not retained because: (1) the seven eigenvalues found were close enough (1.33, 1.20, 1.06, 0.97, 0.87, 0.84, and 0.73), suggesting that each component contributed almost equally to the D; and (2) the relationships between the deprivation levels defined by the 50th, 75th, and 90th percentile values of the score obtained [49] with tobacco, excessive alcohol, and psychotropic drug use were close to those found with D = 0, D = 1, D = 2, and D ≥ 3. Cronbach's alpha was modest (0.24). To assess the relationships between D and tobacco, excessive alcohol and psychotropic drug use, adjusted odds ratios (ORa) and 95% confidence intervals were calculated using logistic models.
Results
References
- ↑J Alonso ,MC Angermeyer, S Bernert , R Bruffaerts, MC Angermeyer, S Bernert, TS Brugha, H Bryson, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, et al. Psychotropic drug utilization in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl. 2004:55–64. [1]
Voir aussi
- Dans le réseau Wicri :
Ceci est la page de référence de « Int J Health Geogr (2007) Baumann » Cet article est également traité sur Wicri/Lorraine et Wicri/Luxembourg.
