Xiushi Yang

Information about Xiushi Yang

Published on August 13, 2007

Author: FunSchool

Source: authorstream.com

Content

Migration, Urbanization, and Drug Use and Casual Sex in China: A Multilevel Analysis *:  Migration, Urbanization, and Drug Use and Casual Sex in China: A Multilevel Analysis * Xiushi Yang Old Dominion University and Huasong Luo Yunnan Normal University * Funding for the research was provided through National Institutes of Health/National Institute on Drug Abuse Grant R01DA13145. The Issues:  The Issues Increasing migration and urbanization Increasing HIV risk behaviors Migration, urban living, and risk behaviors Background:  Background Migration and HIV Risk Behaviors: Spousal or partner separation Post-migration milieus lax social control: detachment from normative and formal social control in places of both origin and destination social and residential isolation, which further leads to lax social control Slide4:  Urban Living HIV Risk Behaviors: The urban built environment: increased stress socioeconomic inequalities anonymity Residential disadvantage/segregation: increased psychosocial stress and interpersonal tension/violence reduced opportunity costs Exposure and access: more tolerable social norms greater exposure to social influences of physical scenes and real life models easier access Data and Method:  Data and Method A community survey of aggregate information and a population-based survey of 5,499 migrants and non-migrants conducted in 2003 in southwestern China Data from the two surveys are combined in the analysis; gllamm multi-level modeling in STATA is used to examine both individual and community risk factors Data analysis focuses on the impact of being temporary migrant and/or urban living on the likelihood of active drug using and casual sex with non-stable partner(s) Individual and community characteristics are first examined in individual and community level models, respectively, and then in combined multilevel models Slide6:  Dependent variables: the odds of current drug use and of having casual sex in the 30 days prior to the survey Independent variables: temporary migrant status and urban residence Other individual level control variables: individual demographic characteristics and psychosocial well being and behavior-specific social influence indicators (all measured as composite scales/indexes) Other community level control variables: mean (1996-2000) annual aggregate data on poverty, drug using population, crimes reported, divorce rate, and number of entertainment establishments Descriptive Results:  Descriptive Results Compared to non-migrants, migrants were significantly Younger Less likely to be married More educated More likely to feel socially isolated More likely to experience lax social control More social influences of risky sexual behavior Less social influences of substance abuse More likely to have had casual sex with non-stable partner(s) Slide8:  Compared to rural residents, urban residents were significantly More educated More likely to have had casual sex with non-stable partner(s) For all other individual level characteristics, urban residents do not differ from rural residents Multilevel Logistic Regression Results:  Multilevel Logistic Regression Results Bivariate results Being migrant makes no significant difference in the odds of drug abuse, but it is a significant and powerful risk factor for having casual sex, increasing the odds by almost five times (OR=5.9) Compared to rural living, living in an urban area more than doubled the odds of active drug use (OR=2.8) and having casual sex (OR=2.3) In both individual and community level models, the PSU level variances are statistically highly significant, suggesting that Other things being equal where one lives (in addition to urban residence) makes significant differences in the likelihood of substance abuse and casual sex, confirming the importance of residential environment in influencing individual drug use and sexual behaviors Slide10:  Multivariate results The control of other individual characteristics reduces (37%) migrant and nonmigrant difference, but being migrant remains a significant and powerful risk factor of casual sex, increasing the odds by almost five times (OR=3.7) For drug abuse, Being migrant is not a risk factor Being less educated and being unmarried are both significant risk factors, so are social isolation and lax social control Social influence turns out to be the most powerful individual risk factor of drug abuse (OR=3.9) The control of other community characteristics reduces the impact of urban residence on drug abuse by about 32% Slide11:  In addition to urban residence, the size of existing pool of drug users in the PSU is positively related to respondents’ own odds of drug use, so is the number of crimes reported Community level poverty as measured by proportion of households under poverty, however, does not seem to be related to the odds of drug use among the respondents By contrast, community level poverty significantly reduces the odds of casual sex in the month prior to the survey among residents Slide12:  For casual sex, Being migrant remains to be a significant risk factor (OR=3.7) In addition, being unmarried, social isolation, lax social control, and sexual influence of social network were all significant risk factors of casual sex with non-stable partner(s) The control of other community characteristics makes little difference in the impact of urban residence on the odds of having casual sex In addition to urban residence, community level poverty significantly reduces the odds of casual sex A higher divorce rate in the PSU, indicative of more tolerable normative environment about sex and marriage, is associated with a greater likelihood of having casual sex The number of entertainment establishment in the PSU, indicating access to commercial sex, also is positively associated with increases the odds of casual sex among its residents Slide13:  Multilevel random coefficient model results Both individual and community variables are examined together in the random coefficient model, allowing the impact of being migrant to vary across PSUs The likelihood-ratio tests of model fit clearly suggest that random coefficient models are superior over random intercept models Variances associated with the coefficient for migrant suggest that the impact of being migrant on individual drug use and casual sex behaviors vary significantly across the PSUs and confirm the importance of understanding the behavioral impact of migration as conditional upon residential contexts Slide14:  Although the impact of being temporary migrant is not a significant risk factor of drug abuse in the random intercept model, it is in the random coefficient model, suggesting that being migrant may be a significant risk factor for drug abuse in some communities but not others For both drug use and casual sex, being temporary migrant was a significant individual risk factor while urban living a significant community risk factor Summary and Conclusions:  Summary and Conclusions There are more significant differences between migrants and nonmigrants in individual demographic and psychosocial well being Other things being equal, being migrant is associated with lower odds of drug abuse, although the difference is not always statistically significant across communities The less exposure to social influence of drug using peers, friends, or relatives may have helped migrants to stay away from drugs Being migrant is a significant, consistent, and powerful risk factor for having casual sex In addition, individual psychosocial wellbeing and behavior specific social influences are all significant risk factors Slide16:  Urban living significantly increases the odds of drug abuse and casual sex, and the impact has been particularly strong on the likelihood of drug abuse Features of the residential environment do not seem to reduce the observed rural-urban difference in casual sex, but they account for approximately one third of the rural-urban difference in drug abuse Education seems to be a powerful deterrent to drug abuse and the higher average education found in urban areas may help to alleviate some of the negative influence of urban living on substance abuse Slide17:  Different from the common belief in China that drugs are mainly a problem in poor rural areas, drug abuse is found in this study very much an urban problem in contemporary China and is not likely the result of poverty For both drug abuse and casual sex, the study confirms the important influence of community context and that the impact of migration depends on where we live More research is needed to further identify contextual risk factors for both theoretical understanding of the links between urban living and substance abuse and/or casual sex and for effective policy prescriptions to moderate the negative impact of urban living on these HIV risk behaviors Slide18:  Future studies of individual health related behaviors must pay attention to contextual influences and try to understand mechanisms through which community context influence individual behavior To be effective, policy and program interventions to reduce unhealthy or risk behaviors must address contextual risk factors, including social influences of people’s broader social networks of peers, friends, and family

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