Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the U.S. Army

BACKGROUND

The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service.

METHODS

21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition.

RESULTS

The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk.

CONCLUSIONS

Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.

Substance use network characteristics and drug and alcohol use behaviors among young men who have sex with men (YMSM)

BACKGROUND

Young men who have sex with men (YMSM) use alcohol and other drugs at rates higher than their heterosexual peers. While social networks of YMSM have been acknowledged as an important contextual influence on their health behavior, studies have largely focused on social and sexual networks rather than substance use networks, despite the potential importance of substance use alters in shaping substance use behavior.

METHOD

Using data collected from a diverse sample of YMSM (n=156), two multilevel models examined the associations between network (e.g., degree and transitivity), dyadic (e.g., strength of relationship), and individual characteristics and two alter level dependent variables: recent drug use (versus no recent drug use) and frequency of substance use.

RESULTS

Results indicated that transitivity was associated with both recent drug use (OR=1.21, p=0.012) and more frequent substance use (b=0.08, p=0.002). Degree was not significantly associated with either variable. Furthermore, participants were also less likely to have recently used drugs (OR=0.93, p<0.001) and tended to use substances less frequently (b=-0.01, p=0.028) with older alters.

CONCLUSIONS

Despite substantial interest in network influences on health, much remains unknown about the impact of network structures on substance use. The current findings suggest that structural characteristics of substance use networks may provide important information regarding the drug and alcohol use behavior of YMSM even when controlling for dyadic and individual characteristics.

Factors Associated With American Indian and White Adolescent Drug Selling in Rural Communities

Relatively few studies have examined the correlates of adolescent drug selling in America, with most of these studies focusing on urban settings. The present study examines the risk and protective factors associated with drug selling among American Indian and white adolescents residing in a rural Northwestern state in the United States. Using survey data collected in 2010-2012, we conduct logistic regression analyses exploring the correlates of drug selling (n=568). Generally, we found support for prior explanations of drug selling, but identified some important race-specific differences. Specifically, we found that stress exposure was a risk factor for American Indians, but not whites. Conversely, academic achievement served as a protective factor for white adolescents but not American Indians. Our findings suggest that the race gap in rural drug selling can be explained by considering differences in social bonds, stress exposure, and exposure to substance using family and friends.

Determinants of alcohol use, risky sexual behavior and sexual health problems among men in low income communities of Mumbai, India

This paper summarizes the main results of the survey component of a mixed methods study of alcohol and sexual risk in a general population of young men 18-29 residing in low income communities in the Greater Mumbai area. The survey included demographic variables, and scales and indices measuring work related stress, social influence, exposure to alcohol in childhood, and currently, hyper masculinity, exposure to media and pornography, risk related leisure time activities and alcohol and alcohol/sex expectancies. Measures of alcohol use included frequency/amount/contextual use of six different types of alcohol, a general estimate of frequency and amount (AUDIT), and an estimate of total ml. alcohol consumed in the past 30 days, based on estimates of alcohol content in all types of alcohol consumed, by unit of consumption (glass, peg, bottle) etc. Sexual outcome measures included types and number of partners ever and in past year with and without alcohol, and a critical event with most recent partner (with or without alcohol) and culturally specific indicators of sexual health related to sexual risk taking. A cluster sampling protocol and the use of a screener produced a sample of 1239 men, 1071 thirty day drinkers and 161 nondrinkers. Logistic regression analysis (binary and multinomial) showed relationships between predictor variables and alcohol consumption and alcohol and sexual risk indicators as well as two of the sexual health indicators associated with extramarital sex. Risk behaviors are associated with higher levels of alcohol consumption in this low risk general population of married and unmarried men. Implications for intervention include: (a) reducing or eliminating home drinking, to reduce early childhood exposure; (b) including alcohol in sexual risk and HIV prevention programs; (c) improving couples (married or unmarried) communication to reduce men's search for sexual alternatives, and (d) treating garmi as an indicator of sexual risk taking rather than STIs.

Popularity among Peers as a Condition for a Child's Risk of Substance Abuse

Popularity or recognition as a friend among peers is a core element in some approaches to substance abuse prevention and treatment. Its effect on a child's risk of substance abuse has not been conclusive in view of the findings involving both positive and negative effects. This study analyzing survey data from 2,051 pupils in Hong Kong, China, ascertain the effects of popularity in the presence of other predictors. Results show that the effect of popularity on substance abuse risk was not significant. Nonetheless, the interaction between popularity and substance abuse generated a significant positive effect on the risk that a child who has experienced substance abuse has a high tendency to have a relapse. This effect embodies the logic of reinforcement in social learning theory. The findings imply that preventive approaches relying on the promotion of popularity among peers need to be cautious and selective to avoid the reinforcement effect.

Stable isotope ratios of marijuana. I. Carbon and nitrogen stable isotopes describe growth conditions

There remains significant uncertainty in illicit marijuana cultivation. We analyzed the delta(13)C and delta(15)N of 508 domestic samples from known U.S.A. counties, 31 seized from a single location, 5 samples grown in Mexico and Colombia, and 10 northwest border seizures. For a subset, inflorescences and leaves were analyzed separately. These data revealed a strong correspondence, with inflorescences having slightly higher delta(13)C and delta(15)N values than leaves. A framework for interpreting these results is introduced and evaluated. Samples identified as outdoor-grown by delta(13)C were generally recorded as such by the Drug Enforcement Administration (DEA). DEA-classified indoor-grown samples had the most negative delta(13)C values, consistent with indoor cultivation, although many were also in the outdoor-grown domain. Delta(15)N indicated a wide range of fertilizers across the dataset. Samples seized at the single location suggested multiple sources. Northwest border delta(13)C values suggested indoor growth, whereas for the Mexican and Colombian samples they indicated outdoor growth.

Explaining Substance Use among Puerto Rican Adolescents: A Partial Test of Social Learning Theory

This study examines the cross-cultural efficacy of social learning theory as it relates to substance use among Puerto Rican adolescents. Using data from a self-report survey of high school students attending private and public schools in San Juan, Puerto Rico, we compare the relative effects of personal and peer definitions (differential association) on substance use. Results indicate that statistical differences exist between public and private school respondents on all three outcomes (cigarette, alcohol, and marijuana use) and the two aspects of social learning theory, definitions and differential association. After controlling for demographic factors, peer definitions are shown to have the greatest effect on likelihood of substance use. Students who perceive greater peer approval of substance use are far more likely to report lifetime cigarette, alcohol, and marijuana use regardless of their own personal definitions of such behavior. Sex differences are also discussed.

Examining the relative importance of social context referents in predicting intention to change substance abuse behavior using the EASE

There is growing consensus across literatures that more than individual motivation and "will to change" influence whether a client will be able to make and sustain recovery-related changes to prevent drug relapse post-treatment. New areas of inquiry in the substance abuse field have proposed conceptual models that promote an integration of both individual and social context factors, which offer the opportunity for important developments in clinical practice. This study examined the influence of social context referents on clients' intention to change substance abusing behaviors. The Ecological Assessment of Substance abuse Experiences (EASE), an instrument that measures the influence of social context referents on addiction and recovery behaviors, was administered to 302 inpatient and outpatient adults in treatment for substance abuse. Results showed that the number of people in his/her social network favorable towards recovery (Beta=.222); the extent to which one personally identifies with being in recovery (Beta=.339); the perceived importance of people in the client's social network encouraging recovery-related behaviors (Beta=.369); weak beliefs that drugs will lead to positive outcomes (Beta=-.220); and strong beliefs that recovery will lead to positive outcomes (Beta=.307) were all associated with intention to change substance abusing behavior.

Risk and protective factors for methamphetamine use and nonmedical use of prescription stimulants among young adults aged 18 to 25

This article reports on correlates of past-year nonmedical use of prescription stimulants and methamphetamine among young adults aged 18 to 25. Data from the 2002 National Survey on Drug Use and Health (NSDUH) were used to conduct logistic regression analyses of the demographic, psychosocial, and behavioral correlates of nonmedical stimulant use. The sample size was 23,645. Multivariate analyses revealed that selling drugs and using marijuana and other illegal drugs were associated with increased odds of both methamphetamine and nonmedical prescription stimulant use. Females, individuals not enrolled in college, and those who had been arrested were more likely than their counterparts to have used methamphetamine, whereas black individuals and less religious individuals were less likely than their counterparts to have used methamphetamine. Psychological distress, sensation seeking, binge drinking, and college enrollment were associated with increased risks of nonmedical prescription stimulant use, whereas Hispanic and other ethnic identification were associated with decreased risks of nonmedical prescription stimulant use. Different intervention strategies are needed to prevent methamphetamine use versus nonmedical prescription stimulant use.