Robert Pope, RN, MSN, PhDUniversity of California, San Francisco

SAMHSA MFP Postdoctoral Fellow John A. Hartford Scholar

This research funded by SAMHSA ANA

Introduction

• Traditionally, health-related studies focus primarily on proximate risk factors.

• This study took a less traditional approach; rather than reviewing just epidemiological factors, this study explored the underlying social factors.

The Purpose

• The central questions related to African

Americans in this study are:

• 1. Why might one begin illicit drug use at a young age and continue this

use

into old age?

• 2. Why might a person 55 or older begin illicit drug use late in life?

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Aim

The purpose of this dissertation study was to explore the underlying social factors associated with substance abuse among older African Americans as an underpinning to the development of approaches to nursing care and treatment.

Significance

• 2020– Approximately five million older Americans with

substance use disorders.– Approximately half a million, will be of African

descent.– Undesirable social, psychological, and health

outcomes such as homelessness, mental illness,

HIV, and hepatitis C.

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•Slavery

•Racial Residential Segregation

•Commercial Activity

•As early as 1910

What We Know Historically

Theoretical PerspectivesHere are two that work that really well...

• Wallhagen’s Perceived Control/Person –Environment Fit

• Winick’s Genesis for Substance Abuse/A Three Pronged Theory Based on Role

Theoretical PerspectivesWallhagen’s Perceived Control/Person –Environment

Fit

– Derived from Lawton’s Person Control Fit• Press-Demands vs. Competence-

Resource• Strengths-Sensitivity to Older AA

Adults (Wallhagen & Lacson, 1999)

Weaknesses-No studies associated with drug use in elders

Theoretical Perspectives

• Winick’s Genesis for Substance Abuse/A Three Pronged Theory Based on Role

1. Access

2. Low Proscription Against drug use

3. Role Strain/Deprivation

Viet Nam as an example of utility

Racial Formation Theory

• The meaning of race:– Is socially unpredictable and politically unstable– Addresses the intersection of discourse with

institutional practices– Expresses those findings in macro and micro

social interpretations

Historico-Cultural-Psycho-Social Framework

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Emulation

The Organizing Concepts

I. Race is significant to African Americans and is defined by existing race

relations within a given historical period

II. Lowered perceived environmental control contributes to drug activity and as one ages perceived control arises from contingencies based on learned experience.

III. Role strain and role deprivation lead to drug dependence.

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Definition

Population of InterestAfrican American

The predominant African American group. Roots are embedded in slavery in America. They have been and continue to be subjected to disparities. All references to African Americans or Blacks, in this study, pertain to this group.

DefinitionPopulation of Interest

OlderWhen compared to the general population there is a premature mortality or truncation of the lives of African Americans.

(Hayward & Heron, 1999)

MethodThe study used a grounded theory design to answer the research questions. A purposive sampling of 20 patients from two Recovery Programs were interviewed with a common interview guide.

Sample

• Nature and size of sample– A purposive sampling of clients from two

local Recovery Programs:– 20 older African American men and

women.– Barriers

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Data Collection Methods

• Data was generated from private, digitally recorded, in-depth interviews, using a common interview guide.

• The trustworthiness and credibility of this study is demonstrated by describing how the steps of the process were conducted.

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In their own wordsFamily Influence

I: “Are you the only sibling, that used drugs?R: No, everyone except my baby brother.I: And who was the first to use?R: On a continuous basis, I believe I was.I: Did you introduce them to drugs?R: No, but by example probably.”

In their own wordsFamily Influence

R: My sister was two years younger than me; my brother’s four years younger than me. I was always the oldest. I tried to shield them from what I was doing because my motheralways instilled upon me: “They’re going to follow you. They’re doing exactly . . . they’re looking at exactly what you do.”

In their own wordsMedia Influence

R: I wasn’t paying attention to that part. I was paying attention to the glamour of him doing what he was doing, but his, his, his, his whole focus was to get out the gang.I: OK. Anything else you care to share about “Superfly” in particular?R: He had the nicest clothes, the finest woman, and the finest car.I: And what did you feel about that?R: I felt that was all right.

In their own wordsMedia Influence

R: “Superfly?”I: Now how old were you when you saw it?R: I don’t know, maybe about 18 or 19...I: Were you into drugs at that point already?R: No. We were just getting in - that helped everybody. After that movie came out, everybody had maxi-coats and their little coke spoons. Everybody had coke spoons, yeah.

Data Analysis

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Definition

Emulation

(Ullman & Orenstein, 1994)

• Identification and imitation of a model with resources desired by the emulator

• The development of a pattern of thinking and behaviors based on an emotional attachment to that model

In their own wordsEmulation of an Admired Person

or LifestyleR: I was in the county jail. Me and about one or two cats on our tier--we were the youngest guys up there--everybody up there was all hardcore dope fiends and stuff. And they used to talk about it all the time--the Puerto Ricans and the blacks that was up there. Everybody’d talk about it and stuff. I thought it was the coolest thing going--all these cats been in the penitentiary, living this lifestyle, you know, kinda attracted my attention because I wanted a part of that lifestyle.

Procedure

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In their own words:Targeted marketing of commodities• R: “Well, from MacAlister to Fulton, from

Fulton to Grove, from Grove to Hayes, from Hayes to Oak, and to Oak and Fillmore, from Oak and Fillmore, down to Page and Fillmore, from Page and Fillmore down to Hanks 500 it was saturated with liquor stores.”

In their own words:Targeted marketing of commodities• I: OK, and how does that play against drug use and

commercial drug activity though...? • R: OK. McDonald’s got a drive-thru window, right?

The quality, the amount, and the cost of the food at Benihanas is way above McDonalds. Am I right?

• I: It is.

In their own words:Targeted marketing of commodities• R: OK. Same thing in Oakland and Fremont. In

Fremont, the quality, the amount, the cost, the drugs there......know what I'm saying.

• I: I got you.• R: What’s different than going through a drive-thru

window in East Oakland, on the corner. That’s all that is. It’s a McDonald’s attitude. You’re getting a value - you order from the value menu, you’re spending 10 dollars or less

• R: I can’t get, spend 10 dollars for no drugs . . . in Fremont. Not readily, you know what I’m saying? But you can come to Oakland, and hit a corner and spend it like that.

In their own words:Targeted marketing of commodities• R: “You had a 24/7 drug house right there

on the corner. You could buy any kind of drug that you wanted.”

Results– Emulation of an Admired Person or

Admired Lifestyle• Family influences• Media influences

– Environment• Targeted Marketing

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Discussion

• Future research– Perceived control from a person

environment fit: Multivariate correlational analysis of perceived control, physical, and psycho-social functioning in the population.

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Thank You!

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