Risk factors for gun-related behaviors among urban out-of-treatment substance using women

Dynamic Risk Factors for Handgun Carrying: Are There Developmental or Sex Differences?

Objective: This study examines the effects of dynamic risk factors on handgun carrying from adolescence into young adulthood.Method: A nationally representative sample of 8,679 individuals (ages 12-26; 51.1% male; 58% White, 26.8% African American; 21.2% Hispanic ethnicity) from the National Longitudinal Survey of Youth (1997 cohort) interviewed at least three times across nine annual waves is used to estimate effects on handgun carrying. Key predictors include gang membership, selling and using drugs, violent crime, and arrest. Using mixed effects models, we focus on within-individual effects across three timeframes from ages 12 to 26: 1) predictors and handgun carrying measured concurrently, 2) predictors measured across one year and handgun carrying measured in the final month of the same year, and 3) predictors measured in the wave before handgun carrying. We also contrast estimates by sex and age.Results: All theoretically relevant predictors statistically significantly predict handgun carrying across the first two timeframes. However, none are statistically significant predictors of handgun carrying in the following year. Few significant sex and age differences emerge.Conclusions: Handgun carrying is an ephemeral behavior particularly during adolescence. The predictors of handgun carrying, which are grounded in gangs, drug use/sale, and crime involvement, appear to have short-term impacts that are consistent across age as well as across sex. Consequently, future work should focus on shorter-term changes in models and there is no evidence that intervention efforts must take fundamentally different approaches to reduce handgun use among males versus females or adolescents versus adults.

Pragmatic trial of a Study Navigator Model (NAU) vs. Ambassador Model (N+) to increase enrollment to health research among community members who use illicit drugs

BACKGROUND

Although drug use is common in the population, drug users are sometimes excluded from research without justification. Two models of individualized study matching were compared for effectiveness in enrolling people who "endorsed current drug use" and those who "did not" into appropriate research.

METHODS

Participants in the NIDA-funded Transformative Approach to Reduce Research Disparities Towards Drug Users study (Navigation Study) were recruited through a Clinical and Translational Science Award (CTSA) community engagement model. Of the 614 community-recruited adults, 326 endorsed current drug use (cases); 288 did not (controls). Participants were randomized to one of two intervention groups: Navigation as Usual (NAU) [individualized study matching through a Study Navigator] or Enhanced Navigation (N+) [individualized study matching plus transportation and other assistance through an Ambassador]. Rates of enrollment into research studies were compared.

RESULTS

At 90 days, N+ vs. the NAU intervention was associated with higher enrollment among both drug users (36.0% N+ vs. 24.9% NAU) and non-drug users (45.5% N+ vs. 25.2% NAU). NAU attained the same rate of enrollment for users of drugs (24.9%) and non-users (25.2%); N+ had similar rates as well (36.0% drug users vs. 45.5% non-drug users). In addition, high rates of enrollment were achieved among all groups of participants, from 24.9% (drug users in NAU) to 45.5% (non-drug users in N+).

CONCLUSIONS

Both the NAU and N+ methods can reduce barriers and help users and non-users become part of the population that participates in research. Working with the local CTSA adds significant value to the research enterprise.

Association Between Gambling and Exposure to Guns Among Cocaine-Using Women

The purpose of this study is to assess the association between gambling severity and exposure to guns among substance-using women recruited in the community. Data for these analyses come from the baseline phase of two community-based HIV prevention interventions conducted among alcohol and drug-using women in St. Louis, MO. Gun exposure was assessed using the Violence Exposure Questionnaire (VEQ), and DSM-IV pathological gambling (PG) symptoms and other psychiatric symptoms were assessed using the Computerized Diagnostic Interview Schedule; The Composite International Diagnostic Interview Substance Abuse Module assessed DSM-IV substance dependence, including cocaine dependence and alcohol dependence. Women in the study were predominantly African American (80%), mean age was 35.70 years ±8.8. Women exposed to guns were significantly more likely than women not exposed to guns to have gambled with all consequences: without meeting PG criteria (21% vs. 15%); to meet 1 to 4 PG criteria (22% vs. 12%), and to report 5 or more PG criteria (10% vs. 5%). These differences were significant at p < 0.0001. Based on the multivariate analysis, women who gambled without PG symptoms (OR = 1.77; 95% CI = 1.10-2.85) were nearly twice more likely to have exposure to guns than women who did not gamble. The risk for gun exposure increased with severity of gambling. Women who gambled and reported one to four PG criteria were twice as likely to have had an exposure to guns (OR 2.04; 95% CI = 1.45-3.06) and this risk increased to nearly threefold among women who met five or more criteria of PG (OR 2.65; 95% CI = 1.32-5.32). In addition, endorsing five or more criteria for major depressive disorder (OR 1.44; 95% CI = 1.00-2.06) and three or more criteria for antisocial personality adult criteria (OR 3.78; 95% CI = 2.03-7.02) were strong predictors for gun exposure among these women. The findings indicate that substance-using women with gambling behavior are at an enhanced risk to have exposure to guns.

Alcohol Use and Firearm Violence

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. To explore this, we undertook a 40-year (1975-2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths. Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study.

Association Between Substance Use and Gun-Related Behaviors

Gun-related violence is a public health concern. This study synthesizes findings on associations between substance use and gun-related behaviors. Searches through PubMed, Embase, and PsycINFO located 66 studies published in English between 1992 and 2014. Most studies found a significant bivariate association between substance use and increased odds of gun-related behaviors. However, their association after adjustment was mixed, which could be attributed to a number of factors such as variations in definitions of substance use and gun activity, study design, sample demographics, and the specific covariates considered. Fewer studies identified a significant association between substance use and gun access/possession than other gun activities. The significant association between nonsubstance covariates (e.g., demographic covariates and other behavioral risk factors) and gun-related behaviors might have moderated the association between substance use and gun activities. Particularly, the strength of association between substance use and gun activities tended to reduce appreciably or to become nonsignificant after adjustment for mental disorders. Some studies indicated a positive association between the frequency of substance use and the odds of engaging in gun-related behaviors. Overall, the results suggest a need to consider substance use in research and prevention programs for gun-related violence.