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Implementation of the world mental health surveys. The diversity of results across substances alcohol versus other drugs precludes the use of any single national measure of gender inequality per country to explain the extent of sex differences across all the countries included here. All Sex dating Huicheng produced probability samples that were representative of the country or regions included.

Nine samples were nationally representative. Table 1 shows the characteristics of the surveys and the sample sizes.

The interview was divided into Part 1, which everyone was asked, and Part 2, which contained additional sections. Selection into Part 2 was based on responses to Part 1; those with anxiety or mood diagnoses from Part 1 or reports of a suicide plan or attempt or hospital admission for mental problems went on to Part 2, as did a random sample of other respondents. At the end of the substance use section, everyone was asked directly Sex dating Huicheng the opportunity ever to use alcohol or other drugs:.

By an opportunity to use I mean someone offered you alcohol or drugs, or you were present when others were using and you could have used if you wanted to. Please do not include times when a health care provider may have offered you free samples. Alcohol use and symptom questions were asked prior Sex dating Huicheng questions about other drugs.

Drug use questions ever, first use, use in the last year were asked for four drug groups: cannabis, cocaine, Sex dating Huicheng drugs used not as prescribedand a composite group of any other drugs. Symptom questions were asked only from those who had ever used drugs.

The opportunity to use question, which followed these drug questions, did not distinguish between drug groups except in ESEMed Belgium, France, Germany, Italy, the Netherlands, Spainthe first in the field, for which opportunity to use and use were asked Sex dating Huicheng for analgesics, cannabis, and cocaine. However, because Sex dating Huicheng analgesic lists shown to participants in most of these countries included over-the-counter drugs such as aspirin, only responses to cannabis and cocaine questions were included for these six countries.

Use given opportunity was calculated from reports of use and opportunity for alcohol and for drugs. The GEM is a composite index measuring gender inequality in political participation and decision-making, economic participation and decision-making, and power over economic resources.

There are complete data on a rather crude indicator produced from the difference in rank for a country on the Human Development Index HDIand its rank on the Sex dating Huicheng Development Index GDIwhich penalizes for gender disparities. A further indicator is the percentage of seats held by women in the national parliament Indicator 3. All estimates were weighted according to study design variables, including the probability of selection into Part 2, if the substance use section was in Part 2.

There was also adjustment for nonresponse and post-stratification to census variables, where possible. Because of the complex design of each survey, Taylor series linearization was used to produce estimates, taking account of stratification, clustering, and weighting. Figure 1 a illustrates the magnitude of the observed sex differences in opportunity to use alcohol and the precision of the estimates.

The remaining 11 surveys had no significant difference between men and women, although the precision of the estimated difference varied widely because of the sample Sex dating Huicheng. Sex differences M—F in opportunity to use alcohol or Sex dating Huicheng and in subsequent use, given the opportunity to use, 18—29 years. Sex comparisons of opportunities to use, and subsequent use, of alcohol and other drugs, years.

A different pattern emerged for the opportunity to use drugs.

Six of the other eight surveys also found males to be more likely to have an opportunity to use drugs, Sex dating Huicheng no differences were significant and difference estimates were quite imprecise, especially for low-opportunity countries.

As for alcohol, there were no surveys in which men were significantly less likely than women Sex dating Huicheng have had an opportunity to use drugs. Other surveys had broader confidence intervals for the sex difference, particularly lower use countries such as Lebanon, Nigeria, Beijing, and Shanghai.

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The evidence for sex differences in the progression to use of alcohol is mixed. Males are more likely to progress in Mexico and Italy, and there is clearly no sex difference in Germany or New Zealand and only a small difference in Columbia, but in all the Sex dating Huicheng surveys, the estimates of sex differences are imprecise.

Because the opportunity to use drugs was less common than the opportunity to use alcohol, the Sex dating Huicheng estimates from opportunity through to use were particularly imprecise for those countries where drug use opportunities were low.

Other countries also showed no evidence of differences, but confidence intervals were wide Figure 1. The three Asian surveys had so few participants with an Sex dating Huicheng to use drugs that no estimates were reported for the progression from opportunity to use.

The diversity of results across substances alcohol versus other drugs precludes the use of any single national measure of gender inequality per country to explain the extent of sex differences across all the countries included here. Even though the measures are country-wide whereas some WMHS surveys are regional, and the measures apply to all ages whereas only 18—29 Sex dating Huicheng olds are included in the WMHS analyses here, such measures do nonetheless provide a context for understanding what is seen, particularly within groups of countries classified by economic development or region.

The publisher's final edited version of this article is available at Subst Use Misuse.

The section presents no new estimates but makes different contrasts. Opportunity to use alcohol was almost universal in the high-income countries of Europe, the USA, and New Zealand, and there Sex dating Huicheng no sex differences.

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Mexico Sex dating Huicheng Colombia Sex dating Huicheng Lebanon and Nigeria Sex dating Huicheng contrasting pairs of countries in terms of opportunity to use alcohol and drugs. Mexico and Colombia score only moderately on the GEM 0.

There are no GEM scores for Lebanon and Nigeria, but on one measure of sexual inequality—seats held in the national parliament by women—they have the lowest percentage of all countries Sex dating Huicheng here 2. The Asian surveys were distinguished by moderate-to-high opportunity to use alcohol but low opportunity to use drugs, with no significant sex differences for either substance. As previous studies of opportunity to use and the progression to use in adults have all been carried out in the United States, results over all ages Sex dating Huicheng across birth cohorts are reported for that country to enable comparisons with previous findings.

In addition, results from New Zealand are reported here because they are based on the largest sample. Results for all other surveys are available on request. The opposite pattern was observed for use of drugs, given the opportunity to use.

The variation in results across countries and across substances alcohol or other drugs shows that there is no cross-nationally consistent pattern of sex differences in the opportunity to use or in the progression from opportunity through to use among young adults aged 18—29 years, born between and In some countries, sex differences were small at both stages, particularly for alcohol, in other countries they were apparent for both stages, and in the remainder, the previous pattern was observed, at least for drugs.

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Sex dating Huicheng, in no country Sex dating Huicheng alcohol or drugs more available for females nor were females more likely than males to make the transition from opportunity through to actual use. The countries included here provide a number of contrasts. The Catholic countries of Mexico and Colombia have ready access to alcohol and small sex differences, whereas Lebanon and Nigeria, with large Muslim populations, have less access to alcohol and large sex differences.

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For drugs, the largest Sex dating Huicheng differences in the opportunity to use were seen in Mexico Sex dating Huicheng Colombia, whereas in Lebanon and Nigeria, neither sex was likely to have an opportunity to use drugs. All four countries have relatively large levels of sexual inequality, but how this is manifested in the first stages toward substance use depends on the acceptability of the substance.

Sex differences in the opportunity to use a substance may be small if the substance is acceptable in the society, regardless of levels of sexual inequality, but are marked if there are religious or social sanctions against use, in the context of availability and sexual inequality. Sex differences in the first two stages toward use are constrained by ceiling effects, as in the developed countries Sex dating Huicheng the opportunity to use alcohol and the transition through Sex dating Huicheng use are nearly universal, and floor effects, as in Beijing and Shanghai where the opportunity to use drugs was uncommon so that the transition from opportunity to use could not be observed.

The time trends in the United States in this Sex dating Huicheng suggest that as drugs become more widely available, sex differences may move from the first stage opportunity to use to the second stage the transition through to use.

The time trends from New Zealand Sex dating Huicheng a counter-example whereby there is a decline in sex differences for both stages for more recent birth cohorts. The failure to replicate the previous results does not invalidate the usefulness of the two-stage approach.

Prevention policies and activities need to be based on what Sex dating Huicheng are available in a country, who has access to them, and how.

The policy context also includes the extent of religious or social prohibitions or restrictions on substance use. Muslim prohibition against alcohol use continues, but Protestant objections have declined from the high Sex dating Huicheng of the Temperance abstinence Movement in the late nineteenth and early twentieth centuries.

Social prohibitions against use of alcohol or other drugs by women appear to be related to the role of Sex dating Huicheng in society, something that has changed markedly in the twentieth century. Modern prevention strategies by secular governments are Sex dating Huicheng to promulgate religious views on substance use but may find that such views, if widespread, may provide support for nonreligious measures such as taxation and licensing of alcohol and laws related to alcohol and other drugs.

Religious views may also produce objections to harm reduction approaches, particularly for drugs other than alcohol. Where there are large sex differences in opportunities Sex dating Huicheng use drugs or in use given opportunity, then part of a prevention approach would be to monitor and try to influence any attempts to reduce such differences, such as alcohol marketing campaigns aimed particularly at women Lebanon and Nigeria would be the key countries to watch here.

The advantages of these surveys are the use of probability samples, standardized interviews, and many techniques to ensure high quality data collection Heeringa et al. One limitation of these surveys, however, is that like all other epidemiological studies of substance use, they rely on self-report. This reliance on self-report, with its problems of recall, was reduced by restricting most analyses to 18—29 year olds, instead of using all adults.

Another limitation comes from Sex dating Huicheng, particularly in the European countries apart from Spain and Italy. Furthermore, the opportunity to use drugs was reported for all drugs together. Thus, across-country differences in opportunities and progression Sex dating Huicheng use for specific types of Sex dating Huicheng cannot be estimated. Although cannabis is the first drug to be used in many countries Degenhardt et al. A conceptual framework for future large-scale epidemiological research arises from this study and earlier work.

The earliest involvement with alcohol or drugs is broken into discrete stages, enabling transitions between the opportunity to use and subsequent use to be examined.

Sex differences are a fruitful topic for investigation because sex is clearly an exogenous variable, not influenced by exposure to alcohol or drugs, yet sex roles differ so Sex dating Huicheng developmentally, across societies, through time and space, that sex differences provide a window into the influence of social factors such as culture and religion.

The differences so often found in adult consumption must therefore be traced to processes that come into play after first use. In some other countries, women are protected from use Sex dating Huicheng not having had the opportunity to try drugs. In the two metropolitan cities in China at least, both sexes Sex dating Huicheng protected from drug use; few have had the chance to try.

These different patterns preclude generalization about sex differences and require data about each specific drug in each country. When longitudinal studies are possible, beginning well before adolescence, then a rich set Sex dating Huicheng data about early childhood, early psychiatric problems, family, school, and local environment can be collected, with temporal information enabling appropriate causal inferences.

However, most large-scale epidemiological studies are cross-sectional surveys, in part because of the time and resources required for longitudinal research, and because of the need Sex dating Huicheng surveillance of trends that become clear only with repeated surveys.

It is difficult to distinguish cause from consequence in cross-sectional surveys, and a caution is required for inferences about possible endogenous variables that arise from previous use. For instance, educational attainment, current income, or current neighborhood may be outcomes rather than causes of use.

Several WMH surveys Belgium, Germany, Italy used municipal resident registries to select respondents without listing households.

For example, Sex dating Huicheng is straightforward to estimate year of birth, sex, race, and other aspects of family history or life experience such as Sex dating Huicheng death of a parent during early childhood, that predate the onset of the first chance to try a drug, or first use.

Even early onset conduct disorder can be assessed through self-report, though undoubtedly with Sex dating Huicheng measurement error. Asking adolescents or young adults about opportunity to use and first use, as well as current use, provides information about the initial stages and can assist in understanding of the development of use in a society.

The World Mental Health Survey Initiative provided assistance with instrumentation, fieldwork, and data analysis. These funders had no role other than funding. The work of the MSU-based authors L. Each country obtained funding for its own survey. Alden Trust.

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Elisabeth WellsPh. She is the author of over papers. Within this consortium, the Drug Dependence workgroup led by Professor J. Anthony is funded to investigate drug use and disorders. The authors report no conflicts of interest.

The authors alone are responsible for the Sex dating Huicheng and writing of the Sex dating Huicheng. The environment and disease: Associations or causation? Proceedings of the Royal Society of Medicine, 58—]. Editor's note. National Center for Biotechnology InformationU.

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Data from 15 surveys in 14 countries were available for this study. We did not use cookies to assign a unique user identifier to each client computer. This is the second stage in which individuals transition from opportunity to use through to use.

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