Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China

Background

Female injecting drug users who are sex workers (IDUFSWs) are at high risk of contracting HIV. They may bridge HIV transmissions from injecting drug users to clients of female sex workers.

Methods

A total of 216 non-institutionalised IDUFSWs were recruited by snowball sampling methods. Anonymous face-to-face interviews were conducted to collect data. Univariate, multivariate and hierarchical logistic regression models were fitted to investigate the associations between background characteristics, cognitive variables, psychological stress and syringe sharing behaviours among IDUFSWs.

Results

Respectively 33.8% and 27.8% of the respondents injected drugs with others’ used syringes and gave used syringes to others for drug injection in the last month. These two syringe sharing behaviours were significantly associated with inconsistent condom use during commercial sex (OR = 5.00 and 1.92, p < 0.05). Over 90% of the respondents reported at least one type(s) of psychological distress included in this study. Adjusting for significant background variables, all variables that are related to the Theory of Planned Behaviour (attitude, norm, perceived control and behavioural intention) and psychological distress (except for depression) were significantly associated with injecting drugs with others’ used syringes (adjusted OR = 2.08-6.25, p < 0.05), whilst variables related to perceived control, behavioural intention and insomnia were significantly associated with providing used syringes to others for injection (adjusted OR = 2.00-3.56, p < 0.05). In two separate summary multivariate models, variables related to the Theory of Planned Behaviours and psychological distress were independently associated with injecting drugs with others’ used syringes (OR = 1.98-4.02, p < 0.05) and giving used syringes to others for injection (OR = 2.06-3.59, p < 0.05).

Conclusions

Syringe sharing behaviours were prevalent among IDUFSWs and were associated with cognitive and psychological factors. Effective integrative intervention programmes targeting IDUFSWs are warranted.     

Associations between polysubstance use and psychiatric problems in a criminal justice population in Sweden

Background

Polysubstance use is common in substance users, and may complicate their clinical course. This study, in a criminal justice setting in Sweden, examines the association between the number of concurrently used substance types and psychiatric symptoms during 30 days before incarceration, while controlling for background variables such as family history (drug and alcohol problems, psychiatric problems, criminality), demographic data and history of emotional, physical or sexual abuse.

Methods

The data material comprised 5659 criminal justice clients reporting a substance use problem, examined with the Addiction Severity Index. Variables were compared in a multinomial regression analysis, comparing clients reporting one (n = 1877), two (n = 1408), three (n = 956), four (n = 443) and five or more (n = 167) substance types.

Results

The 30-day prevalence of most psychiatric symptoms included in the study (depression, anxiety, cognitive problems, hallucinations, difficulty controlling violent behaviour, suicidal ideation, suicide attempts) was higher in individuals with a higher number of concurrent substance types used. In multinomial regression analysis, while controlling for background variables, these associations remained for concurrent suicidal ideation, cognitive problems, hallucinations and violent behaviour, with the latter two being associated with the higher numbers of substance types. Binge alcohol drinking, tranquilizers, opioids and the number of substance types reported were associated with several of the psychiatric symptoms.

Conclusions

In the present criminal justice setting in Sweden, the use of multiple substance types and concurrent psychiatric symptoms appear to be associated, and a sub-group reporting particularly high numbers of concurrent substance types are particularly likely to report potentially severe psychiatric problems.     

"Should I stay or should I go?" Coming off methadone and buprenorphine treatment

Background

This study aimed to investigate patient perspectives regarding coming off maintenance opioid substitution treatment (OST). The study explored previous experiences, current interest and concerns about stopping treatment, and perceptions of how and when coming off treatment should be supported.

Methods

A cross-sectional survey was used. Participants were 145 patients receiving OST at public opioid treatment clinics in Sydney, Australia.

Results

Sixty-two percent reported high interest in coming off treatment in the next 6 months. High interest was associated with having discussed coming off treatment with a greater number of categories of people (OR = 1.72), not citing concern about heroin relapse (OR = 3.18), and shorter duration of current treatment episode (OR = 0.99). Seventy-one percent reported previous withdrawal attempts and 23% had achieved opioid abstinence for ≥3 months following a previous withdrawal attempt. Attempts most commonly involved jumping off (59%), and doctor-controlled (52%) or self-controlled (48%) gradual reduction. For future attempts respondents were most interested in doctor-controlled (68%) or self-controlled (41%) gradual reduction. Concerns regarding coming off treatment included withdrawal discomfort (68%), increased pain (50%), and relapse to heroin use (48%).

Conclusion

While some patients may require lifetime maintenance, the issue of coming off treatment is important to many patients and should be discussed regularly throughout treatment and where appropriate supported by a menu of clinical options.     

Caregiver and self-report of mental health symptoms in 9-year old children with prenatal cocaine exposure

Objective

To assess the effect of prenatal cocaine exposure on mental health symptoms in 9-year old children controlling for potential confounders.

Methods

332 children (170 prenatally cocaine-exposed (PCE), 162 non cocaine-exposed (NCE) were assessed using self (Dominic Interactive; DI) and caregiver report (Child Behavior Checklist; CBCL).

Results

Higher levels of PCE were associated with caregiver report of clinically elevated aggressive and delinquent behavior. With each increased unit of PCE, children were 1.3 times more likely to be rated as aggressive (OR = 1.30, 95% CI: 1.02-1.67, p < 0.04). For each increased unit of PCE, girls were 2 times more likely to be rated as having delinquent behavior (OR = 2.08, 95% CI: 1.46-2.96, p < 0.0001). PCE status was also associated with increased odds of delinquent behavior (OR = 2.41; 95% CI: 1.16-4.97, p = 0.02), primarily due to the increased risk among girls with PCE. While girls with PCE status were 7 times more likely than NCE girls to have delinquent behaviors (OR = 7.42; 95% CI: 2.03-27.11, p < 0.002) boys with PCE did not demonstrate increased risk (OR = 0.98; 95% CI: 0.36-2.65, p > 0.97). Foster or adoptive parents were more likely to rate their PCE children as having more thought problems, inattention, delinquent behavior, aggression, externalizing and overall problems (p < 0.05) than biologic mothers or relative caregivers. Higher 2nd trimester tobacco exposure was associated with increased odds of caregiver reported anxiety (OR = 1.73; 95% CI 1.06-2.81, p < 0.03) and marijuana exposure increased the odds of thought problems (OR = 1.68; 95% CI 1.01-2.79, p < 0.05). Children with PCE self-reported fewer symptoms of oppositional defiant disorder (ODD) compared to NCE children (OR = 0.44, 95% CI: 0.21-0.92, p < 0.03). Greater tobacco exposure was associated with increased odds of child reported ODD (OR = 1.24; 95% CI 1.03-1.78, p < 0.03).

Conclusion

Higher PCE was associated with disruptive behaviors including aggression and delinquent behavior among girls by caregiver report, but not child report. These findings highlight the need for early behavioral assessment using multiple informants in multi-risk children.     

At high risk and want to quit: Marijuana use among adults with depression or serious psychological distress

Objectives

This study compared marijuana use characteristics and quit behaviors between adults with and without depression or serious psychological distress (SPD).

Methods

Drawing data for 39,133 non-institutionalized adults from the 2011 National Survey on Drug Use and Health, we assessed marijuana use status, frequent use, dependence or abuse, and quit behaviors in association with lifetime clinician-identified depression, lifetime and recent major depressive episode (MDE), and recent SPD.

Results

Adults with depression or SPD were at a significantly higher risk of being lifetime ever users (OR = 1.60–2.08), past year users (OR = 1.67–1.86), frequent users (OR = 1.40–1.62), and dependent or abusing users (OR = 2.32–3.05) compared with adults without these symptoms. Adults with depression or SPD had a lower quit ratio overall, but were equally or even more likely to make quit or self-regulation attempts. Further analysis suggested that adults with recent MDE had the greatest level of quit attempts or self-regulation attempts compared with adults without MDE or with past MDE.

Conclusions

These findings highlight the need for tailored cessation programs to sustain quit attempts and promote successful quitting among adults with depression or SPD, especially those with recent symptoms.     

Is opioid substitution treatment beneficial if injecting behaviour continues?

Background

Opioid substitution treatment (OST) is recognised as an effective treatment for opioid dependence. Still, a subgroup of OST users continues to inject drugs. This study examines health risks and criminal activity in a population of needle exchange programme (NEP) participants by comparing those identified as current OST users to (i) those identified as former OST users and (ii) those with no OST experience.

Methods

This was a semi-annual cross-sectional study conducted from 2002 to 2011. NEP participants were interviewed in Oslo, Norway (n = 1760); 341 were identified as current OST users, 356 as former OST users and 1063 had no OST experience. The associations between OST status and health risk and criminal activity were assessed through univariate and multiple logistic regression analyses.

Results

Among NEP participants, those currently in OST had fewer non-fatal overdoses (OR = 0.5 [95% CI 0.3, 0.9]) compared to former OST users and those never in OST. Additionally, they were less likely to have injected frequently (OR = 0.4 [95% CI 0.3, 06]), to have used heroin daily or almost daily (OR = 0.3 [95% CI 0.2, 0.4]), and to have committed theft (OR = 0.6 [95% CI 0.4, 1.0]) and engaged in drug dealing (OR = 0.7 [95% CI 0.5, 0.9]) in the past month. Overall, there was a high level of polysubstance use and no group differences on this measure.

Conclusions

NEP participants who are currently in OST have substantially reduced health risks and criminal activity than other NEP participants. The high level of polysubstance use nevertheless poses a public health challenge.     

Executive dysfunction in chronic cocaine users: an exploratory study

Introduction

Chronic cocaine use is associated with some executive deficits. We assessed executive functions using ecologically valid tests in chronic cocaine users.

Objectives

To investigate the relationship between executive deficits and three measures of severity of cocaine use: years of use, quantity used, and frequency of use.

Methods

Twenty-four cocaine users were compared with twenty-seven community controls. We used Student's t-test and Chi-squared to compare means and categorical variables, respectively. Linear regression analyses for the adjusted comparative analysis between cases and controls, and severity of cocaine use among cocaine users were performed.

Results

Chronic cocaine users performed worse on measures of attention and working memory (Forward and Backward Digit Span, p < .001), set-shifting abilities (difference score between the Trail Making B and A, TMB-A, p = .006), cognitive test of mental flexibility and response inhibition (Rule Shift Cards) (p < .001), and prefrontal functioning (Wisconsin Card Sorting Test, WCST, p = .023) than controls. Years of cocaine use were associated with deficits in the Backward Digit Span (p = .041; CI 95%: −.760 to −.002), the TMB-A (p = .026; CI 95%: .687 to 9.761), the Zoo Map (p = .034; CI 95%: −.480 to −.021), and the Rule Shift Cards (p = .006; CI 95%: −.836 to −.164), among others. Quantity of cocaine use was associated with executive deficits measured by the Forward Digit Span (p = .007; CI 95%: −.727 to −.133), the TMB-A (p = .021; CI 95%: 5.304-57.945), and the number of perseverative errors in the WSCT (p = .002; CI 95%: −10.654 to −2.800). Frequency of cocaine was associated with deficits in the Backward Digit Span (p = .042; CI 95%: −1.548 to −.030).

Conclusions

Chronic use of cocaine is associated with executive deficits, which may influence patients’ functionality, prognosis, and therapeutic failure.     

Violence among men and women in substance use disorder treatment: A multi-level event-based analysis

Background

This study examined associations between acute alcohol and drug use and violence towards others in conflict incidents (overall, partner, and non-partner conflict incidents) by men and women recruited from substance use disorder (SUD) treatment.

Methods

Semi-structured interviews were used to obtain details about interpersonal conflict incidents (substance use, whether specific conflicts were with intimate partners or non-partners) in the 180 days pre-treatment. Participants for this study were selected for screening positive for past-year violence (N = 160; 77% men, 23% women).

Results

Multi-level multinomial regression models showed that after adjusting for clustering within individual participants, the most consistent predictors of violence across models were acute cocaine use (significant for overall, intimate partner and non-partner models), acute heavy alcohol use (significant for overall and non-partner models), and male gender (significant in all models).

Conclusions

This study was the first to explicitly examine the role of acute alcohol and drug use across overall, partner and non-partner conflict incidents. Consistent with prior studies using a variety of methodologies, alcohol, cocaine use and male gender was most consistently and positively related to violence severity (e.g., resulting in injury). The results provide important and novel event-level information regarding the relationship between acute alcohol and specific drug use and the severity of violence in interpersonal conflict incidents.     

Initiation to drug injection among street youth: a gender-based analysis

Objective(s)

To estimate the incidence rate of initiation into drug injection and to identify predictors of initiation into drug injection separately among street girls and boys.

Design

Data from two consecutive prospective street youth cohort studies (1995-2001 and 2001-2005) were used to conduct these analyses, stratified by gender.

Methods

Data were collected using semi-annual interviewer-administered questionnaires. Variables from the following domains were considered in Cox regression models: socio-demographic characteristics, early and current substance abuse, marginalization, childhood traumatic sexual events and injection exposure.

Results

Of the 946 youth who had never injected drugs at study entry, 86.4% completed at least two questionnaires representing 243 girls and 574 boys. Incidence rates of injection of 7.0 and 5.9 per 100 person-years were observed among these girls and boys respectively. Among girls, cocaine or crack use (adjusted hazard ratio (AHR) = 1.97), heroin use (AHR = 2.86), homelessness (AHR = 2.49) and hanging out regularly with people who inject (AHR = 4.46) all independently increased risk of first injection. Among boys, age decreased risk of initiating injection (AHR = 0.90/year), while cocaine or crack use (AHR = 2.14), heroin use (AHR = 3.56), homelessness before age 16 (AHR = 1.68), incest or rape before age 14 (AHR = 1.98) and hanging out regularly with people who inject (AHR = 1.66) all independently increased this risk.

Conclusions

Our findings suggest similar rates of initiation among girls and boys; however, factors associated with initiation vary by gender. This might lead to the design of more effective programs to prevent initiation into drug injection.     

Can intranasal drug use reduce HCV infection among injecting drug users?

Background

Preventing HCV infection among people who inject drugs is a difficult public health challenge. We examined the potential role of intranasal drug use in reducing HCV acquisition.

Methods

Subjects were recruited from IDUs entering the Beth Israel drug detoxification program from 2005 to 2010. A structured interview was administered and serum samples were collected for HCV testing.

Results

726 active injecting drug users were recruited from 2005 to 2010. HCV prevalence was 71%, 90% reported recent heroin injection and 44% reported recent intranasal heroin use. In a multiple logistic regression analysis, being HCV seropositive was associated with more years injecting, Latino ethnicity, previous testing for HCV, and recent injection of speedball, and negatively associated with recent intranasal use of heroin (AOR = 0.52, 95% CI 0.33-0.82) and intranasal use of speedball (AOR = 0.41, 95% CI 0.31-0.80). The association between intranasal heroin use and lower HCV seroprevalance was observed among both new injectors and persons with long injecting histories (16+ years since first injection).

Conclusion

Encouraging intranasal use as an alternative to injection among persons currently injecting drugs may be a viable strategy for reducing HCV transmission.     

Depressive mood and tobacco use: moderating effects of gender and emotional attention

Introduction

Depressive symptomatology is a predictive variable of tobacco use. The objective of the present study was to evaluate the influence that this symptomatology has on tobacco use when moderated by emotional attention.

Methods

A total of 289 participants (127 males, 162 females) completed a survey to measure perceived emotional intelligence, depressive symptomatology, tobacco use and sociodemographic variables. Results were analyzed using a multiple regression model that included self-perceived emotional attention as a moderating variable.

Results

In women, an interaction was found between depressive symptomatology and gender for predicting the number of cigarettes smoked (t = 2.45; p = .01), but not in men (t = −.74; p = .45). This interaction was moderated by emotional attention (t = 2.83; p = .005), such that women with medium and high levels of attention consumed a larger number of cigarettes.

Conclusions

In women, the effect of depressive symptomatology on tobacco use was moderated by the amount of attention that women paid to those symptoms. Such a moderating effect of attention was not observed in men. We recommend that smoking cessation programs incorporate interventions designed specifically for women, in particular to help them manage depressive symptomatology.     

Concurrent heroin use among methadone maintenance clients in China

Background

The study examined concurrent illicit heroin use among methadone maintenance clients in China and its association with clients' demographic characteristics, treatment experience, and personal social network.

Methods

Face-to-face surveys were conducted with 178 clients randomly recruited from six methadone maintenance treatment (MMT) clinics in Sichuan, China. Concurrent heroin use was measured based on self-report of heroin use during the past 30 days and a confirmatory urine morphine test. The participants' demographic characteristics and treatment factors were measured and examined. The drug use status of their family members and friends was also assessed.

Results

A total of 80 participants (44.9%) who either reported illicit heroin use in the past 30 days or had a positive urine test were defined as using heroin concurrently. Having drug-using friends was significantly associated with increased concurrent heroin use. Longer length of treatment (2 years or longer) was associated with increased concurrent heroin use. Among those who had both drug-using family members and friends, more women (71.4%) than men (50.0%) used heroin. For those who had no drug-using family members or friends, more men (34.8%) than women (20.8%) used heroin.

Discussion

Study findings indicate an urgent need to address concurrent illicit heroin use among MMT clients. Further examination of the influence of social networks on concurrent drug abuse behavior is encouraged. Results also highlight the importance of understanding gender differences in treatment seeking and behavioral changes, which is crucial to the development of gender-specific treatment strategies.     

Age and sex effects levels of choline compounds in the anterior cingulate cortex of adolescent methamphetamine users

Background

Methamphetamine can be neurotoxic to the adult brain; however, many individuals first use methamphetamine during adolescence, and the drug's impact on this period of brain development is unknown. Therefore, we evaluated young methamphetamine users for possible abnormalities in brain metabolite concentrations.

Methods

Anterior cingulate cortex (ACC), frontal white matter (FWM), basal ganglia, and thalamus were studied with localized proton magnetic resonance spectroscopy in 54 periadolescent (ages 13-23 years) methamphetamine users and 53 comparison subjects. The concentrations of major brain metabolites and their associations with age, sex and cognition were assessed.

Results

FWM total-creatine correlated with age in methamphetamine-using males and comparison females, but not comparison males or methamphetamine-using females, leading to a drug by sex by age interaction (p = 0.003) and ACC choline-containing compounds (CHO) correlated with age only in comparison males leading to a drug by sex by age interaction (p = 0.03). Higher ACC CHO was associated with faster performance on the Stroop Interference task in the control males. Male methamphetamine users had slowest performance on the Stroop Interference task and did not show age-appropriate levels of ACC CHO.

Conclusions

The altered age-appropriate levels of ACC CHO and poorer executive function in male methamphetamine users suggest methamphetamine abuse may interfere with brain maturation. These periadolescents did not have the abnormal neuronal markers previously reported in adult methamphetamine users, suggesting that neuronal abnormalities may be the result of long-term use or interference in normal cortical maturation, emphasizing the need for early intervention for young methamphetamine users.     

Guidelines for better harm reduction: Evaluating implementation of best practice recommendations for needle and syringe programs (NSPs)

Background

The objective of this study was to evaluate needle and syringe program (NSP) policies and procedures before and after the dissemination of a set of best practice recommendations.

Methods

An on-line survey of 32 core NSP managers (100% response rate) and 62 satellite NSP managers (63% response rate). The survey included items about the distribution of needles/syringes, other injection-related equipment and inhalation equipment, and use of a best practice recommendations document.

Results

The majority of NSPs reported following needle and syringe best practice recommendations. Most core NSPs (88%, n = 28) and satellite NSPs (84%, n = 52) distributed cookers following the dissemination of the document. All core NSPs (100%, n = 32) and nearly all satellite NSPs (97%, n = 60) distributed sterile water ampoules in 2008, many more than in 2006. Although more NSPs distributed safer inhalation equipment in 2008, the majority did not distribute these items. More satellite NSPs (44%, n = 27) distributed glass stems than the core NSPs (16%, n = 5). Commonly cited implementation barriers included funding, senior management and decision-making.

Conclusion

Our findings demonstrate that NSPs will implement empirically based best practice recommendations and welcome such guidance. The managers we surveyed not only reported increased implementation of practices that have been empirically shown to help reduce disease transmission among injection drug users (IDUs), they also used the best practices document for additional purposes, such as planning and advocacy, and expressed interest in having sets of recommendations developed for other areas of harm reduction. Ensuring high-quality and consistent NSP services is essential to prevent transmission of HIV among people who inject drugs and others in the community. Best practice recommendations can assist in achieving these goals.     

Psychosocial treatments for cocaine dependence: the role of depressive symptoms

Background

The association between cocaine use and depression has been frequently observed. However, less is known about the significance of depression in the treatment of cocaine use disorders. This study examined possible interrelations between drug use and depression severity among cocaine-dependent patients in psychosocial treatments for cocaine dependence.

Methods

Monthly assessed drug use and depression severity scores of N = 487 patients during 6-month psychosocial treatments for cocaine dependence were analyzed using hybrid latent growth models.

Results

Results indicated a moderate but statistically significant (z = 3.13, p < .01) influence of depression severity on increased drug use in the upcoming month, whereas drug use did not affect future depression severity.

Conclusions

Findings suggest that depression symptoms are an important predictor of drug use outcomes during psychosocial treatments for cocaine dependence and, hence, underline the importance of adequately addressing depression symptoms to improve treatment outcomes.     

Neural activation during inhibition predicts initiation of substance use in adolescence

Background

Problems inhibiting non-adaptive behaviors have been linked to an increased risk for substance use and other risk taking behaviors in adolescence. This study examines the hypothesis that abnormalities in neural activation during inhibition in early adolescence may predict subsequent substance involvement.

Methods

Thirty eight adolescents from local area middle schools, ages 12-14, with very limited histories of substance use, underwent functional magnetic resonance imaging (fMRI) as they performed a go/no-go task of response inhibition and response selection. Adolescents and their parents were then followed annually with interviews covering substance use and other behaviors. Based on follow-up data, youth were classified as transitioning to heavy use of alcohol (TU; n = 21), or as healthy controls (CON; n = 17).

Results

At baseline, prior to the onset of use, youth who later transitioned into heavy use of alcohol showed significantly less activation than those who went on to remain non to minimal users throughout adolescence. Activation reductions in TU at baseline were seen on no-go trials in 12 brain regions, including right inferior frontal gyrus, left dorsal and medial frontal areas, bilateral motor cortex, cingulate gyrus, left putamen, bilateral middle temporal gyri, and bilateral inferior parietal lobules (corrected p < .01, each cluster ≥32 contiguous voxels).

Conclusions

These results support the hypothesis that less neural activity during response inhibition demands predicts future involvement with problem behaviors such as alcohol and other substance use.     

The prevalence and correlates of single cigarette selling among urban disadvantaged drug users in Baltimore,Maryland

Background

Selling of single cigarettes, also known as loosies, is a public health concern. Loosies allow for those with fewer resources to buy cigarettes without having to purchase a pack. Selling of loosies may cue smoking behaviors. In the US, socioeconomically disadvantaged populations have high rates of smoking and illicit drug use and the selling of loosies appears to be linked to the urban informal economy. We examined the proportion and frequency of cigarette selling and roles in the informal economy associated with selling loosies among a sample of urban drug users.

Methods

There were 801 participants, recruited by community outreach, assessed at baseline, who were enrolled in an HIV prevention intervention for drug users.

Results

Most (89%) smoked cigarettes in the prior 30 days, of whom 92% smoked daily. Self-reported selling of cigarettes was common with 58% reporting that they had sold cigarettes within the last six months; 20.4% reported selling cigarettes a few times a week and 7.4% reported daily selling of cigarettes. In a stepwise regression model, four sources of income were associated with frequent cigarette selling: providing street security (OR = 2.214, 95% CI 1.177–4.164), selling food stamps (OR = 1.461, 95% CI 1.003–2.126), pawning items (OR = 2.15, 95% CI 1.475–3.135), and selling drugs (OR = 1.634, 95% CI 1.008–2.648).

Conclusion

There is a high rate of selling loosies among urban substance users. The wide availability of loosies may promote smoking. Smoking cessation programs with drug treatment and economic development programs may help to reduce economic pressures to sell loosies.     

The psychological impact of heavy drinking among the elderly on their co-residents: the 10/66 group population based survey in the Dominican Republic

Background

There is very limited literature on alcohol use among the elderly and little is known about the impact it has on family and caregivers, especially in low and middle income countries.

Aim

To estimate the independent effect of heavy alcohol use among the elderly on the psychological health of their co-residents.

Methods

This is a secondary analysis using data from the comprehensive cross-sectional survey of the 10/66 dementia research group population-based research programme in the Dominican Republic. The characteristics of the elderly participants as well as the co-residents were described. The independent association of heavy drinking among the participants with psychological morbidity in their co-residents was estimated. Different models were generated to rule out potential mediating effects of disability and behavioural symptoms.

Results

Prevalence of heavy alcohol use in the elderly in Dominican Republic was 10.6%. There was a statistically significant independent effect of heavy alcohol use by the elderly on their co-residents mental health (PR = 1.47; 95% CI 1.07-2.01) which was not accounted by disability (Sobel-Goodman test, p = 0.15). Severity of psychological and behavioural symptoms partially (29.1% of the total effect) explained this association (Sobel-Goodman mediation test, p = 0.006).

Conclusions

Health services for the elderly in low and middle income countries will have to be configured around detection of alcohol problems among the elderly as well as offering appropriate support to their co-residents.