Racial/Ethnic Differences in Recent Drug Detoxification Enrollment and the Role of Discrimination and Neighborhood Factors

Abstract

Drug detoxification and long-term drug treatment utilization is lower for drug-dependent minorities than Whites. Log-binomial regression was used to assess discrimination and neighborhood-level factors on past 6-month drug treatment utilization among 638 New York City (NYC) drug users between 2006 and 2009. Drug-use discrimination was positively associated with detoxification and long-term treatment. Participants in higher concentrated Black neighborhoods were less likely to attend long-term treatment. Significantly fewer Blacks versus Whites and Hispanics reported drug-use discrimination, which may systematically filter drug users into treatment. More research is needed to understand social forms of discrimination and drug treatment.

Keywords :

• discrimination
• neighborhood
• race/ethnicity
• drug treatment
• urban health

THE AUTHORS

Natalie D. Crawford, Ph.D., is an Assistant Professor in the Division of Epidemiology and Biostatistics at the Georgia State University School of Public Health. She completed her postdoctoral training at the University of Michigan as a Robert Wood Johnson Health and Society Scholar and received her Ph.D. in Epidemiology from Columbia University's Mailman School of Public Health. She worked as a Project Director at the New York Academy of Medicine and Columbia University on several federally and privately funded studies that examine social determinants of health. Dr. Crawford's broad research interests are examining the social processes that create and perpetuate racial and ethnic health disparities. Her published work has examined the influence of education, income, social discrimination, and neighborhood environment on a host of health outcomes including, but not limited to, illicit drug use, high-risk relationships, obesity, and diabetes. She has extensive experience in research implementation including primary data collection, community-based participatory research, statistical analyses, and structural interventions. Dr. Crawford's current research examines how contextual neighborhood features and drastic changes in the neighborhood environment influence racial and ethnic disparities in health and health behaviors.

Abby E. Rudolph, Ph.D., M.P.H., is an infectious disease epidemiologist at the Pacific Institute for Research and Evaluation. She holds a Master's degree in Public Health from Columbia University Mailman School of Public Health and a Ph.D. in Epidemiology with a focus on Infectious Diseases from the Johns Hopkins Bloomberg School of Public Health. Dr. Rudolph's research focuses on understanding how individual, environmental, and network factors act together to shape disease transmission dynamics, risk behaviors, and health service utilization among populations disproportionately burdened with disease. Her publications cover a variety of topics including HIV- and drug use-related stigmas, recruitment strategies for hidden populations, network correlates of HIV and risk behaviors, neighborhood correlates of HIV transmission and risk behaviors, respondent-driven sampling, pharmacy syringe access for injection drug users (IDUs), and community-based participatory interventions to connect marginalized populations with health services. She is currently funded by a K01 Mentored Research Scientist Award from the National Institute on Drug Abuse (NIDA) that aims to better understand the independent and combined influence of social network and spatial/neighborhood factors on linkage to care, treatment adherence, and drug treatment enrollment among HIV positive IDUs in Baltimore, MD.

Crystal M. Fuller, Ph.D., has a Ph.D. in Epidemiology from Johns Hopkins University, Bloomberg School of Public Health, and has been on faculty for the past 12 years as an Associate Professor in the Department of Epidemiology at the Mailman School of Public Health, Columbia University. Dr. Fuller has led several large-scale, federal, and private-funded research studies since her professional career began 13 years ago. Her research has led to a publication record of over 65 peer-reviewed manuscripts and 3 book chapters building extensive experience in the design, conduct, and analysis of community-based infectious disease and drug abuse epidemiologic studies, particularly structural and multilevel intervention studies focused on solving the problem of racial disparities in HIV and other social and medical consequences related to HIV and drug abuse. Dr. Fuller conducts original data collection often using community-based participatory research (CBPR) methods with a focus on sustainability, and translating research into practice. Her most recent work is the investigation of access to antiretroviral medication as a means to prevent HIV among drug users and their peers in New York City, also referred to as postexposure prophylaxis (PEP). Complementing this work, Dr. Fuller is developing expertise in the use of technology to support risk reduction behavior, increase access to prevention services, and increase medication adherence among drug users and other marginalized communities. In addition to her research, Dr. Fuller has an extensive background in mentoring undergraduate, graduate, and postdoctoral students, and junior faculty, many of whom have been supported by individual and training grant NIH sponsorship directed and/or coordinated by Dr. Fuller.