Journal Article

Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors

Conroy, Elizabeth, Osei Asibey, Benedict, Marjadi, Brahmaputra

2023

Overview

Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana. 305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression. Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001). Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Adults / Aggression / Alcohol / Alcohol use / Analysis / Biology and Life Sciences / Cannabis / Cocaine / Community / Confidence intervals / Consent / Cross-Sectional Studies / Distribution / Domestic violence / Drinking of alcoholic beverages / Drug abuse / Drug use / Earth Sciences / Ethanol / Evaluation / Female / Ghana / Ghana - epidemiology / Ghettos / Health aspects / Health planning / Health risks / Health status / High risk / Homeless people / Homelessness / Housing / Humans / Hypothesis testing / Ill-Housed Persons / Income / Low income groups / Male / Marijuana / Medical screening / Medicine and Health Sciences / Migration / Mortality / Mortality risk / Narcotics / Participation / People and Places / Physical Sciences / Population growth / Population studies / Public health / Rehabilitation / Risk / Risk assessment / Risk factors / Risk levels / Risk management / Risk reduction / Sex crimes / Sexual assault / Sexual violence / Smoking / Social Sciences / Social workers / Sociodemographics / Statistical analysis / Substance abuse / Substance use / Substance-Related Disorders - epidemiology / Tobacco / Tobacco Products / Victimization / Violence