social networks, drug use, and drug abuse help-seeking

237 Pages·2016·0.92 MB·English

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Theses and Dissertations--Sociology Sociology
2014
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Erin L. Pullen
University of Kentucky, [email protected]
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Pullen, Erin L., "SOCIAL NETWORKS, DRUG USE, AND DRUG ABUSE HELP-SEEKING: A TEST OF THE
NETWORK EPISODE MODEL AMONG AFRICAN AMERICAN WOMEN" (2014). Theses and Dissertations--
Sociology. 15.
https://uknowledge.uky.edu/sociology_etds/15
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Erin L. Pullen, Student
Dr. Brea L. Perry, Major Professor
Dr. Keiko Tanaka, Director of Graduate Studies
SOCIAL NETWORKS, DRUG USE, AND DRUG ABUSE HELP-SEEKING: A TEST
OF THE NETWORK EPISODE MODEL AMONG AFRICAN AMERICAN WOMEN

_________________________________

DISSERTATION

_________________________________
A dissertation submitted in partial fulfillment of the
requirements for the degree of Doctor of Philosophy in the
College of Arts and Sciences
at the University of Kentucky

By
Erin Pullen

Lexington, Kentucky

Co-Directors: Dr. Brea L. Perry, Professor of Sociology
and Dr. Carrie B. Oser, Professor of Sociology

Lexington, Kentucky

Copyright © Erin Pullen 2014
ABSTRACT OF DISSERTATION

SOCIAL NETWORKS, DRUG USE, AND DRUG ABUSE HELP-SEEKING: A TEST
OF THE NETWORK EPISODE MODEL AMONG AFRICAN AMERICAN WOMEN

Untreated substance use disorders are a major public health concern that has
costly consequences at both the societal and individual level. Identifying the
characteristics and resources of those who seek help for substance abuse problems in
order to inform more effective intervention and treatment techniques is therefore an
important research objective. Using the Network Episode Model (NEM) as a theoretical
framework, this dissertation examines both substance abuse help-seeking (i.e.
inpatient/outpatient treatment and 12-Step meeting attendance) and patterns of drug use
over time among low-income African American women, with a special focus on the role
of the social network system in shaping these outcomes.

Drawing on social network theory, critical race theory, and health service
utilization research, this test of the Network Episode Model addresses the relative
absence of work examining the connections between network characteristics and help-
seeking in multiply marginalized groups. The core relationships proposed by the NEM
are systematically tested using longitudinal data gathered for the Black Women in the
Study of Epidemics Project (N=643).

Findings of multilevel models indicate strong support for the Network Episode
Model. Specifically, measures of social influence, social control, and social integration
significantly predict both patterns of drug use and help-seeking. Importantly, having
contact with and receiving health advice from a physician emerged as a significant
predictor of a number of positive outcomes, including quitting or abstaining from illicit
drug use during the study and attending 12-Step meetings.

. Results also reveal that experiences specifically related to low-income African
American women’s multiply marginalized status – such as experiencing gendered racism
– significantly predict patterns of drug use over the study timeframe and may be an
important risk factor for substance abuse. In all, this research reveals the important
contributions of both traditional predictors and social network predictors on substance
abuse help-seeking and patterns of drug use over time. Conclusions suggest that given the
limited financial and material resources of multiply marginalized groups, learning how to
mobilize or effectively build upon available social network resources to encourage
substance abuse treatment may be a particularly fruitful strategy to explore.

KEYWORDS: Social Networks, Substance Use, African
American Women, Network Episode Model,
Help-Seeking

Erin Pullen

June 2, 2014
SOCIAL NETWORKS, DRUG USE, AND DRUG ABUSE HELP-SEEKING: A TEST
OF THE NETWORK EPISODE MODEL AMONG AFRICAN AMERICAN WOMEN

By

Erin Pullen

Brea L. Perry
Co-Director of Dissertation

Carrie B. Oser
Co-Director of Dissertation

Keiko Tanaka
Director of Graduate Studies

June 2, 2014
TABLE OF CONTENTS
Abstract .......................................................................................................................... i
Approval Page .............................................................................................................. iii
Table of Contents ......................................................................................................... iv
List of Tables ............................................................................................................. viii
List of Figures ................................................................................................................x
Chapter One: Introduction and Study Rationale
Addressing Gaps in the Current Research ...............................................................4
Chapter Overviews ...................................................................................................7

Chapter Two: Theoretical and Empirical Background
Social Network Analysis .......................................................................................10
Normative Influence and Health ......................................................................13
Social Control and Health ................................................................................15
The Social Safety Net and Health ....................................................................16
Health Service Utilization Research ......................................................................18
Limitations of the Socio-Behavioral and Health Beliefs Models ....................20
Social Networks and Health Service Utilization ..................................................21
The Network Episode Model ...........................................................................23
Applying the NEM to Special Populations ......................................................26
The Social Networks of African American Women ..............................................27
Networks, Substance Use, and Substance Abuse Help-Seeking .....................29
Critical Race Theory ..............................................................................................30
The Intersectionality Approach ........................................................................31
Critical Race Theory and African American Women’s Health .............................33
Cultural Mistrust ..............................................................................................34
Trust in Physician ............................................................................................35
Gendered Racism .............................................................................................36
Victimization and Exposure to Violence .........................................................37
Active Coping and John Henryism ..................................................................38
Summary ................................................................................................................40

Chapter Three: Data and Measures
Data ........................................................................................................................42
Measures ................................................................................................................45
Social Content and Episode Base ....................................................................46
Age .......................................................................................................47
Education .............................................................................................47
Household Income ...............................................................................47
Sample .................................................................................................47
Financial Crisis ....................................................................................48
iv
Gendered Racism Scale .......................................................................48
Cultural Mistrust Inventory..................................................................49
Adult Victimization .............................................................................50
Insurance Status ...................................................................................50
Usual Doctor ........................................................................................50
Trust in Physician Scale .......................................................................51
Self-Rated Health .................................................................................51
Medication for a Physical Problem ......................................................51
History of Mental Health Problems .....................................................51
Depression............................................................................................52
Active Coping/John Henryism Scale ...................................................52
History of Drug Problems ....................................................................52
Alcohol Use .........................................................................................53
Social Network System ....................................................................................53
Normative Influence ............................................................................54
Social Control ......................................................................................56
Social Safety Net..................................................................................58
The Illness Career ............................................................................................60
Daily Drug Use ....................................................................................61
Drug Abuse Treatment .........................................................................62
Narcotics or Cocaine Anonymous Meeting Attendance ......................62
Illness Career .......................................................................................62

Chapter Four: Methods and Descriptive Statistics
Analytic Strategy ...................................................................................................66
Multilevel Modeling ........................................................................................67
Time-Invariant Models ....................................................................................70
Descriptive Statistics ..............................................................................................70
Social Content and Episode Base Measures ....................................................71
Social Network System ....................................................................................75
Illness Career Measures ...................................................................................78

Chapter 5: Results of Models Predicting the Illness Career with the Social Content and
Episode Base
Daily Drug Use ......................................................................................................86
Help-Seeking..........................................................................................................89
Drug Abuse Treatment .....................................................................................90
Narcotics Anonymous and Cocaine Anonymous Attendance .........................92
Illness Career Measures .........................................................................................94
Summary ..............................................................................................................98

Chapter 6: Results of Models Predicting the Illness Career with the Social Network
System
Daily Drug Use ....................................................................................................111
Help-Seeking........................................................................................................113
Drug Abuse Treatment ...................................................................................113
v
Narcotics Anonymous and Cocaine Anonymous Attendance .......................115
Illness Career Measures .......................................................................................116
Summary ............................................................................................................119

Chapter 7: Results of Models Predicting the Social Network System with Social Content
and Episode Base Measures
Normative Influence ............................................................................................132
Network Size and Structure ...........................................................................132
Sources of Health Information .......................................................................136
Social Control ......................................................................................................139
Ties Encouraging Health Service Utilization ................................................139
Social Safety Net..................................................................................................142
Social Support ................................................................................................142
Summary ............................................................................................................144

Chapter 8: Results of Models Predicting the Social Network System with Illness Career
Measures
Normative Influence ............................................................................................156
Network Size and Structure ...........................................................................156
Sources of Health Information .......................................................................159
Social Control ......................................................................................................160
Mean Encouragement from Health Matters Ties to Utilize Health
Services ..............................................................................................160
Church or Religious Community Membership ..............................................162
The Social Safety Net ..........................................................................................165
Social Support ................................................................................................165
Summary ............................................................................................................167

Chapter 9: Discussion, Limitations, and Implications
Social Networks as Predictors .............................................................................178
The Influence of Family .................................................................................178
Other Significant Social Influences ...............................................................182
Social Support ................................................................................................185
Social Networks as Outcomes .............................................................................186
Criminal Justice Involvement ........................................................................186
Drug User and Networks ...............................................................................189
Intersectionality and Critical Race Theory: Race, Gender, and Class .................192
Gendered Racism ...........................................................................................192
Adult Victimization .......................................................................................193
John Henryism ...............................................................................................194
Limitations ...........................................................................................................195
Implications and Future Research ........................................................................199
Policy and Practice Implications ....................................................................199
Theoretical Implications ................................................................................201
Final Remarks ......................................................................................................203

vi
References ..................................................................................................................205

Vita .............................................................................................................................219
vii