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Adams RS, Corrigan JD, Ritter GA, Pringle ZA, Zolotusky G, Blayney R, Reif S. Association of Disability Status and Type With Binge Drinking and Prescription Opioid Misuse Among Adults From a 3-State Sample. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:453-465. [PMID: 38509844 DOI: 10.1177/29767342241236027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Research examining at-risk substance use by disability status is limited, with little investigation into differences by disability type. We investigated binge drinking and prescription opioid misuse among adults with and without disabilities, and by type of disability, to inform need for assessment and intervention within these populations. METHODS Secondary analyses of adults who completed the disability, alcohol, and prescription opioid misuse items in the 2018 Ohio, Florida, or Nebraska Behavioral Risk Factor Surveillance System surveys (n = 28 341), the only states that included prescription opioid misuse in 2018. Self-reported disability status (yes/no) relied on 6 standardized questions assessing difficulties with: vision, hearing, mobility, cognition, self-care, and independent living (dichotomous, nonmutually exclusive, for each disability). Logistic regression models estimated the association of disability status and type with (1) past 30-day binge drinking and (2) past-year prescription opioid misuse. Additional models were restricted to separate subsamples of adults who: (a) currently drink, (b) received a past-year prescription opioid, and (c) did not receive a past-year prescription opioid. RESULTS One-third reported at least one disability, with mobility (19.5%), cognitive (11.5%), and hearing (10.2%) disability being the most common. Disability status was associated with lower odds of binge drinking (adjusted odds ratio [AOR] = 0.74, 95% confidence interval [CI] 0.68-0.80, P ≤ .01). However, among adults who currently drink, people with disabilities had higher odds of binge drinking (AOR = 1.11, 95% CI 1.01-1.22, P ≤ .05]. Disability was associated with higher odds of past-year prescription opioid misuse (AOR = 2.51, 95% CI 2.17-2.91, P ≤ .01). CONCLUSIONS Adults with disabilities had higher odds of prescription opioid misuse, and among adults who currently drink, higher odds for binge drinking were observed. The magnitude of the association between disability status and prescription opioid misuse was particularly concerning. Providers should be trained to screen and treat for substance use problems for people with disabilities.
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Affiliation(s)
- Rachel Sayko Adams
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Grant A Ritter
- Schneider Institutes for Health Policy and Research, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Zoe A Pringle
- The Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Galina Zolotusky
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Rachel Blayney
- Ohio Department of Health, Violence and Injury Epidemiology and Surveillance Section, Columbus, OH, USA
| | - Sharon Reif
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Schulz JA, Gimm G, West JC, Kock L, Villanti AC. Patterns of Alcohol, Marijuana, and Tobacco Use Among U.S. Adolescents and Young Adults by Disability Status: 2015-2019. J Adolesc Health 2024; 74:764-773. [PMID: 38043040 PMCID: PMC10960707 DOI: 10.1016/j.jadohealth.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/28/2023] [Accepted: 09/12/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE To estimate the national prevalence of tobacco, marijuana, and alcohol use among U.S. adolescents (age 12-17) and young adults (aged 18-25; adolescents and young adults [AYAs]) with a disability and examine associations between disability and substance use from 2015 to 2019. METHODS Data from the 2015-2019 National Survey on Drug Use and Health were used to estimate the prevalence of tobacco, marijuana, and alcohol use among AYAs with disabilities. Modified Poisson regression models evaluated linear time trends in past-month substance use and estimated adjusted prevalence ratios (aPRs) for past-month cigarette, any tobacco, alcohol, and marijuana use. RESULTS Adolescents with any disability had a higher prevalence of past-month cigarette (aPR = 1.87; 95% CI 1.67-2.09), alcohol (aPR = 1.21; 95% CI 1.11-1.31), and marijuana use (aPR = 1.47; 95% CI 1.36-1.60) compared to those without disabilities. Cigarette smoking among adolescents decreased over this time period; however, the decline among adolescents without a disability was greater than those with any disability. Young adults with any disability had a higher prevalence of past-month cigarette (aPR = 1.42; 95% CI 1.35-1.48) and marijuana use (aPR = 1.39; 95% CI 1.34-1.45), but a lower prevalence of past-month alcohol use (aPR = 0.93; 95% CI 0.90-0.95) than those without disabilities. Alcohol use remained constant among young adults with any disability but decreased for those without disabilities. DISCUSSION Population-level disparities in cigarette and marijuana use exist in AYAs with disabilities. Future studies should identify strategies tailored to AYAs with disabilities to encourage smoking cessation and prevent cannabis use disorder.
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Affiliation(s)
- Jonathan A Schulz
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont.
| | - Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Julia C West
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont; Department of Psychological Science, University of Vermont, Burlington, Vermont
| | - Loren Kock
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont
| | - Andrea C Villanti
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Aram J, Slopen N, Arria AM, Liu H, Dallal CM. Drug and alcohol use disorders among adults with select disabilities: The national survey on drug use and health. Disabil Health J 2023:101467. [PMID: 37088676 DOI: 10.1016/j.dhjo.2023.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Deaths caused by drugs and alcohol have reached high levels in the US, and prior research shows a consistent association between disability status and substance misuse. OBJECTIVE Using national data, this study quantifies the association between disability status and drug and alcohol use disorders among US adults. METHODS The most recent pre-pandemic years (2018-2019) of the cross-sectional National Survey on Drug Use and Health (n = 83,439) were used to examine how the presence of any disability, and specific disabilities, were associated with past year drug and alcohol use disorders. Logistic regression was used to estimate adjusted odds ratios (aORs) controlling for potential sociodemographic confounders. RESULTS Adults with any disability had increased odds of drug (aOR = 2.7; 95% CI = 2.5-3.0), and alcohol use disorder (aOR = 1.8; 95% CI = 1.6-2.0), compared to adults without disability. Examining specific types of disabilities, adults with cognitive limitations only had increased odds of drug (aOR = 3.1; 95% CI = 2.6-3.6), and alcohol use disorders (aOR = 2.2; 95% CI = 1.9-2.5), compared to adults without disability. Smaller associations were observed between vision and complex activity limitations and drug use disorder. Adults with two or more types of limitations had increased odds of drug (aOR = 3.7; 95% CI = 3.3-4.3), and alcohol use disorders (aOR = 2.3; 95% CI = 2.0-2.6). CONCLUSIONS The presence of disability, especially cognitive limitation only, or two or more types of limitations, is associated with elevated odds of drug and alcohol use disorder among US adults. Additional research should examine the temporal relationship between and mechanisms linking disability and substance misuse.
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Affiliation(s)
- Jonathan Aram
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, 4200 Valley Drive, Suite 2242, University of Maryland College Park, MD 20742, USA.
| | - Natalie Slopen
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave. Boston, MA 02115, USA.
| | - Amelia M Arria
- Department of Behavioral & Community Health, University of Maryland School of Public Health, 4200 Valley Drive, Suite 2242, University of Maryland College Park, MD 20742, USA.
| | - Hongjie Liu
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, 4200 Valley Drive, Suite 2242, University of Maryland College Park, MD 20742, USA.
| | - Cher M Dallal
- Department of Epidemiology & Biostatistics, University of Maryland School of Public Health, 4200 Valley Drive, Suite 2242, University of Maryland College Park, MD 20742, USA.
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Gimm G, Parekh T, Kitsantas P. Assessing the prevalence and risk factors of marijuana use in adults with disabilities. Addict Behav 2023; 138:107559. [PMID: 36459827 DOI: 10.1016/j.addbeh.2022.107559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/09/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Public support for the legalization of marijuana (cannabis) for medical or recreational use by adults has grown rapidly over the past two decades. Given the growing prevalence and concerns about potential harms, a better understanding is needed of disparities in marijuana use among adults by disability status. METHODS Using 2015-2019 data from the National Survey on Drug Use and Health (NSDUH), we obtained a national sample of 195,130 working-age (18-64 year) adults. Descriptive and multivariable analyses were conducted to assess the prevalence and risk factors associated with marijuana use among adults by disability status and type. RESULTS We found the prevalence of marijuana use was higher among adults with disabilities (16.6% vs 10.9%) compared to those without disabilities, and this disparity widened from 2015 to 2019. Furthermore, the odds of marijuana use varied by disability type. Specifically, adults with vision disability only (OR 1.28; 95% CI 1.14-1.44), cognitive disability only (OR 1.24; 95% CI 1.13-1.35), and those with multiple disabilities (OR 1.22; 95% CI 1.11-1.34) had higher odds of marijuana use compared to adults without any disability. CONCLUSIONS Adults with disabilities have a higher prevalence of marijuana use compared to those without disabilities. Living in a state with legalized medical marijuana also increased the odds of marijuana use. These findings can help to inform policy and public health surveillance of marijuana use in the U.S. Further studies are needed to monitor the rising prevalence of marijuana use and examine how intensity of marijuana use affects health outcomes in adults with and without disabilities.
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Affiliation(s)
- Gilbert Gimm
- Department of Health Administration and Policy, George Mason University, United States.
| | - Tarang Parekh
- Department of Health Administration and Policy, George Mason University, United States
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, United States
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Abstract
According to the social model of disability, it is not individuals' impairments, but societal barriers that cause these impairments to be disabling. Impairment refers to the "loss or abnormality of psychological, physiological, or anatomical structure or function," whereas disability is socially constructed and refers to the inability to independently complete one or more everyday tasks at a "normal" level of functioning. Existing research finds that disability serves as a chronic stressor, and those with disabilities report higher rates of substance use than their able-bodied counterparts. Therefore, this research will be among the first to combine the social model of disability with the stress process framework. It will examine the relationship between impairment and substance use and how disability, as a measure of chronic stress, may affect this relationship. More specifically, using data from the 2019 National Survey on Drug Use and Health (N = 42,739), this article examines the following two research questions: (1) What is the relationship between impairment and substance use disorder? and (2) Does disability, as a measure of chronic stress, mediate the relationship between impairment and substance use disorder? Findings reveal that those with an impairment have significantly greater odds of having a substance use disorder. However, the relationship between impairment and substance use disorder is fully mediated by disability. These findings indicate that disability or the chronic stress one faces living in an inaccessible society, not one's impairments, are what accounts for the increased likelihood of substance use disorder among individuals with disabilities.
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Hinson-Enslin AM, Nahhas RW, McClintock HF. Vision and hearing loss associated with lifetime drug use: NHANES 2013-2018. Disabil Health J 2022; 15:101286. [DOI: 10.1016/j.dhjo.2022.101286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
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Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Pastor-Barriuso R, Galán I. Clustering of unhealthy lifestyle behaviors, self-rated health and disability. Prev Med 2022; 155:106911. [PMID: 34922996 DOI: 10.1016/j.ypmed.2021.106911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/20/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022]
Abstract
The main objective was to identify sociodemographic characteristics of the population at risk for a greater clustering of unhealthy behaviors and to evaluate the association of such clustering with self-rated health status and disability. Data come from the 2017 Spanish National Health Survey with a sample of 21,947 participants of 15 years of age or older. Based on tobacco consumption, risk drinking, unbalanced diet, sedentarism, and body mass index <18.5/≥25 we created two indicators of risk factor clustering: 1) Number of unhealthy behaviors (0-5); and 2) Unhealthy lifestyle index (score: 0-15). Self-rated health was dichotomized into "optimal" and "suboptimal," and disability was classified as "no disability," "mild," and "severe" based on the Global Activity Limitation Index (GALI). We estimated prevalence ratios (PR) adjusted for covariates using generalized linear models using the clustering count variable, and dose-response curves using the unhealthy lifestyle index. Most participants (77.4%) reported 2 or more risk factors, with men, middle-age individuals, and those with low socioeconomic status being more likely to do so. Compared to those with 0-1 risk factors, the PR for suboptimal health was 1.26 (95% CI:1.18-1.34) for those reporting 2-3 factors, reaching 1.43 (95% CI:1.31-1.55) for 4-5 factors. The PR for severe activity limitation was 1.66 (95% CI:1.35-2.03) for those reporting 2-3 factors and 2.06 (95% CI:1.59-2.67) for 4-5 factors. The prevalence of both health indicators increased in a non-linear fashion as the unhealthy lifestyle index score increased, increasing rapidly up to 5 points, slowing down between 5 and 10 points, and plateauing afterwards.
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Affiliation(s)
- Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain.
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