Syndemic Factors associated with Drinking Patterns among Latino Men and Latina Transgender Women Who Have Sex with Men in New York City

Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. 

The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. 

We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. 

In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. 

Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.

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By:  Omar Martinez^a*, Elwin Wu^b, Ethan C. Levine^c, Miguel Muñoz-Laboy^d, Joseph Spadafino^e, Brian Dodge^f, Scott D. Rhodes^g,Javier López Rios^h, Hugo Ovejeroⁱ, Eva M. Moya^j, Silvia Chavez Baray^j, Alex Carballo-Diéguez^h & M. Isabel Fernandez^k

• ^a Temple University School of Social Work, Philadelphia, PA, USA;
• ^b School of Social Work at Columbia University, New York, NY, USA;
• ^c Department College of Liberal Arts at Temple University, Philadelphia, PA, USA;
• ^d College of Public Health at Temple University, Philadelphia, PA, USA;
• ^e Bureau of Public Health Statistics, Phoenix, AZ, USA;
• ^f School of Public Health at Indiana University – Bloomington, Bloomington, IN, USA;
• ^g Wake Forest School of Medicine, Winston-Salem, NC, USA;
• ^h HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA;
• ⁱ Lutheran Family Health Center, Brooklyn, NY, USA;
• ^j School of Social Work at the University of Texas at El Paso, El Paso, TX, USA;
• ^k Department of Public Health at Nova Southeastern University, Fort Lauderdale, FL, USA

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The Impact of Enrolment in Methadone Maintenance Therapy on Initiation of Heavy Drinking among People Who Use Heroin

BACKGROUND:

There is equivocal evidence regarding whether people who use heroin substitute heroin for alcohol upon entry to methadone maintenance therapy (MMT). We aimed to examine the impact of MMT enrolment on the onset of heavy drinking among people who use heroin.

METHODS:

We derived data from prospective, community-based cohorts of people who inject drugs in Vancouver, Canada, between December 1, 2005, and May 31, 2014. Multivariable extended Cox regression analysis examined the effect of MMT enrolment on the onset of heavy drinking among people who used heroin at baseline.

RESULTS:

In total, 357 people who use heroin were included in this study. Of these, 208 (58%) enrolled in MMT at some point during follow-up, and 115 (32%) reported initiating heavy drinking during follow-up for an incidence density of 7.8 events (95% CI 6.4-9.5) per 100 person-years. The incidence density of heavy drinking was significantly lower among those enrolled in MMT at some point during follow-up compared to those who did not (4.6 vs. 16.2). MMT enrolment was not significantly associated with time to initiate heavy drinking (adjusted relative hazard after adjustment for relevant demographic and substance-use characteristics. Age and cannabis use were the only variables that were independently associated with the time to onset of heavy drinking.

CONCLUSION:

In this study, MMT enrolment did not predict heavy drinking and may even appear to decrease the initiation of heavy drinking. Our findings suggest younger age and cannabis use may predict heavy drinking. These findings could help inform on-going discussions about the effects of opioid agonist therapy on alcohol consumption among people who use heroin.

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By:  Klimas J1, Wood E, Nguyen P, Dong H, Milloy MJ, Kerr T, Hayashi K.

• 1British Columbia Centre for Excellence in HIV/AIDS, Vancouver, B.C., Canada.
• Eur Addict Res. 2016 Apr 6;22(4):210-214 

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Risk of Heavy Drinking among Sexual Minority Adolescents: Indirect Pathways through Sexual Orientation-Related Victimization & Affiliation with Substance-Using Peers

AIMS:

To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations.

DESIGN:

Analysis of the first three waves (six-months apart) of a longitudinal adolescent health risk study (2011-2014). Participants were referred by medical providers or a screening system in providers' waiting rooms.

SETTING:

Two large urban adolescent health clinics in Pennsylvania and Ohio, USA.

PARTICIPANTS:

290 adolescents (ages 14-19, mean: 17) who were 71% female, 33% non-Hispanic White, and 34% SMAs.

MEASUREMENTS:

Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables.

FINDINGS:

Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers (wave 2; indirect effect = 0.03, 95%CI: 0.01, 0.07), after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = .10, 95%CI: 0.02-0.19). The social marginalization pathway was not supported as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; β = -.04, p = .66). Sex differences in the indirect effects were not detected (ps > .10).

CONCLUSIONS:

Sexual minority adolescents in the US appear to exhibit increased heavy episodic drinking via an indirect socialization pathway including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.

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By:  Dermody SS1, Marshal MP2,3, Burton CM2, Chisolm DJ4.

• 1Department of Psychology, University of Pittsburgh.
• 2Department of Psychiatry, School of Medicine, University of Pittsburgh.
• 3Department of Pediatrics, School of Medicine, University of Pittsburgh.
• 4Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital. 
• Addiction. 2016 Mar 28. doi: 10.1111/add.13409. 

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Pathways to Romantic Relational Aggression Through Adolescent Peer Aggression & Heavy Episodic Drinking

Adolescent peer aggression is a well-established correlate of romantic relational aggression; however, the mechanisms underlying this association are unclear. Heavy episodic drinking (or "binge" alcohol use) was examined as both a prior and concurrent mediator of this link in a sample of 282 12-18 year old interviewed four times over 6 years. 

Path analyses indicated that early peer relational and physical aggression each uniquely predicted later romantic relational aggression. Concurrent heavy episodic drinking fully mediated this effect for peer physical aggression only. 

These findings highlight two important mechanisms by which peer aggression may increase the risk of later romantic relational aggression: a direct pathway from peer relational aggression to romantic relational aggression and an indirect pathway through peer physical aggression and concurrent heavy episodic drinking. 

Prevention programs targeting romantic relational aggression in adolescence and young adulthood may benefit from interventions that target multiple domains of risky behavior, including the heavy concurrent use of alcohol. 

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By:  Woodin EM1, Sukhawathanakul P1, Caldeira V1, Homel J1, Leadbeater B1.

• 1Department of Psychology, University of Victoria, Victoria, British Columbia, Canada.
• Aggress Behav. 2016 Mar 16. doi: 10.1002/ab.21651.  

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Brief Motivational Intervention to Reduce Alcohol and HIV/Sexual Risk Behavior in Emergency Department Patients

OBJECTIVE:

Given the prevalence of co-occurring risky sexual behavior and drinking among emergency department (ED) patients, we developed a motivational intervention (MI) to address both behaviors. This study tested efficacy of a single-session MI compared to brief advice (BA) for reducing heavy drinking and condomless sex in adult ED patients screening positive for both.

METHOD:

We randomized 372 patients to MI (n = 184) or BA (n = 188). Alcohol and sex risk outcomes were assessed over 9 months.

RESULTS:

Generalized estimating equations models analyzing 327 patients with follow-up data provided strong support for efficacy of this integrated alcohol and sex-risk MI. Compared to BA, and after controlling for baseline covariates, those in MI reported significantly fewer heavy drinking days, drinks per week, and were less likely to engage in excessive drinking over follow-up (all ps < .05). MI was also favored over BA for reducing sex risk. Compared to BA, those in MI reported significantly fewer days on which they engaged in condomless sex with casual partners, had lower odds of reporting any condomless sex with a casual partner, and reported fewer days of sex under the influence of alcohol/other drugs (all ps < .05).

CONCLUSION:

This innovative MI was acceptable, feasible, and successfully delivered in 2 community hospitals and thus shows great promise for scalability and dissemination into complex health settings where newly insured at-risk individuals are likely to seek care. 

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By:  Monti PM, Mastroleo NR, Barnett NP, Colby SM, Kahler CW, Operario D.

J Consult Clin Psychol. 2016 Mar 17.

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Substance Use Patterns of HIV-Infected Russian Women With and Without Hepatitis C Virus Co-infection

Individuals with HIV and hepatitis C virus (HCV) co-infection may experience substance use related health complications. This study characterized substance use patterns between HIV/HCV co-infected and HIV mono-infected Russian women. HIV-infected women (N = 247; M age = 30.0) in St. Petersburg, Russia, completed a survey assessing substance use, problematic substance use, and the co-occurrence of substance use and sexual behaviors. 

Covariate adjusted logistic and linear regression analyses indicated that HIV/HCV co-infected participants (57.1 %) reported more lifetime drug use (e.g., heroin), problem drinking, substance use problems, and increased likelihood of past injection drug use relative to HIV mono-infected individuals. HIV/HCV co-infection was prevalent and associated with increased substance use and problematic drug use. 

Findings highlight the need for ongoing substance use and HIV/HCV risk behavior assessment and treatment among HIV/HCV co-infected Russian women.

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By:  Brown JL1, DiClemente RJ2,3,4, Sales JM2,3, Rose ES2, Safonova P5, Levina OS6, Belyakov N7, Rassokhin VV5.

• 1Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA. jennifer.brown2@uc.edu.
• 2Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
• 3Centers for AIDS Research, Emory University, Atlanta, GA, USA.
• 4Department of Pediatrics, Division of Infectious Diseases, Epidemiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA.
• 5St. Petersburg AIDS Center, St. Petersburg, Russia.
• 6Stellit, St. Petersburg, Russia.
• 7North-West Regional Center for Control and Prevention of AIDS, St. Petersburg, Russia. 
• AIDS Behav. 2016 Mar 19.

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Unintended Pregnancy, Depression, and Hazardous Drinking in a Community-Based Sample of Sexual Minority Women

CONTEXT:

Unintended pregnancy is a stressful life event with important implications for women's health. Little research has examined sexual minority women's (SMW; lesbian, bisexual, mostly heterosexual) experiences of unintended pregnancy, and no studies have examined the relationship between unintended pregnancy, mental health, and negative coping behaviors in this population.

METHODS:

We used the Chicago Health and Life Experiences of Women (CHLEW) Study (n = 454), a diverse sample of SMW, to examine the relationship between self-reported unintended pregnancy, depressive symptoms, and hazardous drinking. We used generalized linear model-building techniques and adjusted for key sociodemographic controls, as well as unintended pregnancy risk factors, including childhood physical and sexual abuse and age of sexual debut.

RESULTS:

Twenty-four percent of the sample reported an unintended pregnancy. SMW who reported unintended pregnancies also reported significantly more depressive symptoms and greater risk of hazardous drinking. Adjusting for childhood abuse explained the relationship between unintended pregnancy and depressive symptoms, but not the relationship between unintended pregnancy and hazardous drinking.

CONCLUSIONS:

Unintended pregnancy among SMW is an understudied topic. Our results suggest that unintended pregnancy is not uncommon among SMW and highlight the need for more research to investigate the mechanisms that link unintended pregnancy to depression and to hazardous drinking within this population.

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By:  Everett BG1, McCabe KF2, Hughes TL3.

• 1 Department of Sociology, University of Utah, Salt Lake City, Utah.
• 2 Department of Sociology, University of Illinois at Chicago, Chicago, Illinois.
• 3 Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois. 
• J Womens Health (Larchmt). 2016 Mar 15.

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Prevalence and Co-Occurrence of Heavy Drinking and Anxiety and Mood Disorders among Gay, Lesbian, Bisexual, and Heterosexual Canadians

OBJECTIVES:

To investigate the prevalence and co-occurrence of heavy drinking, anxiety, and mood disorders among Canadians who self-identified as gay, lesbian, bisexual, or heterosexual.

METHODS:

Pooled data from the 2007 to 2012 cycles of the Canadian Community Health Survey (n = 222 548) were used to fit logistic regression models controlling for sociodemographic characteristics.

RESULTS:

In adjusted logistic regression models, gay or lesbian respondents had greater odds than heterosexual respondents of reporting anxiety disorders, mood disorders, and anxiety-mood disorders. Bisexual respondents had greater odds of reporting anxiety disorders, mood disorders, anxiety-mood disorders, and heavy drinking. Gay or lesbian and bisexual respondents had greater odds than heterosexuals of reporting co-occurring anxiety or mood disorders and heavy drinking. The highest rates of disorders were observed among bisexual respondents, with nearly quadruple the rates of anxiety, mood, and combined anxiety and mood disorders relative to heterosexuals and approximately twice the rates of gay or lesbian respondents.

CONCLUSIONS:

Members of sexual minority groups in Canada, in particular those self-identifying as bisexual, experience disproportionate rates of anxiety and mood disorders, heavy drinking, and co-occurring disorders.

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By:  Pakula B1, Shoveller J1, Ratner PA1, Carpiano R1.

• 1Basia Pakula is a PhD candidate with the School of Population and Public Health, University of British Columbia, Vancouver. Jean Shoveller is with the School of Population and Public Health, University of British Columbia and the Epidemiology/Population Health and Drug Treatment Program, BC Centre for Excellence in HIV/AIDS, Vancouver. Pamela A. Ratner is with the Faculty of Education and the Enrollment and Academic Facilities, University of British Columbia. Richard Carpiano is with the Department of Sociology, University of British Columbia. 
• Am J Public Health. 2016 Mar 17:e1-e7.

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The Male Factor: Outcomes from a Cluster Randomized Field Experiment with a Couples-Based HIV Prevention Intervention in a South African Township

Highlights

• Men in the couples arm were less likely to report heavy drinking at 6-months.
• Men in the couples arm were more likely to report past-month consistent condom use.
• Women tested at twice the prevalence of HIV (26%) as men (13%).
• At 6-months, HIV incidence was significantly lower among women in the intervention.
• Couples-based interventions focusing on intersecting HIV risks can improve outcomes.

BACKGROUND:

This study examined the effects of the Couples Health CoOp intervention on heavy drinking, condom use, and HIV incidence.

METHODS:

Thirty neighborhoods from one South African township were cluster randomized into three intervention arms: Couples Health CoOp (CHC), Women's Health CoOp/Men's Health CoOp (WHC/MHC), or a comparison arm. We recruited 290 men from informal drinking establishments who reported drinking alcohol regularly. We also recruited their main heterosexual sex partners.

RESULTS:

At 6-month follow-up, men in the CHC arm were less likely to report heavy drinking (OR 0.47, 95% CI: 0.25, 0.90) and were more likely to report consistent condom use during the past month (OR 2.66, 95% CI: 1.23, 5.76) than men in the comparison arm. At baseline, 26% of women and 13% of men were HIV-infected; at 6-month follow-up, 16 females and 5 males had seroconverted. HIV incidence was significantly lower among women in the CHC arm (IRR 0.22, 95% CI: 0.04, 1.01) than in the WHC/MHC arm.

CONCLUSIONS:

A couples-based intervention focusing on intersecting risks for HIV can improve biobehavioral outcomes, underscoring the importance of engaging couples together in HIV prevention.

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By:  Wechsberg WM1, Zule WA2, El-Bassel N3, Doherty IA4, Minnis AM5, Novak SD2, Myers B6, Carney T7.

• 1RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States; Department of Psychology in the Public Interest, North Carolina State University, Raleigh, NC, United States; Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States. Electronic address: wmw@rti.org.
• 2RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States.
• 3Columbia University School of Social Work, New York, NY, United States.
• 4RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, United States; University of North Carolina, Chapel Hill, NC, United States.
• 5RTI International, 351 California Street, San Francisco, CA, United States.
• 6Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
• 7Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa. 
• Drug Alcohol Depend. 2016 Apr 1;161:307-15. doi: 10.1016/j.drugalcdep.2016.02.017. Epub 2016 Feb 18.

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Alcohol Use and Firearm Violence

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. 

To explore this, we undertook a 40-year (1975-2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths. 

Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. 

A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. 

Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. 

Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study.

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By:  Branas CC, Han S, Wiebe DJ.

Correspondence to Dr. Charles C. Branas, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 (e-mail: cbranas@upenn.edu).

Epidemiol Rev. 2016 Jan 24. pii: mxv010. 

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High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda

The aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. 

Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. 

At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). 

Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. 

This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.

Full article at:   http://goo.gl/yT7hIa

By:  Weiss HA1, Vandepitte J2, Bukenya JN3, Mayanja Y4, Nakubulwa S5, Kamali A6, Seeley J7,8, Grosskurth H9.

• 1MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK. helen.weiss@lshtm.ac.uk.
• 2Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. jvdpitte@hotmail.co.uk.
• 3Department of Community Health and Behavioral Sciences, School of Public Health, Colleges of Health Sciences, Makerere University, Kampala, Uganda. jbukenya@musph.ac.ug.
• 4Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. yunia.mayanja@mrcuganda.org.
• 5Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. Susan.nakubulwa@mrcuganda.org.
• 6Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. anatoli.kamali@mrcuganda.org.
• 7Uganda Research Unit on AIDS, Medical Research Council/Uganda Virus Research Institute (MRC/UVRI), Entebbe, Uganda. janet.seeley@lshtm.ac.uk.
• 8Department of Global Health and Development, London School of Hygiene &amp; Tropical Medicine, London WC1E 9RE, UK. janet.seeley@lshtm.ac.uk.
• 9MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene &amp; Tropical Medicine, London WC1E 7HT, UK. heiner.grosskurth@lshtm.ac.uk. 
• Int J Environ Res Public Health. 2016 Jan 22;13(2). pii: E153. doi: 10.3390/ijerph13020153.

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