澳门2009-2010年药物滥用者登记资料的流行病学分析

发布时间：2018-06-13 05:48

  本文选题：药物滥用 + 现况　； 参考：《南方医科大学》2013年博士论文

【摘要】：据世界卫生组织在2008年的估计：全球15～64岁的人口中,约3.5%至5.7%使用精神神经性作用的物质；2004年全球疾病负担中约有0.7%是因使用可卡因和鸦片类药物等所引起；在一些国家中,使用非法物质而花费的社会开支占该地区国民生产总值的2%左右。可见药物滥用的广泛性以及其对社会的危害性。澳门特别行政区政府自2009年开始实施r澳门药物滥用者中央登记系统,而且进行了几个研究。然而,这些研究主要是针对特殊的群体,如在学青少年、街头青少年等；此外,研究的样本量较少,采用滚雪球方式的非随机抽样进行,研究方法以横断面描述性研究为主。对于较全面的药物滥用人群情况、滥药的危险因素及滥药模式、总体药物滥用者人数估计的研究尚少见。此外,尽管近年澳门各界对预防药品滥用的积极投入与大力干预,却仍存在较多的问题与挑战,如跨境用药和人体运毒等。这些都为澳门的防治滥用药品的立法、执法、服务规划与资源等带来严峻的挑战。我们尝试对滥药登记系统中的登记人群作现况、用药危险因素等作了解,并试图估计澳门滥用药物的人数,及探讨政策、资源等问题,以能较整体地为相关的政策作参考。第一部分澳门药物滥用者的现况目的：主要是了解2009年和2010年澳门药物滥用的现况,并估计药物滥用者人数；为制订相关政策和支持提供依据。方法：研究采用横断面描述性研究和理论性流行病学方式。研究对象由社会工作局提供的“澳门药物滥用者中央登记系统”2009(957人次)与2010年度(1058人次)总登记人次。统计中,以滥药人次和人数作统计分析单位,对两年度的人口学特征作描述性统计分析；统计推断以卡方检验和方差检验等为主；而多因素分析内,毒品种类使用无序多分类逻辑回归分析；用药量的分析则用线性回归分析;对数据独立性较好的药物滥用人数估计,使用捕获再捕获法,对数据独立性欠佳的则采用对数线性模型估计结果：1药物滥用者现况与药物滥用的影响因素1.1药物滥用者平均年龄36.4±14.0岁(最小14.3岁,最大87.6岁。2009年和2010年药物滥用者的平均年龄相似,分别为36.8±14.1岁和36.0±13.9岁)。3/4为男性和4/5为21岁以上,以中国血统占主要(2009年96.2%,2010年95.7%),3/4的只有初中及以下教育程度,约半数是在澳门出生、未婚和无业的,他们较多住在澳门北区(2009年39.0%,2010年52.8%)及有犯罪记录(2009年32.2%,2010年38.2%)。1.2滥药情况中,平均首次吸毒年龄为21.8岁；以使用1种毒品为主(2009年81.5%,2010年80.7%)；每次使用以海洛因最多(62.5%,55.5%),其次是氯胺酮(25.5%,31.5%)。使用方法均以肌肉注射(44.7%；38.7%)较多；在家中为主要吸毒地点(47.0%,38.6%)；吸毒原因以朋辈影响(27.1%,30.2%)、减低压力／痛苦／挫败感／苦闷(25.1%,26.6%)和避免药瘾起(17.8%,13.2%)占主要；每月毒品开支中位数2009年约3000澳门元,2010年为1800澳门元。1.3影响药物选用的因素上,2009年居住在南区(风顺堂)的选用麻醉镇痛剂(OR=2.7: 95% CI: 1.1,6.5)和兴奋剂(OR=6.7: 95% CI: 2.0,22.6)较多；居住在中国内地的较多选用兴奋剂(OR=6.4: 95% CI: 1.7, 24.2)。2010年有家人吸毒(OR=5.6: 95% CI: 4.8, 6.7)的较多使用兴奋剂。药物使用量的影响因素主要为静脉注射(标准化β系数：2009年0.4,2010年0.3)或肌肉注射毒品(2010年标准化β系数为0.9)、每月毒品开支(2009年标准化β系数为0.4)及离婚或分居(2010年标准化β系数为0.3)等。2药物滥用者人数估计2.1两年度的总体估计药物滥用人数为1791人,居民粗滥药率为3.3‰；为两年度平均人数的2.2倍。2.2两年度平均有1061人滥用药物,粗滥药率约为2.0‰(2009年1085人,2.0‰,为该年人数1.6倍；2010年1037人,1.9‰,为该年人数1.1倍)。2.3以年份和性别变量分层,估计得的95%可信区间范围较窄,估计较准确。结论：12009和2010年澳门药物滥用者约3/4以上均为男性,且约4/5是21岁以上的成人；教育程度以初中及以下为主；平均首次吸毒年龄为21.8岁。人口学特征与国际、国内、香港、台湾省等相似；因此应重点针对成年和教育程度较低的男性,作为药物滥用的预防与健康教育工作的对象。2药物滥用者虽然仍以使用传统毒品(海洛因)为主,但新型(合成)毒品(如氯胺酮)使用增加；使用地点多较隐蔽,如自家/朋友家；朋辈的影响及精神、心灵缺失等是滥药较突显的原因；每月毒品开支约1800～3000澳门元。3估计两年间滥药人数为1061～1791人,居民粗滥药率约为2.0‰～3.3‰,与其它邻近地区差距不大。第二部分澳门药物滥用者影响因素分析目的：了解2009年和2010年澳门药物滥用者使用药物的影响因素与探讨滥药危险因素模型；为制订相关政策和支持提供依据。方法：研究采用理论性流行病学方式。研究数据由社会工作局提供的“澳门药物滥用者中央登记系统”2009(957人次)与2010年度(1058人次)总登记人次。药物滥用危险因素模型就使用结构线性模型进行拟合与优化。结果：两年度假设模型经优化后(2009年：P=0.189；2010年：P=0.800),表示探索性结构方程模型与样本数据可以契合；并且两年度模型达到适配标准：2009年：RMSEA=0.020.05, NFI (0.95)、TLI (0.98)和CFI(0.99)均0.90,卡方自由度比值(NC)=1.252；2010年：RMSEA=0.000.05, NFI (0.93)、TLI(1.05)和CFI(1.00)均0.90,卡方自由度比值(NC)=0.752。2009年用药危险因素的标准化参数估计假设模型图内,形成滥药“个人因素”构念中,受教育程度(标准化路径系数值：0.70)与职业状况(0.70)两变量的影响较大,其次为家人有否吸毒(0.4)和婚姻状况(0.22)；此外,造成滥药方面,个人因素对选择毒品类别(0.01)和每月使用数(次,0.04)的影响较小。在毒品因素中,开始滥用该毒品之年龄变量(-0.72)对其影响较明显；其它的影响变量有最近3个月吸毒原因(0.04)和最近3个月吸毒地点(0.06),但其影响程度较低。毒品因素影响选择毒品类别(0.31)和每月使用数(次,-0.31)较个人因素明显。2010年的标准化参数估计假设模型内,个人因素构念中家人有否吸毒(0.75)对其影响较大,其次是教育程度(0.48)和职业状况(0.04)；而个人因素对毒品类别的选择(-0.10)和每月使用数(次,0.04)仍较偏低。然而,对毒品因素构念影响较大的测量(显性)变量仍是开始滥用该毒品之年龄(-0.37),其次顺序为最近3个月吸毒地点(0.16)、吸毒原因(0.08)和吸毒地方(0.01)。同样,毒品因素影响选择毒品类别(0.80)和每月使用次数(-0.35)较个人因素明显。2009年影响“个人因素”潜在变量的显性指标多一项“婚姻状况”变量；2010年影响“毒品因素”潜在变量的显性指标多一项“最近3个月吸毒地方”变量；其余的显性指标和潜在变量两年度皆相同。结论：形成滥药的个人因素中,主要影响因素有家人有否吸毒、教育程度和职业状况等；而毒品因素主要受开始滥用该毒品之年龄、最近3个月吸毒地点和吸毒原因等因素影响,尤其开始滥用该毒品之年龄显得重要。但在构成选用毒品类别及每月使用数中,仍以毒品因素影响为主要,个人因素影响较少。在防治上可针对以上的危险因素作重点的工作安排。第三部分澳门滥用药物的危险因素模型验证与对策的定性研究目的：是了解药物滥用者其它可能的滥药因素、对用药危险因素模型作评价,及对预防药物滥用作政策性建议。方法：采用扎根理论法；研究对象以非概率抽样中的“综合式抽样”取样方法：对学者以方便抽样法、对行政管理人员及前线工作者用典型个案抽样法,最后共有10位访谈者参与。访谈中使用个人的半结构式访谈及重点访谈法进行；访谈配合录音以保证资料的准确性；其后把录音内容用逐字稿软件誊写成文本,由另一位研究者逐字核对(描述型效度)；最后由二名学者共同分析达成一致性(解释型效度)；分析完成后请研究对象再次审视,保证其真实性(理论型效度)。以内容分析法(文字化、概念化、命题化、图表化和理论化)对内容进行分析。结果：1药物滥用的其它危险因素按病因学说的“三角模型”：1.1宿主方面,朋辈影响、家庭关系与相处是较为重要的原因。朋辈影响主要透过朋友间的模仿学习、共同相处环境、及朋友间的认同感等形式；其中不乏因受伴侣的带动所致。家庭关系与相处大致可分成“家庭系统完整性”和“发挥监护人角色”,寄养的和离婚后单亲的家庭中,其青少年常出现反社会人格,并易有滥药现象。即使青少年处于较完整的家庭中,但其监护人未能刻尽应有的角色,亦易使青少年有滥药行为。其它有负性情绪、好奇心等。1.2环境可约分为个人、家庭及社会环境三方面。缺陷家庭的增多使夜间无人在家看管和近年滥药的场所渐转移至家居,形成“隐蔽”的情况。社会上有较多的娱乐博彩场所、贩毒的利润高昂、缺乏足够的健康活动设施、及未能参与正常的消遣活动、未能认识“正常”的朋友。1.3药物因素,部分的滥药者是由抽烟开始,随后转而滥药；提出了控制抽烟的重要性。2药物滥用危险因素模型的正确性及真实性尚可；但影响因素可以转变。3预防滥药政策有5个方向：3.1立法：澳门仍采用自愿性戒毒方式。而国际上对滥药者有不应予刑事化处理,应予他们“自醒”机会的趋势。3.2执法与国际合作：海关部门要防止毒品的流入、包装与销售；国际间对毒品的认定要有共识及对其惩治有相似性,以防止跨境贩毒犯罪。3.3宣传教育与预防：重点人群应为青少年,可考虑及早开展宣教及延伸较长的阶段,并鼓励医生更多的参与,因医生的专业性及说服力较强。3.4研究：能及时了解现况并对相关的措施给予评价和改进。3.5资源与支持主要是依政策和需要而定立,主要用于治疗康复上,让其能重返社会,主方向有：(1)建立自信：互相尊重的态度而不应有歧视；并以分阶段与持续激励的方式进行。(2)给予帮助：给予帮助时应有清晰的指导与完成途径,并应保护滥药的的个人隐私。主要有：学校关心、辅导就业和提供院舍服务。结论：1朋辈影响、家庭关系与相处、抽烟是影响个人滥药较重要的原因。而社会环境的因素有：在家居滥药形成“隐蔽”的情况增多；有较多的娱乐博彩场所、贩毒的利润高昂、缺乏足够的健康活动设施和未能认识“正常”的朋友等。2药物滥用危险因素模型的正确性及真实性尚可；但影响因素可以转变。3预防滥药政策有：立法、执法与国际合作、宣传教育与预防、研究。资源与支持主要用于治疗康复,透过建立自信和给予帮助让其能重返社会。
[Abstract]:According to the 2008 estimates by the WHO, about 3.5% to 5.7% of the world's 15~64 year old population use psychotic substances; about 0.7% of the global burden of disease in 2004 are caused by the use of cocaine and opioids; in some countries, the use of illegal substances in social expenditure accounts for the population of the region. A total of about 2% of the gross product. The universality of drug abuse and its harm to society is seen. The government of the Macao special administrative region began to implement the central registration system for the drug abusers of the R Macao in 2009 and has conducted several studies. However, these studies are mainly aimed at special groups, such as young people, street adolescents, etc. The sample size of the study was less, and the non random sampling was carried out with snowball method, and the research method was based on cross section descriptive study. The study on the situation of drug abuse, the risk factors and drug abuse patterns of the drug abuse, and the total number of drug abusers were rarely seen. In addition, in recent years, the Macao has been indiscriminate on the prevention of drug abuse. There are still many problems and challenges, such as cross-border drug use and human drug transport, such as cross-border drug use and human drug transport, which have brought serious challenges to Macao's legislation, law enforcement, service planning and resources. We try to understand the status of the registered population in the drug abuse registration system and the risk factors for drug use, And try to estimate the number of drug abuse in Macao, and to explore policies, resources and other issues to be more comprehensive for the relevant policies. Part I, the current status of drug abusers in Macao, mainly to understand the status of drug abuse in 2009 and 2010, and to estimate the number of drug abusers; to formulate relevant policies and support for the formulation of relevant policies and support. Method: a cross-sectional descriptive study and a theoretical epidemiological method were used. The study was conducted by the Social Work Bureau, 2009 (957 people) and 2010 (1058 people) of the Macao drug abusers. In statistics, the number and number of indiscriminate drugs were used as statistical analysis units for the year two. Descriptive statistical analysis of demographic characteristics; statistical inference is dominated by chi square test and variance test; and in multifactor analysis, drug types use disordered multi classification logic regression analysis, and linear regression analysis is used for the analysis of drug quantities; the number of indiscriminate drugs with better data independence is estimated, capture recapture method is used, logarithm According to the logarithmic linear model, the average age of the 1 drug abusers was 36.4 + 14 years old (the minimum 14.3 years old, the maximum 87.6 years old.2009 and the average age of the drug abusers, 36.8 + 14.1 and 36 + 13.9 years, respectively).3/4 as men and 4/5, according to the logarithmic linear model. For more than 21 years of age, Chinese blood was dominated by Chinese blood (96.2% in 2009, 95.7% in 2010). Only half of 3/4 was born in Macao, unmarried and unemployed. They lived more in the Northern District of Macao (2009 39%, 2010 52.8%) and the criminal record (2009 32.2%, 2010 38.2%) in the case of indiscriminate drugs, the average first year of drug use. The age was 21.8 years old, with the use of 1 drugs (81.5% in 2009, 80.7% in 2010); most of the use of heroin (62.5%, 55.5%), followed by ketamine (25.5%, 31.5%). The use of the methods were intramuscularly injected (44.7%; 38.7%); at home as the main drug use location (47%, 38.6%); drug abuse (27.1%, 30.2%), reduction of low pressure. Force / pain / frustration / frustration (25.1%, 26.6%) and avoidance of drug addiction (17.8%, 13.2%) accounted for the main; the median monthly drug expenditure in 2009 was about 3000 Macao yuan, and 2010 was 1800 Macao yuan.1.3 affecting drug selection. In 2009, the use of narcotic analgesics (OR=2.7: 95% CI: 1.1,6.5) and stimulants (OR=6.7 95% CI: 2.0,22.6); more use of stimulants in mainland China (OR=6.4: 95% CI: 1.7, 24.2).2010 years with family drug use (OR=5.6: 95% CI: 4.8, 6.7) more use of stimulants. The influence factors of drug use are intravenous injection (standardized beta coefficient: 0.42010 year 0.3 in 2009) or intramuscular injection (2010). The standardized beta coefficient was 0.9), the monthly drug expenditure (2009 standardized beta coefficient was 0.4) and the number of.2 drug abusers, such as divorce or separation (2010 standardized beta coefficient is 0.3), estimated the number of drug abusers in 2.1 two, and the total drug abuse rate was 3.3 per thousand, and the average of 2.2 times the average number of two year.2.2 in two was 1 in two. The drug abuse rate of 061 people was about 2 per thousand (1085 people in 2009, 2 per thousand, 1.6 times the number of people in the year; 1037 in 2010, 1.9 per thousand, 1.1 times that of the year)..2.3 was stratified with years and sex variables. The estimated range of the 95% confidence interval was narrower and more accurate. Conclusion: in 12009 and 2010, more than 3/4 of the drug abusers of Macao were all male, and About 4/5 is an adult over 21 years of age; education is dominated by junior high school and below; the average age of first drug use is 21.8 years. Demographic characteristics are similar to international, domestic, Hongkong, and Taiwan; therefore, the emphasis should be on men with lower levels of education and education as drug abusers for drug abuse prevention and health education. Although the use of traditional drugs (heroin) is still the main use, the use of new (synthetic) drugs (such as ketamine) is increased; the location of the use is more concealed, such as home / friend's home, the influence of the peer, the spirit, the lack of mind, and so on; the monthly drug expenditure of about 1800~3000 Macao yuan.3 is estimated to be 1061~17 in two years. 91 people, the resident drug rate was about 2 per thousand to 3.3 per thousand, and the difference from other adjacent areas was not significant. Second factors of drug abusers in Macao were analyzed in order to understand the influence factors of drug abusers in 2009 and 2010 and to explore the risk factors model of drug abuse, and to provide the basis for formulating relevant policies and support. Methods: The study adopted the theoretical epidemiological method. The data were collected by the Social Work Bureau, "central registration system for drug abusers in Macao" 2009 (957 people) and 2010 annual (1058 people). The model of drug abuse risk factors was fitted and optimized using a structural linear model. Results: the two-year hypothesis model was optimized. After (2009: P=0.189; 2010: P=0.800), the exploratory structural equation model is compatible with the sample data; and the two annual model reaches the standard of adaptation: 2009: RMSEA=0.020.05, NFI (0.95), TLI (0.98) and CFI (0.99) 0.90, the ratio of chi square freedom (NC) =1.252; 2010: RMSEA=0.000.05, NFI (0.93), TLI (1.05) and C. FI (1) 0.90, chi square's degree of freedom ratio (NC) in the standardized parameter estimation of the risk factors for drug use in =0.752.2009 years, the influence of Education (standardized path system value: 0.70) and occupational status (0.70) two changes, followed by family members (0.4) and marital status (0) .22); in addition, the impact of individual factors on the selection of drug categories (0.01) and the monthly use number (0.04) was smaller. In the drug factors, the age variable (-0.72), which began to abuse the drug, was significantly affected; the other factors had the last 3 months of drug abuse (0.04) and the last 3 months of drug use (0.06). The effect of drug factors (0.31) and monthly use number (-0.31) was significantly higher than that of individual factors in the.2010 year standard parameter estimation hypothesis. The influence of family members on drug abuse (0.75) was greater, followed by educational level (0.48) and occupational status (0.04), and personal factors on drugs. Category selection (-0.10) and monthly use number (times, 0.04) were still relatively low. However, the measured (dominant) variables affecting the drug factor construction were still the age of drug abuse (-0.37), followed by the order of drug abuse (0.16) in the last 3 months (0.16), drug addicts (0.08) and drug abuse (0.01). Similarly, drug factors affected drug selection. Different (0.80) and monthly use times (-0.35) were more than individual factors in.2009 years. The dominant index of "personal factors" potential variables was more than a "marital status" variable; in 2010, the dominant index of the potential variable of "drug factors" was more than the "last 3 month drug addicts" variable; the remaining dominant and potential variables were two. Conclusion: among the individual factors of indiscriminate drug abuse, the main factors affecting the drug abuse are family drug abuse, educational level and occupational status, and drug factors are mainly affected by the age of the drug abuse and the factors such as drug abuse and drug abuse in the last 3 months, especially the age of the abuse of the drug. In the third part of the drug abuse, the third part of the risk factors for drug abuse and the qualitative research of the countermeasures are to understand the other possibility of drug abusers. Indiscriminate drug factors, evaluation of the risk factors model of drug use and policy recommendations for the prevention of drug abuse. Method: adopt the root theory method; the study object is the "comprehensive sampling" sampling method in non probability sampling: the scholars use the convenient sampling method and the typical case sampling method of the administrative staff and the frontline workers, finally, the common sampling method is used. 10 interviewees participated in the interview. The interviews were conducted using personal semi structured interviews and key interviews; interviews were conducted with recording to ensure the accuracy of the data. Subsequently, the transcripts were transcribed into text by word by word software, and the other researcher checked (the descriptive validity) verbatim; finally, the consensus was reached by two scholars. After the analysis was completed, the object was examined again to ensure its authenticity (theoretical validity). Content analysis was carried out by content analysis (literalization, conceptualization, propositional, graphic and theoretical). Results: 1 other risk factors for drug abuse were based on the "triangle model" of the etiological theory: 1.1 host and peer shadow The relationship between family and family is a more important reason. The influence of the peer is mainly through imitation and learning among friends, together with the environment, and the sense of identity among friends; among them, there are no lack of the lead of a partner. Family relations and coexistence can be roughly divided into "family system integrity" and "play guardian role" and foster. In the family of single parent after divorce, teenagers often have antisocial personality and are prone to indiscriminate drugs. Even if teenagers are in a relatively complete family, their guardians are unable to engrave their roles as they should be, and they are prone to indiscriminate behavior. Other negative emotions, curiosity and other.1.2 environments can be divided into individual, family and social environment three On the other hand, the increase in the number of defective families has led to the gradual transfer of unmanned and indiscriminate places to home in the night, forming a "concealment" situation. There are more entertainment and gambling places in the society, the high profits of drug trafficking, lack of adequate health facilities, and failure to participate in normal recreational activities and the failure to recognize the "normal" friend.1.3 medicine. Physical factors, some of the indiscriminate drugs were initiated by smoking and then transferred to drug abuse; the importance of controlling smoking was proposed, the correctness and authenticity of the.2 drug abuse risk factor model was still available, but the influencing factors could change the 5 directions of the.3 prevention policy: the 3.1 legislation: Macao is still using voluntary detoxification methods. They should not be criminalization, and should give them the trend of "self awakening".3.2 law enforcement and international cooperation: the customs department should prevent the inflow of drugs, packaging and sales; international consensus on drug identification and the similarity to its punishment in order to prevent the cross-border drug trafficking and the prevention of.3.3 publicity and education and prevention: the key population should be young. In the year, early education and extension can be considered, and doctors should be encouraged to participate more, because doctors are more professional and persuasive.
【学位授予单位】：南方医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R749.61
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本文编号：2012950