| According to the estimates of World Health Organization in 2008,3.5% to 5.7% of the world’s population aged 15-64 were users of psychoactive substances, while in 2004, cocaine and opiod abuse accounted for 0.7% of the global disease burden. In some countries, the social expenditure of illicit substance misuse consumed about 2% of GDP. It is obvious that drug abuse is a worldwide phenomenon causing very serious problems to the society.Since 2009, the Macao SAR Government has started a "Central Registration System for Drug Abusers of Macao", and conducted several research studies. However, these studies were restricted to special groups such as teenagers in schools or in the street. Some were cross-sectional descriptive studies of small groups using snowball sampling of non-randomized populations. They contained incomplete investigations on risk factors in drug abuse, estimation of the total number of drug addicts and sub-populations, and the mode of drug misuse. Although much efforts in the prevention and intervention of drug abuse have been made by the government and other organizations in recent years, there remain many serious problems and challenges including drug abuse and trafficking across the border, legislation and law enforcements, as well as planning for services and resources of related medical and social services.We have studied the situation of registered drug addicts in Central Registration System, risk factors of drug abuse, estimated number of drug addicts, and relevant policies and resources. The findings could provide the Macao government with guidance for developing public health policies.Part I The situation of drug addiction in MacaoObjectivesThe aim of this study was to investigate the prevalence of drug abuse in Macau, bewteen 2009 and 2010.MethodsA Cross-sectional study and A theoretical epidemiology were used in this quantitative research. The study sample was provided by the Central Registration System for Drug Abusers of Macao from the Anti-drug Education Resource Centre of Social Welfare Bureau of Macao SAR Government. Nine hundred and fifty sever (957) and 1058 person-times were captured in 2009 and 2010, respectively. Person-times and number of people constituted the main parameters for statistical analysis. Demographic characteristics were summarized by descriptive statistics. Chi square test and ANOVA were used for statistical inference. Choice of abused drugs was analyzed by Multinomial Logistic Regression. Dosage of drug (realted to times per month) was calculated by Linear Regression. For estimating the number of drug addicts, the Capture-Recapture method was performed if the two groups of data were independent, while the General Log-linear Model (GLM) was used when the two groups of data were dependent.Results1 The situation of drug addiction and influencing factors of drug abuse1.1 Characteristics of Substance AbusersThe average age of drug addiction was 36.4±14.0 (M±SD) years, the youngest age was 14.3 years and the oldest age was 87.6 years [36.8±14.1 years in 2009 and 36.0±13.9 years in 2010]. Cases were mainly male (3/4), aged over 21 year (4/5) and of Chinese ethnic origin (96.2% in 2009 and 95.7% in 2010). Three-quarter (3/4) of cases just had the educational level of junior high school or below; above half of them were born in Macao, unmarried and unemployed Many of them lived in the North District of Macao (39.0% in 2009 and 52.8% in 2010) and had criminal records (32.2% and 38.2%).1.2 Situation of drug addictionThe average age of first-time use was 21.8 years, taking mainly 1 kind of drug (81.5% in 2009 and 80.7% in 2010). Heroin was most frequently abused (62.5% and 55.5%), followed by Ketamine (25.5%and 31.5%). The most common route and cite of administration was muscle injection (44.7%,38.7%) at home (47.0% and 38.6%). The reasons of misuse were peer influence (21.7% and 30.2%), reducing the pressure/affliction/frustration/dejected feeling (25.1% and 26.6%), and avoiding withdrawal symtoms (17.8% and 13.2%). The median expenditure per month of drug abuse was MOP 3000 in 2009 and MOP 1800 in 2010.1.3 Influencing factors for choice of drugDrug abusers who lived in South District were more likely to take narcotic analgesics (OR=2J; 95% CI:1.1,6.5) and cordial (OR=6.7; 95% CI:2.0,22.6), while abusers who lived in Mainland China chose cordial (OR=6.4; 95% CI:1.7,24.2) in 2009. In 2010, cordial was the preferred drug when there was a drug addict in family (OR=5.6; 95% CI:4.8,6.7). Dosage and frequency of drug use was mainly affected by whether injection site was vein (standardized βcoefficient:0.4 in 2009 and 0.3 in 2010) or muscle (0.9 in 2010), expenditure per month of drug (0.4 in 2009) and marital status fo divorce or separation (0.3 in 2010).2 Estimation of the number of drug addicts in the population2.1 The estimated total number of drug addicts by 2 years was 1791; the crude rate of drug abuse among residents was 3.3%o; the estimated total number was 2.2 times more than average number of drug addicts by 2 years.2.2 The average estimated number of drug addicts by 2 years was 1061 (1085 people, or 2.0%o were 1.6 times more than 696 people in 2009; 1037 people orl.9%o were 1.1 times more than 957 people in 2010); the crude rate of drug abuse among residents was 2.0%o.2.3 The estimated numbers should be more accurate using year and sex as variables, because the 95% confidence interval of each estimated number would be narrower.Conclusions1. Drug addicts in Macao were mainly male, over 21-year old, with an educational level of junior high school or below. The average age of first-time abuse was 21.8 years. Demographic characteristics were similar to neighboring cities. Therfore, target persons of prevention and health education against drug abuse should be adult men with lower education.2 Although the traditional drug Heroin was the chief drug of abuse by drug addicts, misuse of new synthetic drugs such as Ketamine was rapidly rising. The places of drug misuse were private hidden premises:subjects’ own family or friend’s home. Influences by peers and low morale and loss of self-esteem were significant reasons for drug abuse; monthly expenditure were for consuming the drug was MOP 1800-3000.3 The estimated numbers of drug addicts in Macao were 1061 to 1791 in 2009 and 2010, respectively. The crude rate of drug abuse among residents was 2.0%o-3.3%o, the estimated number and crude rate were similar to the International, Mainland China, Hong Kong and Taiwan.Part II The modeling of risk factors for drug abuse in MacaoObjectivesThe aim of this study was to investigate the modeling of risk factors for drug abuse in Macau, in 2009 and 2010.MethodsA theoretical epidemiology were used in this quantitative research. The study sample was provided by the Central Registration System for Drug Abusers of Macao from the Anti-drug Education Resource Centre of Social Welfare Bureau of Macao SAR Government.957 and 1058 person-times were captured in 2009 and 2010. Risk factor model of drug abuse was fitted and optimized by Structural Equation Model (SEM).ResultsThe sample data was matched with 2 exploratory structural equation models after the 2 year hypothetical models were optimized (Year 2009:P=0.189; 2010:P=0.800). The two exploratory structural equation models showed good fitting [2009: RMSEA=0.02<0.05; NFI(0.95), TLI(0.98) and CFI(0.99)>0.90,x2/df(NC)=1.25<2; 2010:RMSEA=0.00<0.05, NFI(0.93), TLI(1.05) and CFI(1.00)>0.90, //df(NC)=0.75<2].In the hypothetical model of risk factors for drug abuse by standardized parameter estimates 2009, personal factor of drug abuse was observed to be more affected by educational level (standardized path coefficient:0.70) and occupational status (0.70); the other risk factors were family drug (0.4) and marital status (0.22). Furthermore, choosing the kind of drug (0.01) and dosage of drug use per month (0.04) were slightly influenced by personal factor. Drug factor was markedly affected by the age of first-time use of this drug (-0.72), the other drug factor was reasons for (0.04) and places of (0.06) drug abuse in recent 3 months. In addition, choice of the kind of drug (0.31) and dosage of drug use per month (-0.31) were more influenced by drug factors than personal factors.In the hypothetical model of 2010, personal factor of drug abuse was more affected by drug use in the family (0.75), the other personal factors were educational level (0.48) and employment status (0.04). Furthermore, choice of the kind of drug (-0.10) and dosage of drug use per month (0.04) were also slightly influenced by personal factors. Drug factor was still markedly affected by the age of first-time use (-0.37), followed by reasons (0.08), places (0.16) and district (0.01) of drug abuse in recent 3 months. Similarly, choice of the kind of drug (0.80) and dosage of drug use per month (-0.35) were more evidently influenced by drug factor.There were a ’marital status’ variable of personal factor in 2009 and a’district of drug abuse in recent 3 months’ variable of drug factor in 2010, the other variables were same in each year.ConclusionsThe main personal risk factors for drug abuse were drug addict in the family, low educational level and unemployment status. The main drug-related factors were the age of first-time drug use, and reasons for and places of drug abuse in recent 3 months, with the former being more important. The drug-related factors were more important than personal factor in choice of the kind of drug and dosage of drug use per month. Therefore, prevention strategy could be arranged based on the above considerations. Part Ⅲ Confirming the risk factor model and studying the policies of drug abuse in MacaoObjectivesThe aim of this study was to investigate other risk factors, evaluate the risk factor model and devise preventive policies of drug abuse.MethodsThe Grounded Theory was used in this qualitative research. Comprehensive sampling was conducted: scholars were selected by Convenience sampling, the administrative staffs and frontline workers were selected by typical case sampling, finally,10 interviewees participated. Semi-structured interviews and in-depth interviews were applied, the interviews were tape-recorded to ensure the preciseness of data. After the intereviews the sound record were transcribed to text by verbatim software; the text was word for word checked by a researcher for descriptive validity and analyzed by two scholars for ensuring consistency with regard to interpretative validity). Subsequently, the interviewees were invited to review the results after analysis, so the truth of results were guaranteed (theoretical validity); reliability=1.0. The content was analyzed by content analysis (text, conceptualization, proposition, graphed and theorized).Results1 The other risk factors of drug abuseAccording to the epidemiologic triangle of etiology:1.1 Host’s factorsInfluences of peers, relationship and domesticity of family were more important risk factors for drug addiction. Drug abuse could also be affected by friends in many ways, such as imitation, sharing environment, identity and peer recognition. Cohabiting couples could also be a cause. Family relationship and domesticity could be divided into two parts: integrality in family and the role of guardian. Many researches have reported that youths were easy to have antisocial personality and drug abuse if they were in a foster and / or single-parent family. Even youths in complete families are prone to drug abuse when the guardian role of guardian is unable to play his / her role. The other factors include negative emotion and curiosity.1.2 Environmental factorsEnvironmental factors could comprise individual, family and social environment aspects. Because the number of incomplete families had been increasing, many families wer just not well cared for. Parents could be away at night, facilitating drug abuse at home. There were many factors that could lead the drug misuse, for example, there were gaming and drinking places in Macao, the profit of drug trafficking was high, there were not enough fitness activities, the drug addicts could not make good friends because they could not join the normal entertainment.1.3 Drug-related factorsSome drug addicts have drug abuse after cigarette smoking, so cigarette smoking is the most important preventable cause of drug addiction.2 The reliability and validity of risk factor model were acceptable, but the risk factors could change.3 The 5 directions of drug abuse prevention3.1 LegislationMacao still adopts voluntary residential drug treatment and rehabilitation for management of drug addiction. Moreover, there is an international tendency that drug addicts should not be convicted and should be given the chances of self-awareness.3.2 Law enforcement and international cooperationThe Customs Department should prevent import, package, selling and buying of illicit drugs. The categorization of drugs of abuse should have a consensus and penalties should be among between different countries and / or regions, so the cross-border drug trafficking and crimes could be prevented.3.3 Health promotion and preventionThe targeted population for drug use prevention should be youths. The health promotion could be considered to early teach and prolong in the whole education. Doctors should be encouraged to participate because of their professional knowledge and authority.3.4 ResearchThe situation, evaluation and improvement of drug abuse could be understood timelily.3.5 Resource and supportResource and support were set up by policies and demands and used in treatment and rehabilitation for providing valuable services in rehabilitating drug addicts and returning them back to society. There were two ways. (1) Establishing confidence of drug addicts:they should not be discriminated against and should be gradually and continuously encouraged to give up the drug. (2) Giving helps:the guidance and approaches to drug treatmens should be clear, the privacies of drug addicts should also be protected; there should be advisory care from school, employment counseling and provision of residential services.Conclusions1 Influences of peers, relationship and domesticity of family, cigarette smoking were more important factors of drug abuse. Social environmental factors were increase drug use at home. There were gaming and drinking places in Macao, the profit of drug trafficking was high, there were no enough fitness activities, the drug addicts could not make good friends because they could not join the normal entertainment et al.2 The reliability and validity of risk factor model were acceptable, but the risk factors will be changed.3 The preventive policies were legislation, law enforcement and international cooperation, health promotion and prevention, research, resource and support. Resource and supports were used in treatment and rehabilitation which returning them back to society. |
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