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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Titre Associations of social and material deprivation with tobacco, alcohol, and psychotropic drug use, and gender: a population-based study Auteurs Michèle Baumann(1), Elisabeth Spitz(2) ; Francis Guillemin(3) , Jean-François Ravaud(4) ; Marie Choquet(5,6,7), Bruno Falissard(5,6,7,8) ; Nearkasen Chau(5,6,7) and Lorhandicap group Affiliations (1)INtegrative research unit on Social and Individual DEvelopment (INSIDE),University of Luxembourg, Faculty LSHASE, Luxembourg; Luxembourg; (2)Department of psychology, University of Metz, Metz, France; (3)EA 4003, Ecole de Santé Publique, University Henri Poincaré – Nancy 1, Faculté de Médecine, Vandoeuvre-lès-Nancy, France; (4)INSERM, U 750, CERMES, IFR25-IFRH, Villejuif, France; (5)INSERM, U669, Paris, France; (6) Univ Paris-Sud, Paris, France; (7) Univ Paris-Descartes, UMR-S0669 Paris, France; (8)AP-HP, Villejuif, France. In international journal of health geographics, Date 2007 DOI 10.1186/1476-072X-6-50 En ligne Sur PMC : http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211297/ Sur BioMed Central : http://www.ij-healthgeographics.com/content/6/1/50

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.

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References

1. ↑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]

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