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Vest BM, Hoopsick RA, Homish DL, Kulak JA, Homish GG. Longitudinal effects of military separation and mental health symptomatology on substance use among a cohort of reservists. J Stud Alcohol Drugs 2024. [PMID: 38319103 DOI: 10.15288/jsad.23-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The relationship between mental health and substance use among military populations is well-established, and evidence suggests these risks may be greater for those who have left the military. However, it is less clear what independent effects leaving the military may have on substance use behaviors. This study examined the longitudinal relationship between leaving the military and substance use outcomes (hazardous drinking, frequent heavy drinking, non-medical use of prescription drugs, illicit drug use) in a cohort of Reserve and National Guard (R/NG) soldiers. Further, we examined whether mental health symptoms moderate the relationship between leaving the military and substance use. METHOD Analyses used data (N=485 soldiers) from the first four annual waves of Operation: SAFETY, an ongoing prospective cohort study of US Army R/NG soldiers and their spouses. We used generalized estimating equations (GEE) to examine the relationships between military status (former vs. current soldier) and substance use outcomes over four years. Lastly, we examined interactions between military status and mental health indicators (anxiety, anger, depression, and PTSD) on substance use over time. RESULTS After controlling for sex, age, race, years of military service, sleep problems, bodily pain, and substance use norms, being a former soldier, compared to a current soldier, was associated with greater odds of current illicit drug use (AOR: 2.86; 95% CI: 1.47, 5.57; p<.01). Mental health symptomatology did not moderate the relationship between leaving the military and current drug use. CONCLUSIONS Leaving the military in and of itself may result in increased drug use for some individuals, regardless of mental health symptomatology.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, State University of New York at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA
| | - Rachel A Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth St., 2017 Khan Annex, Huff Hall, Champaign, IL 61820, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY, 14214, USA
| | - Jessica A Kulak
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY, 14214, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY, 14214, USA
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Kulak JA, Lopez J, Lawson SC, Arif M, Homish DL, Homish GG. Cannabis approval and perceived risk of use among minority U.S. Army Reservists. J Ethn Subst Abuse 2024:1-14. [PMID: 38270145 DOI: 10.1080/15332640.2024.2302312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This study examined how minoritized U.S. Army Reserve/National Guard service members perceive cannabis use amid a continuously evolving societal and legal landscape in the United States. Logistic regression analyses were conducted to examine relationships between cannabis perceptions and race while considering illicit drug use norms, posttraumatic stress disorder symptomatology, and current drug use. Non-Hispanic Black soldiers had lower odds of approval for medicinal cannabis use and Hispanic soldiers had higher odds of perceived risk of cannabis use, both of which persisted when considering key covariates. These findings may be partly explained by a confluence of societal and cultural factors.
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Affiliation(s)
- Jessica A Kulak
- State University of New York at Buffalo, Buffalo, New York, USA
| | - Joel Lopez
- Columbia University, New York City, New York, USA
| | | | - Mehreen Arif
- State University of New York at Buffalo, Buffalo, New York, USA
| | - D Lynn Homish
- State University of New York at Buffalo, Buffalo, New York, USA
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3
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Hoopsick RA, Vest BM, Homish DL, Homish GG. United States Army Reserve/National Guard soldiers' healthcare experiences, attitudes, and preferences: Differences based on deployment status. PSYCHOL HEALTH MED 2024:1-13. [PMID: 38193498 DOI: 10.1080/13548506.2024.2303409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
Some United States Army Reserve/National Guard (USAR/NG) soldiers have substantial health needs, which may be service-related, but not necessarily resulting from deployment. However, most USAR/NG members need to have been deployed to qualify for Veterans Administration (VA) benefits. Therefore, many USAR/NG soldiers seek care from civilian healthcare providers (HCPs). Using a subset (N = 430 current/former soldiers) of Operation: SAFETY study data, we used regression models to examine differences in healthcare experiences, attitudes, and preferences by deployment status (never-deployed vs. previously-deployed). Final models controlled for age, sex, rank (enlisted vs. officer), military status (current vs. former military), and RAND SF-36 General Health Score. Over 40% of soldiers agreed that civilian HCPs should ask patients about their military service, but never-deployed soldiers were less likely to report being asked about their service (p < 0.05) or how their service affects their health (p < 0.10). Never-deployed soldiers were also less likely to attribute their health concerns to military service (p < 0.001). Although never-deployed soldiers were more likely to prefer receiving physical (p < 0.05) and mental (p < 0.05) healthcare outside of the VA than previously-deployed soldiers, never-deployed soldiers had low confidence in their HCP's understanding of their needs (49% thought that their civilian HCP did not understand them; 71% did not think that their civilian HCP could address military-related health concerns; 76% thought that their civilian HCP did not understand military culture). Findings demonstrate that although civilian HCPs may be the preferred (and only) choice for never-deployed USAR/NG soldiers, they may need additional support to provide care to this population.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Bonnie M Vest
- Department of Family Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, NY, USA
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Lawson SC, Arif M, Hoopsick RA, Homish DL, Homish GG. Exploring Racial/Ethnic Disparities in Substance Dependence and Serious Psychological Distress among US Veterans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01753-9. [PMID: 37603224 PMCID: PMC10879463 DOI: 10.1007/s40615-023-01753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/03/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES There are substantial racial/ethnic disparities in substance use and mental health among civilian populations, but few studies have examined these disparities in veterans using a nationally representative sample. Thus, we examined differences in substance dependence and serious psychological distress (SPD) by race/ethnicity among a national sample of US veterans. METHODS We pooled cross-sectional data from the 2015-2019 waves of the National Survey on Drug Use and Health (N = 7,653 veterans aged 18-64 years). Regression models were utilized to examine racial/ethnic differences in DSM-IV substance dependence and SPD with a Benjamini-Hochberg correction applied. RESULTS Compared to non-Hispanic White veterans: American Indian/Alaska Native veterans had significantly higher odds of past-year alcohol dependence (AOR = 2.55, 95% CI: 1.28, 5.08); Asian American veterans had significantly lower odds of past-year alcohol dependence (AOR = 0.12, 95% CI: 0.02, 0.62); non-Hispanic Black (AOR = 0.60, 95% CI: 0.48, 0.77), Hispanic (AOR = 0.47, 95% CI: 0.34, 0.65), and veterans of more than one race (AOR = 0.55, 95% CI: 0.36, 0.83) had significantly lower odds of past-month nicotine dependence; Asian American veterans had significantly lower odds of past-year illicit drug dependence (AOR = 0.05, 95% CI: 0.01, 0.35); and non-Hispanic Black veterans had significantly lower odds of past-year SPD (AOR = 0.69, 95% CI: 0.55, 0.85) after correction for multiple comparisons. CONCLUSION Overall, racial/ethnic disparities in substance dependence and SPD among veterans are not as stark as in civilian populations, but some disparities remain.
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Affiliation(s)
- Schuyler C Lawson
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Mehreen Arif
- Graduate Research Assistant, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Assistant Professor, Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, Champaign, IL, USA
| | - D Lynn Homish
- Project Director, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Professor and Chair, Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Kulak JA, Homish DL, Kozlowski LT, Homish GG. Cannabis Use and Perceptions Among Current and Former Military Service Members. Cannabis 2023; 6:104-112. [PMID: 37484055 PMCID: PMC10361804 DOI: 10.26828/cannabis/2023/000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background Research indicates separation from the military may result in increased risk of alcohol use. However, there is little data on cannabis use among military service members, particularly when examining the period after separation from military service. This research examines cannabis-related perceptions and use among U.S. Army Reserve/National Guard (USAR/NG) current and former soldiers. Methods Data come from Operation: SAFETY (Soldiers And Families Excelling Through the Years), an ongoing study examining health among male and female USAR/NG soldiers. The current sample was comprised of 401 current and former USAR/NG soldiers. Logistic regression models examined the associations between past-year cannabis use, military status (i.e., current versus former), attitudes towards recreational cannabis, perceived ease of access, and perceived risk of cannabis use, while controlling for age, problematic alcohol use, and current cigarette smoking. Results Overall, 7.4% of current and 20.3% of former military service members used cannabis in the past year. Favorable attitudes towards cannabis use and perceived ease of accessing cannabis were associated with increased odds of use among all soldiers. In adjusted models, former military members had greater odds (AOR = 5.28, 95% CI = 2.16, 12.87) of past-year cannabis use compared to current service members. Conclusions Findings indicate that separation from the military may be an important risk factor to consider when assessing cannabis use in the military. Additional research is needed to examine socioenvironmental factors (e.g., access to post-deployment support services and healthcare, state legalization laws, other behavioral health conditions) that contribute to former service members' cannabis use.
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Affiliation(s)
- Jessica A. Kulak
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Lynn T. Kozlowski
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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Fillo J, Goodell EMA, Homish DL, Homish GG. Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers. Alcohol Clin Exp Res (Hoboken) 2023; 47:736-747. [PMID: 36869424 PMCID: PMC10351397 DOI: 10.1111/acer.15045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/11/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes. METHODS Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex. RESULTS Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females. CONCLUSION Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.
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Affiliation(s)
- Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
| | - Erin M. Anderson Goodell
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
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Vest BM, Hoopsick RA, Homish DL, Homish GG. The Role of Military Identity in Substance Use and Mental Health Outcomes among U.S. Army Reserve and National Guard Soldiers. Mil Psychol 2023; 35:85-93. [PMID: 36568407 PMCID: PMC9770498 DOI: 10.1080/08995605.2022.2082812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We investigated how military identity (i.e., veteran identity centrality, the extent to which military service is central to an individual's sense of self) relates to substance use and mental health among U.S. Army Reserve and National Guard (USAR/NG) soldiers. Data were drawn from Operation: SAFETY, a longitudinal survey study of USAR/NG soldiers. Regression models (n=413 soldiers) examined relationships between military identity and substance use (i.e., alcohol problems, past 3-months non-medical use of prescription drugs (NMUPD), illicit drug use, tobacco use), and mental health (i.e., generalized anxiety, anger, depression, PTSD), controlling for sex, race, age, education, years of military service, military status (current/former), and deployment (ever/never). In adjusted models, stronger military identity was not related to alcohol, illicit drug, or tobacco use, but was associated with past 3-months NMUPD (OR: 1.40, 95% CI: 1.12, 1.75, p<.01) and greater symptoms of anger (IRR: 1.02, 95% CI: 1.01, 1.03, p<.01), generalized anxiety (IRR: 1.05, 95% CI: 1.01, 1.10, p<.01), depression (IRR: 1.06, 95% CI: 1.02, 1.10, p<.01), and PTSD (IRR: 1.07, 95% CI: 1.02, 1.12, p<.01). Findings demonstrate the importance of military identity for health-related outcomes. NMUPD suggests potential self-medication and an avoidance of help-seeking, as admitting difficulties may conflict with military identity.
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Affiliation(s)
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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8
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Vest BM, Weiss-Laxer NS, Homish DL, Homish GG. Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers. J Trauma Stress 2022; 35:1642-1655. [PMID: 35901312 PMCID: PMC10440733 DOI: 10.1002/jts.22867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/24/2022]
Abstract
Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.
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Affiliation(s)
| | | | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo
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9
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Hoopsick RA, Homish DL, Lawson SC, Homish GG. Drug use over time among never-deployed US Army Reserve and National Guard soldiers: The longitudinal effects of non-deployment emotions and sex. Stress Health 2022; 38:1045-1057. [PMID: 35500288 PMCID: PMC9853315 DOI: 10.1002/smi.3156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 01/24/2023]
Abstract
Some US military service members who have never been deployed experience negative emotions related to never having been deployed, and some work shows these non-deployment emotions (NDE) are cross-sectionally associated with hazardous drinking for male, but not female, US Army Reserve/National Guard (USAR/NG) soldiers. However, it is not known if these effects extend to drug use or persist longitudinally, which is the focus of the current study. We conducted a longitudinal residual change analysis of a subset of data (N = 182 never-deployed soldiers) from Operation: SAFETY, an ongoing survey-based study of USAR/NG soldiers recruited from units across New York State. Outcome measures included current tobacco use, non-medical use of prescription drugs (NMUPD), current cannabis use, and other current illicit drug use (excluding cannabis) at four time points over a 3-year period. Results from bootstrapped residual change generalized estimating equation (GEE) models show that more negative NDE were longitudinally associated with a greater likelihood of current NMUPD among male, but not female, soldiers (p < 0.05). NDE were not longitudinally associated with current tobacco use, cannabis use, or other illicit drug use among male or female soldiers (ps > 0.05). NDE may contribute to ongoing NMUPD among male USAR/NG soldiers who have never been deployed. Never-deployed soldiers, especially those with negative emotions related to never having been deployed, should not be overlooked in military screening and intervention efforts.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Schuyler C. Lawson
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
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10
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Hoopsick RA, Vest BM, Homish DL, Homish GG. Differences in alcohol screening and alcohol problems among United States veterans based on military service history. Psychol Serv 2022; 19:710-718. [PMID: 34516202 PMCID: PMC8918068 DOI: 10.1037/ser0000584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military deployment is a risk factor for alcohol problems, and postdeployment alcohol problems are more prevalent among part-time reservists than full-time active duty service members. However, emerging research suggests that reservists who never experience deployment are also at risk. We examined if never-deployed/activated reserve veterans differed from active duty/deployed veterans in alcohol screening and misuse. Using pooled cross-sectional data from the National Survey on Drug Use and Health (NSDUH; 2015-2019), we estimated the prevalence of past-year self-reported alcohol screening by a health care provider and measured DSM-IV alcohol abuse and alcohol dependence among U.S. veterans aged 18-49 years with at least one health care visit in the past year (N = 4,148). We used regression models to examine for differences in these outcomes between never-deployed/activated reserve veterans and active duty/deployed veterans. Overall, 15% of veterans reported not being screened for alcohol use, despite 1 in 11 meeting DSM-IV criteria for alcohol abuse/dependence. Active duty/deployed veterans were more likely to have been screened for alcohol use than never-deployed/activated reserve veterans (p < .05). However, there was no difference in past-year alcohol abuse (p > .05) or dependence (p > .05) between never-deployed/activated reserve veterans and veterans with a history of active duty service/activation. Never-deployed/activated reserve veterans are less likely to be screened for alcohol use than active duty/deployed veterans, despite no significant difference in meeting alcohol abuse/dependence criteria. Providers may not recognize never-deployed reservists as veterans. We recommend systematic screening for military service history and alcohol use for all veterans, regardless of deployment/active duty service. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Family Medicine, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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11
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Vest BM, Goodell EMA, Homish DL, Homish GG. Effects of Social Network Characteristics on Mental Health Outcomes Among United States Army Reserve and National Guard Soldiers. Community Ment Health J 2022; 58:1268-1278. [PMID: 34981277 PMCID: PMC9250539 DOI: 10.1007/s10597-021-00935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
We sought to examine the relative salience of multiple social network structural characteristics (e.g., size, composition, quality, substance use) for understanding soldiers' mental health symptoms (anger, anxiety, depression, PTSD). Data are drawn from soldiers (N = 421) participating in the Operation: SAFETY study. Negative binomial regression models examined the relationship between ten social network characteristics and mental health outcomes, controlling for age, sex, years of military service, and deployment history. Greater number of close network ties was associated with fewer symptoms of anger, anxiety, and depression (ps < 0.05), but not PTSD. Having more illicit drug-using network ties was associated with greater severity of anxiety symptoms (p < 0.05). Finally, more days spent drinking with network members was related to higher levels of anger (p < 0.05). Interpersonal relationships that entail substance use are associated with greater anxiety and anger while a greater number of close ties is associated with fewer anger, anxiety, and depression symptoms.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
| | - Erin M Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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12
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Vest BM, Hoopsick RA, Fillo J, Homish DL, Homish GG. Problems With Sleep Are Common and Predict Increased Risk for Alcohol and Drug Use Among Reserve and National Guard Soldiers. J Stud Alcohol Drugs 2022. [DOI: 10.15288/jsad.2022.83.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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13
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Vest BM, Hoopsick RA, Fillo J, Homish DL, Homish GG. Problems With Sleep Are Common and Predict Increased Risk for Alcohol and Drug Use Among Reserve and National Guard Soldiers. J Stud Alcohol Drugs 2022; 83:537-545. [PMID: 35838431 PMCID: PMC9318696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Sleep problems are common among military members and may increase substance use risk. This study examines longitudinal associations between sleep problems and substance use among U.S. Army Reserve and National Guard (USAR/NG) soldiers as well as differences between current and former soldiers. METHOD Data are drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing prospective study of the health and well-being of USAR/NG soldiers and their spouses. We used generalized estimating equation models (N = 485 soldiers; 79.8% male) to examine residual change in substance use (alcohol problems, heavy drinking, current use of any drug, nonmedical use of prescription drugs [NMUPD], and illicit drugs) associated with sleep problems (globally and particular dimensions) over 3 years, controlling for probable post-traumatic stress disorder, age, sex, and substance use at the prior time point. Interaction models examined differences by military status (current vs. former soldier). RESULTS Sleep problems were associated with increased risk of heavy drinking (p < .05), any current drug use (p < .05), current NMUPD (p < .01), and current illicit use (p < .05). There were significant interactions between sleep quality and military status on any current drug use (p < .01) and current illicit use (p < .05) and between sleep duration and military status on current NMUPD (p < .05), such that the risk of substance use was greater for former compared with current soldiers. CONCLUSIONS Sleep problems are prevalent among USAR/NG soldiers and are longitudinally associated with alcohol and drug use. This risk may increase for soldiers who have separated from the military. These findings support routine screening for sleep problems among soldiers and predischarge education around substance use risks related to unaddressed sleep problems.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, New York,Correspondence may be sent to Bonnie M. Vest at the Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, or via email at:
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - Jennifer Fillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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Hoopsick RA, Homish DL, Vest BM, Bartone PT, Homish GG. Resilience to Hazardous Drinking Among Never-Deployed Male United States Army Reserve and National Guard Soldiers. Alcohol Clin Exp Res 2021; 45:566-576. [PMID: 33503277 DOI: 10.1111/acer.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Negative emotions related to never having been deployed to active duty are associated with an increased risk of hazardous drinking among United States Army Reserve/National Guard (USAR/NG) soldiers. Resiliency factors are known to buffer the effects of combat on hazardous drinking among service members who have been deployed, but it is not known whether these factors are protective for never-deployed service members, or which domains of hazardous drinking might be affected. Therefore, we examined the effects of a range of resiliency factors (i.e., marital satisfaction, psychological hardiness, intrinsic religiosity) on the relation between nondeployment emotions (NDE) and domains of hazardous drinking. METHODS We drew a subset of data from Operation: Soldiers and Families Excelling Through the Years (N = 112 never-deployed male soldiers), an ongoing study of USAR/NG soldiers. Regression models examined the main effects of NDE on each of the domains of hazardous drinking (i.e., total Alcohol Use Disorders Identification Test [AUDIT] score, consumption subscale, dependence subscale, alcohol-related problems subscale) and effect modification of each of the resiliency factors on the relations between NDE and the domains of hazardous drinking, separately. Final models controlled for years of military service, rank (enlisted vs. officer), number of military friends in the social network, and depression. RESULTS Greater NDE were associated with a higher total AUDIT score, alcohol consumption, and alcohol dependence (ps < 0.05), but not alcohol-related problems (p > 0.05). Marital satisfaction and psychological hardiness buffered the effects of NDE on total AUDIT score and alcohol dependence (p < 0.05). Intrinsic religiosity only modified the effect of NDE on total AUDIT score. None of the resiliency factors modified the effects of NDE on alcohol consumption or alcohol-related problems. CONCLUSIONS Soldiers with greater NDE had a greater risk of hazardous drinking in the presence of low resilience. Interventions to promote resiliency are an important consideration for protecting USAR/NG soldiers from hazardous drinking, regardless of their deployment history.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Bonnie M Vest
- Department of Family Medicine, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Paul T Bartone
- Institute for National Strategic Studies, National Defense University, Washington, DC, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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15
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Hoopsick RA, Homish DL, Collins RL, Nochajski TH, Read JP, Homish GG. Is deployment status the critical determinant of psychosocial problems among reserve/guard soldiers? Psychol Serv 2020; 17:461-471. [PMID: 30762411 PMCID: PMC6693987 DOI: 10.1037/ser0000331] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A general assumption that deployment is the primary catalyst for psychological and social difficulties may contribute to underrecognition and undertreatment of problems among never-deployed service members (i.e., having no history of ever being deployed). We aimed to determine if ever-deployed (i.e., having a history of at least one deployment) and never-deployed United States Army Reserve and National Guard (USAR/NG) soldiers differed in mental health, substance use, and resiliency factors, and to determine the relative influence of deployment status and each of these factors on poor psychosocial outcomes. We analyzed a subset of data from Operation: SAFETY (Soldiers and Families Excelling Through the Years) (N = 404), an ongoing study examining the health and well-being of USAR/NG soldiers. Bivariate analyses demonstrated that soldiers did not significantly differ across a range of measures on the basis of deployment status (ps > 0.05). In fact, Factor Analyses and Discriminant Function Analysis revealed that deployment status was the least salient factor to psychosocial problems among the measured variables and that the observed variables could not accurately discriminate between ever-deployed and never-deployed soldiers, F(8, 374) = 1.34, p > .05. Measures of mental health and substance use were more salient to psychosocial problems (ps < .05). Measures of resiliency loaded negatively onto psychosocial problems (ps < .05), indicating that they contribute to better well-being. Targeting screening and intervention efforts only on soldiers who have been deployed will miss opportunities to intervene on an equally affected group. Resiliency factors should be considered as intervention targets. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
| | - Thomas H. Nochajski
- School of Social Work, University at Buffalo, The State
University of New York, Buffalo, NY 14260, USA
| | - Jennifer P. Read
- Department of Psychology, College of Arts and Sciences,
University at Buffalo, The State University of New York, Buffalo, NY 14260,
USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School
of Public Health and Health Professions, University at Buffalo, The State University
of New York, Buffalo, NY 14215, USA
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16
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Vest BM, Kulak JA, Homish DL, Hoopsick RA, Homish GG. Mental and physical health factors related to dual use of veterans affairs and non-veterans affairs healthcare among U.S. reserve soldiers. PSYCHOL HEALTH MED 2020; 27:976-986. [PMID: 32997548 DOI: 10.1080/13548506.2020.1828945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the association between mental and physical health factors and dual use of Veterans' Affairs (VA) and non-VA healthcare among previously deployed male Reserve/National Guard (R/NG) soldiers (N = 214). Participants completed online annual surveys on a range of topics, including validated measures of mental and physical health, as well as questions about past-year healthcare utilization. Multinomial logistic regression models separately examined the association between mental health symptoms (PTSD, anxiety, depression, emotional role limitations), physical health symptoms (bodily pain, physical role limitations), and healthcare use (single use and dual use compared to no use), controlling for geography, trust in the VA, age, and race. Anxiety (aRR: 1.13; 95% Confidence Interval (CI): 1.02, 1.26; p<.05), depression (aRR: 1.23; 95% CI: 1.06, 1.43; p<.01), and PTSD (aRR: 1.05; 95% CI: 1.01, 1.10; p<.05) symptoms were all related to past year dual use of VA and non-VA healthcare, even after controlling for known demographic factors. Bodily pain and emotional and physical role limitations were not related to healthcare outcomes. This suggests that mental health symptoms themselves may be a primary factor driving healthcare use. Further study is needed to examine whether dual use of VA and non-VA healthcare is duplicative or complementary.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, Buffalo, NY, USA
| | - Jessica A Kulak
- Department of Health, Nutrition, & Dietetics, Buffalo State College, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Rachel A Hoopsick
- Department of Family Medicine, University at Buffalo, Buffalo, NY, USA.,Department of Community Health & Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo, NY, USA
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17
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Vest BM, Hoopsick RA, Homish DL, Homish GG. Lower levels of bodily pain increase risk for non-medical use of prescription drugs among current US reserve soldiers. Addict Behav 2020; 108:106443. [PMID: 32315933 DOI: 10.1016/j.addbeh.2020.106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Military populations have a higher prevalence of pain compared to their civilian counterparts and are also at increased risk for substance use. The link between clinically significant pain and substance use has been established, but it is unclear if lower levels of pain relate to risk. The goal of this inquiry was to determine if level of bodily pain was associated with increased risk of current substance use over time among a community sample of U.S. Army Reserve/National Guard (USAR/NG) soldiers. METHODS Data were drawn from an ongoing study of USAR/NG soldiers. We used generalized estimating equations to examine the longitudinal impact of baseline bodily pain level (modeled in standard deviations from the mean pain score) on current drug use (illicit and non-medical use of prescription drugs [NMUPD]) among soldiers (n = 387) over two-years. Final models controlled for baseline post-traumatic stress disorder (PTSD), anxiety, and depression symptomatology, history of deployment (yes/no), years of military service, and substance use norms. RESULTS Bodily pain was longitudinally associated with increased odds of current NMUPD (AOR: 1.49, p < .05), but not with the current use of illicit drugs (AOR: 1.18, p > .05), controlling for symptoms of PTSD, anxiety, depression, deployment, years of service, and substance use norms. CONCLUSIONS Overall, our findings indicate that bodily pain is longitudinally associated with NMUPD among male soldiers, but not with illicit drugs. Significantly, our results stem from a non-clinical sample of soldiers with overall lower levels of pain. This indicates that pain may be important, even at lower levels, and underscores the importance of early non-pharmacologic interventions for pain.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Rachel A Hoopsick
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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18
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Hoopsick RA, Vest BM, Homish DL, Homish GG. Problems with Social Acceptance and Social Victimization Predict Substance Use among US Reserve/Guard Soldiers. Stress Health 2020; 36:311-321. [PMID: 31999055 PMCID: PMC7390694 DOI: 10.1002/smi.2934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/14/2020] [Accepted: 01/17/2020] [Indexed: 12/30/2022]
Abstract
The effects of negative social interactions/experiences on substance use have largely been studied in civilian populations, but less is known about United States Army Reserve/National Guard (USAR/NG) soldiers-a high-risk group. We examined the associations between problems with social acceptance, social victimization, and substance use among USAR/NG soldiers, and examined potential differences by deployment history. The sample consisted of soldiers who completed baseline and 1-year follow-up assessments (N = 445) of Operation: SAFETY, an ongoing study of USAR/NG soldiers. We examined the effects of baseline problems with social acceptance/social victimization on nonmedical use of prescription drugs (NMUPD), illicit drug use, frequent heavy drinking (FHD), and alcohol problems at follow-up. Significant effects were small in magnitude but consistent in direction. Greater problems with social acceptance were associated with higher odds of NMUPD and illicit drug use. Greater social victimization was associated with higher odds of NMUPD and illicit drug use. There were no differences by deployment history. Problems with social acceptance/social victimization were not associated with FHD or alcohol problems. Problems with social acceptance/social victimization may contribute to drug use among USAR/NG soldiers. Intervention programs should address social issues, regardless of deployment history.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-5704,
| | - Bonnie M. Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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19
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Anderson Goodell EM, Johnson RM, Latkin CA, Homish DL, Homish GG. Risk and protective effects of social networks on alcohol use problems among Army Reserve and National Guard soldiers. Addict Behav 2020; 103:106244. [PMID: 31838442 DOI: 10.1016/j.addbeh.2019.106244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Military personnel engage in alcohol-related behaviors for a variety of reasons, some of which may be socially-motivated. Although civilian-based research has established that peers' drinking behaviors are correlated with individuals' own drinking behaviors, military work has not yet examined the influence of social network characteristics on soldier drinking behaviors. This study describes characteristics of soldiers' social networks in association with soldier alcohol use problems. METHODS This study includes data on 353 U.S. Reserve and National Guard (R/NG) soldiers and their 2154 past-year social ties. Descriptive analyses examined social tie characteristics (e.g., military affiliation, substance misuse, and drinking influence). Negative binomial regression models examined relationships between social network characteristics and soldier alcohol use problems. RESULTS On average, 14% of a R/NG soldier's social network was comprised of military-affiliated ties. Further, an average of 14% of ties in a soldier's network were considered drinking buddies, and 8% of ties were heavy-drinkers. More drinking buddies and heavy-drinking ties in a soldier's social network and greater average number of past-month days drinking with ties were associated with increases in soldier alcohol problems. For deployed soldiers, larger military-affiliated social networks were protective against alcohol problems. CONCLUSIONS Drinking-related social network characteristics are associated with increased alcohol problems among soldiers, while military-affiliated ties are protective specifically for deployed soldiers. Interventions to reduce alcohol use problems may focus on enhancing social connections between R/NG soldiers and providing opportunities to connect deployed R/NG soldiers with one another during and after reintegration.
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20
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Vest BM, Hoopsick RA, Homish DL, Homish GG. Mental health and educational outcomes among current and former National Guard and Reserve soldiers. J Am Coll Health 2020; 68:110-114. [PMID: 30570455 PMCID: PMC6586523 DOI: 10.1080/07448481.2018.1536056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/06/2018] [Accepted: 09/25/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examined the relationships between mental health and educational outcomes among student service members and veterans (SSM/Vs). Participants: Current/former Reserve and National Guard (R/NG) soldiers who were enrolled in school, college, or university in the past year (n = 130). Data were collected in 2014-2016. Methods: Exact logistic regression models separately examined the impact of anxiety, depression, anger, and PTSD on quitting/flunking in the past year. Final models controlled for sex and deployment status. Results: In final models, anxiety [OR: 1.14; 95% confidence interval (CI): 1.05, 1.23; p<.01], anger (OR: 1.12; 95% CI: 1.04, 1.21; p<.01), and PTSD (OR: 1.06; 95% CI: 1.02, 1.10; p<.01) were associated with a higher odds of quitting/flunking school, college or university. Depression was not associated with quitting/flunking. Conclusion: Anxiety, anger, and PTSD are associated with quitting/flunking among SSM/Vs. Interventions tailored to this population that address mental health needs may improve the likelihood of academic success.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo NY 14203
| | - Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY 14214
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY 14214
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo NY 14214
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21
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Kulak JA, Homish DL, Hoopsick RA, Fillo J, Bartone PT, Homish GG. Hardiness protects against problematic alcohol use in male, but not female, soldiers. Psychol Serv 2020; 18:426-432. [PMID: 31971440 DOI: 10.1037/ser0000409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Military service members are at high risk for problematic substance use compared with the general population; deployment and combat exposure further increases this risk. It is thus critical to identify resiliency factors that can buffer the negative effects of military experiences and potentially prevent problematic alcohol use. The current research examines the extent to which psychological hardiness predicts lower risk of problematic alcohol use and explores potential sex differences in this association. Data are from Operation: SAFETY, an ongoing study of U.S. Army Reserve/National Guard soldiers. Negative binomial regression models examined the relation between baseline hardiness, assessed by the 15-item Dispositional Resiliency Scale, and problematic alcohol use at the 1-year follow-up, assessed by the Alcohol Use Disorders Identification Test (N = 260), controlling for baseline combat exposure (Combat Exposure subscale, Deployment Risk and Resilience Inventory-2) and baseline quantity and frequency of alcohol use. To examine the impact of hardiness on men and women, models were stratified by sex. In final, adjusted models, hardiness predicted lower risk of problematic alcohol use (adjusted risk ratio = 0.98; p < .05) for male soldiers and was unrelated to alcohol use for female soldiers (adjusted risk ratio = 1.01; p > .05). Post hoc analyses explored the impact of each dimension of hardiness (i.e., commitment, control, and challenge) on problematic alcohol use. Hardiness assessment may complement existing screening tools to identify high-risk populations; interventions to promote hardiness may help in preventing problematic alcohol use, particularly among male soldiers. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Abstract
Research on the behavioral health of military spouses/partners is essential, yet lacking. Data on 344 civilian spouses were drawn from a study of U.S. Army Reserve/National Guard soldier couples. This project characterizes civilian spouses' behavioral health symptoms. Regression analyses assessed the relationship between substance use and mental health symptoms. Overall, findings indicate civilian spouses had behavioral health impairments. Mental health, alcohol use, and tobacco use did not differ by soldiers' deployment history; illicit drug use and non-medical use of prescription drugs did at trend level. Support initiatives focusing on all military spouses, not just those of deployed soldiers, are needed.
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Affiliation(s)
- Jessica A Kulak
- University at Buffalo - The State University of New York, Family Medicine, Buffalo, New York.,Buffalo State College - The State University of New York, Health, Nutrition, and Dietetics, Buffalo, New York
| | - Jennifer Fillo
- University at Buffalo - The State University of New York, Clinical and Research Institute on Addictions, Buffalo, New York
| | - D Lynn Homish
- University at Buffalo - The State University of New York, Community Health and Health Behavior, Buffalo, New York
| | - Linda Kahn
- University at Buffalo - The State University of New York, Family Medicine, Buffalo, New York
| | - Gregory G Homish
- University at Buffalo - The State University of New York, Community Health and Health Behavior, Buffalo, New York
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Hoopsick RA, Homish DL, Bartone PT, Homish GG. Developing a Measure to Assess Emotions Associated with Never Being Deployed. Mil Med 2019; 183:e509-e517. [PMID: 29547934 DOI: 10.1093/milmed/usy005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/06/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Much research has focused on stress related to deployments; however, a substantial proportion of soldiers never deploy. In a study of 1.3 million veterans, suicide risk was higher among veterans who had never deployed. Thus, not being deployed may have an impact on soldiers' well-being; however, no measures exist to assess emotions regarding non-deployment. We aimed to develop and test an original measure of non-deployment emotions. METHODS We examined the Non-Deployment Emotions (NDE) questionnaire, a novel four-item measure of guilt, unit value, unit camaraderie, and unit connectedness in a sample of never-deployed male and female US Army Reserve/National Guard (USAR/NG) soldiers (N = 174). Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing survey-based study examining the health of USAR/NG soldiers and their partners. The protocol was approved by the Institutional Review Board at the State University of New York at Buffalo. The relationship between each of the items was examined by calculating correlation and alpha coefficients. Latent class analyses tested for the existence of distinct levels of negative emotions related to non-deployment. Negative binomial regression models examined the cross-sectional associations between NDE summary score and each of the following outcomes, separately: anger, anxiety, depression, and post-traumatic stress. FINDINGS More than half of never-deployed USAR/NG soldiers expressed negative emotions for having not been deployed. "Guilt," "value," "camaraderie," and "connectedness" were each positively correlated with each other (p < 0.001) and the internal consistency reliability was high (male soldier α = 0.90, female soldier α = 0.93). Latent class analyses revealed a superior three-class model with well-delineated class membership (entropy = 0.93): "Class 1" (low NDE; 47.6%), "Class 2" (moderate NDE; 33.8%), and "Class 3" (high NDE; 18.6%). Regression models demonstrated that greater non-deployment emotions were independently associated with more severe anger (RR = 1.02, 95% CI: 1.01, 1.03, p < 0.001), anxiety (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), depression (RR = 1.06, 95% CI: 1.01, 1.11, p < 0.05), and PTSD (RR = 1.10, 95% CI: 1.04, 1.16, p < 0.01). DISCUSSION Findings demonstrate that negative emotions regarding non-deployment are prevalent among never-deployed USAR/NG soldiers and that these emotions are related to a mental health. The NDE provides a measure of "guilt," "value," "camaraderie," and "connectedness" specific to non-deployed soldiers and is able to well discriminate between soldiers that have low, moderately, and highly negative non-deployment emotions. These findings suggest that all military personnel, regardless of deployment status, could be at risk for negative outcomes. As with any survey-based study, there is a potential for response bias; however, given the range of responses collected with the NDE, social desirability is unlikely. Further work is needed to confirm our findings in other components of the military and to examine soldiers in the rear detachment.
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Affiliation(s)
- Rachel A Hoopsick
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
| | - Paul T Bartone
- Center for Technology & National Security Policy, Institute for National Strategic Studies, National Defense University, 300 5th Avenue SW, Building 62, Fort Lesley J. McNair, Washington, DC
| | - Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY
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24
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Hoopsick RA, Benson KR, Homish DL, Homish GG. Resiliency factors that protect against post-deployment drug use among male US Army Reserve and National Guard soldiers. Drug Alcohol Depend 2019; 199:42-49. [PMID: 30981048 PMCID: PMC7370314 DOI: 10.1016/j.drugalcdep.2019.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Service members who have been deployed are at risk for substance use, especially Reserve/Guard troops. However, it is unclear what modifiable factors protect against substance use in this at-risk population. Our objective was to examine the effects of pre-, peri-, and post-deployment resiliency factors on post-deployment drug use. METHODS Data were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study examining the health of US Army Reserve/National Guard (USAR/NG) soldiers. This sample consisted of male USAR/NG soldiers with at least one combat deployment (N = 228). At baseline, we assessed the following as potential protective factors: deployment preparation, unit support and support from family/friends during soldiers' most recent deployment, and marital satisfaction. We examined the relations between each of these resiliency factors with drug use at the first follow-up assessment using the NIDA modified ASSIST 2.0. RESULTS Greater unit support (AOR = 0.56, 95% CI: 0.34, 0.92; p < 0.05) and support from family/friends during deployment (AOR = 0.64, 95% CI: 0.43, 0.96; p < 0.05) were associated with lower odds of drug use, controlling for age, rank, years of military service, combat exposure, traumatic brain injury, time since last deployment, and baseline drug use. Deployment preparation and marital satisfaction were not associated with drug use (ps > 0.05). CONCLUSIONS Social support provided to soldiers during deployment, either by his unit or his family/friends, showed evidence of protection against post-deployment drug use. In addition to existing post-deployment efforts, we recommend interventions that facilitate stronger interpersonal relationships during deployment.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA,Corresponding Author: Rachel A. Hoopsick, MS, MPH, CHES, Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, 3435 Main Street, 335 Kimball Tower, Buffalo, NY 14214, USA. Phone: 716-829-4731,
| | - Katelyn R. Benson
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G. Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Abstract
Use of family readiness programs (FRPs) by military families is not well understood. This work uses the Gelberg-Andersen Behavioral Model to identify characteristics of Reserve and National Guard (R/NG) couples who access FRPs. Data are from Operation: SAFETY, a study of R/NG soldiers and partners. Logistic regression models examined odds of accessing FRPs based on predisposing, enabling, and need factors. Greater length of military service, greater presence of non-military social ties, and civilian partner reports of adequate support during deployment were associated with higher likelihood of accessing FRPs. Results provide information on FRP utilization and may help inform outreach efforts.
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Affiliation(s)
- Erin M Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo - The State University of New York, Buffalo, NY
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo - The State University of New York, Buffalo, NY.,Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY
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26
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Homish GG, Hoopsick RA, Heavey SC, Homish DL, Cornelius JR. Drug use and hazardous drinking are associated with PTSD symptoms and symptom clusters in US Army Reserve/National Guard Soldiers. Am J Addict 2018; 28:22-28. [PMID: 30548523 DOI: 10.1111/ajad.12829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/27/2018] [Accepted: 11/17/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is strong evidence of the association between Posttraumatic Stress Disorder (PTSD) symptoms and substance use. Previous work has found sex differences in these associations. With revisions to the DSM, it is important to understand how overall PTSD symptoms and the new symptom clusters relate to substance use among Reserve/Guard soldiers-a high risk group. METHODS Data are from the baseline assessment of Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers (N = 389 males, N = 84 females). We examined associations between current substance use (drug use, hazardous drinking, and smoking) and overall PTSD symptoms, and symptom clusters. Additionally, we examined PTSD by sex interactions. RESULTS Greater overall PTSD symptoms were associated with higher odds of drug use (OR = 1.08; 95%CI: 1.05, 1.12) and hazardous drinking (OR = 1.04; 95%CI: 1.02, 1.07). Greater individual symptom cluster scores were associated with higher odds of drug use (ps < .001) and hazardous drinking (ps < .01). Interaction models revealed no differences in these associations on the basis sex (ps > .05). There were no associations between PTSD symptoms or symptom clusters on smoking (ps > .05). DISCUSSION AND CONCLUSION Soldiers experiencing PTSD symptoms are reporting current drug and hazardous alcohol use, suggestive of self-medication. SCIENTIFIC SIGNIFICANCE It is imperative to consider the impact of PTSD on substance use broadly, as this work shows that overall symptoms and symptom clusters have an impact on male and female USAR/NG soldiers. (Am J Addict 2019;28:22-28).
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Affiliation(s)
- Gregory G Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York.,Departments of Pediatrics and Family Medicine, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Rachel A Hoopsick
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Sarah Cercone Heavey
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - D Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, 3435 Main Street, Buffalo 14214, New York
| | - Jack R Cornelius
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh 15213, Pennsylvania
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Hoopsick RA, Homish DL, Vest BM, Homish GG. Alcohol Use Among Never-Deployed U.S. Army Reserve and National Guard Soldiers: The Effects of Nondeployment Emotions and Sex. Alcohol Clin Exp Res 2018; 42:2413-2422. [PMID: 30381833 PMCID: PMC6286239 DOI: 10.1111/acer.13901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited research shows that mental health problems are prevalent among never-deployed soldiers and many experience negative emotions related to their nondeployment. U.S. Army Reserve/National Guard (USAR/NG) soldiers are also at high risk for alcohol misuse. However, it is not known if nondeployment emotions contribute to an increased risk of alcohol misuse among never-deployed USAR/NG soldiers. METHODS Data are from Operation: SAFETY (Soldiers and Families Excelling Through the Years), an ongoing study of USAR/NG soldiers. We used regression models to examine the relations between nondeployment emotions, assessed by the Non-Deployment Emotions (NDE) Questionnaire, and a range of alcohol use outcomes, assessed by the Alcohol Use Disorders Identification Test and standard quantity and frequency questions, among a sample of never-deployed soldiers who were partnered at baseline (N = 174). Final models controlled for years of military service, current number of close military friends in the social network, marital satisfaction, and depression. We also tested for potential differences in these associations by sex. RESULTS Nondeployment emotions were associated with frequency of getting drunk (adjusted risk ratio [aRR] = 1.02, 95% CI: 1.01, 1.04; p < 0.05) and typical number of drinks consumed during a drinking episode (aRR = 1.03, 95% CI: 1.01, 1.04; p < 0.01). Nondeployment emotions had a trend-level association with percent of days drinking (adjusted odds ratio = 1.05, 95% CI: 1.00, 1.11; p = 0.055). Nondeployment emotions had a significant interaction with sex (p < 0.05) on the likelihood of alcohol problems, such that only male soldiers experienced a greater likelihood of alcohol problems when they had highly negative nondeployment emotions. There was no relation between nondeployment emotions and alcohol problems among female soldiers. CONCLUSIONS Findings demonstrate that greater nondeployment emotions are associated with increased alcohol use among never-deployed USAR/NG soldiers. The NDE Questionnaire may assist in identifying those at highest risk for alcohol problems.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Bonnie M. Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York
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28
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Vest BM, Homish DL, Fillo J, Homish GG. Military status and alcohol problems: Former soldiers may be at greater risk. Addict Behav 2018; 84:139-143. [PMID: 29679924 PMCID: PMC5975126 DOI: 10.1016/j.addbeh.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal of this study was to explore differences in alcohol problems as a function of military status (current soldier, previous soldier and civilian spouses), and the possible interaction between sex and military status. We hypothesized that 1) soldiers would be at greater risk for alcohol problems than civilian spouses, and 2) former soldiers would be at greater risk compared to current soldiers. METHODS Data were drawn from Operation: SAFETY, a longitudinal study examining physical and mental health among U.S. Army Reserve and National Guard soldiers and their partners. The analytic sample included male and female participants who completed both the baseline and first follow-up assessments (N = 772). Negative binomial regression models were used to examine differences between military status group on alcohol problems at follow-up, controlling for sex and alcohol consumption at baseline. Interactions between military status and sex were also examined. RESULTS Among current soldiers, males experienced significantly more alcohol problems compared to women (4.47, 3.46; p = 0.005). Likewise, among previous soldiers, males experienced significantly more alcohol problems compared to women (6.69, 2.92; p = 0.002). Male previous soldiers had significantly more alcohol problems compared to both male current soldiers and male civilian spouses (6.69, 4.47, p = 0.04; 6.69, 3.96; p = 0.02). Among women, there were no significant differences by military status. CONCLUSIONS Our results indicate that male previous soldiers are at greater risk of alcohol problems than both current soldiers and civilian spouses. Health care and service providers should consider screening and monitoring soldiers who separate from the military, as alcohol use may increase.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, United States.
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
| | - Jennifer Fillo
- Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
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29
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Abstract
BACKGROUND The goal of this work was to examine associations among childhood trauma, combat trauma, and substance use (alcohol problems, frequent heavy drinking [FHD], current cigarette smoking, and current/lifetime drug use) and the interaction effects of childhood trauma and combat exposure on those associations among National Guard/reserve soldiers. METHODS Participants (N = 248) completed an electronic survey asking questions about their military experiences, physical and mental health, and substance use. Childhood trauma and combat exposure were examined jointly in regression models, controlling for age, marital satisfaction, and number of deployments. RESULTS Childhood trauma was associated with current drug use (trend level, odds ratio [OR] = 1.44, 95% confidence interval [CI]: 0.97, 2.14; P = .072) in the main effect model; however, there was not a significant interaction with combat. Combat exposure had a significant interaction with childhood trauma on alcohol problems (b = -0.56, 95% CI: -1.12, -0.01; P = .048), FHD (b = -0.27, 95% CI: -0.47, -0.08; P = .007), and lifetime drug use (OR = 1.78, 95% CI: 1.04, 3.04; P = .035). There were no associations with either of the trauma measures and current cigarette smoking. CONCLUSIONS These results demonstrate that childhood and combat trauma have differential effects on alcohol use, such that combat trauma may not add to the effect on alcohol use in those with greater child maltreatment but may contribute to greater alcohol use among those with low child maltreatment. As expected, childhood and combat trauma had synergistic effects on lifetime drug use. Screening for multiple types of trauma prior to enlistment and/or deployment may help to identify at-risk individuals and allow time for early intervention to prevent future adverse outcomes.
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Affiliation(s)
- Bonnie M Vest
- a Department of Family Medicine , University at Buffalo , Buffalo , New York , USA
| | - Rachel A Hoopsick
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - D Lynn Homish
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - Rachel C Daws
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - Gregory G Homish
- a Department of Family Medicine , University at Buffalo , Buffalo , New York , USA.,b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
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30
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Abstract
BACKGROUND Military deployment and combat are associated with worse outcomes, including alcohol misuse. Less is known about how these experiences affect soldiers' spouses. OBJECTIVE The study objective was to explore relationships between deployment, combat exposure, and alcohol misuse; especially cross-spouse effects (effect of one partner's experiences/behavior on the other partner), which has been under-examined in military samples. METHODS U.S. Army Reserve/National Guard soldiers and their partners completed a questionnaire covering physical and mental health, military service and substance use. Negative binomial regression models examined number of deployments and combat exposure individually for alcohol misuse and frequent heavy drinking (FHD). In additional models, we examined combat exposure's role on alcohol outcomes, controlling for the soldiers' number of deployments, PTSD symptoms, age, and in cross-spouse models, alcohol use and FHD. We considered individuals' deployment experiences related to their alcohol outcomes and to their spouses' alcohol outcomes. RESULTS The study sample included male soldiers with current/lifetime military service (n = 248) and their female partners. Combat exposure was related to FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) among male soldiers while controlling for PTSD symptoms, number of deployments, and age. Female partners of male soldiers were more likely to engage in FHD (RR: 1.01, p < .05, 95% CI: 1.01, 1.01) if their spouse experienced combat. CONCLUSIONS Our results demonstrate that male soldiers and their spouses are at increased risk of FHD if the soldier experienced combat. This points to the need for better screening, particularly of spouses of soldiers, whose alcohol misuse may be overlooked.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, University at Buffalo, Buffalo NY
| | - Sarah Cercone Heavey
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - D. Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - Gregory G. Homish
- Department of Family Medicine, University at Buffalo, Buffalo NY
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
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Vest BM, Homish DL, Hoopsick RA, Homish GG. What drives the relationship between combat and alcohol problems in soldiers? The roles of perception and marriage. Soc Psychiatry Psychiatr Epidemiol 2018; 53:413-420. [PMID: 29282479 PMCID: PMC5864545 DOI: 10.1007/s00127-017-1477-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND While the relationship between combat exposure and alcohol problems is well-established, the role of perceptions of trauma is less understood. The goal of this study was to explore associations between National Guard (NG) and reserve soldiers' perceptions of combat experiences as traumatic and alcohol problems, and to examine marital satisfaction as a possible protective factor. METHODS The Operation: SAFETY study recruited US Army Reserve and NG soldiers and their partners to complete a questionnaire covering many physical and mental health, military service, and substance use topics. Negative binomial regression models examined the impact of perceived trauma of combat experiences on alcohol problems (N = 198). The potential role of marital satisfaction as a resiliency factor was also examined. RESULTS The perception of combat experiences as traumatic was associated with increased risk of alcohol problems (risk ratio [RR] = 1.06, 95% confidence interval [CI] 1.01, 1.12; p = 0.024). Combat exposure itself showed no relationship. Marital satisfaction had a significant interaction with perceived combat trauma on alcohol problems (RR = 0.90, 95% CI 0.81, 0.99, p = 0.046), such that soldiers who perceived combat exposure as moderately-highly traumatic were less likely to have alcohol problems when they rated their marital satisfaction highly. CONCLUSIONS Our results demonstrate that the perception of combat experiences as traumatic may be a greater contributor to adverse outcomes, such as alcohol problems, than mere combat exposure. They also demonstrate the importance of marital satisfaction as a resiliency factor, particularly at the highest levels of trauma.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Rachel A Hoopsick
- Department of Community Health and Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY, 14214, USA
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Heavey SC, Homish DL, Goodell EA, Homish GG. U.S. reserve soldiers' combat exposure and intimate partner violence: Not more common but it is more violent. Stress Health 2017; 33:617-623. [PMID: 28198140 PMCID: PMC6419092 DOI: 10.1002/smi.2748] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/27/2016] [Accepted: 01/20/2017] [Indexed: 11/11/2022]
Abstract
Combat exposure's influence on intimate partner violence (IPV) in reserve soldiers is not well understood. This work examines combat exposure's influence on IPV in U.S. Army Reserve/National Guard soldiers and partners. Data are from Operation: SAFETY, a longitudinal study of U.S. Army Reserve/National Guard soldiers and partners. Logistic regression models examined odds of sexual aggression, physical aggression, and physical injury with combat exposure, controlling for posttraumatic stress disorder symptoms, marital satisfaction, and age. Combat exposure was associated with greater physical injury, despite no association between combat exposure and physical aggression. This was significant for male soldier to female partner, as well as female partner to male soldier injury. In addition, female partners were more likely to be sexually aggressive against their male soldiers. Female soldiers' combat exposure was not associated with IPV or injury. Although men's combat exposure did not increase the likelihood of physical aggression, it increased the likelihood of IPV resulting in injury for both husband to wife and wife to husband aggression. Results indicate postdeployment programming should focus on conflict resolution and communication for both partners.
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Affiliation(s)
- Sarah Cercone Heavey
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York at Buffalo
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York at Buffalo
| | - Erin Anderson Goodell
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, State University of New York at Buffalo
- Departments of Pediatrics and Family Medicine, Jacobs School of Medicine & Biomedical Science, State University of New York at Buffalo
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Fillo J, Heavey SC, Homish DL, Homish GG. Deployment-Related Military Sexual Trauma Predicts Heavy Drinking and Alcohol Problems Among Male Reserve and National Guard Soldiers. Alcohol Clin Exp Res 2017; 42:111-119. [PMID: 29171862 DOI: 10.1111/acer.13528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Military sexual trauma (MST) is associated with a range of deleterious mental and physical health consequences; however, far less attention has been paid to the associations between MST and negative health behaviors, such as substance abuse. This study examined 2 focal research questions: (i) What is the prevalence of experiencing MST during deployment among male Reserve and National Guard soldiers? and (ii) to what extent is the degree of MST exposure during deployment associated with frequent heavy drinking and alcohol problems postdeployment? METHODS Data from male soldiers who had been deployed (N = 248) were drawn from the baseline wave of Operation: SAFETY (Soldiers And Families Excelling Through the Years) an ongoing study examining health among U.S. Army Reserve and National Guard and their partners. Participants were recruited over a 15-month period (Summer 2014 to Fall 2015) from units in New York State. Deployments occurred prior to the baseline wave of the study. Analyses examined the relation between degree of MST exposure during soldiers' most recent deployment and (i) frequent heavy drinking and (ii) alcohol problems, measured at baseline, controlling for posttraumatic stress disorder symptoms and age. RESULTS 17.3% of the male service members reported experiencing MST during their most recent deployment. Further, greater MST exposure was associated with a greater likelihood of engaging in frequent heavy drinking (adjusted risk ratio [aRR] = 1.03, 95% CI [1.01, 1.05]) and experiencing alcohol problems (aRR = 1.03, 95% CI [1.01, 1.06]) at baseline. CONCLUSIONS Findings demonstrate that MST rates are high among male Reserve and National Guard soldiers, and greater MST exposure is associated with an increased likelihood of engaging in frequent heavy drinking and experiencing alcohol problems among a population already at risk for problematic alcohol use.
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Affiliation(s)
- Jennifer Fillo
- Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Sarah Cercone Heavey
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York
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Hoopsick RA, Fillo J, Vest BM, Homish DL, Homish GG. Substance use and dependence among current reserve and former military members: Cross-sectional findings from the National Survey on Drug Use and Health, 2010-2014. J Addict Dis 2017; 36:243-251. [PMID: 28813208 DOI: 10.1080/10550887.2017.1366735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Maladjustment after leaving the military may contribute to poor health outcomes, including increased risk for substance use and dependence. The authors examined differences in substance use and dependence on the basis of military involvement in a large nationally representative sample. Data are from a subset of the 2010-2014 waves of the National Survey on Drug Use and Health (n = 5,608). The sample included men (81.9%) and women (18.1%) aged 20-49 years who had either separated/retired from the military (n = 4,862) or were a current reserve service member (n = 746). The sample was 70.8% Non-Hispanic White with a median family income between $50,000 and $74,999. Those who were separated/retired from the military had a higher odds of past month smoking (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI]: 1.27, 2.36; p = 0.001), nonmedical use of prescription painkillers (AOR = 4.07, 95% CI: 1.88, 8.83; p < 0.001), illicit drug use (AOR = 2.75, 95% CI: 1.79, 4.24; p < 0.001), alcohol dependence (AOR = 2.17, 95% CI: 1.20, 3.93; p = 0.011), nicotine dependence (AOR = 2.03, 95% CI: 1.25, 3.28; p = 0.004), and illicit drug dependence (AOR = 5.89; 95% CI: 2.19, 15.85; p = 0.001), compared to current reserve service members, controlling for sex, age, race, and income. Service members are leaving the military at an increasing rate and substance use may increase after separation. Across a range of substances, those who are separated/retired from the military have a higher likelihood of substance use/dependence than current reserve service members. Care models that assist in the transition from discharge to civilian life should be considered.
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Affiliation(s)
- Rachel A Hoopsick
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA
| | - Jennifer Fillo
- b Research Institute on Addictions, State University of New York at Buffalo , Buffalo , New York , USA
| | - Bonnie M Vest
- c Department of Family Medicine , State University of New York at Buffalo , Buffalo , New York , USA
| | - D Lynn Homish
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA
| | - Gregory G Homish
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA.,b Research Institute on Addictions, State University of New York at Buffalo , Buffalo , New York , USA.,c Department of Family Medicine , State University of New York at Buffalo , Buffalo , New York , USA
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35
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Vest BM, Heavey SC, Homish DL, Homish GG. Marital Satisfaction, Family Support, and Pre-Deployment Resiliency Factors Related to Mental Health Outcomes for Reserve and National Guard Soldiers. ACTA ACUST UNITED AC 2017; 5:313-323. [PMID: 30505630 DOI: 10.1080/21635781.2017.1343694] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of this study is to examine the relationship between resiliency factors and mental health outcomes among US Army Reserve and National Guard soldiers. Our results demonstrate that higher marital satisfaction is significantly associated with lower anger, depression, anxiety, and PTSD. Importantly, our results provide evidence that among the assessed resiliency factors (pre-deployment preparation, unit social support, martial satisfaction and family support), marital satisfaction has the strongest evidence for promoting resiliency. Future research should develop interventions that can be provided jointly to the soldier and his partner to facilitate stronger relationships and promote improved mental health and reintegration post-deployment.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, Buffalo NY
| | - Sarah Cercone Heavey
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
| | - Gregory G Homish
- Department of Family Medicine, University at Buffalo, Buffalo NY.,Department of Community Health & Health Behavior, University at Buffalo, Buffalo NY
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Kozlowski LT, Homish DL, Homish GG. Daily users compared to less frequent users find vape as or more satisfying and less dangerous than cigarettes, and are likelier to use non-cig-alike vaping products. Prev Med Rep 2017; 6:111-114. [PMID: 28289597 PMCID: PMC5344323 DOI: 10.1016/j.pmedr.2017.02.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/23/2017] [Accepted: 02/25/2017] [Indexed: 12/11/2022] Open
Abstract
We assessed the roles of perceived satisfaction and perceived danger and vaping-product-type as correlates of more frequent use of vaping products. In a baseline assessment of a longitudinal study of US Army Reserve/National Guard Soldiers and their partners (New York State, USA, 2014-2016), participants were asked about current use of vaping products (e-cigarettes) and perceived satisfaction and danger in comparison to cigarettes as well as type of product used. Fisher-exact tests and multiple ordinal logistic regressions were used. In multivariable and univariate models, more perceived satisfaction, less perceived danger, and use of non-cig-alike products were associated with more frequent use of vaping products (ps < 0.05, two-tailed). For self-selected, more frequent adult users, e-cigs can be at least as satisfying as cigarettes and often more satisfying and are perceived as less dangerous than cigarettes. Non-cig-alike products were more likely in daily users. Some concern that e-cigs are a gateway to cigarettes arises from assuming that e-cigs may not be as reinforcing and pleasurable as cigarettes. These results indicate that accurate perception of comparative risk and use of more effective-nicotine delivery product can produce for some users a highly-satisfying alternative to cigarettes.
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Affiliation(s)
- Lynn T. Kozlowski
- University at Buffalo, State University of New York, School of Public Health and Health Professions, Department of Community Health and Health Behavior, Buffalo, NY, USA
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Orom H, Underwood W, Cheng Z, Homish DL, Scott I. Relationships as Medicine: Quality of the Physician-Patient Relationship Determines Physician Influence on Treatment Recommendation Adherence. Health Serv Res 2016; 53:580-596. [PMID: 27981559 DOI: 10.1111/1475-6773.12629] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether quality of physician-patient relationships influences uptake of physician treatment recommendations in men with clinically localized prostate cancer (PCa). STUDY SETTING Data were collected July 2010 to August 2014 at two cancer centers and three community facilities. STUDY DESIGN Analyses were prospective and cross-sectional. We modeled associations between quality of the patient-physician relationship and influence of physician recommendations on treatment choice using generalized estimating equations (GEE). DATA COLLECTION Data were collected via survey and medical record abstraction. PRINCIPAL FINDINGS Participants (N = 1166) were 14.7 percent minority; 37.1 percent had low-, 47.5 percent had intermediate-, and 15.4 percent had high-risk PCa. Those reporting a better physician-patient relationship perceived that their physician's treatment recommendation was more influential (RR = 1.05, 95 percent CI = 1.04-1.05, p < .001) and were more likely to choose the recommended treatment (OR = 2.92, 95 percent CI = 2.39, 3.58, p < .001). A pattern of interactions emerged indicating that quality of the physician-patient relationship was more strongly associated with influence of recommendations for more, versus less aggressive treatment in those with low-risk, but not intermediate-risk disease. CONCLUSIONS Prioritizing quality of the physician-patient relationship through training, practice change, and patient feedback may increase adherence. However, strategies need to align with efforts to reduce physician recommendations for inefficacious treatments to prevent overtreatment.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Zinan Cheng
- Touro College of Osteopathic Medicine, Middletown, NY
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - I'Yanna Scott
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY
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Orom H, Sharma C, Homish GG, Underwood W, Homish DL. Racial Discrimination and Stigma Consciousness Are Associated with Higher Blood Pressure and Hypertension in Minority Men. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0284-2. [PMID: 27800597 PMCID: PMC5411333 DOI: 10.1007/s40615-016-0284-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We examined whether lifetime racial discrimination and stigma consciousness (expecting to be stigmatized) are associated with blood pressure in minority and White middle-aged and older adult men. DESIGN Participants were 1533 men (mean age = 63.2 [SD = 7.9, range = 37.4-89.2]; 12.4 % Black, 7.8 % Hispanic, 2.0 % other) diagnosed with clinically localized prostate cancer. We separately modeled associations between discrimination/stigma consciousness and blood pressure outcomes for minorities and Whites controlling for education, income, employment status, age, marital status, BMI, and recruitment site. RESULTS Minorities reported more racial discrimination and stigma consciousness than Whites (ps < .001). For minorities, having experienced more racial discrimination was associated with having higher diastolic blood pressure (B = 0.15, p = .016) and having greater stigma consciousness was associated with greater odds of having hypertension (OR = 1.04, p = .047). Greater stigma consciousness was associated with lower systolic blood pressure in Whites (B = -0.24, p = .012). CONCLUSION Discrimination and stigma consciousness are associated with common risk factors for chronic disease and premature death that disproportionately affect minorities. Findings for stigma consciousness suggest that anticipatory vigilance may be impacting minority health.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA.
| | - Chaman Sharma
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Buffalo, Buffalo, NY, 14263, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
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Mollica MA, Underwood W, Homish GG, Homish DL, Orom H. Spirituality is associated with less treatment regret in men with localized prostate cancer. Psychooncology 2016; 26:1839-1845. [PMID: 27530290 DOI: 10.1002/pon.4248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 07/26/2016] [Accepted: 08/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Some patients with prostate cancer regret their treatment choice. Treatment regret is associated with lower physical and mental quality of life. We investigated whether, in men with prostate cancer, spirituality is associated with lower decisional regret 6 months after treatment and whether this is, in part, because men with stronger spiritual beliefs experience lower decisional conflict when they are deciding how to treat their cancer. METHODS One thousand ninety three patients with prostate cancer (84% white, 10% black, and 6% Hispanic; mean age = 63.18; SD = 7.75) completed measures of spiritual beliefs and decisional conflict after diagnosis and decisional regret 6 months after treatment. We used multivariable linear regression to test whether there is an association between spirituality and decisional regret and structural equation modeling to test whether decisional conflict mediated this relationship. RESULTS Stronger spiritual beliefs were associated with less decisional regret (b = -0.39, 95% CI = -0.53, -0.26, P < .001, partial η2 = 0.024, confidence interval = -0.55, 39%, P < .001, partial η2 = 0.03), after controlling for covariates. Decisional conflict partially (38%) mediated the effect of spirituality on regret (indirect effect: b = -0.16, 95% CI = -0.21, -0.12, P < .001). CONCLUSIONS Spirituality may help men feel less conflicted about their cancer treatment decisions and ultimately experience less decisional regret. Psychosocial support post-diagnosis could include clarification of spiritual values and opportunities to reappraise the treatment decision-making challenge in light of these beliefs.
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Affiliation(s)
- Michelle A Mollica
- Division of Cancer Control and Population Sciences, Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | | | - Gregory G Homish
- Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Orom H, Biddle C, Underwood W, Nelson CJ, Homish DL. What Is a "Good" Treatment Decision? Decisional Control, Knowledge, Treatment Decision Making, and Quality of Life in Men with Clinically Localized Prostate Cancer. Med Decis Making 2016; 36:714-25. [PMID: 26957566 DOI: 10.1177/0272989x16635633] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/02/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We explored whether active patient involvement in decision making and greater patient knowledge are associated with better treatment decision-making experiences and better quality of life (QOL) among men with clinically localized prostate cancer. Localized prostate cancer treatment decision making is an advantageous model for studying patient treatment decision-making dynamics because there are multiple treatment options and a lack of empirical evidence to recommend one over the other; consequently, it is recommended that patients be fully involved in making the decision. METHODS Men with newly diagnosed clinically localized prostate cancer (N = 1529) completed measures of decisional control, prostate cancer knowledge, and decision-making experiences (decisional conflict and decision-making satisfaction and difficulty) shortly after they made their treatment decision. Prostate cancer-specific QOL was assessed at 6 months after treatment. RESULTS More active involvement in decision making and greater knowledge were associated with lower decisional conflict and higher decision-making satisfaction but greater decision-making difficulty. An interaction between decisional control and knowledge revealed that greater knowledge was only associated with greater difficulty for men actively involved in making the decision (67% of sample). Greater knowledge, but not decisional control, predicted better QOL 6 months after treatment. CONCLUSIONS Although men who are actively involved in decision making and more knowledgeable may make more informed decisions, they could benefit from decisional support (e.g., decision-making aids, emotional support from providers, strategies for reducing emotional distress) to make the process easier. Men who were more knowledgeable about prostate cancer and treatment side effects at the time that they made their treatment decision may have appraised their QOL as higher because they had realistic expectations about side effects.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
| | - Caitlin Biddle
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA (WU)
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA (CJN)
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA (HO, CB, DLH)
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Mollica MA, Underwood W, Homish GG, Homish DL, Orom H. Spirituality is associated with better prostate cancer treatment decision making experiences. J Behav Med 2015; 39:161-9. [PMID: 26243642 DOI: 10.1007/s10865-015-9662-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/17/2015] [Indexed: 12/12/2022]
Abstract
This study examined whether spiritual beliefs are associated with greater decision-making satisfaction, lower decisional conflict and decision-making difficulty with the decision-making process in newly diagnosed men with prostate cancer. Participants were 1114 men diagnosed with localized prostate cancer who had recently made their treatment decision, but had not yet been treated. We used multivariable linear regression to analyze relationships between spirituality and decision-making satisfaction, decisional conflict, and decision-making difficulty, controlling for optimism and resilience, and clinical and sociodemographic factors. Results indicated that greater spirituality was associated with greater decision-making satisfaction (B = 0.02; p < 0.001), less decisional conflict (B = -0.42; p < 0.001), and less decision-making difficulty (B = -0.08; p < 0.001). These results confirm that spiritual beliefs may be a coping resource during the treatment decision-making process. Providing opportunities for patients to integrate their spiritual beliefs and their perceptions of their cancer diagnosis and trajectory could help reduce patient uncertainty and stress during this important phase of cancer care continuum.
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Affiliation(s)
- Michelle A Mollica
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA. .,Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA.
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA.
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, 320 Kimball Tower, 3435 Main St., Buffalo, NY, 14214, USA.
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Orom H, Underwood W, Homish DL, Kapoor D, Nelson C, Schiffman Z, Reyna J. PD34-12 EMOTIONAL DISTRESS PREDICTS CHOOSING SURGERY OVER ACTIVE SURVEILLANCE IN CLINICALLY LOCALIZED PROSTATE CANCER PATIENTS. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Orom H, Nelson CJ, Underwood W, Homish DL, Kapoor DA. Factors associated with emotional distress in newly diagnosed prostate cancer patients. Psychooncology 2015; 24:1416-22. [PMID: 25631163 DOI: 10.1002/pon.3751] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 11/25/2014] [Accepted: 12/18/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early identification and intervention have been recommended for newly diagnosed prostate cancer patients who experience significant emotional distress; however, there is little empirical basis for designing or selecting interventions for these men. We sought to identify factors that are associated with distress in these men as a basis for identifying suitable intervention strategies. METHODS Using cross-sectional data and validated scales, we investigated the extent to which clinical, demographic, belief, and personality characteristics are associated with emotional distress assessed with the Distress Thermometer in 1425 men newly diagnosed with clinically localized prostate cancer (pretreatment). RESULTS Beliefs potentially amenable to psychoeducational interventions [low self-efficacy for decision-making (B =-0.11, p = 0.02), low confidence in cancer control (B =-0.03, p < 0.001), and masculine identity threat (B =-0.26, p = 0.001)] were associated with higher emotional distress, as well as personality factors [low optimism (B =-0.04, p = 0.052) and low resilience (B =-0.83, p < 0.001)]. CONCLUSIONS Findings provide a framework for the development of interventions for prostate cancer patients with elevated emotional distress. These may include improving provider communication about prostate cancer prognosis for those with low confidence in cancer control, providing decision-making support to increase decision-making self-efficacy, or referral to brief cognitive behavioral interventions to help patients reframe masculine identity threat or for those with low optimism or resilience reframe and adjust to the health threat.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Willie Underwood
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Deepak A Kapoor
- Integrated Medical Professionals, PLLC, Melville, NY, USA.,Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Orom H, Underwood W, Homish DL, Kiviniemi MT, Homish GG, Nelson CJ, Schiffman Z. Prostate cancer survivors' beliefs about screening and treatment decision-making experiences in an era of controversy. Psychooncology 2014; 24:1073-9. [PMID: 25382436 DOI: 10.1002/pon.3721] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 09/09/2014] [Accepted: 10/15/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Controversy about the costs and benefits of screening and treatment of prostate cancer (PCa) has recently intensified. However, the impact of the debate on PCa patients has not been systematically studied. METHODS We assessed knowledge of, and attitudes toward, the U.S. Preventive Services Task Force's (USPSTF) May 2012 recommendation against PSA-based screening among men diagnosed with clinically localized PCa, and tested whether exposure to the recommendation and associated controversy about overtreatment of PCa predicted treatment decisional conflict, affected treatment choice, or increased regret about PSA testing. RESULTS Accurate knowledge of the USPSTF recommendation was uncommon (19.1%). Attitudes toward the recommendation were negative, and the vast majority (86.5%) remained highly supportive of annual PSA testing in men ≥50. Although exposure to the recommendation and controversy about treatment was associated with lower enthusiasm for screening and treatment, it was not associated with treatment decisions, or greater decisional-conflict, or regret. CONCLUSIONS Findings may alleviate concern that exposure to PSA-based screening and overtreatment controversies has adversely affected recent cohorts of PCa patients. However, patients remain highly supportive of PSA-based screening. As survivor anecdotes often influence people's medical decisions, it is important to appreciate the scale of opposition to the new recommendation.
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Affiliation(s)
- Heather Orom
- Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Willie Underwood
- Urologic Oncology, Roswell Park Cancer Institute, Elm & Carlton, Buffalo, NY, 14263, USA
| | - D Lynn Homish
- Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Marc T Kiviniemi
- Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Gregory G Homish
- Community Health and Health Behavior, University at Buffalo, 3435 Main St., Buffalo, NY, 14214, USA
| | - Christian J Nelson
- Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, New York, NY, 10022, USA
| | - Zvi Schiffman
- Houston Metro Urology P. A., 4223 Richmond Ave, Houston, TX, 77027, USA
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Orom H, Homish DL, Homish GG, Underwood W. Quality of physician-patient relationships is associated with the influence of physician treatment recommendations among patients with prostate cancer who chose active surveillance. Urol Oncol 2013; 32:396-402. [PMID: 24332649 DOI: 10.1016/j.urolonc.2013.09.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/18/2013] [Accepted: 09/19/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE With growing evidence that some men with prostate cancer (PCa) may be overtreated, clinicians need greater knowledge of the factors that influence uptake of treatment recommendations in general, and specifically, uptake of active surveillance in patients for whom this is an appropriate treatment option. The objective of this study was to test the role of the quality of the physician-patient relationship in the choice to be followed by active surveillance, rather than receive definitive therapy (e.g., surgery and radiation). We hypothesized that patients would have been more influenced by their physicians' treatment recommendations to the degree that they held more positive perceptions of their relationship with their physicians, independent of treatment recommended. METHODS AND MATERIALS Patients with PCa (n = 120) being followed with active surveillance at a comprehensive cancer center completed self-report assessments of their treatment decision-making process. Generalized estimating equations were used to model the association between participants' perceptions of their relationships with their physicians and influence of these physicians' recommendations on their treatment decision. RESULTS After controlling for the type of treatment recommended, Gleason score, and education, 3 predictors, trust in the physician, perceived closeness with the physician, and the degree to which the physician shared control over treatment decision making, were associated with greater influence of physician's treatment recommendation. Receiving a recommendation for active surveillance, compared with definitive therapy, was also associated with higher perceived trust, closeness, shared control over treatment decision making, lower likelihood of having been treated poorly by a physician, and greater influence of physician's treatment recommendation. CONCLUSIONS There is increasing concern that patients with relatively less aggressive PCa, older age, or serious comorbidities are being unnecessarily treated with surgery or radiation, putting them at risk for side effects, and contributing to high health care costs. When active surveillance is an appropriate course of treatment, the quality of patients' relationships with their physicians may be a determinant of following a recommendation for active surveillance. Results may have implications for treatment uptake in general, indicating that the quality of the physician-patient relationship, including trust, closeness, shared decision making--all elements of patient-centered care--may be important motivators of treatment adoption and adherence.
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Affiliation(s)
- Heather Orom
- Community Health and Health Behavior, University at Buffalo, Buffalo, NY.
| | - D Lynn Homish
- Community Health and Health Behavior, University at Buffalo, Buffalo, NY
| | - Gregory G Homish
- Community Health and Health Behavior, University at Buffalo, Buffalo, NY
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Stouthamer-Loeber M, Wei EH, Homish DL, Loeber R. Which Family and Demographic Factors Are Related to Both Maltreatment and Persistent Serious Juvenile Delinquency? ACTA ACUST UNITED AC 2010. [DOI: 10.1207/s15326918cs0504_3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Loeber R, Pardini D, Homish DL, Wei EH, Crawford AM, Farrington DP, Stouthamer-Loeber M, Creemers J, Koehler SA, Rosenfeld R. The prediction of violence and homicide in young men. J Consult Clin Psychol 2006; 73:1074-88. [PMID: 16392981 DOI: 10.1037/0022-006x.73.6.1074] [Citation(s) in RCA: 198] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this prospective study, the authors predicted violence and homicide in 3 representative school samples (N = 1,517). Participants were part of a longitudinal, multiple cohort study on the development of delinquency in boys from late childhood to early adulthood in Pittsburgh, Pennsylvania. Thirty-three participants were convicted of homicide, 193 participants were convicted of serious violence, whereas another 498 participants self-reported serious violence. Predictors of violence included risk factors in the domains of child, family, school, and demographic characteristics. Boys with 4 or more violence risk factors were 6 times more likely to later commit violence in comparison with boys with fewer than 4 risk factors (odds ratio [OR] = 6.05). A subset of risk factors related to violence also predicted homicide among violent offenders. Boys with 4 or more risk factors for homicide were 14 times more likely to later commit homicide than violent individuals with fewer than 4 risk factors (OR = 14.48). Implications for the prevention of violence and homicide are discussed.
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Affiliation(s)
- Rolf Loeber
- Department of Psychiatry, University of Pittsburgh School of Medicine, 15213 PA, USA.
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Stouthamer-Loeber M, Loeber R, Homish DL, Wei E. Maltreatment of boys and the development of disruptive and delinquent behavior. Dev Psychopathol 2002; 13:941-55. [PMID: 11771915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Data from a longitudinal, inner-city community sample were used to examine the prevalence of child maltreatment in males and to relate this to disruptive and delinquent child behavior. By age 18 years, almost one fourth of the families had been referred to Children and Youth Services (CYS). Investigation by the CYS resulted in substantiated maltreatment of 10% of the participants, mostly for physical abuse and neglect. Almost all maltreatment was perpetrated by people living in the same house as the victim. Maltreatment was related to the boys progressing on three pathways in disruptive and delinquent behavior: authority conflict pathway, overt pathway, and covert pathway. Two thirds of the victims showed authority conflict problems, and almost all of the maltreated boys displayed behaviors characteristic of the overt and covert pathways. Victims, compared to matched controls, were more likely to have engaged in behaviors characteristic of the authority conflict and the overt pathways but less strongly engaged in behaviors associated with the covert pathway. Victims were also more likely than controls to have a referral to juvenile court. Most of the CYS contact tended to precede or co-occur with onset of overt and covert problem behavior, but about half of the onset of authority conflict behaviors tended to precede contact with CYS.
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