Persistent Cocaine Use Linked to Lower Education Level


BALTIMORE -- The message that it's not smart to use cocaine has apparently gotten across to better educated people, found researchers here.

BALTIMORE, Aug. 29 -- The message that it's not smart to use cocaine has apparently gotten across to better educated people, found researchers here.

Although people with more education were major recreational users of cocaine 25 years ago, there has been a dramatic decrease in persistent cocaine use (versus new use) among those with a college or high school degree, the researchers found.

But persistent use remained constant among those who never finished high school, Valerie S. Harder, M.H.S., and Howard D. Chilcoat, Sc.D., of Johns Hopkins reported in the October issue of the American Journal of Public Health.

It is likely that high-school dropouts are less informed about risks and have poor access to health care services and drug treatment programs, they wrote.

The high price of powder cocaine in the early 1980s restricted its use, but after 1985, there was an epidemic-like growth in the prevalence of crack, a cheaper alternative, mostly in impoverished urban areas.

Soon after, however, highly publicized cocaine-related deaths increased the perception of risk, and this perception was inversely related to cocaine use.

To examine the inverse association between the perception of risk and cocaine use, the researchers used data from the 1979-2002 National Survey on Drug Use and Health to compare cocaine use and educational achievement for those ages 19 to 50.

They were categorized as non-high school graduate, high school graduate, and college graduate. Past-year cocaine use (powder, crack, free base, and coca past) was divided into recent onset or persistent use.

Recent-onset users reported first usage within 24 months of the interview, persistent users reported use in the past year, and first use more than two years before the interview.

In analyzing recent-onset use, the researchers reported that the proportion of cocaine use diminished steadily for all levels of educational achievement.

From 1979 to 1982, the relative odds of recent-onset cocaine use were actually significantly greater for college and high school graduates than for non-high school graduates (odds ratio range=1.8-2.6; P

These results could not be explained by changes in the demographic distribution (race or gender) within levels of education over time, or potential misclassification of some college students as being high school graduates, as well as potential error associated with self-reported drug use.

The results of this study suggest that as unhealthy behaviors are identified, people with more education better understand the risks and have more resources to engage in protective efforts and modify their behavior. Better educated individuals also may have more access to health care services, such as drug treatment programs, they said.

In relation to public health, "these results highlight the need for improved intervention programs that target adults with lower levels of educational achievement who persist in their cocaine use, not just prevention of first use," Harder and Dr. Chilcoat said.

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