Skip to main content
PMC home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2002 Dec 1;79(4):586–599. doi: 10.1093/jurban/79.4.586

Health care utilization among drug-using and non-drug-using women

Claire E Sterk 1,✉, Katherine P Theall 1, Kirk W Elifson 2
PMCID: PMC3456726  PMID: 12468678

Abstract

This article explores patterns of health care utilization among urban female illegal drug users and nonusers. Interviews were conducted between August 1997 and August 2000 in Atlanta, Georgia, among current drug-using and nonusing women aged 18 to 71 years (n=235). Women were recruited using outreach, and targeted sampling. Data were examined with multivariate and bivariate methods. Compared to nonusers, the most frequent users were significantly more likely to fail to seek needed health care (adjusted odds ratio [aOR]=3.31,95% confidence interval [CI]=1.18, 9.29) and to use a hospital emergency room as their primary source for care (aOR= 6.04, 95% CI=1.97, 18.56). Multivariate results also suggest that age, self-rated health, alcohol use, insurance coverage, financial strain, and the presence of minor children are associated with health service utilization. Future health policy and research among similar populations must continue to address individual and sociodemographic factors that influence service utilization and seek to incorporate preventive care for vulnerable populations within emergency room settings.

Keywords: Age, Health care utilization, Illegal drugs, Women

Full Text

The Full Text of this article is available as a PDF (99.4 KB).

References

  • 1.Abadinsky H. Drug Abuse: an Introduction. 3rd ed. Chicago, IL: Nelson-Hall; 1997. [Google Scholar]
  • 2.Brody SL, Slovis CM, Wrenn KD. Cocaine-related medical problems: consecutive series of 233 patients. Am J Med. 1990;88:325–331. doi: 10.1016/0002-9343(90)90484-U. [DOI] [PubMed] [Google Scholar]
  • 3.Goldstein A, Kalant H. In: Confronting Drug Policy: Illicit Drugs in a Free Society. Bayer R, Oppenheimer GM, editors. New York: Cambridge University Press; 1993. pp. 24–77. [Google Scholar]
  • 4.Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency virus, and human T-lymphotropic viruses. Am J Public Health. 1996;86:655–661. doi: 10.2105/AJPH.86.5.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Metsch LR, McCoy VH, McCoy CB, Miles CC, Edlin BR, Pereyra M. Use of health care services by women who use crack cocaine. Women Health. 1999;30:35–51. doi: 10.1300/J013v30n01_03. [DOI] [PubMed] [Google Scholar]
  • 6.Kidder D, Sterk C, Elifson K. Health care access and use in female African-American crack cocaine users. Women and Health. 2001;43:79–97. doi: 10.1300/J013v34n01_06. [DOI] [Google Scholar]
  • 7.Comerford M, Chitwood DD, McElrath K, Taylor J. Pregnancy among women with a history of injection drug use. Drugs Soc. 1998;13:177–192. doi: 10.1300/J023v13n01_11. [DOI] [Google Scholar]
  • 8.Armstrong KA, Kennedy MG, Kline A, Tunstall C. Reproductive health needs: comparing women at high, drug-related risk of HIV with a national sample. J Am Med Women's Assoc. 1999;54:65–70. [PubMed] [Google Scholar]
  • 9.Oliva G, Rienks J, McDermid M. What high-risk women are telling us about access to primary and reproductive health care and HIV prevention services. AIDS Educ Prev. 1999;11:513–524. [PubMed] [Google Scholar]
  • 10.Spurlock C, Nadel M, McManmon E. Age and Pap smear history as a basis for intervention strategy. J Community Health. 1992;17:97–107. doi: 10.1007/BF01321578. [DOI] [PubMed] [Google Scholar]
  • 11.Novick DM, Haverkos HW, Teller DW. The medically ill substance abuser. In: Lowinson JH, Ruiz P, Mullman RB, Langrod JG, editors. Substance Abuse. Baltimore, MD: Williams & Wilkins; 1997. pp. 534–550. [Google Scholar]
  • 12.Minkoff HL, Henderson C, Mendez H, et al. Pregnancy outcomes among mothers infected with HIV and uninfected control subjects. Am J Obstet Gynecol. 1990;163:1598–1604. [PubMed] [Google Scholar]
  • 13.French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med. 2000;50:1703–1713. doi: 10.1016/S0277-9536(99)00411-6. [DOI] [PubMed] [Google Scholar]
  • 14.Solomon L, Frank R, Vlahov D, Astemborski J. Utilization of health services in a cohort of intravenous drug users with known HIV-1 serostatus. Am J Public Health. 1991;81:1285–1290. doi: 10.2105/AJPH.81.10.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Selwyn PA. The impact of HIV infection on medical services in drug abuse treatment programs. J Subst Abuse Treat. 1996;13:397–410. doi: 10.1016/S0740-5472(96)00114-6. [DOI] [PubMed] [Google Scholar]
  • 16.McGeary KA, French MT. Illicit drug use and emergency room utilization. Health Serv Res. 2000;35:153–169. [PMC free article] [PubMed] [Google Scholar]
  • 17.Chitwood DD, McBride DC, Metsch LR, Comerford M, McCoy CB. A comparison of the need for health care and use of health care by injection-drug users, other chronic drug users, and nondrug users. Am Behav Sci. 1998;41:1107–1122. doi: 10.1177/0002764298041008007. [DOI] [Google Scholar]
  • 18.Williams D, Lawler KA. Stress and illness in low-income women: the roles of hardiness, John Henryism, and race. Women Health. 2001;32:61–75. doi: 10.1300/J013v32n04_04. [DOI] [PubMed] [Google Scholar]
  • 19.Blaine D. Editorial: Social determinants of health—socioeconomic status, social class, and ethnicity. Am J Public Health. 1995;85:903–905. doi: 10.2105/AJPH.85.7.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Geronimus AT. To mitigate, resist, or undo: addressing structural influences on the health of urban populations. Am J Public Health. 2000;90:867–872. doi: 10.2105/AJPH.90.6.867. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Rice DP, Kelman S, Miller L. Estimates of economic costs of alcohol and drug abuse and mental illness, 1985 and 1988. Public Health Rep. 1991;106:281–291. [PMC free article] [PubMed] [Google Scholar]
  • 22.Padgett DK, Struening EL. Influence of substance abuse and mental disorders on emergency room use by homeless adults. Hospital Community Psychiatry. 1991;42:834–838. doi: 10.1176/ps.42.8.834. [DOI] [PubMed] [Google Scholar]
  • 23.Fiscella K, Franks P, Clancy C. Skepticism toward medical care and health care utilization. Med Care. 1998;36:180–189. doi: 10.1097/00005650-199802000-00007. [DOI] [PubMed] [Google Scholar]
  • 24.Bloom B, Simpson G, Cohen RA, Parsons PE. Access to Health Care. Part 2: Working-age Adults. Hyattsville, MD: National Center for Health Statistics; 1997. pp. 1–47. [PubMed] [Google Scholar]
  • 25.Janes GR, Blackman DK, Bolen JC, et al. Surveillance for use of preventive health-care services by older adults, 1995–1997, MMWR. Morb Mortal Wkly Rep CDC Surveill Summ. 1999;48:51–88. [PubMed] [Google Scholar]
  • 26.Rosenblatt RA, Wright GE, Baldwin LM, et al. The effect of the doctor-patient relationship on emergency department use among the elderly. Am J Public Health. 2000;90:97–108. doi: 10.2105/AJPH.90.1.97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.Kiefe CI, Hyman DJ. Do public clinic systems provide health care access for the urban poor? A cross-sectional survey. J Community Health. 1996;21:61–70. doi: 10.1007/BF01682764. [DOI] [PubMed] [Google Scholar]
  • 28.Sox CM, Swartz K, Burstin HR, Brennan TA. Insurance or a regular physician: which is the most powerful predictor of health care? Am J Public Health. 1998;88:364–370. doi: 10.2105/AJPH.88.3.364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.McCorkel JA, Butzin CA, Martin SS, Inciardi JA. Use of health services in a sample of drug-involved offenders: a comparison with national norms. Am Behav Sci. 1998;41:1079–1089. doi: 10.1177/0002764298041008005. [DOI] [Google Scholar]
  • 30.Rivers JE. Services for substance abusers in a changing health care system. Am Behav Sci. 1998;41:1136–1156. doi: 10.1177/0002764298041008009. [DOI] [Google Scholar]
  • 31.Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Soc Problems. 1989;36:416–430. doi: 10.2307/800824. [DOI] [Google Scholar]
  • 32.Tashima N, Crain S, O'Reilly K, Sterk-Elifson C. The community identification process: a discovery model. Qual Health Res. 1996;6:23–48. doi: 10.1177/104973239600600103. [DOI] [Google Scholar]
  • 33.Goodwin DW. Alcohol: clinical aspects. In: Lowinson JH, Ruiz P, Mullman RB, Langrod JG, editors. Substance Abuse. Baltimore, MD: Williams and Wilkins; 1997. pp. 142–148. [Google Scholar]
  • 34.Jarvik ME, Schnider NG. Nicotine. In: Lowinson JH, Ruiz P, Mullman RB, Langrod JG, editors. Substance Abuse. Baltimore, MD: Williams and Wilkins; 1997. pp. 276–294. [Google Scholar]
  • 35.Dennis ML, Rourke KM, Lucas RL, et al. Global Appraisal of Individual Needs (GAIN): Resource Manual. Research Triangle Park, NC: Research Triangle Institute; 1995. [Google Scholar]
  • 36.Kleinbaum DG. Modeling strategy guidelines. In: Dietz GM, Krickeberg K, Singer B, editors. Logistic Regression: a Self-Learning Text. New York: Springer New York; 1994. pp. 161–189. [Google Scholar]
  • 37.Office of National Drug Control Policy (ONDCP). Focus on: The Drug Problem. ONDCP; 1998. Available at: www.whitehouse.gov. Date accessed: February 19, 2000.
  • 38.Sterk C, Elifson K, Theall K. Women and drug treatment experiences: a generational comparison of mothers and daughters. J Drug Issues. 2000;30:839–861. doi: 10.1177/002204260003000410. [DOI] [Google Scholar]
  • 39.Falck RS, Ashery RS, Carlson RG, Wang J, Siegal HA. Injection drug users, crack smokers, and the use of human services. Soc Work Res. 1995;19:164–173. [PubMed] [Google Scholar]
  • 40.Greenberg JB, MacGowan R, Neumann M, et al. Linking injection drug users to medical services: role of street outreach referrals. Health Soc Work. 1998;23:298–309. doi: 10.1093/hsw/23.4.298. [DOI] [PubMed] [Google Scholar]
  • 41.Strathdee SA, Celentano DD, Shah N, et al. Needle-exchange attendance and health care utilization promote entry into detoxification. J Urban Health. 1999;76:448–460. doi: 10.1007/BF02351502. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Pachter LM. Culture and clinical care: folk illness beliefs and behaviors and their implications for health care delivery. JAMA. 1994;271:690–694. doi: 10.1001/jama.1994.03510330068036. [DOI] [PubMed] [Google Scholar]
  • 43.National Center for Alcohol and Substance Abuse at Columbia University (CASA). Missed opportunity: national survey of primary care physicians and patients on substance abuse. On-line April 2000. Available at: www.casacolumbia.org/usr_doc/29109. pdf. Date accessed: November 3, 2000.

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES