Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers.

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.

Drinking location moderates the association between social group size and alcohol consumption among young adults: An event-level study.

INTRODUCTION: Previous studies have demonstrated relationships between social and environmental characteristics of the drinking context and alcohol use. However, the use of event-level data to investigate individual and joint relationships between such characteristics and alcohol use remains a gap in the literature. This study aimed to examine associations between drinking context (location and social group size) and alcohol consumption, and estimate the relationship between the interaction of context and alcohol consumption. METHODS: Using an Internet-based cellphone-optimised assessment technique, 183 Swiss young adults (mean: 23 years; range: 17-37 years) completed hourly assessments from 8 pm to midnight Thursday through Saturday for five consecutive weeks. Participants contributed 3454 hourly questionnaires. The number of drinks, the number of friends present and location (off-premise-home, outdoors; on-premise-bars, restaurants) were assessed based on the previous hour. Multilevel mixed-effects models were used to assess the relationships of interest. RESULTS: Being off-premise compared to on-premise was associated with fewer hourly drinks consumed (b = -0.44, P < 0.001). Greater numbers of friends present were associated with more drinks consumed (b = 0.02, P < 0.001). The association between number of friends and number of drinks consumed was significantly stronger for off-premise compared to on-premise locations (b = 0.03, P < 0.001). DISCUSSION AND CONCLUSIONS: Compared to off-premise locations, on-premise locations are associated with more hourly drinks consumed. However, the positive relationship between social group size and drinks consumed is significantly stronger for off-premise locations compared to on-premise locations. Findings have implications for tailored interventions focused on reducing alcohol consumption by young adults.

Differences in beliefs about COVID-19 by gun ownership: a cross-sectional survey of Texas adults.

OBJECTIVES: We investigated the association between gun ownership and perceptions about COVID-19 among Texas adults as the pandemic emerged. We considered perceived likelihood that the pandemic would lead to civil unrest, perceived importance of taking precautions to prevent transmission and perceptions that the threat of COVID-19 has been exaggerated. METHODS: Data were collected from 5 to 12 April 2020, shortly after Texas' stay-at-home declaration. We generated a sample using random digit dial methods for a telephone survey (n=77, response rate=8%) and by randomly selecting adults from an ongoing panel to complete the survey online (n=1120, non-probability sample). We conducted a logistic regression to estimate differences in perceptions by gun ownership. To account for bias associated with use of a non-probability sample, we used Bayesian data integration and ran linear regression models to produce more accurate measures of association. RESULTS: Among the 60% of Texas adults who reported gun ownership, estimates of past 7-day gun purchases, ammunition purchases and gun carrying were 15% (n=78), 20% (n=100) and 24% (n=130), respectively. We found no evidence of an association between gun ownership with perceived importance of taking precautions to prevent transmission or with perceived likelihood of civil unrest. Results from the logistic regression (OR 1.27, 95% CI 0.99 to 1.63) and the linear regression (ß=0.18, 95% CI 0.07 to 0.29) suggest that gun owners may be more likely to believe the threat of COVID-19 was exaggerated. CONCLUSIONS: Compared with those without guns, gun owners may have been inclined to downplay the threat of COVID-19 early in the pandemic.

Feasibility and acceptability of using smartphone-based EMA to assess patterns of prescription opioid and medical cannabis use among individuals with chronic pain.

BACKGROUND: Intensive longitudinal studies are needed to examine the co-use of prescription opioid medication and medical cannabis and their effects on chronic pain. The current study sought to investigate the feasibility and participant compliance with a smartphone-based Ecological Momentary Assessment (EMA) data collection protocol among individuals who use multiple substances and suffer from chronic pain. METHODS: A total of 46 participants (mean age = 44.8 years; 78% female; 85% Non-Hispanic White) were recruited online and completed a 30-day EMA phase where they responded to prompted surveys (four random past-hour surveys and one daily diary per day) about opioid medication use, medical cannabis use, and pain symptoms. Qualitative follow-up interviews were conducted with a subset of 10 participants. Linear and logistic regression models were used to examine baseline participant characteristics in relation to EMA compliance. Qualitative indicators of participant study experience were extracted from interviews. RESULTS: Participants responded to an average of 70% of past-hour surveys and 92% of daily diaries. Female participants were more likely to complete all daily diaries and at least one past-hour survey per day on all 30 days, respectively (OR = 5.60, 95% CI: 1.02-30.77, p < .05; OR = 7.08, 95% CI: 1.28-39.16, p < .05). Female participants were also more likely to complete at least 75% of their prompted past-hour surveys (OR = 4.67, 95% CI: 1.00-21.69, p < .05). Interview participants reported a positive study experience overall, although some mentioned problems related to smartphone notifications, redundant questions, or being prompted when they were not feeling well. Participants also mentioned problems with reporting the amount of medical cannabis used (e.g., milliliters of vaping liquid). CONCLUSIONS: Study results demonstrate both feasibility and acceptability of using EMA methodology to examine use patterns of medical cannabis and prescription opioid medication among individuals with chronic pain.

Risk and protective effects of social networks on alcohol use problems among Army Reserve and National Guard soldiers.

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.

Adolescent Marijuana Use, Marijuana-Related Perceptions, and Use of Other Substances Before and After Initiation of Retail Marijuana Sales in Colorado (2013-2015).

Due to the recentness of changes to marijuana policies in a number of states, the effect on adolescent use and perceptions is not yet well understood. This study examines change in adolescent marijuana use and related perceptions in Colorado, before and after the implementation of legal commercial sale of recreational marijuana for adults starting on January 1, 2014. The data are from a repeated cross-sectional survey of a representative sample of Colorado high school students, with separately drawn samples surveyed in fall 2013 (prior to implementation) and fall 2015 (18 months after implementation). We examined change in the prevalence of adolescent marijuana use, measured by lifetime use, past 30-day use, frequent use, and use on school property. To consider the possibility of heterogeneity in the change in marijuana use, we examined change in past 30-day marijuana use by demographic characteristics (sex, grade, race/ethnicity), school characteristics (poverty, percent minority), urbanicity of the school district, and whether the city or county permitted retail marijuana stores. There was an absence of significant effects for change in lifetime or past 30-day marijuana use. Among those reporting past 30-day use, frequent use and use on school property declined. There was a significant decline in the perceived harm associated with marijuana use, but we did not find a significant effect for perceived wrongfulness, perceived ease of access, or perceived parental disapproval. We did not find significant variability in past 30-day use by demographic characteristics or by school and community factors from 2013 to 2015. We did not find a significant effect associated with the introduction of legal sales of recreational marijuana to adults in Colorado on adolescent (illegal) use, but ongoing monitoring is warranted, including consideration of heterogeneity in the effects of marijuana policies.

Socioecological Risk and Protective Factors for Smoking Among Active Duty U.S. Military Personnel.

Introduction: Cigarette smoking can have negative consequences in military populations including injury, reduced physical endurance, higher frequency of sick days, and reduced combat readiness. This study used the socioecological model to understand individual, interpersonal, and organizational influences on cigarette smoking among military members. Materials and Methods: The sample for this secondary analysis was drawn from personnel at 24 large U.S. military installations, six from each service branch. Analyses included 4,728 personnel who were classified as current cigarette smokers. Generalized linear mixed models were used to estimate the associations among risk and protective factors from multiple ecological levels for smoking intensity and nicotine dependence. Results: Smoking to fit in with one's unit, being in the Army, smoking as a reaction to stress, and work-related stressors were all related to increased intensity of smoking and nicotine dependence. More active coping was associated with lower nicotine dependence and reduced smoking intensity. Conclusion: Results based on the socioecological model identify influencing factors and suggest possible interventions for smoking cessation. Reducing tobacco use in the military will require coordinated interventions that address multilevel determinants of use and improve military health. This is important to the strategic alignment of policy and services across the continuum of health care needs.