The role of community disorder in the association between drug availability and drug use: A moderated mediation analysis

Introduction: Drug availability plays a crucial role in shaping drug use behavior. This study examines how reported drug presence, operationalized as living on a drug hot spot street, influences self-reported drug use through perceived drug availability and whether community disorder moderates this relationship. Methods: This cross-sectional study analyzed survey data from 3738 respondents residing on 449 street segments in Baltimore, Maryland (August 2013 – June 2014), categorized as crime hot spots or non-hot spots. Logistic regression models with robust standard errors estimated the direct association between reported drug presence and self-reported drug use, as well as the indirect association mediated through perceived drug availability. Additionally, a moderated mediation analysis tested whether community disorder conditioned the indirect pathway. Results: The relationship between reported drug presence and self-reported drug use was primarily indirect, operating through perceived availability. When perceived availability was included, the odds ratio for reported drug presence decreased from 1.19 [95 % CI: 1.00, 1.40] to 1.09 [95 % CI: 0.92, 1.29], while perceived availability was strongly associated with self-reported drug use (odds ratio = 1.45 [95 % CI: 1.23, 1.72]). However, this indirect pathway was statistically significant only in areas with lower levels of community disorder but insignificant in high-disorder settings. Conclusions: Perceptions of drug availability significantly influence drug use behavior. While reducing perceived availability may be particularly effective in lower-disorder areas, addressing drug use in vulnerable, high-disorder settings requires a comprehensive, cross-sector approach that improves environmental conditions and addresses broader socioeconomic factors contributing to disorder and drug use.