https://orcid.org/0000-0002-9218-2416
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Abstract
Background and Purpose: Over 247,000 people died in the U.S. from overdoses related to prescription opioids in 1999–2019, leading the WHO to deem the situation an epidemic. The purpose of this study is to examine whether culture is related to perceptions and behaviors around opioid consumption because culture has been shown, for example, to influence decision-making strategies, risk-taking, and responses to self-congruent communications. Methods: Scores for country-wide dimensions of culture from Hofstede and opioid consumption data from the International Narcotics Control Board were used to study a possible relationship. The relationship was tested by including a set of economic and socio-economic indicators from the World Bank, the United Nations, and PROSPERED. Results: The scores for the cultural dimension of individualism are correlated with opioid consumption on a country level, with higher levels of individualism connected to higher consumption. This correlation is robust to the inclusion of economic and socio-economic variables (GDP per capita, inflation, income inequality, unemployment, education, life expectancy, median age, and sick leave coverage). Conclusions and Importance: Because messages that reinforce a group’s cultural value are more meaningful and effective in motivating action, educational health messages about opioid consumption in the U.S. need to be designed with culture in mind to disrupt decisions to take opioid analgesics unless medically justified or to limit their use. More research is needed on how to design self-congruent individualistic versus collectivistic persuasive appeals.
Notes
1 While the age-standardized prevalence of experiencing chronic pain in the U.S. (43%) is similar to that of France (47.8%) and Italy (42.8%) (Tsang et al., Citation2008), the standard daily doses of opioids consumed per capita are dramatically higher in the U.S. Quality of health care between these three countries does not provide an explanation either: Life expectancy at age 65 (an important indicator of healthcare system effectiveness) is higher in France and Italy than in the U.S. (“Life expectancy at 65,” 2016).
2 The 2013 version of the survey instrument can be downloaded at https://geerthofstede.com/research-and-vsm/vsm-2013/
3 A self-construal is a combination of feelings, thoughts, and actions that reflect an individual’s relationship to others and his/her view of self as distinct from others (Singelis, Citation1994). As such, self-construals reflect the impact of individualism-collectivism on an individual level (Gudykunst et al., Citation1996; Singelis & Brown, Citation1995).
4 Data is reported to the INCB by the individual countries. Reporting to the INCB is governed by the 1961 United Nations Single Convention on Narcotic Drugs (United Nations, Citation1961). As part of the convention, member countries furnish quarterly statistics of imports and exports of narcotic drugs and annual estimates of requirements for narcotic drugs, manufacture of synthetic drugs, and cultivation of the opium poppy, the cannabis plant and the coca bush. They also report annual statistics on the manufacture, consumption, utilization and stocks of substances controlled under the Convention on Narcotic Drugs of 1961 and notifications on seizures of internationally controlled licit substances smuggled through the mail, including those ordered via the internet. It is not further specified which agencies within each country are responsible for completing the reports.
5 A defined daily dose is “the assumed average maintenance dose per day for a drug used for its main indication in adults” (“Defined Daily Dose,” n.d.).
6 Lower secondary education generally continues the basic programs of the primary level, although teaching is typically more subject-focused and specialized. Lower secondary education may either be “terminal” (i.e., preparing students for entry directly into working life) and/or “preparatory” (i.e., preparing students for upper secondary education) (“Glossary of Statistical Terms,” Citation2004).
7 0, No, none |1, Yes, paid leave, but not from 1st day | 2, Yes, paid from 1st day
8 PROSPERED (Policy-Relevant Observational Studies for Population Health Equity and Responsible Development) is a project supported by the Foundation Grant from the Canadian Institutes of Health Research that examines how country-level policies and programs affect the social determinants of health.
9 See Shorrocks-Shapley Decomposition calculations (Huettner and Sunder, 2012; Shorrocks, 1982) included in Appendix 1 - Table 2
10 “The Rx Awareness campaign focuses on adults ages 25–54 who have taken opioids at least once for medical or nonmedical (recreational) use, and it highlights the importance of reducing opioid abuse to prevent overdoses. CDC incorporated first-person stories into the campaign based on past effective use of testimonials to communicate about complex and sensitive health behaviors. The cornerstone of the campaign is a series of videos that feature individuals who are either living in recovery from opioid use disorder, or who are family members who lost someone to a prescription opioid overdose” (“Addressing the Prescription Opioid Crisis: CDC Rx Awareness Campaign Overview,” n.d., p. 6).
11 Not included in the analysis.
12 Not included in the analysis.
13 Not included in the analysis.