High prevalence of unhealthy alcohol use and comparison of self-reported alcohol consumption to phosphatidylethanol among women engaged in sex work and their male clients in Cambodia

BACKGROUND:

In Cambodia, most of the female sex workers (FSW) work in venues where unhealthy alcohol use is ubiquitous and potentially contributing to the HIV epidemic. However, no accurate data exists. We compare self-reported unhealthy alcohol consumption to a biomarker of alcohol intake in Cambodian FSW and male clients, and determine factors associated with unhealthy alcohol use.

METHODS:

A cross-sectional study was conducted among FSW (n=100) and male clients (n=100) in entertainment and sex work venues in Cambodia. Self-reported unhealthy alcohol use (AUDIT-C) was compared to phosphatidylethanol (PEth) positive (≥50ng/ml), a biomarker of alcohol intake. Sociodemographics data was collected. Correlates of self-reported unhealthy alcohol use and PEth positive were determined.

RESULTS:

The prevalence of PEth positive in FSW was 60.0%. Self-reported unhealthy alcohol consumption was reported by 85.0% of the women. Almost all women (95.0%) testing PEth positive also reported unhealthy alcohol use. Prevalence of unhealthy alcohol consumption (self-report and PEth positive) was higher in FSW working in entertainment establishments compared to other sex work venues (p<0.01). Among male clients, 47.0% reported unhealthy alcohol consumption and 42.0% had a PEth positive. However, only 57.1% of male clients with PEth positive reported unhealthy alcohol use.

CONCLUSIONS:

Unhealthy alcohol consumption is prevalent in Cambodian sex work settings. Self-reported unhealthy alcohol use is well reported by FSW, but less by male clients. These findings highlight the urgency of using accurate measures of unhealthy alcohol consumption and integrating this health issue into HIV prevention interventions.

Purchase full article at:  http://goo.gl/OVW2hK

By:  Couture MC¹, Page K², Sansothy N³, Stein E⁴, Vun MC⁵, Hahn JA⁶.

¹Department of Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, 2130 Fulton St., San Francisco, CA 94117, United States. Electronic address: mcouture@usfca.edu.

²University of New Mexico Health Sciences Center, Dept. of Internal Medicine MSC 10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States.

³National Center for HIV, AIDS, Dermatology and STDs, #245H, Street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia; University of Health Sciences-Cambodia, #73 Monivong Boulevard, Srah Chak, Phnom Penh, Cambodia.

⁴Global Health Sciences/Prevention and Public Health Group, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.

⁵National Center for HIV, AIDS, Dermatology and STDs, #245H, Street 6A, Phum Kean Khlang, Sangkat Prekleap Russey Keo, Phnom Penh, Cambodia.

⁶Department of Medicine, University of California San Francisco, Mission Hall, 550 16th St., Third Fl., Box 1224, San Francisco, CA 94158, United States.

Drug Alcohol Depend. 2016 May 21. pii: S0376-8716(16)30117-X. doi: 10.1016/j.drugalcdep.2016.05.011. [Epub ahead of print]

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Early sex work initiation and condom use among alcohol-using female sex workers in Mombasa, Kenya: A cross-sectional analysis

OBJECTIVES:

Early initiation of sex work is prevalent among female sex workers (FSWs) worldwide. The objectives of this study were to investigate if early initiation of sex work was associated with: (1) consistent condom use, (2) condom negotiation self-efficacy or (3) condom use norms among alcohol-using FSWs in Mombasa, Kenya.

METHODS:

In-person interviews were conducted with 816 FSWs in Mombasa, Kenya. Sample participants were: recruited from HIV prevention drop-in centres, 18 years or older and moderate risk drinkers. Early initiation was defined as first engaging in sex work at 17 years or younger. Logistic regression modelled outcomes as a function of early initiation, adjusting for drop-in centre, years in sex work, supporting others and HIV status.

RESULTS:

FSWs who initiated sex work early were significantly less likely to report consistent condom use with paying sex partners compared with those who initiated sex work in adulthood. There was no significant difference between groups in consistent condom use with non-paying sex partners. FSWs who initiated sex work early endorsed less condom negotiation self-efficacy with paying sex partners compared with FSWs who did not initiate sex work early.

CONCLUSIONS:

Findings highlight a need for early intervention for at-risk youth and adolescent FSWs, particularly in relation to HIV sexual risk behaviours. Evidence-based interventions for adolescent FSWs or adult FSWs who began sex work in adolescence should be developed, implemented and evaluated.

Purchase full article at:  http://goo.gl/Vi0r9e

By:  Parcesepe AM¹, L'Engle KL², Martin SL³, Green S³, Suchindran C⁴, Mwarogo P⁵.

¹Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, New York, USA.

²FHI 360, Durham, North Carolina, USA Population Health Sciences, School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA.

³Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁴Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.

⁵FHI 360, Nairobi, Kenya.

Sex Transm Infect. 2016 May 23. pii: sextrans-2016-052549. doi: 10.1136/sextrans-2016-052549. [Epub ahead of print]

  

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Perceived benefits and negative consequences of alcohol consumption in cving with HIV: A qualitative study

BACKGROUND:

Women living with HIV have increased prevalence of medical and psychological comorbidities that could be adversely affected by alcohol consumption. Little is known about their unique motivations for drinking or perceptions of HIV-related consequences. In preparation for an alcohol intervention study, we sought to better understand reasons for drinking and perceived consequences of alcohol consumption among a sample of women living with HIV.

METHODS:

Four focus groups, with a total of 24 adult women (96 % African-American, 88 % HIV-positive), were conducted in Jacksonville, FL, Washington, DC and Chicago, IL. Focus group discussions were tape-recorded and transcribed verbatim; a conventional content analysis approach was used to identify themes, that were then grouped according to a biopsychosocial model.

RESULTS:

Regarding reasons for drinking, women described themes that included biological (addiction, to manage pain), psychological (coping, to escape bad experiences, to feel in control), and social (peer pressure, family). Themes related to consequences from alcohol included biological (damage to body, poor adherence to medications), psychological (risky or regrettable behavior, memory loss), and social (jail, loss of respect, poor choices). When discussing how their drinking impacted their health, women focused on broader issues, rather than HIV-specific issues.

CONCLUSION:

Many women living with HIV are drinking alcohol in order to self-manage pain or emotions, and their perceived consequences from drinking extend beyond HIV-specific medical issues. Most participants described themes related to psychological issues and situations that are common in women living with HIV. Interventions to address drinking should inquire more specifically about drinking to manage pain or emotion, and help women to recognize the potential adverse impact of alcohol on comorbid health issues, including their own HIV infection.

Full article at:   http://goo.gl/vA9COI

By:  Cook RL1, Cook CL2, Karki M3, Weber KM4, Thoma KA5, Loy CM6, Goparaju L7, Rahim-Williams B8.

• 1Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA. cookrl@ufl.edu.
• 2Department of Family, Community, and Health System Science, University of Florida College of Nursing, PO Box 100197, Gainesville, FL, 32610-0197, USA.
• 3Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, 32610, USA.
• 4Cook County Health and Hospital System and Hektoen Institute of Medicine, 2225 W Harrison St, Chicago, IL, 60612, USA.
• 5Clinical Research Specialist, UF CARES, University of Florida Center for HIV/AIDS, Research, Education & Service, 653-1 West 8th Street, LRC 3rd Floor L-13, Jacksonville, FL, 32209, USA.
• 6Departments of Epidemiology and Medicine, University of Florida, 2004 Mowry Road, Gainesville, FL, 32610, USA.
• 7Women's Interagency HIV Study (WIHS), Georgetown University Medical Center, 2115 Wisconsin Ave NW, Suite 130, Washington DC, 20007, USA.
• 8Department of Public Health, Bethune-Cookman University, College of Health Sciences, 640 Dr. Mary McLeod Bethune Blvd., Daytona Beach, Florida, 32114, USA. 
• BMC Public Health. 2016 Mar 15;16(1):263. doi: 10.1186/s12889-016-2928-x.

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Social-Context Factors, Refusal Self-Efficacy, and Alcohol Use among Female Sex Workers in China

Excessive alcohol use is considered as a health risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in a social or individual context can advance understanding of why people indulge in alcohol use. 

Our research on female sex workers (FSWs) examined associations among several social-context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. 

Seven hundred FSWs were recruited from two cities in Southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs’ alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. 

Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs’ alcohol use; the prediction effect of alcohol use by peers on FSWs’ alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs’ alcohol use and indirectly influenced FSWs’ alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs’ alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer, and sex work establishments on FSWs’ alcohol use. 

Meanwhile, training to improve refusal self-efficacy should also be included in intervention programs to reduce FSWs’ alcohol use.

Below:  Associations among social-context factors, refusal self-efficacy and alcohol use of FSWs (N=688)

Full article at: http://goo.gl/kwYF36

By:  Shaobing Su,1 Xiaoming Li,2,* Danhua Lin,3 Chen Zhang,4 Shan Qiao,2 and Yeujiao Zhou5

¹ Eliot-Pearson Department of Child and Human Development, Tufts University, Medford, MA 02155, USA.

² Carman and Ann Adams Department of Pediatrics Prevention Research Center, Wayne State University School of Medicine, Detroit, MI 48201, USA

³ Institute of Developmental Psychology, Beijing Normal University, Beijing, 100875, China

⁴ Division of Epidemiology, Vanderbilt Institute of Global Health, Nashville, TN, USA

⁵ Center for Disease Control and Prevention, Guangxi, China.

Psychol Health Med. 2015; 20(8): 889–895.

Published online 2014 Oct 15. doi:  10.1080/13548506.2014.966727

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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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High Prevalence of Forced Sex among Non-Brothel Based, Wine Shop Centered Sex Workers in Chennai, India

Sexual violence has been shown to increase women’s risk of HIV infection. India is a country where the HIV epidemic is growing among women and intimate partner violence is pervasive. 

This study examined prevalence of and factors associated with forced sex among female sex workers (FSWs) in Chennai, India. We conducted a probability survey among FSWs in 24 slum venues and identified predictive factors for recent forced sex using univariate and multivariable proportional odds models. 

Among 522 FSWs, 28% reported having forced sex with 1 partner and 35% with 2+ partners. In the final multivariable model, women who had a high number of partners who had a strong tendency to drink alcohol before sex were more likely to have experienced forced sex, and women who had both unprotected sex with a nonspousal partner and > 20 days of alcohol consumption in the last 30 days were more likely to have experienced forced sex. 

Discussion about family violence with larger social networks was independently associated with lower odds of forced sex among FSWs. HIV interventions for FSWs and their clients aimed at reducing alcohol consumption and encouraging condom use could be enhanced by violence prevention interventions to facilitate discourse about sexual violence.

Multivariate Proportional Odds Model Results for Forced Sex (with 2 or more partners; with any partners) Among Sex Workers in Chennai, India

Independent Variable Combinations		OR [95% CI]
Any unprotected sex with non-spousal partner in last 3 mos?
	No. days alcohol consumed in last 30 days
No	0–9	reference
	10–19	0.60 [0.24,1.48]
	20+	0.36 [0.11,1.13]
Yes	0–9	1.42 [0.82,2.46]
	10–19	1.71 [0.82,3.56]
	20+	2.66 [1.13,6.29]
No. people spoke with about family violence in last 3 mos
	0	reference
	1–5	0.61 [0.44,0.86]
	6+	0.41 [0.22,0.75]
No. partners with strong tendency to drink alcohol before sex
	0	reference
	1	1.43 [0.91,2.25]
	2+	1.87 [1.38,2.54]

Under the proportional odds assumption, the odds ratios apply to either of the two odds ratios being modeled – the odds ratio for forced sex by 2 or more partners relative to forced sex by one or less partners and the odds ratio for forced sex by any partner relative to forced sex by no partners. A significant interaction was found between unprotected sex with a non-spousal partner and alcohol consumption of the sex worker.

Full article at:   http://goo.gl/Z1tmf1

By:  Vivian F. Go,1 Aylur K. Srikrishnan,2 Corette Breeden Parker,3 Megan Salter,1 Annette M. Green,3 Sudha Sivaram,1Sethulakshmi C. Johnson,2 Carl Latkin,1 Wendy Davis,1 Suniti Solomon,2 and David D. Celentano1

¹Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA

²YRG Centre for AIDS Research and Education, Chennai, India

³Research Triangle Institute, Research Triangle Park, North Carolina, USA

^*Correspondence and request for reprints should be addressed to: Vivian Go, PhD, Johns Hopkins University Bloomberg School of Public Health, Infectious Diseases Program, Department of Epidemiology, 615 North Wolfe Street, Suite E-6610, Baltimore, Maryland 21205, USA, Fax: 1-410-955-1383, Tel: 1-410-614-4755

AIDS Behav. 2011 Jan; 15(1): 163–171., doi:  10.1007/s10461-010-9758-0

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Age of Sexual Debut and Cannabis Use in the United States

BACKGROUND:

Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health.

OBJECTIVES:

The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity.

METHODS:

Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n = 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity.

RESULTS:

Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37-0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68-1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42-0.78). Results were generally consistent across race/ethnicity and gender.

CONCLUSIONS:

Multifactorial intervention strategies targeting both sexual health and substance use may be warranted.

Purchase full article at:   http://goo.gl/oCWGir

By:  Cha S1, Masho SW1,2,3, Mezuk B1,4.

• 1 Department of Family Medicine and Population Health , School of Medicine, Virginia Commonwealth University , Richmond , Virginia , USA.
• 2 Department of Obstetrics and Gynecology, School of Medicine , Virginia Commonwealth University , Richmond , Virginia , USA.
• 3 Institute for Women's Health , Virginia Commonwealth University , Richmond , Virginia , USA.
• 4 Virginia Institute for Psychiatric and Behavioral Genetics , Virginia Commonwealth University , Richmond , Virginia , USA.
• Subst Use Misuse. 2016 Mar 20;51(4):439-48. doi: 10.3109/10826084.2015.1110177. Epub 2016 Feb 16. 

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Association of Lifetime Mental Disorders and Subsequent Alcohol and Illicit Drug Use: Results From the National Comorbidity Survey-Adolescent Supplement

OBJECTIVE:

To estimate the association of prior lifetime mental disorders with transitions across stages of substance use in a cross-sectional, nationally representative sample of US adolescents.

METHOD:

The sample includes 10,123 adolescents aged 13 to 18 years who participated in the National Comorbidity Survey-Adolescent Supplement (NCS-A), and who were directly interviewed with the Composite International Diagnostic Interview (CIDI) Version 3.0 that generates criteria for DSM-IV disorders.

RESULTS:

Adolescents with prior lifetime mental disorders had high rates of both alcohol (10.3%) and illicit drug (14.9%) abuse, with or without dependence. Alcohol and drug abuse were highest among adolescents with prior anxiety disorders (17.3% and 20%, respectively) and behavior disorders (15.6% and 24%, respectively). Any prior disorder significantly increased the risk of transition from nonuse to first use, and from use to problematic use of either alcohol or illicit drugs. Multivariate models attenuated the magnitude of the risk of transition associated with each disorder, although prior weekly smoking and illicit drug use demonstrated significant risks of transitions across the 3 stages of alcohol or drug use, as did behavior disorders.

CONCLUSION:

The findings provide the first evidence from a nationally representative sample that prior mental disorders represent risk factors for the transition from nonuse to use, and the progression to drug- and alcohol-related problems. Treatment of primary mental disorders is likely to be an important target for the prevention of secondary substance use disorders in youth.

Purchase full article at:   http://goo.gl/vK1AQ9

By:  Conway KP1, Swendsen J2, Husky MM3, He JP4, Merikangas KR5.

• 1Division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse (NIDA), Rockville, MD.
• 2École Pratique des Hautes Études (EPHE), Paris, the National Center for Scientific Research (CNRS), Paris, and University of Bordeaux, France.
• 3University of Paris Descartes, Paris.
• 4Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health (NIMH), Bethesda, MD.
• 5Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health (NIMH), Bethesda, MD. Electronic address: merikank@mail.nih.gov. 
• J Am Acad Child Adolesc Psychiatry. 2016 Apr;55(4):280-8. doi: 10.1016/j.jaac.2016.01.006. Epub 2016 Feb 2.

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Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

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The Effect of Glass Shape on Alcohol Consumption in a Naturalistic Setting: A Feasibility Study

BACKGROUND:

Alcohol-related harms are a major public health concern, and population-level interventions are needed to reduce excessive alcohol consumption. Glass shape is an easily modifiable target for public health intervention. Laboratory findings show beer is consumed slower from a straight glass compared to a curved glass, but these findings have not been replicated in a naturalistic setting. The purpose of this study is to investigate the feasibility of conducting a randomised controlled trial investigating the effect of glass shape on alcohol consumption in public houses.

METHODS:

Straight and curved half-pint and pint glasses were delivered to three public houses over two weekends. Glass type was counterbalanced over the two weekends and between the public houses. Monetary takings were recorded as an indirect measure of consumption.

RESULTS:

Replacing stocks of glassware in public houses was feasible and can be enacted in a short space of time. One landlord found the study too disruptive, possibly due to a laborious exchange of glassware and complaints about the new glassware from some customers. One public house's dishwasher could not accommodate the supplied curved full-pint glasses. Obtaining monetary takings from public house staff was a feasible and efficient way of measuring consumption, although reporting absolute amounts may be commercially sensitive. Monetary takings were reduced by 24 % (95 % confidence interval 77 % reduction to 29 % increase) when straight glasses were used compared to curved glasses.

CONCLUSIONS:

This study shows that it is feasible to carry out a trial investigating glass shape in a naturalistic environment, although a number of challenges were encountered. Brewery owners and landlords are willing to engage with public health research in settings where alcohol is consumed, such as public houses. Good communication with stakeholders was vital to acquire good data, and highlighting the potential commercial benefits of participating was vital to the study's success. A full scale evaluation of the effects of glass shape on alcohol consumption could inform local and national policy.

Below:  Shapes of glasses. a Sahm’s Tokyo glass, pint glass: Art. Nr. 1005428 and half-pint glass: Art. Nr. 1005930. b Arcoroc’s Geo glass 20 oz (58.5 cl) glass. c Paşabahçe’s highball long drinking glass can hold 285 cc, 9.5 oz (US) and 10.25 oz (UK)

Full article at:   http://goo.gl/prVkw8

By:  Troy DM1, Maynard OM1, Hickman M2, Attwood AS1, Munafò MR1.

• 1MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK ; UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol BS8 1TU, UK.
• 2School of Social and Community Medicine, University of Bristol, Bristol, UK. 
• Pilot Feasibility Stud. 2015 Dec 1;1(1):27.

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