Gender, occupational, and socioeconomic correlates of alcohol and drug abuse among U.S. rural, metropolitan, and urban residents

A closer examination of the "rural mortality penalty": Variability by race, region, and measurement

BACKGROUND

Racial health disparities are well documented and pervasive across the United States. Evidence suggests there is a "rural mortality penalty" whereby rural residents experience poorer health outcomes than their urban counterparts. However, whether this penalty is uniform across demographic groups and U.S. regions is unknown.

OBJECTIVE

To assess how rural-urban differences in mortality differ by race (Black vs. White), U.S. region, poverty status, and how rural-urban status is measured.

METHODS

Age-standardized mortality rates (ASMRs)/100,000 by U.S. county (2015-2019) were obtained by race (Black/White) from the CDC Wonder National Vital Statistics System (2015-2019) and were merged with county-level social determinants from the US Census Bureau and County Health Rankings. Multivariable generalized linear models assessed the associations between rurality (index of relative rurality [IRR] decile, rural-urban continuum codes, and population density) and race-specific ASMR, overall, and by Census region and poverty level.

RESULTS

Overall, average ASMR was significantly higher in rural areas than urban areas for both Black (rural ASMR = 949.1 per 100,000 vs. urban ASMR = 857.7 per 100,000) and White (rural ASMR = 903.0 per 100,000 vs. urban ASMR = 791.6 per 100,000) populations. The Black-White difference was substantially higher (p < 0.001) in urban than in rural counties (65.1 per 100,000 vs. 46.1 per 100,000). Black-White differences and patterns in ASMR varied notably by poverty status and U.S. region.

CONCLUSION

Policies and interventions designed to reduce racial health disparities should consider and address key contextual factors associated with geographic location, including rural-urban status and socioeconomic status.

Pattern of novel psychoactive substance use among patients presented to the poison control centre of Ain Shams University Hospitals, Egypt: A cross-sectional study

Background

Novel psychoactive substances (NPSs) are relatively new substances in the illicit drug market, not previously listed in the United Nations Office on Drugs and Crime (UNDOC). Strox and Voodoo are considered some of the most popular blends of NPS in the Egyptian drug market.

Objectives

The current study was conducted to assess NPS's use pattern: Voodoo and Strox among acutely intoxicated patients presented to the poison control center of Ain Shams University Hospitals (PCC- ASUH).

Methods

A single center based cross-sectional study was carried out in the PCC-ASUH among acutely intoxicated patients presenting to the emergency department (ED) over four months (from January-April 2019. using a previously adopted and validated Fahmy and El-Sherbini socioeconomic scale (SES). Data were presented as mean, median and range as appropriate. Both smoking and crowding indexes were calculated and presented as previously reported.

Results

Fifty-one patients were presented to the ED of PCC-ASUH during the study period. A total of 96.1% (n = 49) were males. The mean age was 25 ± 7.5 years. The most common NPS used was Strox: 54.9% (n = 28), followed by Voodoo: 27.4% (n = 14). Neurological and gastrointestinal (GI) symptoms were the most frequent presentations. The most common motive behind NPS use was the desire to give a trial of new psychoactive substances. The mean SES score was 35.1 ± 13.17. Most patients have the preparatory as the highest education 36.0% (n = 18).

Conclusions

NPS use is common among young males in preparatory education from different social classes, starting it most commonly as a means to experiencing a new high. Neurological and GI manifestations are the most common presenting symptoms of NPS intoxication.

Self-perceived substance and behavioral addictions among Jewish Israeli adolescents during the COVID-19 pandemic

This study examined self-perceived substance and behavioral addictions among Israeli adolescents during the COVID-19 pandemic across different sociodemographic categories. The sample comprised 2,074 adolescents (40% males, 60% females) aged 12-19 years who completed the survey anonymously and with parental consent. We examined what is the prevalence of self-perceived substance and behavioral addictions in this population in the COVID-19 pandemic context. Participants reported self-perceived addictions to social networks (70%), shopping (46%), binge eating (34%), gaming (30%), sex-related behavior (15%), psychoactive substance (31%, including alcohol, tobacco, cannabis, and/or cocaine), and gambling (3%). Moreover, differences were found to be directly related to age, biological sex, religiosity, socioeconomic status, and immigration status. From a lay epidemiological perspective, the current research expands our knowledge about self-perceived addiction among adolescents during the COVID-19 pandemic, offering better understanding of the likelihood probability factors for self-perceived addiction among adolescents and its related negative outcomes, including increased risk factors for later adult life.

Place of alcohol in the 'wellness toolkits' of midlife women in different social classes: A qualitative study in South Australia

In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.

Hazardous alcohol use and alcohol-related harm in rural and remote communities: a scoping review

Alcohol use is a major risk factor for death and disease worldwide and alcohol-related harms appear to be more prevalent in rural and remote, relative to urban, communities. This Review synthesised international research on rural-urban disparities in hazardous and harmful alcohol use and risk factors for these outcomes within rural and remote communities. 280 studies from 49 countries were included in the Scoping Review. Most studies (60%) found rural, relative to urban, residence to be associated with an increased likelihood of hazardous alcohol use or alcohol-related harm. This proportion increased between 1990 and 2019 and varied by country, age group, and outcome type, being highest in Australia, among young adults, and for more severe alcohol-related harms, such as drink driving and alcohol-related suicide. Improved public health strategies to reduce the burden of alcohol use in rural communities are required but their efficacy will depend on how well they are tailored to the unique needs of the region they are implemented in.

Adolescent measures of family socioeconomic status: Reliability, validity, and effects on substance use behaviors in adolescence and young adulthood

Socioeconomic status (SES) is a robust predictor of health disparities in adolescence and early adulthood, yet obtaining accurate and reliable measurements of family SES from younger participants remains a challenge. We evaluated the reliability and validity of a subjective SES measure, i.e., perceived family financial security (PFS), which assesses adolescents' perceptions of whether their family has enough money to meet their needs. We also examined the predictive associations of PFS and parental education (adolescent reports) with alcohol, marijuana, and tobacco use during adolescence and young adulthood. Longitudinal data were obtained from 593 parent-child dyads in the Pacific Northwest region of the United States, who were assessed eight times between 2005 and 2014. Present analyses included data from four annual assessments conducted when the participating children were adolescents (age range = 10.25-16.33 years) and a final follow-up in young adulthood (age range = 20-23.42 years). PFS had good test-retest reliability and convergent validity with other parent and adolescent reported SES measures. Adolescent-reported PFS significantly predicted tobacco use frequency in young adulthood, whereas adolescent-reported parental education predicted alcohol use frequency. PFS was not a significant predictor of alcohol or marijuana use. Findings suggest that PFS can be a psychometrically sound measure to assess a unique dimension of SES in adolescent samples, with differential predictive associations among substance use outcomes in young adulthood compared to more traditional measures like parental education. Future research should evaluate the psychometric properties and utility of PFS as a complementary SES measure.

Differences in how spouses influence each other's alcohol use in same- and different-sex marriages: A daily diary study

RATIONALE

Different-sex spouses influence each other's alcohol consumption, with women having more influence on their spouses than men. Because women drink less than men, this long-term influence partly explains why married men and women consume less alcohol than their unmarried peers. However, much less is known about possible gender differences in the ways spouses influence each other's alcohol use on a day-to-day basis in same-compared to different-sex marriages. Because sexual minority people are at higher risk for alcohol use disorders compared to their heterosexual counterparts, such knowledge could shed light on ways to reduce this risk and alcohol use disparities between sexual minority and heterosexual people.

METHOD

We use 10 days of diary data collected in 2014-2015 in the United States from 157 female same-sex, 106 male same-sex, and 115 different-sex married couples in midlife (ages 35-65) to examine how one spouse's drinking influences how much the other spouse drinks on the following day.

RESULTS

Men reported higher levels of daily drinking than women; after including covariates, men in different-sex marriages reported drinking at the highest levels. Results from actor-partner interdependence models show that men in same- and different-sex marriages drink more, and women in different-sex marriages drink less when their spouse drinks more the previous day. Female same-sex spouses did not change their drinking behaviors in response to their spouse's drinking.

CONCLUSIONS

Overall higher rates of drinking among men in same-sex marriages suggest an accumulation effect of drinking that may contribute to sexual minority health disparities. Women and men in different-sex marriages may be engaging in social control or navigating masculinity norms. Women in same-sex marriages may not feel the need to adjust to low levels of drinking by their spouses. Findings suggest that spousal influence over alcohol consumption unfolds differently in same-sex compared to different-sex marriages.

Mental illness, drinking, and the social division and structure of labor in the United States: 2003-2015

BACKGROUND

We draw on a relational theoretical perspective to investigate how the social division and structure of labor are associated with serious and moderate mental illness and binge and heavy drinking.

METHODS

The Panel Study of Income Dynamics and the Occupational Information Network were linked to explore how occupation, the productivity-to-pay gap, unemployment, the gendered division of domestic labor, and factor-analytic and theory-derived dimensions of work are related to mental illness and drinking outcomes.

RESULTS

Occupations involving manual labor and customer interaction, entertainment, sales, or other service-oriented labor were associated with increased odds of mental illness and drinking outcomes. Looking for work, more hours of housework, and a higher productivity-to-pay gap were associated with increased odds of mental illness. Physical/risky work was associated with binge and heavy drinking and serious mental illness; technical/craft work and automation were associated with binge drinking. Work characterized by higher authority, autonomy, and expertise was associated with lower odds of mental illness and drinking outcomes.

CONCLUSIONS

Situating work-related risk factors within their material context can help us better understand them as determinants of mental illness and identify appropriate targets for social change.

Alcohol consumption among rural African American and White adolescents: The role of religion, parents, and peers

Although studies have examined ethnic differences in psychosocial factors and adolescent alcohol use, most have not examined these relationships for rural adolescents. The Community Drug and Alcohol Survey (CDAS) was completed by 23,163 rural adolescents attending African American secondary schools. Multilevel analysis tested the hypothesis of stronger relationships of peer use and religiosity with alcohol use and a weaker relationship for parental permissiveness and alcohol use for White compared to African American adolescents. Results suggested that peer use, religiosity, and parental permissiveness were more strongly associated with changes in alcohol use for White adolescents. Findings provide insight for alcohol prevention among rural adolescents.

Explaining socioeconomic inequalities in illicit drug use disorders in Iran

Background: Drug use disorders are one of the major health problems in societies, which cause physical, psychological, and social damages to individuals. Socioeconomic status is often inversely associated with drug use disorders. The present study aimed at determining the effect of socioeconomic inequality on the prevalence of drug use disorders and identifying its determinants in Iran.

Methods: Data of 7886 individuals aged 15 to 64 years were collected from Iran Mental Health Survey (IranMHS). Initially, the socioeconomic status of the participants was determined by principal component analysis. Later, socioeconomic inequality was measured using the concentration index, and the factors influencing the gap between the high and low socioeconomic groups were identified using the Oaxaca-Blinder Decomposition.

Results: The concentration index for drug use disorders in Iran was -0.29 (standard error= 0.06). The results of decomposition technique revealed that 1.14% and 2.7% of the participants with high and low socioeconomic status were affected by drug use disorders, respectively. In addition, the gap between these 2 groups was found to be 1.65%. Among the studied variables, occupation, marital status, and gender accounted for the highest contribution to inequality, respectively.

Conclusion: There is inequality in the prevalence of drug use disorders in Iran; these disorders are more common in lower socioeconomic group. Based on the findings, it is suggested that improvement in the socioeconomic status of the households, especially for males, the divorced or widowed individuals, and the unemployed may lead to a reduction in inequality in drug use disorders.

Heterogeneity in educational pathways and the health behavior of U.S. young adults

An increasing number of U.S. adults are progressing through college in decidedly more complex ways. Little is known, however, about how this growing heterogeneity may be associated with the health behaviors and ultimately health of young adults. Using a life course perspective, we investigate whether and why different educational pathways - that is, variation in when people attend and complete school - are associated with daily smoking and binge drinking among U.S. young adults. We use 14 waves (1997-2011) of data from the National Longitudinal Survey of Youth 1997 cohort (n=7,359) that enable us to identify the most common educational pathways, as well as their association with young adult health behaviors. Bachelor's degree recipients who enrolled immediately after high school but did not attain their degree within 4 years were more likely to smoke daily in early adulthood (i.e., ages 26 to 32) than those who enrolled in college immediately after high school and attained a bachelor's degree within 4 years. Conversely, bachelor's degree recipients who delayed college enrollment were less likely to binge drink in early adulthood than individuals who enrolled in college immediately after high school and attained a bachelor's degree within 4 years. Marital status and household income in young adulthood accounted for some of the relationships between educational pathways and health behavior. These findings highlight the complexity of education's relationship to health behavior and strongly suggest that heterogeneity in educational pathways should be explicitly examined in population health research. Word Count: 241.

Illegal drug use and its correlates in San Juan, Puerto Rico

BACKGROUND

Data on the prevalence and correlates of illegal drug use in Puerto Rico are now almost 20 years old.

OBJECTIVES

This study sought to estimate the 12-month prevalence of illegal and non-prescribed medical drug use in San Juan, Puerto Rico and identify sociodemographic correlates of use.

METHODS

Data are from a random household sample of 1510 individuals, 18-64 years of age in San Juan, Puerto Rico.

RESULTS

The 12-month prevalence of any illegal or non-prescribed drug use was 16.5%. Prevalence among men (20.7%) was higher than among women (12.9%; chi² = 16.308; df = 1; p < .01). Prevalence for specific drugs ranged from 11.2% for marijuana to 0.2% for methadone.

RESULTS

of the multiple logistic regression analysis showed that male gender (OR = 1.67, 95CI = 1.21-2.3; p < .01), age 18-29 (OR = 2.39; 95CI = 1.35-4.23; p < .01), age 30-39 (OR = 1.93; 95CI = 1.01-3.69; p < .05), low (OR = 2.03; 95CI = 1.36-3.02; p < .001) and medium (OR = 1.50; 95CL = 1.01-2.23; p < .05) family cohesion/pride, and no religious preference (OR = 1.99; 95CI = 1.23-3.22; p < .01) increased the odds of drug use. Annual family income of $40,000-$60,000 (OR = 0.45; 95CI = 0.21-0.93; p < .05) and $60,001 and more (OR = 0.35; 95CI = 0.13-0.94; p > .05) were negatively associated with drug use compared to annual income up to $10,000.

CONCLUSIONS

As in many other places in the U.S., drug use in San Juan, Puerto Rico is high, affecting about 1 in 6 adults in the population. The highest prevalence is for marijuana use, which cannot be medically prescribed and of which recreational use is illegal on the island.

Alcohol consumption among tobacco farmers: prevalence and associated factors

RESULTS

This study aims to describe the prevalence of heavy drinking, high-risk alcohol consumption and associated factors among tobacco farmers. A cross-sectional study was carried out with 2,469 tobacco farmers over 18 years old in 2011. High-risk alcohol consumption was considered the intake of three or more standard doses per day for men or two or more for women. Heavy drinking was considered the intake of four or more standard doses per day for men and three or more for women. Hierarchical multivariate analysis was performed to investigate the association with socioeconomic, behavioral, and occupational variables. : The prevalence of high-risk and heavy drinking was of 4.7% and 1.09% among women and 30.8% and 4.8% among men, respectively. The factors associated with high-risk drinking for men and women were the percentage of income tobacco accounted for (PR 1.3 and 0.4), being an employee (PR 1.3 and 3.1), and use of pesticides (PR 1.5 and 2.1), respectively. Heavy drinking among men was associated with losing the crop (PR 1.6), attending religious activities (PR 0.3), and hours working in agriculture (PR 0.6). Occupational factors were associated wit high-risk alcohol consumption among men. The associated factors vary according to the pattern of consumption assessed.

Recent Trend and Associated Factors of Harmful Alcohol Use Based on Age and Gender in Korea

BACKGROUND

Previous studies suggest that the impact of social factors on harmful alcohol use between men and women may be different. We aimed to explore the gender-based difference in temporal trend and social risk factors associated with harmful alcohol use.

METHODS

The Korea National Health and Nutrition Examination Survey (2007-2014) was used to explore the recent trend of harmful alcohol use in the general population. Among all current alcohol drinkers aged 20-64 years, the frequencies of harmful alcohol use in each age group, year of birth, marriage, income, education, and occupation were analyzed based on gender.

RESULTS

A total of 34,478 people (14,544 men and 19,834 women) who reported drinking alcohol in the last month at the time of interview were included in the analysis. The proportion of harmful alcohol use in men decreased (P for trend = 0.002) during the study period, whereas significant change was not observed in women (P for trend = 0.173). The prevalence of harmful alcohol use was highest in men aged 35-49 years and women aged 20-34 years. For both men and women, lower level of education and service occupation were the common risk factors of harmful alcohol use. Additionally, low income was a risk factor of harmful alcohol use in women but not in men. Marriage increased the risk of harmful alcohol use in women but decreased in men.

CONCLUSION

Public health interventions in reducing harmful alcohol use should consider the different high-risk groups between men and women.

Parallel contagion phenomenon of concordant mental disorders among married couples: a nationwide cohort study

BACKGROUND

The aggregation of mental disorders in couples, as reported by prior research, indicates the effect of familial environments and warrants attention. However, the concordant categories of mental disorders in couples remain unclear. This study investigated spousal concordance for the category of mental disorders among couples throughout Taiwan by using factors associated with such disorders.

METHODS

5643 couples in the 2002-2013 Taiwan National Health Insurance Research Database were analysed and compared with propensity-matched 5643 non-couples. Twelve independent variables, including spouse and shared characteristics, and the category of mental disorders were analysed, mainly by using multinomial logistic regression.

RESULTS

The determined prevalence rates for concordant categories of mental disorder were 0.19% for affective disorders, 6.96% for anxiety disorders, and 3.15% of other mental disorders. Multinomial logistic regression results revealed that two spouses were significantly more likely to be diagnosed with the same category of the aforementioned mental disorders (ORs=2.914, 1.776 and 1.727, respectively). Other associated factors included gender, age, occupation, comorbidity and region. The odds of concordances were significantly higher in couples than in non-couples.

CONCLUSIONS

A category of mental disorder in one spouse is a determinant of that in the other spouse. This study extended the emotional contagion theory to the phenomenon of parallel contagion to reflect the three concordances, suggesting a direction of family-based mental health intervention, particularly prevention for the same category of mental disorders in couples. Policymakers should strengthen the coping strategies of the caring spouse and external support system to psychiatrically vulnerable families.

Disparities in Substance Abuse Treatment Utilization Among Women with Intellectual Disability

Despite concerns about health disparities among women with intellectual disabilities, little is known about substance abuse treatment access in this population. Using standardized performance measures, treatment initiation and engagement were examined retrospectively for women aged 18 to 64 (N = 3,752), men with (N = 5,732) and women without intellectual disability (N = 493,446). Logistic regression models of utilization were conducted. Women in the sample were less likely than men in the sample or women without intellectual disability to utilize treatment, suggesting both gender-related and disability-related barriers. Policy and practice implications for improving the health and welfare of women with intellectual disabilities are discussed.

Clinical Experiences With Clients Who Are Low-Income: Mental Health Practitioners' Perspectives

The experiences of nine licensed mental health practitioners regarding their work with clients from low-income backgrounds were examined utilizing grounded theory methodology. Themes that emerged from the semi-structured interviews highlighted a rich narrative that portrayed the work as both deeply satisfying and inherently complex. Participants described the personal nature of this work, including countertransference elicited because of their own personal economic contexts and emotional reactions experienced within and outside the therapy room. Their stories acknowledged systematic challenges that act as barriers to treatment. Some participants noted that this has contributed to feelings of disillusionment toward the field as well as fears about the future of the mental health care. Based on these findings, we discuss implications for training, future research, and clinical practice.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

A multilevel model of postmenopausal breast cancer incidence

BACKGROUND

Breast cancer has a complex etiology that includes genetic, biologic, behavioral, environmental, and social factors. Etiologic factors are frequently studied in isolation with adjustment for confounding, mediating, and moderating effects of other factors. A complex systems model approach may present a more comprehensive picture of the multifactorial etiology of breast cancer.

METHODS

We took a transdisciplinary approach with experts from relevant fields to develop a conceptual model of the etiology of postmenopausal breast cancer. The model incorporated evidence of both the strength of association and the quality of the evidence. We operationalized this conceptual model through a mathematical simulation model with a subset of variables, namely, age, race/ethnicity, age at menarche, age at first birth, age at menopause, obesity, alcohol consumption, income, tobacco use, use of hormone therapy (HT), and BRCA1/2 genotype.

RESULTS

In simulating incidence for California in 2000, the separate impact of individual variables was modest, but reduction in HT, increase in the age at menarche, and to a lesser extent reduction in excess BMI >30 kg/m(2) were more substantial.

CONCLUSIONS

Complex systems models can yield new insights on the etiologic factors involved in postmenopausal breast cancer. Modification of factors at a population level may only modestly affect risk estimates, while still having an important impact on the absolute number of women affected.

IMPACT

This novel effort highlighted the complexity of breast cancer etiology, revealed areas of challenge in the methodology of developing complex systems models, and suggested additional areas for further study.

Preconception health indicators: a comparison between non-Appalachian and Appalachian women

To compare preconception health indicators (PCHIs) among non-pregnant women aged 18-44 years residing in Appalachian and non-Appalachian counties in 13 U.S. states. Data from the 1997-2005 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of PCHIs among women in states with ≥1 Appalachian county. Counties were classified as Appalachian (n = 36,496 women) or non-Appalachian (n = 88,312 women) and Appalachian counties were categorized according to economic status. Bivariate and multivariable logistic regression models examined differences in PCHIs among women by (1) Appalachian residence, and (2) economic classification. Appalachian women were younger, lower income, and more often white and married compared to women in non-Appalachia. Appalachian women had significantly higher odds of reporting Collapse

Key Words

• preconception health
• appalachia
• disparities
• socioeconomic status
• behavioral risk factor surveillance system
• rural populations

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MESH Headings

• Adolescent
• Adult
• Age Factors
• Appalachian Region/epidemiology
• Behavioral Risk Factor Surveillance System
• Cross-Sectional Studies
• Female
• Health Behavior
• Health Status
• Health Status Indicators
• Healthcare Disparities
• Humans
• Insurance Coverage/statistics & numerical data
• Logistic Models
• Obesity/epidemiology
• Population Surveillance
• Preconception Care
• Prevalence
• Preventive Health Services/statistics & numerical data
• Risk Factors
• Rural Population
• Socioeconomic Factors
• United States/epidemiology
• Vaginal Smears/statistics & numerical data
• Young Adult

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Grants

• CC999999 Intramural CDC HHS
• U38 HM000414 NCHM CDC HHS
• 5U38HM000414 NCHM CDC HHS

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Affiliation(s)

Vanessa L. Short Mississippi State Department of Health, Jackson, MS, USA
Reena Oza-Frank Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA. Department of Pediatrics, The Ohio State University, Columbus, OH, USA
Elizabeth J. Conrey Ohio Department of Health, State Maternal and Child Health Epidemiologist, 246 North High Street, Columbus, OH 43215, USA. Centers for Disease Control and Prevention, Atlanta, GA, USA

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Socioeconomic status and substance use among young adults: a comparison across constructs and drugs

OBJECTIVE

Little consensus exists regarding the relationship between socioeconomic status (SES) and substance use. This study examined the associations of three indicators of family SES during childhood--income, wealth, and parental education--with smoking, alcohol use, and marijuana use during young adulthood.

METHOD

Data were obtained from the national Panel Study of Income Dynamics, a survey of U.S. families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood data drawn from a national sample of young adults, 18-23 years old. Data from the young adults (N = 1,203; 66.1% White; 51.5% female) on their current use of alcohol, cigarettes, and marijuana were used as outcome variables in logistic regressions. Socioeconomic background was calculated from parental reports of education, wealth, and income during the respondent's childhood (birth through age 17 years).

RESULTS

Smoking in young adulthood was associated with lower childhood family SES, although the association was explained by demographic and social role covariates. Alcohol use and marijuana use in young adulthood were associated with higher childhood family SES, even after controlling for covariates.

CONCLUSIONS

Findings based on three indicators of family background SES--income, wealth, and parental education--converged in describing unique patterns for smoking and for alcohol and marijuana use among young adults, although functional relationships across SES measures varied. Young adults with the highest family background SES were most prone to alcohol and marijuana use.

Occupation as an independent risk factor for binge drinking

BACKGROUND

Understanding associations between binge drinking and occupation is important from economic and public health perspectives.

OBJECTIVE

While unadjusted differences in binge drinking by occupation have been reported previously, this study tests these differences after adjusting for important common determinants.

METHODS

To assess the relationship between occupation and binge drinking after adjusting for worker characteristics, a probit model was fit to data from 29,785 working-age respondents to the 2005 California Health Interview Survey. Unadjusted and adjusted marginal effects are reported. Professionals, the largest employed category, were the referent.

RESULTS

Professionals had a binge drinking risk of 16.6%. Before adjustment, workers in several occupational groups had higher risk compared to professionals, including those in installation (15.2 percentage points higher; 95% CI: 9.2, 21.1), construction (14.8 percentage points higher; 95% CI: 10.4, 19.2), and sales (6.9 percentage points higher; 95% CI: 4.0, 9.9), while those without employment had a 6.6 point lower risk (95% CI: -8.4, -4.9). After adjustment, workers employed in installation were 6.7 points (95% CI: 1.8, 11.7), construction 4.8 points (95% CI: 1.0, 8.6), and salespersons 5.3 points (95% CI: 2.8, 7.7) more likely to binge drink relative to professionals. No significant adjusted differences in risk between professionals and those without a job were found.

CONCLUSIONS

This study demonstrates binge drinking varies significantly across occupations. Adjusting for worker characteristics accounted for much of the unadjusted relationship between employment in physically demanding occupations (e.g., installation, construction) and binge drinking. Distinguishing between occupation- and employee-level determinants of alcohol misuse may improve employee assistance programs and preventive services.

Development and Exploration of the Experiences With Classism Scale

The examination of barriers in relation to college students’ vocational choice and development is an important area of research, but the barrier of classism is relatively underexamined. This may be due to the deficiencies in measurement, so we describe herein the development of a new measure, the Experiences with Classism scale (EWCS). The EWCS was developed to extend prior qualitative work that highlighted the need to consider experiences with classism in the lives of undergraduate students. Results provided initial evidence for the usefulness of the EWCS to measure undergraduate students’ experiences with classism at a personal and systemic level. Across two studies, the EWCS was demonstrated to have high internal consistency reliability, to have a stable factor structure consisting of two factors, to correlate as expected with relevant demographic variables, and to fit within a nomological network of convergent and discriminant constructs. The EWCS was also demonstrated to predict self-reported experiences of depression, anxiety, stress, self-esteem, and psychological wellness. Implications for further research and practice are suggested.

Use and abuse of alcohol and illicit drugs in US adolescents: results of the National Comorbidity Survey-Adolescent Supplement

CONTEXT

Comprehensive descriptions of substance use and abuse trajectories have been lacking in nationally representative samples of adolescents.

OBJECTIVE

To examine the prevalence, age at onset, and sociodemographic correlates of alcohol and illicit drug use and abuse among US adolescents.

DESIGN

Cross-sectional survey of adolescents using a modified version of the Composite International Diagnostic Interview.

SETTING

Combined household and school adolescent samples.

PARTICIPANTS

Nationally representative sample of 10,123 adolescents aged 13 to 18 years.

MAIN OUTCOME MEASURES

Lifetime estimates of alcohol and illicit substance use and DSM-IV diagnoses of abuse, with or without dependence.

RESULTS

By late adolescence, 78.2% of US adolescents had consumed alcohol, 47.1% had reached regular drinking levels defined by at least 12 drinks within a given year, and 15.1% met criteria for lifetime abuse. The opportunity to use illicit drugs was reported by 81.4% of the oldest adolescents, drug use by 42.5%, and drug abuse by 16.4%. The median age at onset was 14 years for alcohol abuse with or without dependence, 14 years for drug abuse with dependence, and 15 years for drug abuse without dependence. The associations observed by age, sex, and race/ethnicity often varied significantly by previous stage of use.

CONCLUSIONS

Alcohol and drug use is common in US adolescents, and the findings of this study indicate that most cases of abuse have their initial onset in this important period of development. Prevention and treatment efforts would benefit from careful attention to the correlates and risk factors that are specific to the stage of substance use in adolescents.

Differences between the factors affecting high-risk drinking and those affecting smoking in Korea

This study examines the factors influencing high-risk drinking and cigarette smoking and assesses the differences in those factors between 2 risky behaviors in Korea. A national, cross-sectional health behavior survey was performed on 12,303 households in 2006 and a data set of 2925 adult males was analyzed using bivariate probit estimation model. The likelihood of high-risk drinking rose with an increase in the level of income, whereas that of smoking was lowest in a medium income. White-collar workers were more at risk of high-risk drinking than blue-collar workers. Conversely, blue-collar workers tended to smoke more frequently than white-collar workers. Body mass index showed a positive association with high-risk drinking, but it had no significant relationship with smoking. Significant differences may exist in associations between factors influencing high-risk drinking and those influencing smoking. The comprehensive understanding of these differences would allow for the development of appropriate public health programs.

Predictors of mental distress among substance abusers receiving inpatient treatment

Background

Mental distress measured by the HSCL-10 is used as an indicator of psychiatric disorders in population studies, where a higher level of mental distress has been shown to be related to demographic factors such as living conditions and level of education. The first aim of the study was to explore whether mental distress could be a valuable concept in substance use treatment. The second aim of the study was to explore to what degree mental distress among substance users at admission to treatment could be explained by the same demographic factors as in population studies, or whether treatment differences or differences in substance use would be better predictors of mental distress in this population.

Methods

Patients (N = 185) who received inpatient substance use treatment in five different settings in Northern Norway participated in the study. HSCL-10 was used as a measure for mental distress at admission to treatment. The self-report measures AUDIT, DUDIT and DUDIT-E were used for measuring substance use and readiness for treatment. The patients' clinicians reported demographic and treatment factors. A three-block hierarchical multiple regression analysis was conducted to determine potential predictors of mental distress. Block 1 included demographic variables, Block 2 included treatment variables, and Block 3 substance use variables.

Results

Patients generally reported a high level of mental distress at admission to treatment, and 83% reported mental distress higher than the established cut-off level. Being female, having previously received psychiatric treatment, having a higher score on DUDIT and AUDIT, and using a larger number of substances all predicted a higher level of mental distress. The model explained 32% of the variance in mental distress.

Conclusions

Mental distress measured by the HSCL-10 can be a valuable concept in substance use treatment. The HSCL-10 can be useful in screening for patients who are in need of further assessment for psychiatric disorders. Female gender, previous psychiatric treatment, and higher use of substances all predicted a higher level of mental distress. The study underlines the importance of assessing the mental health of patients in substance use treatment.

Is there a gender difference in associates of adolescents' lifetime illicit drug use in Tehran, Iran?

INTRODUCTION

Information regarding gender differences in drug use of adolescents is essential for designing gender-specific drug prevention policies. This study was conducted in high school students in Tehran, Iran, in 2007. Here, we report the gender differences in lifetime prevalence as well as psychosocial associates of drug use.

MATERIAL AND METHODS

This was a gender analysis of the data collected in a drug use survey conducted in a random sample of high school adolescents (573 boys and 551 girls) in Tehran, Iran, 2007. Demographic characteristics, parental and peers' substance use, school performance, religious beliefs, attachment, self-esteem and emotional intelligence (EI) were entered in logistic regression analyses to predict the lifetime illicit drug use in boy and girls, separately.

RESULTS

Boys were more likely to report lifetime illicit drug use than girls (10.1% vs. 6.4%, p = 0.023). Differences in the risk profile associated with lifetime illicit drug use by gender included history of substance use in the family, higher score of attachment, and having an employed mother as predictors of substance use in boys, but not girls.

CONCLUSIONS

Understanding this gender difference in predictors of lifetime use of illicit drugs in high school adolescents facilitates the design of gender-sensitive drug use preventive programmes. It seems that family variables may have more value in prevention of illicit drug use in male adolescents.

Individual differences and the neural representations of reward expectation and reward prediction error

Reward expectation and reward prediction errors are thought to be critical for dynamic adjustments in decision-making and reward-seeking behavior, but little is known about their representation in the brain during uncertainty and risk-taking. Furthermore, little is known about what role individual differences might play in such reinforcement processes. In this study, it is shown behavioral and neural responses during a decision-making task can be characterized by a computational reinforcement learning model and that individual differences in learning parameters in the model are critical for elucidating these processes. In the fMRI experiment, subjects chose between high- and low-risk rewards. A computational reinforcement learning model computed expected values and prediction errors that each subject might experience on each trial. These outputs predicted subjects' trial-to-trial choice strategies and neural activity in several limbic and prefrontal regions during the task. Individual differences in estimated reinforcement learning parameters proved critical for characterizing these processes, because models that incorporated individual learning parameters explained significantly more variance in the fMRI data than did a model using fixed learning parameters. These findings suggest that the brain engages a reinforcement learning process during risk-taking and that individual differences play a crucial role in modeling this process.

The emergence of gonadal hormone influences on dopaminergic function during puberty

Adolescence is the developmental epoch during which children become adults-intellectually, physically, hormonally and socially. Brain development in critical areas is ongoing. Adolescents are risk-taking and novelty-seeking and they weigh positive experiences more heavily and negative experiences less than adults. This inherent behavioral bias can lead to risky behaviors like drug taking. Most drug addictions start during adolescence and early drug-taking is associated with an increased rate of drug abuse and dependence. The hormonal changes of puberty contribute to physical, emotional, intellectual and social changes during adolescence. These hormonal events do not just cause maturation of reproductive function and the emergence of secondary sex characteristics. They contribute to the appearance of sex differences in non-reproductive behaviors as well. Sex differences in drug use behaviors are among the latter. The male predominance in overall drug use appears by the end of adolescence, while girls develop the rapid progression from first use to dependence (telescoping) that represent a female-biased vulnerability. Sex differences in many behaviors including drug use have been attributed to social and cultural factors. A narrowing gap in drug use between adolescent boys and girls supports this thesis. However, some sex differences in addiction vulnerability reflect biologic differences in brain circuits involved in addiction. The purpose of this review is to summarize the contribution of sex differences in the function of ascending dopamine systems that are critical to reinforcement, to briefly summarize the behavioral, neurochemical and anatomical changes in brain dopaminergic functions related to addiction that occur during adolescence and to present new findings about the emergence of sex differences in dopaminergic function during adolescence.

Socio-demographic risk factors for alcohol and drug dependence: the 10-year follow-up of the national comorbidity survey

AIMS

Continued progress in etiological research and prevention science requires more precise information concerning the specific stages at which socio-demographic variables are implicated most strongly in transition from initial substance use to dependence. The present study examines prospective associations between socio-demographic variables and the subsequent onset of alcohol and drug dependence using data from the National Comorbidity Survey (NCS) and the NCS Follow-up survey (NCS-2).

DESIGN

The NCS was a nationally representative survey of the prevalence and correlates of DSM-III-R mental and substance disorders in the United States carried out in 1990-2002. The NCS-2 re-interviewed a probability subsample of NCS respondents a decade after the baseline survey. Baseline NCS socio-demographic characteristics and substance use history were examined as predictors of the first onset of DSM-IV alcohol and drug dependence in the NCS-2.

PARTICIPANTS

A total of 5001 NCS respondents were re-interviewed in the NCS-2 (87.6% of baseline sample).

FINDINGS

Aggregate analyses demonstrated significant associations between some baseline socio-demographic variables (young age, low education, non-white ethnicity, occupational status) but not others (sex, number of children, residential area) and the subsequent onset of DSM-IV alcohol or drug dependence. However, conditional models showed that these risk factors were limited to specific stages of baseline use. Moreover, many socio-demographic variables that were not significant in the aggregate analyses were significant predictors of dependence when examined by stage of use.

CONCLUSIONS

The findings underscore the potential for socio-demographic risk factors to have highly specific associations with different stages of the substance use trajectory.

Predictors of illicit substance dependence among individuals with alcohol dependence

OBJECTIVE

Individuals with alcohol dependence (AD) are at increased risk for developing dependence on illicit and prescription drugs. The goal of this cross-sectional study was to identify factors associated with drug dependence among individuals with AD.

METHOD

The sample consisted of 855 adults from the Irish Affected Sib Pair Study of Alcohol Dependence who were treated in inpatient or outpatient alcohol treatment programs and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for lifetime AD. We studied predictors of dependence on six classes of drugs: cannabis, sedatives, stimulants, cocaine, opioids, and hallucinogens. Potential predictors examined included gender, age, education, and socioeconomic status; the personality traits of extraversion, neuroticism, and novelty seeking; conduct disorder, major depressive disorder, nicotine dependence, age at onset of alcohol use, early illicit drug use, and parental AD.

RESULTS

Nicotine dependence, depression that began before substance use, and drug use before age 19 each increased the risk for dependence on several substance classes. Male gender, younger age, maternal AD, fewer years of education, higher neuroticism scores, conduct disorder, and early alcohol use each increased the risk of dependence on one or more substance classes.

CONCLUSIONS

Among individuals in treatment for AD, cigarette smoking, early onset of major depression, and early drug use were associated with increased risk for drug dependence. These results suggest individuals with these risk factors may benefit from more intensive screening to prevent the onset of or to identify and treat drug dependence.

High frequency of adverse health behaviors in multiple sclerosis

Background

Health behaviors influence chronic disease risks in the general population, and may influence health outcomes independently of comorbid diseases. Health behaviors receive less attention in multiple sclerosis (MS) than in the general population. We assessed health behaviors among participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry and the demographic characteristics associated with particular health behaviors.

Methods

In October 2006, we surveyed NARCOMS participants regarding smoking using questions from the Behavioral Risk Factor Surveillance Survey; physical activity using questions from the PEPI study, alcohol use using the AUDIT-C; and height and weight. To determine the independent demographic predictors of health behaviors, we used multivariable logistic regression, either binary or polytomous as appropriate.

Results

Of 8983 responders, 4867 (54.2%) ever smoked; 1542 (17.3%) currently smoked. On the basis of the AUDIT-C, 1632 (18.2%) were at risk for alcohol abuse or dependence. A quarter of participants were obese ( n = 2269), and 2780 (31.3%) were overweight. Fewer than 25% of participants reported moderate or heavy leisure-time physical activity. Generally, lower socioeconomic status was associated with a higher frequency of adverse health behaviors accounting for other demographic factors. With increasing levels of disability, the reported intensity of physical activity was lower, and the frequency of overweight or obesity was higher.

Conclusions

Patients with MS exhibit frequent adverse health behaviors, increasing the risk of other chronic diseases. Further research is needed to determine how these behaviors influence disability progression, quality of life, and other MS-related outcomes.

Readiness to change as a predictor of drug-related behaviors in a sample of rural felony probationers

OBJECTIVE

Relationships between readiness to change and common drug-related behaviors were explored in a sample (N = 776) of rural probationers in the state of Kentucky.

METHODS

Self-reported data was gathered on measures of readiness to change, frequency of marijuana use, possession of drugs/related paraphernalia, and driving while under the influence of drugs/alcohol at time periods before and after arrest.

RESULTS

Independent of the influence of demographic characteristics such as age, gender, race, and treatment history, increases in readiness to change scores were accompanied by reductions in all three drug-related behaviors.

CONCLUSION

Readiness to change has important implications for treatment involving rural probationers.

Improving targets for the prevention of drug use disorders: sociodemographic predictors of transitions across drug use stages in the national comorbidity survey replication

OBJECTIVES

Models of drug use etiology and prevention require precise information concerning the expression of population-based risk factors across the continuum of drug use. However, the majority of previous epidemiologic research on this topic has not addressed transitions between specific drug stages. The present investigation examined the sociodemographic predictors of progression across six stages of drug use in the National Comorbidity Survey Replication (NCS-R), a nationally representative household survey of the U.S. population conducted between February, 2001 and April, 2003.

METHODS

Lifetime history of opportunity to use illicit substances, initial drug use, and DSM-IV drug use disorders were collected using in-person structured diagnostic interviews.

RESULTS

The median age of first opportunity to use drugs as well as drug use, abuse and dependence each occurred prior to age 20, while the median remission from abuse and dependence occurred at 26 and 30 years, respectively. Most sociodemographic variables, in particular sex and ethnicity, demonstrated highly differential associations with transitions depending on the stage examined.

CONCLUSIONS

The findings may partially explain the effectiveness of strategies designed to reduce drug use, abuse and dependence, and indicate that increased correspondence is needed between available epidemiologic data and existing models of etiology or prevention.

Rural-urban differences in substance use among African-American adolescents

PURPOSE

To examine substance use differences among African-American adolescents living in rural and more urban areas in Iowa and Georgia and factors thought to be related to those differences. Specifically, negative affect and perceived availability were examined as mediators of the relation between community size and alcohol, tobacco, and drug use.

METHODS

In-home interviews with the adolescents (Time 1: N = 897, Mean age = 10.5) assessed their use, perceived substance availability, and negative affect across 3 waves. Their parents' use was also assessed. Census data were used to determine community size (rural <or= 2,500; urban >or= 2,500).

FINDINGS

Perceived substance availability and use were both higher among the more urban adolescents. As expected, negative affect was a primary antecedent to use at each wave. Structural Equation Modeling indicated that the relation between population and use was mediated by perceived availability of the substances. Additional multigroup analyses indicated that the relations between negative affect and use were significantly stronger among the urban adolescents at all waves.

CONCLUSIONS

Results suggest that stress or negative affect is an important antecedent to use among African-American adolescents, especially when it occurs at an early age, but living in rural areas may be a buffer for both problems, in part, because exposure to this type of risk is lower in these environments.

Ethical disparities: challenges encountered by multidisciplinary providers in fulfilling ethical standards in the care of rural and minority people

CONTEXT

Health care disparities are well documented for people living in rural areas and for people who are members of ethnic minorities.

PURPOSE

Our goal was to determine whether providers report greater difficulty in providing care for rural than urban residents and for ethnic minorities than patients/clients in general in 4 practice areas of ethical relevance: attaining treatment adherence, assuring confidentiality, establishing therapeutic alliance, and engaging in informed consent processes.

METHODS

We received survey responses from 1,558 multidisciplinary medical and behavioral providers across rural and non-rural areas of New Mexico and Alaska in 2004 to assess a wide range of issues in providing health care.

FINDINGS

Providers reported some difficulties in fulfilling various ethical practices for all types of patients, but not more difficulty when caring for minority compared to nonminority patients/clients. However, they do report more frequent additional problems related to the practice issues of treatment adherence, therapeutic alliance, informed consent, and confidentiality with minority patients than others. Difficulties and more frequent additional problems are greater for providers in rural than in non-rural areas. Results generalize across both Alaska and New Mexico with few differences.

CONCLUSIONS

We obtained evidence for disparity in care for patients/ clients who were minority group members, and clear evidence of disparity for people residing in rural compared to non-rural areas of 2 states with large rural areas.

A life course model of education and alcohol use

Working from a life course perspective, this study examined the paradoxical association between academic status and drinking across the transition to young adulthood with multilevel modeling and a nationally representative sample of young people from the Add Health data project (n = 6,308). Taking academically advanced courses in high school was associated with lower rates of current drinking and binge drinking during high school (grades 9-12) but higher rates of both after high school (age range: 20-26). This positive longitudinal association between academic status and drinking was explained partly, but not completely, by educational, family, and work circumstances in young adulthood. The association was less likely to occur among students who attended high schools in which high achievement was the norm. Thus, the association between academic status and drinking behavior reverses across the transition to young adulthood, especially in certain types of peer environments within the educational system.

A psychosocial resource impairment model explaining partner violence and distress: moderating role of income

This study examines the role of income in a psychosocial resource impairment model that explains partner violence and distress. Using data from a nationally representative sample, we test whether psychosocial resources of social support and self-esteem operate differently in four income groups (poor, "working"-poor, middle and upper-income). Structural equation modeling shows that among women considered working-poor, low self-esteem is relevant for the process through which violence becomes linked to distress. Women of upper-income appear distinct with negative interactions serving as sole mediator of violence and distress. Other findings indicate impaired support may mediate the violence and distress relation for women, regardless of income. Overall, income partially moderates the impact of partner violence on distress, suggesting social contexts should be considered when examining the effects of violence.

Treatment Seeking in Populations in Urban and Rural Settings on the Border

BACKGROUND

Only a small proportion of persons with alcohol or drug problems seek help in the form of treatment for these problems. To examine service disparities among Hispanics living in urban and rural border areas, an improved understanding of factors associated with service seeking is needed for this population.

METHODS

In-person interviews were conducted with a sample of 1,200 colonia residents and urban residents living along the Texas border with Mexico. For the present study, the dataset was limited to Hispanic respondents (85% of the sample) and those who reported any indicator of need for treatment (38% of the sample). There were 380 respondents who met these criteria. Treatment seeking was measured by any past attempt, successful or unsuccessful, to obtain treatment or by their present stated desire for treatment. Factors influencing treatment seeking were compared across 3 sites.

RESULTS

Path analyses indicated that, after taking demographics into account, severity of need (the total number of drug-related and alcohol-related problems experienced by an individual) was a strong influence on treatment seeking, but income-related variables were more influential than severity of need in 1 site. Generation of immigration was positively related to treatment seeking in 2 sites, and in colonias, high religiosity was related to treatment seeking. In 2 sites, need severity was related to neighborhood variables. In colonias, need severity was related to low income and low religiosity.

CONCLUSIONS

This framework for understanding treatment seeking in border communities suggests that pathways to treatment seeking vary by locality in ways that may reflect variations in local environments and service systems. Design of outreach efforts should be tailored to the unique social and service system challenges of each local community. Although service seeking is low overall, findings are suggestive of an inequitable service access structure in 1 site where need is not the predominant factor for treatment seeking.

Comorbid substance and mental disorders among rural Americans: results from the National Comorbidity Survey

BACKGROUND

The purpose of this study was to examine whether rural inhabitants were more likely than urban inhabitants to meet the criteria for comorbid mental health and substance abuse or dependence disorders.

METHODS

Data were from the National Comorbidity Survey, and included 5185 (532=rural; 4653=urban) persons age 14-54 years of age who were interviewed using the Composite International Diagnostic Interview (CIDI). Logistic regression that accounted for the complex survey data and weighting scheme was utilized.

RESULTS

Participants residing in rural areas were more likely to meet the DSM-III-R criteria for past month alcohol abuse or dependence if they also met the diagnostic criteria for past month major depressive disorder (MDD) or lifetime antisocial personality disorder (ASPD), adjusting for age, race, gender, education and income. Similarly, rural participants were more likely to meet the criteria for comorbid drug abuse or dependence in the past month if they met the diagnosis for either past month MDD, generalized anxiety disorder or lifetime ASPD, controlling for demographic characteristics. Rural residents with any current mental disorder also were less likely to seek treatment than their urban counterparts.

LIMITATIONS

Data were collected in 1991 and do not capture changes in prevalence of comorbidities. Also, the small number of rural residents sampled resulted in small cell sizes for some comorbidities.

CONCLUSIONS

Rural residents were significantly more likely to meet the criteria for substance disorders given they also met the criteria for a mental disorder, and those with any current mental disorder were less likely to seek treatment. Since the overall prevalence of these disorders does not differ between rural and urban inhabitants, findings suggest that rural persons may lack access to adequate treatment for their mental health disorders and subsequently may be self-medicating with alcohol and/or drugs.

HIV risk behaviors among rural stimulant users: variation by gender and race/ethnicity

We examined data from a community sample of rural stimulant users (n = 691) in three diverse states to identify gender and racial/ethnic differences in HIV risk behaviors. Bivariate and logistic regression analyses were conducted with six risk behaviors as dependent variables: injecting drugs, trading sex to obtain money or drugs, trading money or drugs to obtain sex, inconsistent condom use, multiple sex partners, and using drugs with sex. Controlling for state, income, age, heavy drinking, and type of stimulant used, men had lower odds than women for trading sex to obtain money or drugs (adjusted odds ratio [AOR] =0.4, confidence interval [CI] = 0.28-0.59; p < .0001), greater odds than women for trading money or drugs to obtain sex (AOR = 44.4, CI = 20.30-97.09; p < .0001), greater odds than women of injecting drugs (adjusted odds ratio (AOR =1.6, CI = 1.11-2.42; p = .01), and lower odds than women of using condoms inconsistently (AOR = 0.6, CI = 0.35-0.92; p = .02); African Americans had lower odds than Whites of injecting drugs (AOR = .08, CI = 0.04-0.16; p < .0001), greater odds than Whites for trading sex to obtain money or drugs (AOR = 1.7, CI = 1.01-2.85; p = .04) and for trading money or drugs to obtain sex (AOR = 2.9, CI = 1.53-5.59; p = .001), and greater odds than Whites of using drugs with sex (AOR = 3.9, CI = 1.47-10.09; p = .006). These findings indicate HIV prevention efforts should be tailored to address gender and racial/ethnic differences in risk behaviors among rural stimulant users.