The effects of the military's antidrug policies over the life course: the case of past-year hallucinogen use

Poverty and birth cohort effects of experiencing the 2007-2009 Great Recession during adolescence on major depressive episodes and mental health treatment of young adults in the United States

PURPOSE

Household economic adversity during adolescence is hypothesized to be a risk factor for poor mental health later in life. To test this hypothesis, we conducted a quasi-experimental analysis of an economic shock, the Great Recession of 2007-2009. We tested if going through adolescence during the Great Recession was associated with increased risk of major depressive episodes (MDE) and mental health treatment in young adulthood with potential moderation by household poverty to explore differences by economic adversity.

METHODS

We analyzed data on young adults age 18-29 years from the 2005-2019 National Survey on Drug Use and Health (N = 145,394). We compared participants who were adolescents during the recession to those followed-up prior to the recession. Regression analysis tested effect modification by household poverty status.

RESULTS

Adolescent exposure to the Great Recession was associated with higher likelihood of MDE during young adulthood (aOR = 1.30, 95% CI = 1.23, 1.37); there was no relationship with mental health treatment. Effects on MDE were stronger among those in households with higher incomes compared to those living in poverty.

CONCLUSION

Findings support the hypothesis that exposure to the Great Recession during adolescence may have increased risk for MDE, but raise questions about whether the mechanism of this association is economic distress.

Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System

Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension).

PURPOSE

Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other.

METHODS

We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables.

RESULTS

One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05).

DISCUSSION

Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure).

Age, Period, and Cohort Trends in Perceived Mental Health Treatment Need and Differences by Mental Health Severity in the United States, 2008-2019

Identifying age, period, and cohort trends in perceived mental health treatment need over time by mental illness severity is important to identify where to focus early intervention efforts. We included adults who did not report receiving past-year mental health treatment in the 2008-2019 National Survey on Drug Use and Health (N = 364,676). Hierarchical age-period-cohort models were used to assess perceived mental health treatment need, adjusting for demographics stratified by mental illness severity (none, any but not severe [AMI], severe [SMI]). Median odds ratios estimated cohort and period variance. Cohort effects explained a significant portion of the variance over time; period effects were minimal. Perceived mental health treatment need was highest among adults with AMI from recent birth cohorts (2000-2002: β = 1.12; 95% CI = 0.96, 1.28). Efforts are needed to address increases in perceived mental health treatment need in younger birth cohorts, such as removing structural barriers (e.g., healthcare system barriers).

Alcohol or Drug Self-Help Use Among Adults in the United States: Age, Period, and Cohort Effects Between 2002 and 2018

In the context of an ongoing and worsening drug overdose epidemic in the USA, increases in free support services like self-help groups may be expected. We estimated differences in self-help use by age, period, or cohort among people who may have needed treatment. We included N = 92,002 adults from the 2002-2018 National Surveys on Drug Use and Health who met past-year DSM-IV substance use disorder criteria or received alcohol/drug treatment in any location. We used hierarchical age-period-cohort (HAPC) modeling to estimate average age-period-cohort associations with self-help. Level-1 covariates included age, race and ethnicity, household income, and sex. We quantified level-2 variance components using the median odds ratio (MOR). We found small positive HAPC period effects for alcohol/drug self-help that were driven by alcohol-specific effects. Birth cohort differences were observed starting at age 48. Younger birth cohorts, especially among Black adults, were less likely to report self-help use than older birth cohorts. MOR was consistently elevated for cohort effects (MOR = 1.17; covariance parameter: 0.15; 95% CI [0.11, 0.23]) but not for period effects. Overall, self-help use did not increase in the context of substantial treatment needs and worsening overdose racialized disparities. Instead, cohort effects explained trends in alcohol/drug self-help. Findings could indicate that younger birth cohorts may need additional supports, especially services tailored for Black and Hispanic people.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-023-01012-2.

Self-Reported ADHD and Adult Health in the United States

Objective: Informed by a social determinants of health framework, we investigate the relationship between self-reported ADHD diagnosis status and adult health, and whether observed associations are attenuated by biomedical and socioeconomic factors. Method: Using 2007 National Health Interview Survey data (N = 19,104), we present multivariate logistic regression analyses of associations between self-reported ADHD diagnosis status and five adult health outcomes. Results: ADHD diagnosis was significantly associated with higher odds of injury, physical health conditions, functional limitations, fair/poor health, and psychological distress in fully specified models (adjusted odds ratios [AORs] = 1.62-2.36). Inclusion of controls for exogenous demographic characteristics, psychiatric comorbidities and health behaviors, and adult social and economic statuses attenuated but did not eliminate observed associations between ADHD and poorer adult health. Conclusion: Research on adult health outcomes for those with ADHD should include consideration of the mechanisms by which a diagnosis of ADHD leads to cumulative social disadvantages that independently contribute to poorer health outcomes.

Variations in Risk and Motivations for Substance Use over the Course of Military Service

Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.

The Influence of Military Service Experiences on Current and Daily Drinking

Background: An extensive public health literature associates military service with increased alcohol consumption and problematic drinking. However, few well-controlled population-based studies compare alcohol use among nonveterans and veterans with diverse military service experiences, and no such study examines everyday drinking. Methods: We use population-representative data from the 2010 and 2011 Behavioral Risk Factor Surveillance System and distinguish four groups of men: nonveterans; non-combat veterans without a psychiatric disorder (PD) or traumatic brain injury (TBI); combat veterans without a PD or TBI; and veterans (non-combat and combat combined) with a PD and/or TBI. We estimate hierarchical multivariate logistic regression models of current drinking (N = 21,947) and daily drinking (among current drinkers; N = 11,491). Results from supplemental analyses are discussed. Results: Relative to nonveterans, non-combat veterans with no PD or TBI and veterans with a PD and/or TBI, respectively, but not combat veterans with no PD or TBI, are more likely to be current drinkers. Among current drinkers, non-combat and combat veterans with no PD or TBI, respectively, are less likely than nonveterans to be daily drinkers. Conversely, among current drinkers, veterans with a PD and/or TBI are more likely to be daily drinkers than nonveterans, non-combat veterans with no PD or TBI, and combat veterans with no PD or TBI. Conclusion: We document heterogeneous and countervailing influences of military service experiences on current and daily drinking. Results indicate that harmful military service experience may be associated with an increased risk of current, moderate daily drinking, which may represent a form of self-medication.

The Influence of Men's Military Service on Smoking Across the Life Course

The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men's smoking outcomes across the life course. Descriptive findings from an age-period-cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.

Veteran Status and Men’s Later-Life Cognitive Trajectories

Objective: The aim of this study is to determine the extent to which men’s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men’s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations.

Bennett A. Introduction to the special issue: drugs, wars, military personnel, and veterans

This special issue examines major structural, sociocultural, and behavioral issues surrounding substance use and misuse among U.S. military personnel and veterans who served in recent military conflicts in Iraq and Afghanistan. This introduction provides a brief historical review of the US's experiences of the linkages between war and substance use, misuse, and abuse. It then describes how the various topics covered in this issue span the military-veteran life course and explains the significance of each contribution.