Transcript National Health and Nutrition Examination

Association between employment and drug abuse among young adults:
National Health and Nutrition Examination Survey, 2001-2004
Alberto J. Caban-Martinez, Manuel A. Ocasio, Tainya C. Clarke, John D. Clark III, and Diana Kachan
Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida, USA
This work was funded in part by the U.S. National Institute of Environmental Health Sciences Fellowship
F30ES015969 (PI: Clark); and the U.S. National Institute for Occupational Safety and Health R01 0H03915 (PI Lee/Fleming).
Contact: Alberto Caban-Martinez | Email: [email protected]
ABSTRACT
Introduction: Harmful substance use patterns among young adults
that are established before or during employment represent an
important public health concern. The social, economic, and health
consequences of illicit drug abuse may persist not only into their
young adult life, but may carry forward into their professional life.
We examine the association between employment status,
occupation type and drug use among U.S. young adults.
Methods: We analyzed pooled data on 1,009 U.S. young adults
(representing an annual 5,119,332 young people) age 20-25
participating in the 2001-2004 National Health and Nutrition
Examination Survey, who reported on their lifetime use of cocaine
or street drugs, employment status, occupation type, and sociodemographic characteristics.
Results: The overall lifetime prevalence of cocaine or street drug
use among U.S. young adults was 21.7%±3.4; highest among males
(12.7±1.9), non-Hispanic whites (13.7±2.9), those with a high school
diploma or GED (7.9±1.4), unmarried (13.7±2.6), those with an
annual household income of less than $20,000 (8.1±2.5); those
employed as blue-collar workers (8.1±1.8, and those with a job
(14.7±3.1). Among employed young adults, those in Construction
trade (3.7±1.2) and Health service occupations (2.3±1.4) had the
highest proportion of workers reporting a high lifetime prevalence
of cocaine or street drug use. Employed young adults were
significantly more likely 1.32 [1.01-1.98] (adjusted odds ratio [95%
Confidence Interval]) to report a lifetime use of cocaine or street
drugs even after controlling for gender, race/ethnicity, education,
marital status, and annual household income as compared to
unemployed young adults.
Conclusions: Knowledge of rates of substance use among both
employed and unemployed young adults will offer support towards
building better prevention programs for younger members of the
workforce, thereby offering protection against continued or
accelerated use and abuse. The workplace may be a useful venue in
which to target tailored drug abuse educational interventions at
high risk employed young adults.
epidemiological studies in the last decade,
up to 50% of adolescents have used cannabis at least once
INTRODUCTION
Epidemiological studies, suggest that up to
50% of U.S. adolescents have used cocaine or
street drugs at least once during their life-time.
Longitudinal studies that have examined risk
and vulnerability factors for onset of cocaine
and street drug use, have also identified
potential negative consequences of regular
drug use, abuse and dependence.
Employment experiences in young adulthood
often forecast later occupational attainment
patterns, therefore understanding factors
associated with job type and drug use remains
of major public health importance.
OBJECTIVE
Examine the association between employment
status, occupation type and drug use among
U.S. young adults.
Describe the lifetime prevalence of cocaine or
street drug use among U.S. young adults.
List, in rank order, young adult occupations
that report high levels of cocaine or street drug
use.
METHODS
National Health and Nutrition Examination
Survey (NHANES) is a population-based health
survey of non-institutionalized U.S. residents
conducted by the National Center for Health
Statistics of the Centers for Disease Control and
Prevention
NHANES uses a complex, multistage probability
sampling design, with oversampling of minority
populations.
All participants completed household surveys
conducted by trained study staff that included
questions on demographics and health history.
Data obtained from 1,009 young U.S. adults
age 20-25 years old participating in the 20012004 NHANES, who reported on their lifetime
use of cocaine or street drugs (using computerassisted [CASI] technology), employment
status,
occupation
type,
and
sociodemographic characteristics.
Analyses completed with the PASW Statistics
18 and PASW Complex Sample package (IBM,
Inc.) to take into account sample weights,
design effects and aggregation of data over
multiple survey years.
Table 1. Proportion of Young Adults (20-25 years old) by socio-demographic characteristics who reported on ever
using cocaine or street drugs: National Health and Nutrition Examination Survey 2001-2004 (n=1,009)
% Ever used Cocaine or Street Drug
(n=118)
Occupation Title
Other transportation and material moving occupations
Extractive and precision production occupations
Other mechanics and repairers
Construction trades
Writers, artists, entertainers, and athletes
Material recording, scheduling, and distributing clerks
Related agricultural, forestry, and fishing occupations
Records processing occupations
Miscellaneous food preparation and service occupations
Technicians and related support occupations
Waiters and waitresses
Health service occupations
Cooks
Management related occupations
Secretaries, stenographers, and typists
Vehicle and mobile equipment mechanics and repairers
Fabricators, assemblers, inspectors, and samplers
Motor vehicle operators
Executive, administrators, and managers
Construction laborers
Cleaning and building service occupations
Sales workers, retail and personal services
Laborers, except construction
Miscellaneous administrative support occupations
Personal service occupations
Health diagnosing, assessing and treating occupations
Sales representatives, finance, business, & commodities ex. retail
Other helpers, equipment cleaners, hand packagers and laborers
Protective service occupations
Other professional specialty occupations
Freight, stock, and material movers, hand
Engineers, architects and scientists
Teachers
Supervisors and proprietors, sales occupations
Secretaries, stenographers, and typists
Private household occupations
Personal service occupations
Farm and nursery workers
Textile, apparel, and furnishings machine operators
Table 2. Weighted logistic regression model for predictors of ever using cocaine or street drugs
among young adults (20-25 years old) participating in the NHANES 2001-2004
Unadjusted
†Adjusted
Predictors
Odds Ratio [95%CI]
Odds Ratio [95%CI]
Employment Status (ref = Unemployed)
Employed
1.37 [1.05-2.03]
1.32 [1.01-1.98]
Gender (ref = females)
Male
2.01 [1.31-3.06]
Race/Ethnicity (ref = Non-Hispanic Whites)
Mexican American
1.25 [1.01-1.89]
Other Hispanic
1.83 [1.13-4.08]
Non-Hispanic Black
0.31 [0.23-0.54]
Other Race
1.08 [0.22-5.17]
Education (ref = Less than High School)
High School Diploma / GED
1.45 [1.06-3.18]
Some College
0.93 [0.39-2.16]
College Graduate
0.38 [0.10-1.49]
Marital Status (ref = Married / Living with Partner)
Widowed, Divorced or Separated
0.97 [0.10-4.55]
Single
1.24 [1.04-2.06]
Income (ref = $0 to $19,999)
$20,000 to $54,999
0.48 [0.20-0.88]
$55,000 and over
0.56 [0.22-0.96]
†Adjusted model controls for age (continuous)
RESULTS
Lifetime prevalence of cocaine or street drug
use among U.S. young adults was 21.7% ± 3.4.
Among employed young adults, those in
Construction trade (3.7±1.2) and Health service
occupations (2.3±1.4) reported the highest
proportion of workers with drug use.
Employed young adults were significantly more
likely 1.32 [1.01-1.98] to report a lifetime use
of drug use compared to those unemployed.
66.7
50.0
40.0
36.6
33.3
33.3
33.3
26.7
26.1
25.0
25.0
21.9
21.7
20.0
20.0
20.0
20.0
18.8
18.5
18.2
14.3
13.0
12.5
11.1
11.1
10.0
9.1
9.1
7.1
6.7
5.9
5.0
3.7
0.0
0.0
0.0
0.0
0.0
0.0
CONCLUSIONS
Knowledge of rates of substance use among
both employed and unemployed young adults
will offer support towards building better
prevention programs for younger personnel,
thereby offering protection against continued
or accelerated use and abuse.
The workplace may be a useful venue in which
to target tailored drug abuse educational
interventions at high risk employed young
adults.