The incidence of drug use and associated factors in two small towns: a community survey

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Abstract
Method
Results
Discussion

Details

Author: Lee H. BOWKER,
Pages: 17 to 25
Creation Date: 1976/01/01

The incidence of drug use and associated factors in two small towns: a community survey *

Ph.D. Lee H. BOWKER,
Chairperson, Dept. of Sociology and Anthropology, Whitman College, Walla Walla, Washington 99362, U.S.A.

Abstract

The article reports the results of a 1974 drug Survey in two rural municipalities in the Pacific Northwest. Drug use in these towns was found to be similar to drug use in urban areas. It appears that towns size 2,500 to 50,000 have been absorbed into the national drug culture while only farmers and people living in very small towns still experience relatively low rates of drug use. Other findings include attitudes toward and needs met by drug use, the effect of parental drug use on perceived children's drug use, and the relationships between drug use and age, sex, and general health.

In the past few years, articles have appeared describing adult drug use in the United States as a whole, or in selected urban populations. The most comprehensive study is a national survey of a representative sample of 2,552 adults completed in 1971 [ 1] - [ 3] . Among the regional reports are studies carried out in California [ 4] , [ 5] and New York [ 6] , [ 7] . What these studies have in common is the absence of data on rural or small town drug use as compared with urban drug use. A national study by Cahalan, Cisin, and Crossley [ 8] does analyse rural-urban differences, but only for alcohol use. No comprehensive treatment of this topic exists in the literature. The research reported in the present article represents an attempt to begin to fill in this void with data on small town drug use in a rural setting.

Method

In early 1974, research aides distributed questionnaires to a random sample of adults aged 18 and over in the only two municipalities in a rural county in the Pacific Northwest. The sample was selected using a multi-stage random sampling design so as to be representative of the entire adult population of these communities.

When delivering the questionnaires, research aides included unmarked envelopes and displayed locked metal boxes having slits into which the sealed completed questionnaires were to be deposited by the respondents when the aides returned the following day, or later the same day. The research aides were carefully trained to answer any questions respondents might have about the project. Additional information was provided by newspaper articles and a series of three minute radio broadcasts. Those respondents who needed help to complete the questionnaire due to inadequate eyesight, poor reading skills, etc. were provided that support by the research aides.

* The data used in this article were partially collected under grant ≠l-D20 00931-01 of the National Institute of Mental Health.

Completed questionnaires were returned by 516 adults, which makes for a response rate of 71 per cent. It is impossible to scientifically ascertain whether the 29 per cent non-respondents were heavier or lighter drug users than the 71 per cent who completed questionnaires. However, anecdotal evidence from the research aides suggests that heavy drug users were under-represented among those completing questionnaires. If this is correct, then the drug use rates produced by this survey should be considered to be underestimating the true rates for the population studied. Though it is not legitimate to generalize from this study to other rural counties, comparisons between data presented in this article and national or urban data may be taken to be indicative of at least the direction if not the magnitude of rural-urban differences in drug use and associated variables.

An initial questionnaire draft was written by the author, following which a committee of citizens from the area to be studied, criticized, refined and pretested the instrument. In its final form, the questionnaire contained 137 questions, including items on drug use, needs met by drug use, social agency contacts, attitudes toward drug use, perceived children's drug use, and demographic variables. In addition, there was a cover letter and a detachable reference card for respondents to use in filling out the questionnaire. This reference card explained the 12 categories of drugs as defined for the study (alcohol, amphetamines, aspirin, barbiturates, caffeine, hallucinogenic agents, marijuana and/or hashish, narcotics, nicotine, other prescription medicines, over-the-counter medicines, and tranquillizers) and gave many examples of each.

The questionnaires were coded and keypunched onto cards for computer processing. The data were formed into bivariate and multivariate distributions and analysed, using chi-square as a test of statistical significances and gamma as a measure of strength of association.

Results

Drug use incidence

Table 1 presents the incidence of use for 12 categories of drugs at four levels, at least once last year, once per month last year, once per week last year, and five or more times per week last year. Aspirin was used at least once by more respondents than any other drug, but only caffeine was used five or more times per week by more than half of the respondents. This table also shows the dropoff effect as the frequency of use of a drug rises from at least once last year to five or more times per week. For example, alcohol use drops from 67 to 44 to 33 to 8 per cent. There is a plateau between once per month and once per week, with comparatively few users going on to the five or more times per week level. Some drugs, such as amphetamines, barbiturates, hallucinogens, and narcotics have a high proportion of triers and a relatively low number of users at even the once per month level. Others, such as caffeine and nicotine, have few triers compared to the large number of respondents who use them at the highest level measured.

TABLE 1

Comparison of the frequency of use of drugs during the past year, expressed in percentages, among the sample of adults (N = 516)

Drug

At least once

At least once per month

At least once per week

Five or more time per week

Alcohol
67 44 33 8
Amphetamines
13 4 2 1
Aspirin
86 42 21 11
Barbiturates
18 6 4 1
Caffeine
79 71 68 57
Hallucinogens
5 1 1 0
Marijuana
13 6 5 3
Narcotics
15 3 2 1
Nicotine
34 29 29 28
Other prescription medicines
73 31 25 19
Other over-the-counter medicines
70 23 11 4
Tranquillizers
23 9 7 3

Objective reports of drug use must be balanced by subjective estimates of the level of drug use. In table 2, these dataIare presented for the same 12 drug categories. Comparatively few respondents defined their drug use as heavy. Most readers would probably define five or more times per week as heavy use for all drugs except possibly aspirin, caffeine, and nicotine. Yet only 45 per cent of the respondents using alcohol five or more times per week defined their use as heavy. The 12 drug categories fall into two extreme groups, with alcohol nicotine and marijuana in between. Comparatively few of the five or more times per week users of aspirin (20 per cent), caffeine (30 per cent), other prescription medicines (14 per cent), other over-the-counter medicines (25 per cent), and tranquillizers (7 per cent) defined their use as heavy. In contrast, for amphetamines, barbiturates and hallucinogens, all of the small number of respondents reporting use five or more times per week defined this use as heavy. At the intermediate level, we have the two most popular recreational drugs, alcohol (45 per cent) and marijuana (54 per cent), along with nicotine (54 per cent).

TABLE 2

Comparison of the rating of use of drugs during the past year, expressed in percentages, among the sample of adults (N=516)

Drug

Light

Moderate

Heavy

Alcohol
40 22 3
Amphetamines
9 3 1
Aspirin
59 19 2
Barbiturates
15 3 2
Caffeine
24 35 17
Hallucinogens
2 1 1
Marijuana
5 3 1
Narcotics
10 1 1
Nicotine
7 14 15
Other prescription medicines
57 18 3
Other over-the-counter medicines
62 12 1
Tranquillizers
19 5 0

Attitudes toward drug use

A high percentage of the respondents rejected the illegal use of all types of drugs. For legal use, the situation was different. More respondents approved than disapproved of the legal use of over-the-counter medicines, other prescription medicines, caffeine, aspirin, and alcohol. Disapproval of even legal use was the norm for amphetamines, barbiturates, narcotics, nicotine, and tranquillizers.

A. second series of attitude questions dealt with the perceived helpfulness or harmfulness of the drugs. Most respondents rated aspirin, other prescription medicines, and other over-the-counter medicines as helpful. All other drugs were rated as harmful by a majority of respondents. Despite the preponderance of negative opinion about these drugs, alcohol was seen as helpful by 22 per cent of the respondents, amphetamines by 13 per cent, barbiturates by 24 per cent, caffeine by 44 per cent, narcotics by 12 per cent, hallucinogens by 4 per cent, nicotine by 10 per cent, marijuana by 10 per cent, and tranquillizers by 40 per cent.

The final group of attitude questions was on the perceived relationship between drug use and various social problems. A majority of the respondents rated drug use as highly related to all nine of the social problems listed. Crime problems and driving problems were seen as most strongly related to drug use, followed by emotional problems and juvenile problems. Problems about finances, marriage, work, school, and human communication were also seen as highly related to drug use, but by a smaller proportion of respondents than crime, driving, juvenile and emotional problems.

Needs met by drug use

Respondents were asked to indicate which of eight categories of needs (physical/sensory, to relieve tension, to socialize, to rebel, to become more alert, aesthetic appreciation, to increase life's meaning, and for adventure) were met by twelve kinds of drug use. These eight need categories were derived from a slightly larger list presented by Allan Y. Cohen in a recent article published in the Journal of Psychedelic Drugs [ 9] . Cohen argues that different drugs meet different patterns of needs, and that each of these needs could be better met by non-drug alternatives.

The adults surveyed reported using nicotine and alcohol for the same reasons, to relieve tension and to socialize. Amphetamines were used to relieve tension and to increase alertness. Caffeine combined elements of all three of these drugs. It was used for increasing alertness and to socialize.

A second group of drugs was used mainly for physical/sensory reasons This group is composed of aspirin, narcotics, other prescription medicines, and other over the counter medicines. Barbiturates and tranquillizers were also used for physical/sensory reasons, but they met the additional need of relief from tension.

Hallucinogens met a very different pattern of needs. They were used because they heightened aesthetic appreciation and for adventure and kicks. Marijuana is a unique drug, for it satisfies a larger range of needs than any other drug. Respondents reported that it relieved tension, enhanced socializing, heightened aesthetic appreciation, and gave a sense of adventure, thus combining many of the properties of the common social drugs plus barbiturates, tranquillizers and hallucinogens.

The need-drug use interactions were broken down by sex of respondent. In general, there were few differences between the sexes. The patterns discussed above applied to males and females alike.

The influence of parental drug use and attitudes on perceived children's drug use

What is the effect of parental drug use or attitudes toward drug use on the drug use of children? The present survey could not measure this relationship directly. Instead, the dimensions of the parental drug environment were related to what was called perceived children's drug use. Perceived children's drug use is children's drug use as reported by parents rather than the children themselves.

Of 14 relationships tested between parental drug use and perceived children's drug use, 11 were statistically significant at the 0.05 level or better. Correlations ranged from 0.13 to 0.77. Table 3 summarizes these relationships.

TABLE 3

Chi-square significance levels and gamma correlations for relationships between parental drug use variables and perceived children's drug use variables

Parental drug use variable

Children's drug use variable

Significance level

Correlation

Alcohol use
Alcohol use
0.001 0.46
Alcohol use
Marijuana use
0.02 0.49
Amphetamine use
Amphetamine use
0.001 0.73
Barbiturate use
Barbiturate use
0.001 0.77
Caffeine use
Caffeine use
0.001 0.49
Caffeine use
Marijuana use
NS
0.13
Nicotine use
Marijuana use
NS
0.16
Nicotine use
Nicotine use
NS
0.21
Use of other prescription medicines
Use of other prescription medicines
0.001 0.52
Use of other over-the- counter medicines
Use of other over-the counter medicines
0.05 0.34
Tranquillizer use
Tranquillizer use
0.001 0.72
Use of drugs to sleep
Alcohol use
0.01 0.35
Use of drugs to sleep
Barbiturate use
0.001 0.73
Use of drugs to sleep
Marijuana use
0.05
0.41

In addition, a total of 12 relationships between parental drug attitudes and perceived children's drug use were examined. Eight of nine relationships involving parental attitudes toward the legal use of drugs were found to be statistically significant, but none of the three relationships involving parental attitudes toward the illegal use of drugs were significant. Correlations ranged from 0.29 to 0.70 for attitudes toward legal drugs and from 0.03 to 0.31 for attitudes toward illegal drugs.

Some parents were sure that their children were using the same drugs they were, for they allowed their children to use drugs from their parents' own prescriptions. Of all the adults who used amphetamines in the previous year, 26 per cent reported allowing their children to use their amphetamine prescription. Percentages for other drugs were 16 per cent for barbiturates, 5 per cent for tranquillizers, and 5 per cent for other prescription medicines. These percentages are underestimates since less than two-thirds of the adult users of these drugs reported having children. When adjusted of this, figures for prescription sharing inflate to 42 per cent for amphetamines, 25 per cent for barbiturates, and 8 per cent for both tranquillizers and other prescription medicines. Even these figures must be underestimates, for many of the children were very young, and had not yet moved into adolescence, at which time they would be more likely to be given drugs by parents than when they were infants.

Epidemiological perspectives

The distribution of the use of the different drug categories was broken down by sex, age, and general health. In table 4, we see the correlations between demographic variables and 12 types of drug use. In general, the correlations are small, indicating that differences in drug use between age, sex, and health groups are fairly minor.

TABLE 4

Comparison of chi-square significance levels and gamma correlations for relationships between 12 types of drugs and sex, age, and general health

 

Sex

Age

General health

 

Correlation*

Sig. Level

Correlation*

Sig. Level

Correlation*

Sig. Level

Alcohol
0.24 0.01
- 0.22
0.01
- 0.28
0.05
Amphetamines
0.02
NS
- 0.32
0.001
- 0.29
0.01
Aspirin
- 0.12
NS
0.03
NS
- 0.46
0.001
Barbiturates
- 0.24
0.05
- 0.12
NS
- 0.37
0.001
Caffeine
- 0.03
NS
- 0.25
0.001
- 0.26
0.01
Hallucinogens
0.37 0.05
- 0.87
0.001 0.14 0.05
Marijuana
0.23
NS
- 0.88
0.001 0.02
NS
Narcotics
0.27 0.05
- 0.01
NS
- 0.11
NS
Nicotine
0.24 0.01
- 0.32
0.02
- 0.33
0.01
Other prescription medicines
- 0.19
0.05 0.28 0.05
- 0.32
0.001
Other over-the- counter medicines
- 0.13
NS
- 0.05
NS
- 0.13
0.01
Tranquillizers
- 0.26
0.02 0.03
NS
- 0.27
0.01

For sex, a positive correlation indicates that males use that particular drug more than females. In negative correlations, females use drugs more than males.

Males and females have somewhat different drug use patterns. Males are higher users of alcohol, hallucinogens, marijuana (though the difference in this case did not reach statistical significance), narcotics, and nicotine. Females are higher users of barbiturates, other prescription medicines, and tranquillizers. All correlations were modest, with only the use of hallucinogens raising above ±.30.

Age differences in drug use patterns are pronounced (gamma>±.30) only for amphetamines, hallucinogens, marijuana, and nicotine. For all these drugs, younger people are heavier users than older people. The only drug category for which there is a steady rise in use with increasing age is "other prescription medicines''. It is often said that alcohol is the social drug of choice for adults while marijuana is rapidly becoming the social drug for adolescents, but in the towns studied, young people used alcohol more heavily than adults.

There are only two drugs for which there is not a negative correlation in table 4 between drug use and general health. For the other 10 categories of drugs, people who rate their general health higher are lower users of drugs, and in nine out of ten these category differences were statistically significant. It is interesting that marijuana and hallucinogens, two drugs that are constantly vilified in the press, are, in a sense, used by the healthiest of all the groups of drug users. Their health is unlikely to be due to the drug action, however, but rather to the fact that they tend to be younger than other users, and therefore in the age range where greater general health would be expected.

Discussion

Comparison of rural and urban drug use

Green and Nemzer [ 10] present national data on nicotine use in 1970. They found that 36 per cent were current smokers. In our small town sample, 34 per cent reported smoking at least once last year, and 28 per cent more than five times per week. Data from another 1970 national survey [ 3] indicate that 22 per cent of the adults aged 18-74 used prescription psychotherapeutic drugs and 12 per cent over-the-counter psychotherapeutic drugs in the past year. Sixty-nine per cent used alcohol. The alcohol figure is similar to the 67 per cent alcohol users in the small town study, and the other figures are not sufficiently comparable to the breakdowns in the small town study to make a sound judgment one way or the other. San Francisco data from 1968 [ 5] on the use of stimulants, tranquillizers and barbiturates, though also presented in non-comparable categories, seem to be similar to the rates recorded in the present study.

The 1968 use of barbiturates, tranquillizers and amphetamines in New York State [ 6] was somewhat higher than the 1974 data in the small town sample, but there was approximately equal use of marijuana, hallucinogens and narcotics. In the New York State study, the breakdowns of drug use by occupation showed that farmers had unusually low drug use. A similar finding has been reported for alcohol use in a national sample [ 8] studied at about the same time. In that study, 79 per cent of the adult residents in cities of a million or more inhabitants were alcohol users, and 18 per cent "heavy" users. For cities size 2,500 to 49,999 (comparable to the two towns reported on in this article), 63 per cent were users and 11 per cent "heavy" users. Among farmers, these figures decreased to 43 per cent and 5 per cent, respectively.

The time lag between all these studies and the 1974 small town sample study is crucial. It is likely that all these figures would have increased quite a bit by 1974. Considering all the evidence at hand, the following tentative conclusions can be stated

  1. Though drug use in small towns may be somewhat lower than use in urban areas for certain drugs, the similarities on the whole are striking. Small towns have been largely absorbed into the national drug culture.

  2. Fragmentary reported findings suggest that, at least as late as in 1970, farmers and people living in towns with a population under 2,500 had not yet adopted the relatively high national rates of drug use.

Other conclusions and cautions

The rather strong negative judgement of nicotine by most respondents illustrates the success of the recent educational campaign to influence the public's point of view on a drug. Unfortunately, the continuing use of nicotine by a significant portion of the community suggests that the link between attitudes and behaviour is a weak one.

Looking at the data on the influence of parental drug use on children's drug use, we find that relationships in which parent and child use the same drug are stronger than relationships in which they use different drugs. A second principle is that relationships involving the parental use of the most widely used drugs are weaker than relationships in which the parent is using the less popular drugs. Finally, correlations involving parental drug use were generally stronger than those involving parental attitudes toward legal drug use, which were in turn stronger than those involving parental attitudes toward illegal drug use. This means that parental drug use has a greater effect on perceived children's drug use than parental drug attitudes. "Do as I do" is a more important principle than "do as I say." The only two exceptions to this rule were for over-the-counter medicines (0.41 for attitudes, 0.34 for use) and nicotine (0.65 for attitudes, 0.16 for use). The strange pattern for nicotine may be due to its position as a drug rated as harmful by most, yet heavily used by many.

The differences in drug use between males and females are consistent with theories advanced in the literature by Cooperstock (11) and Bowker (12). Cooperstock notes that females see themselves, are seen by their doctors as being more emotional than males and therefore as needing more mood-modifying prescriptions. Bowker argues that while Cooperstock is correct, there is the additional factor that males are always higher consumers of illegal drugs while females tend to participate in a more limited fashion in the use of illegal drugs. When females do use illegal drugs, they commonly obtain them through their boyfriends or other male associates. As American society becomes less sexist, these differences may be expected to diminish.

Finding that younger people use more drugs than older people in a cross-sectional survey does not necessarily mean that the drug use of a given cohort of young people declines as they age. It could also mean that drug use is increasing in every generation of adolescents to such an extent that this generational increase obscures the increase of drug use with age within each generation. This point illustrates the perils of making causal inferences from cross-sectional data, a difficulty which readers should keep in mind when making inferences from data presented in this article.

These developmental questions would be better answered by a panel study in which repeated measurements were made of the same sample over time. The question of rural-urban differences also requires additional research. In this case, what is needed is not so much a panel study, but a national cross-sectional sample that breaks down all responses by the size of the urban community studied and other appropriate indices of placement on the rural-urban continuum.

References

001

H.J. Parry. Patterns of psychotropic drug use among American adults. J. Drug Issues, 1:269-273, 1971.

002

H.J. Parry, B. Mitchell, G.D. Mellinger, et al. National patterns of psychotherapeutic drug use. Arch Gen Psychiatry, 28 :769-783, 1973.

003

G.D. Mellinger, M.B. Balter, H.J. Parry, et al. An overview of psychotherapeutic drug use in the United States, in Drug Use, Epidemiological and Sociological Approaches. Edited by E. Josephson, E.E. Carroll. New York, Halsted Press, pp. 333-366, 1974.

004

G.D. Mellinger. Psychotherapeutic drug use among adults: A model for young drug users? J. Drug Issues, 1 :274-285, 1971.

005

G.D. Mellinger, M.B. Balter, D.I. Manheimer. Patterns of psychotherapeutic drug use among adults in San Francisco. Arch. Gen. Psychiatry, 25 :385-394, 1971.

006

C.D. Chambers. Differential Drug Use Within the New York State Labor Force. New York, New York State Narcotic Addiction Control Commission, 1971.

007

M. Koval, D.V. Babst, D.S. Lipton. Development of Drug Involvement Classification for Residents of New York State. New York, New York State Drug Abuse Control Commission, 1974.

008

D. Cahalan, I.H. Cisin, H.M. Crossley: Demographic and sociological correlates of levels of drinking, in Drug Use and Social Policy. Edited by J. Susman. New York, AMS Press, pp. 3-49, 1972.

009

A.Y. Cohen. The journey beyond trips: Alternatives to drugs. J. Psychedelic Drugs, 3 :16-21, 1971.

010

D.E. Green, D.E. Nemzer. Changes in cigarette smoking by women - An analysis, 1966 and 1970. Health Service Rep, 88:631-636, 1973.

011

R. Cooperstock. Sex differences in the use of mood-modifying drugs: An explanatory model. J. Health and Social Beh, 12 :238-244, 1971.

012

L.H. Bowker. Student drug use and the perceived peer drug environment. Int. J. Addictions, 9 :851-861, 1974.