Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions.

INTRODUCTION: Rates of substance use and mental health conditions vary across military service branches, yet branches also differ notably in terms of demographics and deployment experiences. This study examines whether branch differences in substance use and mental health outcomes persist after adjustment for a comprehensive set of demographic and deployment-related factors. METHODS: Data on 16,699 Armed Forces Active Duty service members were from the 2015 Department of Defense Health Related Behaviors Survey. Service branch-specific prevalences were estimated for self-reports of heavy episodic drinking (HED), possible alcohol use disorder (AUD), current smoking, e-cigarette use, smokeless tobacco use, prescription drug misuse, probable post-traumatic stress disorder (PTSD), probable depression, and probable anxiety. Using logistic regression, we assessed whether branch differences persisted after adjusting for an extensive array of demographic factors (among full sample) and deployment/combat factors (among ever-deployed subgroup). RESULTS: HED, AUD, smoking, e-cigarette use, smokeless tobacco use, depression, and anxiety were highest in the Marine Corps; prescription drug misuse and PTSD were highest in the Army. HED, AUD, smoking, smokeless tobacco use, PTSD, depression, and anxiety were lowest in the Air Force; e-cigarette use and prescription drug misuse were lowest in the Coast Guard. Demographics and deployment/combat experiences differed across branches. After adjustment, service members in the Army, Marine Corps and Navy exhibited nearly 2-3 times the odds of multiple mental health conditions and substance use behaviors relative to the Air Force. CONCLUSION: Service branch differences were not fully explained by variation in demographics and deployment/combat experiences.

Co-occurring alcohol and mental health problems in the military: Prevalence, disparities, and service utilization.

OBJECTIVE: To examine the prevalence of co-occurring alcohol and mental health (MH) problems (COPs), perceived MH service need, and MH service utilization among active duty service members, and to identify differences in gender, race/ethnicity, age, and sexual orientation and gender identity. METHOD: 16,699 active duty service members participated in the Department of Defense's 2015 Health Related Behaviors Survey. Measures included demographics, combat deployment, smoking status, problematic alcohol use (Alcohol Use Disorders Identification Test-C, AUDIT-C), posttraumatic stress disorder (PTSD Checklist, Civilian Version, PCL-C), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder-7, GAD-7), and perceived need for and use of MH services. We examined groups of service members with probable: COP, alcohol problem only, MH problem only, and neither. RESULTS: Eight percent of service members reported COPs, 26.89% reported alcohol use problem only, and 9.41% reported a MH condition only. COPs were more common among those who were lesbian, gay, bisexual, and transgender (LGBT), those who had three or more combat deployments, and smokers, and less common among those aged 35 years and older, Asian or Black, and in the Air Force and Coast Guard (relative to Navy). Those reporting a probable MH problem only were significantly less likely to report use of past year MH counseling than those with probable COPs; otherwise, patterns of service utilization and perceived need were similar. CONCLUSIONS: COPs are common enough that screening for and attention to their co-occurrence are needed in the military, and some subgroups of service members are at particularly high risk for COPs. Future research and policy should delve deeper into how the needs of service members with COPs can be addressed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Persistent Risk-Related Worry as a Function of Recalled Exposure to the Deepwater Horizon Oil Spill and Prior Trauma.

Large oil spills are disasters associated with psychological effects for exposed communities. The amount of worry that individuals experience after a disaster may be influenced by many factors, such as the type and extent of exposure to disaster impacts, prior trauma, and sociodemographic characteristics. This study examined the nature and predictors of worry about ongoing impacts of the 2010 Deepwater Horizon (DH) oil spill reported by Gulf of Mexico coastal residents. A random sample of 2,520 adult residents of Gulf of Mexico coastal counties were administered a telephone survey in 2016, including items about persistent worry and exposure to DH impacts, prior trauma, residence at the time of the spill, and sociodemographic characteristics. Respondents varied in the amount of worry they reported about ongoing health, social, and economic impacts. Controlling for sociodemographic characteristics, higher exposure to the DH oil spill was related to higher levels of worry about ongoing impacts, with past traumatic events related specifically to worry about health impacts. Unexpectedly, those who moved into the region after the spill showed similar levels of worry to residents exposed to the spill, and higher levels than residents who did not recall being exposed to the DH oil spill. This study highlights the impact of the DH oil spill on coastal residents many years after the DH disaster. The findings underscore the need to examine multiple pathways by which individuals experience disasters and for risk researchers to close knowledge gaps about long-term impacts of oil spills within a multi-dimensional framework.

Exposure to the Deepwater Horizon Oil Spill, Associated Resource Loss, and Long-Term Mental and Behavioral Outcomes.

OBJECTIVE: The aim of this study was to (1) assess the long-term mental and behavioral health outcomes of the Deepwater Horizon Oil Spill of residents in the Gulf Coast and to (2) identify populations that may be particularly vulnerable to future disasters. METHODS: The Survey of Trauma, Resilience, and Opportunity in Neighborhoods in the Gulf (STRONG) is a population-representative sample of 2520 coastal residents surveyed in Texas, Louisiana, Alabama, Mississippi, and Florida in 2016. We present prevalence estimates for positive screens of depression, anxiety, and alcohol misuse, as well as receipt of health care services. We examine differences in these outcomes across states, affected occupational groups, and demographic groups. RESULTS: Resource loss attributed to the spill was associated with positive screens for depression and anxiety. Almost 50% of adults screened positive for depression, anxiety, or alcohol misuse, but less than 20% of these currently access mental health care. Black residents were less likely to have health insurance and a usual source of care but were more likely to have visited the emergency room in the past 12 months. CONCLUSIONS: Surveillance data from STRONG can help policy-makers and other stakeholders develop targeted approaches to foster resilience, particularly among vulnerable populations, and thereby mitigate the effects of future disasters.

Behavioral Health of Gulf Coast Residents 6 Years After the Deepwater Horizon Oil Spill: The Role of Trauma History.

OBJECTIVE: The purpose of this study was to examine the associations between oil spill exposure, trauma history, and behavioral health 6 years after the Deepwater Horizon oil spill (DHOS). We hypothesized that prior trauma would exacerbate the relationship between oil spill exposure and behavioral health problems. METHODS: The sample included 2,520 randomly selected adults in coastal areas along the Gulf of Mexico. Participants reported their level of oil spill exposure, trauma history, depression, anxiety/worry, illness anxiety, and alcohol use. RESULTS: Individuals with more traumatic experiences had a significantly higher risk for all measured behavioral health problems after controlling for demographic factors and DHOS exposure. Those with higher levels of DHOS exposure were not at greater risk for behavioral health problems after controlling for prior trauma, with the exception of illness anxiety. There was no evidence that trauma history moderated the association between DHOS exposure and behavioral health. CONCLUSIONS: Findings suggest that trauma exposure may be a better indicator of long-term behavioral health risk than DHOS exposure among disaster-prone Gulf Coast residents. DHOS exposure may be a risk factor for illness anxiety but not more general behavioral health concerns. Trauma history did not appear to exacerbate risk for behavioral health problems among Gulf residents exposed to the DHOS. (Disaster Med Public Health Preparedness. 2019;13:497-503).

The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use.

BACKGROUND: Among high-risk youth, those who may be at increased risk for adverse alcohol and other drug (AOD) use outcomes may benefit from targeted prevention efforts; how youth acquire AOD may provide an objective means of identifying youth at elevated risk. METHODS: We assessed how youth acquired alcohol and marijuana (purchasing vs. other means), demographics, AOD behaviors/consequences, and environment among adolescents referred to a diversion program called Teen Court (N = 180) at two time points (prior to the program and 180 days from baseline). Participants were predominantly White and Hispanic/Latino(a). RESULTS: In cross-sectional analyses among alcohol and marijuana users, purchasing marijuana was associated with more frequent marijuana use and consequences, time spent around teens who use marijuana, higher likelihood of substance use disorders, and lower resistance self-efficacy compared to non-purchasers. Teens who purchased both alcohol and marijuana experienced similar outcomes to those who purchased only marijuana, and also reported more frequent and higher quantity of drinking, greater alcohol-related consequences, time spent around teens who use other drugs, and prescription drug misuse. Longitudinally, purchasing alcohol and marijuana at baseline was associated with more frequent and higher quantity of drinking compared to non-purchasers at follow-up. Marijuana only purchasers had a greater likelihood of substance use disorders at follow-up compared to non-purchasers. CONCLUSIONS: In an era where drinking is commonplace and attitudes towards marijuana use are becoming more tolerant, it is essential to evaluate how accessibility to AOD and subsequent purchasing behaviors affect youth consumption and intervene accordingly to prevent future consequences.

A psychometric assessment of the GAIN individual severity scale (GAIN-GISS) and short screeners (GAIN-SS) among adolescents in outpatient treatment programs.

The global appraisal of individual needs (GAIN)-general individual severity scale (GAIN-GISS), and GAIN-short screener (GAIN-SS) are widely used diagnostic measures of internalizing disorders, externalizing disorders, substance abuse, and criminal and violent behavior. Although prevalent in clinical and research settings, there is only limited psychometric evidence of the dimensional structure of these scales. Our investigation used intake data from 6,909 adolescents presenting to outpatient substance abuse treatment facilities in the United States. Our analytic approach used exploratory and item factor analyses to evaluate the underlying factor structure. Multi- and unidimensional item response theory models were employed to evaluate the utility of the scales at providing precise score estimates at various locations of severity. Most scales were confirmed as unidimensional; scales with evidence of multidimensionality, identified as having a weak general dimension and strong specific dimensions using a bifactor IRT model, include the Crime and Violence Scale and the GAIN-SS.

Alcohol abuse and illegal drug use among Los Angeles County trauma patients: prevalence and evaluation of single item screener.

BACKGROUND: The misuse of alcohol and illicit drugs is implicated with injury and repeat injury. Admission to a trauma center provides an opportunity to identify patients with substance use problems and initiate intervention and prevention strategies. To facilitate the identification of trauma patients with substance use problems, we studied alcohol abuse and illegal substance use patterns in a large cohort of urban trauma patients, identified correlates of alcohol abuse, and assessed the utility of a single item binge-drinking screener for identifying patients with past 12-month substance use problems. METHODS: Between February 2004 and August 2006, 677 patients from four large trauma centers in Los Angeles County were interviewed. The sample was broadly representative of the entire Los Angeles County trauma center patient population. RESULTS: Twenty-four percent of patients met criteria for alcohol abuse and 15% reported using an illegal drug other than marijuana in the past 12 months. Male gender, assaultive injury, peritrauma substance use, and history of binge drinking were prominent risk factors. A single item binge drinking screen correctly identified alcohol abuse status in 76% of all patients; the screen also performed moderately well in discriminating between those who had or had not used illegal drugs in the past 12 months, with sensitivity estimates reaching 0.79 and specificity estimates reaching 0.74. CONCLUSIONS: A large proportion of urban trauma patients abuse alcohol and use illegal drugs. Distinct sociodemographic and substance use history may indicate underlying risky behaviors. Interventions and injury prevention programs need to address these causal behaviors to reduce injury morbidity and recidivism. In the busy trauma care setting, a one-item screener could be helpful in identifying patients who would benefit from more thorough assessment and possible brief intervention.

Substance use and delinquency among fifth graders who have jobs.

BACKGROUND: Working for pay is associated with substance use and delinquency among older adolescents, although information is scant about younger youth who work. This study investigates associations between self-reports of having a job and substance use and delinquent behaviors in a sample of U.S. 5th graders. METHODS: A total of 5147 5th graders and their parents from three large metropolitan areas were assessed in a cross-sectional survey between Fall 2004 and Summer 2006. Multivariate regression was used to estimate associations between having a job and substance use and delinquency. Analyses were conducted in Fall 2007. RESULTS: Twenty-one percent of 5th graders reported having a job, with most working <5 hours per week. Typical jobs included yard work, babysitting, and cleaning. In multivariate models that controlled for demographic characteristics, household composition, and household income, having a job was significantly associated with past-30-day use of tobacco (OR=2.2), alcohol (OR=1.7), and marijuana (OR=3.1). Having a job was also significantly associated with ever being in a fight (OR=1.5) and with running away from home (OR=1.8). Further analyses indicated that the associations between holding a job and delinquency outcomes were driven largely by young workers who worked >2 hours per week. CONCLUSIONS: Among 5th graders, having a job was associated with substance-using behaviors and delinquency. Clinicians should consider asking young patients whether they work, and stress to parents the importance of monitoring the work activities, workplaces, and associates of their children.

The effect of working for pay on adolescent tobacco use.

OBJECTIVES: We investigated the links between working for pay and adolescent tobacco use to determine whether working for pay increases smoking risk. METHODS: We performed retrospective and prospective analyses using data from a cohort of 799 predominantly African American students in Baltimore, Md, who had been followed since the first grade. RESULTS: At the 10th year of follow-up, when the adolescents were aged 14 to 18 years, there was a positive relationship between the time they spent working for pay and current tobacco use. This relationship was attenuated somewhat after adjustment for potential selection effects. Adolescents who spent more than 10 hours per week working for pay also tended to initiate tobacco use earlier than did their peers. Among adolescents who had not yet used tobacco, those who started to work 1 year after assessment and those who worked over 2 consecutive assessments had an elevated risk of initiating use relative to adolescents who did not start working. CONCLUSIONS: There is a strong link between working for pay and adolescent tobacco use. Policymakers should monitor the conditions under which young people work to help minimize young workers' tobacco use and potential for initiating use.