Stress and substance use among military women and men.

This paper examines the relationship between perceived stress (at work, in family or personal life, and from being a woman in the military) and substance use (heavy drinking, illicit drug use, cigarette smoking) among active-duty military women and men. Data were drawn from over 16,000 respondents to the 1995 Department of Defense Survey of Health Related Behaviors Among Military Personnel. Findings indicated substantial substance use and perceived high stress in the armed forces. Further, the relation between substance use and stress varied by gender. Military women reported substantially lower rates of heavy drinking than men, but had similar rates of illicit drug use and cigarette smoking. Both military women and men were more likely to describe their military duties as more stressful than their family or personal lives; for women, the stress associated with being a woman in the military was second to stress at work. Stress at work or in the family was an important predictor of substance use among military men, but not among military women. For military women, stress associated with being a woman in the military was predictive of illicit drug use and cigarette use. These findings suggest that more effective stress management strategies may need to be implemented for military men to reduce the link between stress and heavy alcohol use, illicit drug use, and smoking.     

Stress and Substance Use Among Military Women and Men

This paper examines the relationship between perceived stress (at work, in family or personal life, and from being a woman in the military) and substance use (heavy drinking, illicit drug use, cigarette smoking) among active-duty military women and men. Data were drawn from over 16,000 respondents to the 1995 Department of Defense Survey of Health Related Behaviors Among Military Personnel. Findings indicated substantial substance use and perceived high stress in the armed forces. Further, the relation between substance use and stress varied by gender. Military women reported substantially lower rates of heavy drinking than men, but had similar rates of illicit drug use and cigarette smoking. Both military women and men were more likely to describe their military duties as more stressful than their family or personal lives; for women, the stress associated with being a woman in the military was second to stress at work. Stress at work or in the family was an important predictor of substance use among military men, but not among military women. For military women, stress associated with being a woman in the military was predictive of illicit drug use and cigarette use. These findings suggest that more effective stress management strategies may need to be implemented for military men to reduce the link between stress and heavy alcohol use, illicit drug use, and smoking.     

Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+

Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR?=?3.37, 95% CI: 1.23–9.21, p?=?.018 and heavy drinking, AOR?=?2.47, 95% CI: 1.07–5.71, p?=?.033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.     

The impact of illicit drug use and substance abuse treatment on adherence to HAART

High levels of adherence to highly active antiretroviral therapy (HAART) are essential for virologic suppression and longer survival in patients with HIV. We examined the effects of substance abuse treatment, current versus former substance use, and hazardous/binge drinking on adherence to HAART. During 2003, 659 HIV patients on HAART in primary care were interviewed. Adherence was defined as > or =95% adherence to all antiretroviral medications. Current substance users used illicit drugs and/or hazardous/binge drinking within the past six months, while former users had not used substances for at least six months. Logistic regression analyses of adherence to HAART included demographic, clinical and substance abuse variables. Sixty-seven percent of the sample reported 95% adherence or greater. However, current users (60%) were significantly less likely to be adherent than former (68%) or never users (77%). In multivariate analysis, former users in substance abuse treatment were as adherent to HAART as never users (Adjusted Odds Ratio (AOR)=0.82; p>0.5). In contrast, former users who had not received recent substance abuse treatment were significantly less adherent than never users (AOR=0.61; p=0.05). Current substance users were significantly less adherent than never users, regardless of substance abuse treatment (p<0.01). Substance abuse treatment interacts with current versus former drug use status to affect adherence to HAART. Substance abuse treatment may improve HAART adherence for former substance users.     

Binge drinking by gender and race/ethnicity among California adults, 2007/2009

Background: This study provides binge drinking population estimates for California adults by gender and detailed race/ethnicity categories. This information may be helpful for planning targeted initiatives to decrease binge drinking. Method: Data were from the 2007 and 2009 California Health Interview Surveys. The 98?662 respondents represent an annual estimated population of 27.2 million adults. Survey adjusted binary logistic regression was used to calculate gender-specific binge drinking population rates and multinomial logit regression to estimate binge drinking frequency. Results: Adjusting for socio-demographics, any binge drinking during the past year was reported by 31.0% (95% Confidence Interval?=?30.5–31.4%) of men and 18.0% (17.7–18.3%) of women. Rates among White men and women were 30.5% and 19.6%, respectively. Binge drinking rates ranged from 11.9% among Chinese to 42.9% among Mexican men and from 4.8% among Vietnamese to 25.7% among “Other Latino” women. Five race/ethnicity categories of men and seven categories of women were significantly less likely to binge drink compared to Whites. Although Whites had the highest overall binge drinking rates, an estimated 12.5% of White men binge drank less than monthly, significantly exceeded by Mexican and Central American men, 19.9 and 19.6%, respectively. An estimated 9.6% of White women binge drank less than monthly, exceeded only by “Other Latino” women, 13.6%. Conclusion: These findings underscore the importance of detailed gender and race/ethnicity breakdowns when examining any binge drinking. Furthermore, there is variability across Asian and Latino subgroups in the frequency of binge drinking episodes, which is not evident in broad-group population studies.     

Gender differences in the individual characteristics and life contexts of late-middle-aged and older problem drinkers

This study focuses on gender differences in the individual characteristics and life contexts of late-life problem drinkers. Late-middle-aged women with drinking problems (n = 183) consumed less alcohol, had fewer drinking problems, and reported more recent onset of drinking problems than did their male counterparts (n = 476). They also used more psychoactive medications, were more depressed, and were less likely to seek alcohol treatment. Consistent with a gender role perspective on alcohol abuse, problem-drinking women had more family-related and fewer financial stressors than did problem-drinking men. Contrary to expectation, however, problem-drinking women reported more support from children, extended family members, and friends than did problem-drinking men. Moreover, women who continued to have drinking problems over a 1-year interval reported some unexpected short-term benefits at follow-up, including reduced spouse stressors. Women who had remitted at follow-up experienced less spouse support, and more family-related stressors and depression than did remitted men. They also lost support from extended family members over the 1-year interval. The results suggest a need for screening and treatment efforts tailored more closely to the life circumstances of women with late-life drinking problems.     

Gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town, South Africa.

Because men account for nearly half of the HIV cases in South Africa, it is critical to understand the contexts in which they live and the behaviors in which they engage. The purpose of this study was to describe and examine gender differences in intimate partner violence on substance abuse, sexual risks, and depression among a sample of South Africans in Cape Town. We found that recent exposure to intimate partner violence among men was associated with all forms of drug use, whereas women who were recently abused were more likely to suffer from depression and problem drinking. We also found high levels of problem drinking among both men (58%) and women (42%). Men were more likely to use drugs. Exposure to community violence increased sexual risk behaviors among men. Overall, these gender differences have important implications for alcohol and drug prevention strategies as they relate to HIV transmission risk.     

The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients

Background: Binge drinking is associated with risky sexual behaviors and sexually transmitted diseases (STDs). Few studies have investigated this by gender or in an STD clinic. This cross‐sectional study examined the association between binge drinking and risky sexual behaviors/STDs among patients attending an urban STD clinic. Method: A total of 671 STD clinic patients were tested for STDs, and queried about recent alcohol/drug use and risky sexual behaviors using audio computer‐assisted‐self‐interview. The association between binge drinking and sexual behaviors/STDs was analyzed using logistic regression adjusting for age, employment, and drug use. Results: Binge drinking was reported by 30% of women and 42% of men. Gender differences were found in rates of receptive anal sex which increased linearly with increased alcohol use among women but did not differ among men. Within gender analyses showed that women binge drinkers engaged in anal sex at more than twice the rate of women who drank alcohol without binges (33.3% vs. 15.9%; p < 0.05) and 3 times the rate of women who abstained from alcohol (11.1%; p < 0.05). Having multiple sex partners was more than twice as common among women binge drinkers than women abstainers (40.5% vs. 16.8%; p < 0.05). Gonorrhea was nearly 5 times higher among women binge drinkers compared to women abstainers (10.6% vs. 2.2%; p < 0.05). The association between binge drinking and sexual behaviors/gonorrhea remained after controlling for drug use. Among men, rates of risky sexual behaviors/STDs were high, but did not differ by alcohol use. Conclusion: Rates of binge drinking among STD clinic patients were high. Among women, binge drinking was uniquely associated with risky sexual behaviors and an STD diagnosis. Our findings support the need to routinely screen for binge drinking as part of clinical care in STD clinics. Women binge drinkers, in particular, may benefit from interventions that jointly address binge drinking and risky sexual behaviors. Developing gender‐specific interventions could improve overall health outcomes in this population.     

Sexual behaviour,STDs and drug use in a crack house population

We aimed to investigate the prevalence of ulcerative sexually transmissible diseases (STDs) and hepatitis in crack users. We interviewed 435 crack users on site in crack houses in Houston, Texas and took blood for laboratory analysis. There was evidence of syphilis infection in 13%, herpes simplex virus-2 (HSV-2) in 61%, HIV in 12%, hepatitis B in 52%, and hepatitis C in 41% of cases. On DSM-III-R criteria, 12% were crack abusers and 84% crack dependent: over half reported previous treatment. Forty per cent reported also injecting. Sexual behaviour indicated a mean of 2.4 partners in the past month for men, 3.7 for women. Sexual behaviour was largely vaginal, although women also reported more than twice the level of oral sex of men. Significant multivariate predictors for HIV and hepatitis B and C were previous reported STD and injecting drug use (including sharing needles), while female gender for syphilis and HSV-2, and additionally condom use for HSV-2, were significant risks. These data confirm high rates of STDs in a crack house population as inferred from previous clinic-based and community studies, and the link between STDs, injecting and HIV. The high rates of STDs found should lead to considering STDs and substance abuse to be dual diagnoses in crack users and the integration of STD diagnosis and treatment into crack outreach and treatment programmes.     

Psychoactive drugs, alcohol, and stress and coping processes in older adults

Data are presented on a) the relationship between psychoactive substance use and personal characteristics, b) the relationship between psychoactive substance use and appraisal of and coping with stressful situations, and c) the use of psychoactive substances specifically to cope with stress among older people. Data were provided by 141 65-to-74-year-old retired Caucasians who were assessed repeatedly over 6 months. Compared to national samples, subjects were relatively heavy users of alcohol and average users of psychoactive drugs. Use of alcohol increased with income, and drug use was associated with several psychosocial characteristics as well as with psychological and somatic health. Psychoactive substance use did not relate to the ways subjects appraised and coped with stressful encounters. Further, only a small number of subjects used drugs or alcohol specifically to help them cope in these encounters. The findings about psychoactive drug users are compared with other findings about misusers of drugs, and the risks associated with each type of drug use are discussed.     

Alcohol consumption and binge drinking in Novosibirsk, Russia, 1985–95

Aims . It has been suggested that the effects of alcohol, and binge drinking in particular, contributed to the dramatic fluctuations in Russian mortality rates: rapid decline in 1985‐87, slow increase in 1988‐91 and sharp increase in 1992‐94. To date, there have been no data available to substantiate this claim. We examine for the first time the trends in alcohol intake and binge drinking in a Russian urban population. Methods . Independent random samples of men and women aged 25‐64 in two districts of Novosibirsk city (Western Siberia) have been examined in 1985/86 (1535 men and 1296 women), 1988/89 (1700 men, no women), and 1994/95 (1539 men and 1511 women). Response rates ranged from 71% to 73%. The subjects reported frequency of drinking alcohol, average amount of alcohol consumed at a typical occasion, and their alcohol intake in the week preceding the interview. Two cut‐off points to define binge drinking were adopted: ≥ 80 g and ≥ 120 g at a single occasion. Results . The proportion of men who drank at least once a week increased from 27% in 1985/86 to 38% in 1994/95; corresponding figures among women were 0.6% and 6.5%, respectively. The mean consumption of pure alcohol at a single occasion in men was 90 g in 1985/86, 119 g in 1988/89 and 112 g in 1994/95; in women, it was 33 g in 1985/86 and 32 g in 1994/95. Between the first and the last survey, the mean weekly intake of pure alcohol increased from 120 g to 184 g in men and from 31 g to 41 g in women. Prevalence rates of binge drinking (≥ 80 g at least once a month) in the three surveys were 36%, 52% and 51%, respectively, in men, and 0.4% in the first and 5% in the last survey among women. Conclusion . Alcohol consumption and prevalence of binge drinking were high in men and low in women. The frequency of binge drinking among men increased between 1985/86 and 1988/89 and remained stable between 1988/89 and 1994/95. This is not consistent with trends in mortality. Shorter‐term fluctuations between surveys, however, cannot be excluded.     

Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This article reports a study of the association between alcohol use and HIV risk-related behavior among 614 men and 157 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results for men showed that drinking in sexual contexts as well as their partner's drinking were related to higher rates of unprotected intercourse. However, the number of sex partners men reported was only associated with their own use of alcohol before sex. In contrast, women's partners drinking before sex was related to higher frequencies of unprotected intercourse, but it was their own drinking before sex that was related to women's number of sex partners. Results therefore suggest that the context of alcohol use is more closely related to sexual risks than are the quantity or frequency of use. Interventions are needed that integrate HIV risk reduction with alcohol risk reduction in South Africa.     

Illicit drug use among Mexicans and Mexican Americans in California: the effects of gender and acculturation

Aims. To examine the effects of gender and acculturation on illicit drug use among the Mexican-origin population in California. Design. The 3012 subjects between 18 and 59 years of age were selected under a stratified, multi-stage cluster sampling method. Setting. Fresno County in California is primarily agricultural, with only one metropolitan area. Over 30% of the total population of 764 800, are Hispanics, of Mexican origin. Measurements. A modified version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI) was used to ascertain drug use. Respondents were considered drug users if they had ever used marijuana, cocaine, hallucinogens, heroin or inhalants. Acculturation was measured with a Likert scale, assessing English vs. Spanish language preference. Other covariates of interest were nativity and place of residence. Findings. Men had higher rates of use than women for every drug (men = 46.3%, women = 23.2%). Urban rates were higher than rural rates, for both women (urban = 32.8% vs. rural = 16.6%) and men (urban = 57.0% vs. rural = 36.8%). In logistic regression models, men were more likely than women to have ever used illicit drugs or inhalants (adjusted OR = 4.8), cocaine (adjusted OR = 5.3) or marijuana (OR = 4.3). However, the combined effect of United States nativity and acculturation, on drug use, was greater among women (adjusted OR = 29.3) than among men (adjusted OR = 7.4). The effect of acculturation was stronger among urban, than among town or rural residents. Conclusions. Acculturation and United States nativity are risk factors for illicit drug use among Mexican origin men and women. However, women have increased vulnerability compared with men. Findings reinforce the need for culturally based public health interventions.     

Alcohol use, comorbidity, and mortality

OBJECTIVES: To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey). DESIGN: Longitudinal analysis of a national probability sample-based cohort study. SETTING: Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971-1974, and the NHANES Epidemiologic Followup Survey, 1992. PARTICIPANTS: Four thousand six hundred ninety-one adults aged 60 and older who provided data on alcohol use. MEASUREMENTS: The prevalence of at-risk drinking in older adults in the United States and the 20-year all-cause mortality risk associated with it. At-risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method. RESULTS: The prevalence of at-risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at-risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2-3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at-risk drinking was associated with higher mortality rates than not-at-risk drinking (hazard ratio=1.20, 95% confidence interval=1.01-1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at-risk drinking was associated with greater mortality rates. CONCLUSION: In this first, large population-based study of older adults examining the mortality risks of alcohol use and comorbidity, at-risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks.     

Frequency,Quantity, and Contextual Use of Alcohol Among Sexually Transmitted Infection Clinic Patients in Cape Town,South Africa

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This article reports a study of the association between alcohol use and HIV risk-related behavior among 614 men and 157 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results for men showed that drinking in sexual contexts as well as their partner's drinking were related to higher rates of unprotected intercourse. However, the number of sex partners men reported was only associated with their own use of alcohol before sex. In contrast, women's partners drinking before sex was related to higher frequencies of unprotected intercourse, but it was their own drinking before sex that was related to women's number of sex partners. Results therefore suggest that the context of alcohol use is more closely related to sexual risks than are the quantity or frequency of use. Interventions are needed that integrate HIV risk reduction with alcohol risk reduction in South Africa.     

Sex differences of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume in alcohol-dependent patients

BACKGROUND: Biological markers like carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and mean corpuscular volume (MCV) are used widely to screen for alcoholism. Most research has focused on male alcoholics, and there are few studies on female patients. The results are inconsistent; in general, they show lower sensitivities for all markers for women. METHODS: We compared the diagnostic value of CDT, GGT, and MCV in 126 alcohol-dependent patients (91 men, 35 women) who entered an inpatient treatment program. For the receiver operating characteristic (ROC) analyses, we investigated a control group of 112 patients (64 men, 38 women) from the Department of Psychiatry at the University of Tübingen with no diagnosis of substance abuse or substance dependency. RESULTS: Mean levels of CDT and MCV were significantly different in male and female patients. CDT showed higher test results in men (4.4% vs. 2.8%, p < 0.05), whereas mean levels of MCV were higher in women (99.7 fl vs. 96.4 fl,p < 0.01). The sensitivities of CDT and GGT were higher in men than in women (CDT: 76% vs. 54%,p < 0.1; GGT: 68% vs. 43%,p < 0.05), and the sensitivity of MCV was significantly higher in women (71% vs. 41%,p < 0.01). The superiority of MCV in women also was supported by ROC analyses (p < 0.01). The combined use of markers showed satisfactory sensitivity rates of > or = 80% not only in men but also in women. Yet, the specificity rates were partly below the recommended 90% for identifying alcohol abuse; therefore, these markers must be combined with caution. CONCLUSIONS: If combined, the biological markers CDT and GGT are useful diagnostic instruments for both alcohol-dependent men and women. According to our results, the "forgotten" marker MCV is superior in women and is a marker of second choice in men. The combination GGT and MCV is the most cost-effective choice for men and women.     

Perceived causal and treatment factors related to substance abuse: gender differences

The study aimed to examine gender differences of causal and treatment factors in substance use as perceived by adults who are addicted to drugs in the southern region of Israel. Eighty-one men and a matched group of 81 women recruited from one methadone center and several welfare agencies, average age was about 31 years, about a third immigrated from the former Soviet Union, were administered self-report questionnaires, which measured the following: demographic variables, perceived causal and treatment factors. Results indicated the following: women drug users perceived familial circumstances such as domestic violence or incest to have higher impact on substance abuse than men; men reported curiosity and the influence of addicted friends to have higher impact on substance abuse than women. In addition, women perceived personality characteristics such as willpower to have greater impact on treatment retention than men; men regarded formal and informal social support to have greater impact on treatment retention than women. Results were discussed in light of planning and developing treatment programs.     

Sharp increase in illicit drug use in Greece: trends from a general population survey on licit and illicit drug use

The study aims to follow trends in the prevalence of licit and illicit substance use between 1984 and 1998 in the Greek general population. Data are drawn from two nationwide cross-sectional household surveys. Probability samples consisted of 4,297 (1984) and 3,759 (1998) 12- to 64-year-old respondents. Regular tobacco smoking in the total sample increased in women and decreased in men while alcohol consumption remained at similar levels. The use of illicit drugs showed a 3-fold increase since 1984 reaching a lifetime prevalence of 19% in males and 6% in females. In contrast, a significant decrease was noted in the unprescribed use of psychoactive medicines, especially among women. Trends in licit and illicit substance use can be explained by sociocultural and policy changes in Greece in the last 15 years.