Pre-deployment Alcohol Misuse Among Shipboard Active-Duty U.S. Military Personnel

Cross-Sectional Study of Sexual Behavior, Alcohol Use, and Mental Health Conditions Associated With Sexually Transmitted Infections Among Deploying Shipboard US Military Personnel

INTRODUCTION

Limited comprehensive data exist on risk behavior associated with sexually transmitted infections (STI) among ship-assigned US military personnel during the predeployment time period (PDT). This study examined whether sexual risk behaviors, alcohol use, involuntary drug consumption (IDC), posttraumatic stress disorder (PTSD), and depression during the 12 months prior to deployment were associated with provider-diagnosed STIs in this population.

MATERIALS AND METHODS

Using cross-sectional data collected during 2012-2014 among sexually active personnel, multivariable regression assessed factors associated with STIs among all men (n = 1,831). Stratified analyses were conducted among men who have sex with women (MSW, n = 1,530), men who have sex with men or men and women (MSM, n = 83), and excluded those not reporting sexual partner gender (n = 218).

RESULTS

Among MSW, transactional sex (AOR 3.8, 95% CI 1.5-9.4) meeting sexual partners at work (AOR 4.3, 95% CI 2.0-9.2), IDC (AOR 6.6, 95% CI 3.0-14.5), and incomplete mental health assessments (AOR 4.4, 95% CI 1.6-12.0) were significantly associated with STIs after adjustment. Among all men, those who identified as MSM (AOR 4.6, 95% CI 1.9-11.2) and drug screen positive (AOR 3.3, 95% CI 1.3-8.6) were significantly more likely to report an STI.

CONCLUSIONS

Previously unreported factors significantly associated with STIs at the PDT among MSW in the adjusted analysis were meeting sexual partners at work and IDC. IDC during the PDT warrants further exploration. These results can inform tailored STI reduction interventions among shipboard personnel and similarly aged civilians undergoing similar transition/travel experiences.

Hazardous drinking and clinical correlates among suicidal patients receiving psychiatric inpatient care at military medical settings

BACKGROUND

To describe prevalence and identify clinical correlates of hazardous drinking among suicidal inpatients at military medical settings.

METHOD

Data were drawn from the baseline assessment of a multisite randomized controlled trial of Post-Admission Cognitive Therapy (PACT). Participants were military Service members or adult beneficiaries (N = 218) who were admitted to inpatient care following a suicide-related crisis. Hazardous alcohol use in the past year was assessed using the Alcohol Use Disorder Identification Test (AUDIT).

RESULTS

The average AUDIT score was 6.78 (SD = 7.87), with 28.9% reporting hazardous drinking (scored ≥8 on the AUDIT). Hazardous drinkers were more likely than nonhazardous drinkers to meet diagnosis of Substance Use Disorder (SUD; Odds Ratio [OR] = 5.96, 95% confidence intervals [CI] = 2.13, 16.71). Hazardous drinking was neither associated with measures of suicide ideation nor aborted or interrupted suicide attempt. However, hazardous drinkers had greater risk of having both single (RRR [Relative Risk Ratio] = 2.55, 95% CI = 1.18, 5.50) and multiple actual suicide attempts (RRR = 2.38, 95% CI = 1.06, 5.32) than nonhazardous drinkers. The association between hazardous drinking and single (but not multiple) actual suicide attempt remained significant after controlling for gender, depressive symptoms, hopelessness, Post-Traumatic Stress Disorder, and SUD (adjusted RRR = 2.48, 95% CI = 1.09, 5.65).

CONCLUSIONS

A history of actual suicide attempt is associated with hazardous alcohol use among suicidal psychiatric inpatients. Assessment of drinking and drug use may inform case conceptualization and treatment of suicide-related behaviors in psychiatric inpatient settings.

Longitudinal survey of condom use across a US Navy and Marine Corps shipboard deployment

OBJECTIVES

Condoms are highly effective in preventing sexually transmitted infections (STIs) but implementation is often inconsistent with use rarely examined across travel transition periods. We examined the prevalence of condom use among ship-assigned US military personnel across an overseas deployment cycle and identified factors associated with condom non-use.

METHODS

Longitudinal survey data were collected from ship-assigned US Navy/Marine Corps personnel on 11 ships before (T1), during (T2) and after (T3) an overseas deployment. The anonymous, self-completed survey included demographics, condom use at last sex, STI diagnosis, alcohol misuse and drug use with sex. Descriptive and generalised regression model analyses were conducted.

RESULTS

Analysis included 1900 (T1), 549 (T2) and 1168 (T3) personnel who reported age, sex and condom use/non-use at last sex. The proportion reporting condom use was significantly higher during T2 (53%, p<0.0001) than T1 (27%) or T3 (28%), with STI prevalences of 1% (T1), 7% (T2) or 2% (T3), with fewer (29%) sexually active individuals at T2. In adjusted models, condom non-use was associated with hazardous alcohol use (OR 1.44, 95% CI 1.21 to 1.71), or drug use to enhance sex (OR 1.37, 95% CI 1.06 to 1.77), but transactional sex was negatively associated (OR 0.69, 95% CI 0.50 to 0.84).

CONCLUSIONS

Condom use was highest during deployment, as was STI prevalence (among non-users), possibly reflecting concentration of high-risk sexual activities/individuals and/or sexual partners more likely to be infected. Higher condom use with transactional sex likely reflects awareness of higher STI risk. These data can be used to facilitate targeted interventions to reduce STI transmission and may extend to similarly aged cohorts travelling outside the US (eg, college students on spring break).

Comparing short versions of the Alcohol Use Disorders Identification Test (AUDIT) in a military cohort

Background

The Alcohol Use Disorders Identification Test (AUDIT) is widely used for monitoring harmful alcohol consumption among high-risk populations. A number of short versions of AUDIT have been developed for use in time-constrained settings. In military populations, a range of AUDIT variations have been used, but the optimal combination of AUDIT items has not been determined.

Methods

A total of 952 participants (80% male), recruited as part of a wider study, completed the AUDIT-10. We systematically assessed all possible combinations of three or four AUDIT items and established AUDIT variations using the following statistics: Cronbach’s alpha (internal consistency), variance explained (R2) and Pearson’s correlation coefficient (concurrent validity).

Results

Median AUDIT-10 score was 7 for males and 6 for females, and 380 (40%) participants were classified as having a score indicative of harmful or hazardous alcohol use (≥8) according to WHO classifications.

A novel four-item AUDIT variation (3, 4, 8 and 9) performed consistently higher than established variations across statistical measures; it explained 85% of variance in AUDIT-10, had a Pearson’s correlation of 0.92 and Cronbach’s alpha was 0.63. The FAST, an established shortened AUDIT variant, together with several other four-item novel variants of AUDIT-10 performed similarly. The AUDIT-C performed consistently low on all measures, but with a satisfactory level of internal consistency (75%).

Conclusion

Shortened AUDIT variations may be suitable alternatives to the full AUDIT for screening hazardous alcohol consumption in military populations. Four-item AUDIT variations focused on short-term risky drinking and its consequences performed better than three item versions.

Trial registration number

ACTRN12614001332617.

Prospective risk factors for post-deployment heavy drinking and alcohol or substance use disorder among US Army soldiers

BACKGROUND

Investigations of drinking behavior across military deployment cycles are scarce, and few prospective studies have examined risk factors for post-deployment alcohol misuse.

METHODS

Prevalence of alcohol misuse was estimated among 4645 US Army soldiers who participated in a longitudinal survey. Assessment occurred 1-2 months before soldiers deployed to Afghanistan in 2012 (T0), upon their return to the USA (T1), 3 months later (T2), and 9 months later (T3). Weights-adjusted logistic regression was used to evaluate associations of hypothesized risk factors with post-deployment incidence and persistence of heavy drinking (HD) (consuming 5 + alcoholic drinks at least 1-2×/week) and alcohol or substance use disorder (AUD/SUD).

RESULTS

Prevalence of past-month HD at T0, T2, and T3 was 23.3% (s.e. = 0.7%), 26.1% (s.e. = 0.8%), and 22.3% (s.e. = 0.7%); corresponding estimates for any binge drinking (BD) were 52.5% (s.e. = 1.0%), 52.5% (s.e. = 1.0%), and 41.3% (s.e. = 0.9%). Greater personal life stress during deployment (e.g., relationship, family, or financial problems) - but not combat stress - was associated with new onset of HD at T2 [per standard score increase: adjusted odds ratio (AOR) = 1.20, 95% CI 1.06-1.35, p = 0.003]; incidence of AUD/SUD at T2 (AOR = 1.54, 95% CI 1.25-1.89, p < 0.0005); and persistence of AUD/SUD at T2 and T3 (AOR = 1.30, 95% CI 1.08-1.56, p = 0.005). Any BD pre-deployment was associated with post-deployment onset of HD (AOR = 3.21, 95% CI 2.57-4.02, p < 0.0005) and AUD/SUD (AOR = 1.85, 95% CI 1.27-2.70, p = 0.001).

CONCLUSIONS

Alcohol misuse is common during the months preceding and following deployment. Timely intervention aimed at alleviating/managing personal stressors or curbing risky drinking might reduce risk of alcohol-related problems post-deployment.