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 KachanDepartment 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: acaban@med.miami.edu

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 socio-demographic 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.

ABSTRACTNational 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 2001-2004 NHANES, who reported on their lifetime use of cocaine or street drugs (using computer-assisted [CASI] technology), employment status, occupation type, and socio-demographic 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.

METHODSepidemiological studies in the last decade,up to 50% of adolescents have used cannabis at least once

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.

INTRODUCTION

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.

OBJECTIVE

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)

Occupation Title

% Ever used Cocaine or Street Drug(n=118)

Other transportation and material moving occupations 66.7Extractive and precision production occupations 50.0Other mechanics and repairers 40.0Construction trades 36.6Writers, artists, entertainers, and athletes 33.3Material recording, scheduling, and distributing clerks 33.3Related agricultural, forestry, and fishing occupations 33.3Records processing occupations 26.7Miscellaneous food preparation and service occupations 26.1Technicians and related support occupations 25.0Waiters and waitresses 25.0Health service occupations 21.9Cooks 21.7Management related occupations 20.0Secretaries, stenographers, and typists 20.0Vehicle and mobile equipment mechanics and repairers 20.0Fabricators, assemblers, inspectors, and samplers 20.0Motor vehicle operators 18.8Executive, administrators, and managers 18.5Construction laborers 18.2Cleaning and building service occupations 14.3Sales workers, retail and personal services 13.0Laborers, except construction 12.5Miscellaneous administrative support occupations 11.1Personal service occupations 11.1Health diagnosing, assessing and treating occupations 10.0Sales representatives, finance, business, & commodities ex. retail 9.1Other helpers, equipment cleaners, hand packagers and laborers 9.1Protective service occupations 7.1Other professional specialty occupations 6.7Freight, stock, and material movers, hand 5.9Engineers, architects and scientists 5.0Teachers 3.7Supervisors and proprietors, sales occupations 0.0Secretaries, stenographers, and typists 0.0Private household occupations 0.0Personal service occupations 0.0Farm and nursery workers 0.0Textile, apparel, and furnishings machine operators 0.0

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

Predictors

UnadjustedOdds Ratio [95%CI]

†AdjustedOdds 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)

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.

CONCLUSIONS

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.

RESULTS