BMC Public Health 2008, 8:149 http://www.biomedcentral.com/1471-2458/8/149 3 )12.5 o t 5 ilte 2 n i u inoq1.5 t a v irep 1 d ( o tra i 0.5 s d d O 0 18 - 24 25 - 34 35 - 44 Age group (years) 45 - 54 55 - 74 tTFrhiegeautamrseseon1cti,abtiyonagbeetween deprivation and drop out from drug The association between deprivation and drop out from drug treatment, by age. and to identify factors associated with drop out. While a number of factors associated with drop out are identified, results also highlight the complexity of factors associated with treatment outcomes. Results show that, overall in the North West, the treat- ment systems achieved the Government's retention target in 2005/06, with 75% of people retained for 12 weeks or more. Contextual information provides a more valuable assessment of how services should be improved, and the analyses presented here shows that current services are failing to retain Asian drug users. Furthermore, demo- graphic data from the 2001 census [20] shows that Asian people are underrepresented in drug treatment services while those from white, mixed, black and 'other' ethnici- ties are adequately represented. While people of Asian ethnicity account for 3.4% of the population of the North West [20] they accounted for just 1.9% of the drug treat- ment population (Table 3). This finding may reflect the lower prevalence of drug use among Asian people although a growing body of evidence indicates that drug use exists among black and minority ethnic (BME) groups and that it is increasing [21]. Qualitative research into the extent and nature of drug use among young Asians sug- gests that they were increasingly likely to use illicit drugs and that knowledge and use of heroin, and perhaps crack cocaine, indicated similar use to the general population of the UK [22]. An alternative explanation is that Asian drug users are not attracted by current treatment provision. A recent review of literature on drug use and service provision for BME communities in England reported a number of potential reasons for differential treatment outcomes among drug users from different ethnicities, over and above the possi- bility of differing drug profiles [21]. Such reasons included the ethnicity of drugs workers, communication problems for those unable to speak English and a percep- tion among drug users that drug workers lacked awareness of their culture. No literature which evaluated outcomes of culturally-sensitive initiatives in the clinical drug treat- ment field in the UK could be identified by reviewers although they pointed to two USA-based studies which showed that culturally competent and culturally respon- sive treatment was often associated with greater treatment retention and longer treatment durations [23,24]. With respect to drug use among young Asians, healthcare pro- fessionals must be sensitive to the cultural context in which their behaviours occur and in particular the poten- tial conflict of being affiliated to two different and at times incongruent cultural groups – British youth culture and that of their ethnic origin [22]. Further work is required to identify perceived barriers to treatment among Asian drug users and the reasons why they are more likely to drop out than their white counterparts, once contact has been initi- ated. With respect to other individual characteristics, studies in the USA have reported longer durations of treatment for older drug users [8,10,25] and for male drug users [10]. Evidence from a UK-based retrospective cohort study showed no difference between men and women in rates of drop out compared to drug free discharge but that younger drug users (aged 10 to 19 years) were more likely to drop out than their older counterparts [18]. Here, bivar- iate analysis showed that the odds of drop out exhibited a significant inverse linear relationship with age. However, the multivariate analysis showed that age was not signifi- cantly associated with drop out once adjusted for depriva- tion and that a significant interaction between deprivation and age existed. The effect of deprivation was not included in the retrospective cohort study just detailed so no assessment of the relationship between age and dep- rivation is available. A wealth of data exists which shows the relationship between socio-economic status and health. In the North West of England, standardised mortality rates by depriva- tion show that the all-age rate for those in the most deprived quintile of population is one and three quarter times the rate for the most affluent quintile of the popula- tion [26]. However, results presented here show a com- plex relationship between deprivation and age and their effects upon drug treatment outcomes (Figure 1). For those aged between 18 and 24 years, people living in least deprived areas were almost twice as likely to drop out of treatment than those living in the most deprived areas. A similar effect, of smaller magnitude, was observed for those aged 25 to 34 years. For those in the oldest age group, (55 to 74 years) the converse was true and those living in the most deprived areas were less likely to drop out than those living in the least deprived areas. A similar, Page 8 of 11 (page number not for citation purposes)