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Substance Abuse Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wsub20
Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy Emily C. Williams PhD, MPH c
abc
, Katharine A. Bradley MD, MPH c
c
abcd
, Benjamin H. Balderson ce
PhD , Jennifer B. McClure PhD , Lou Grothaus MA , Katryna McCoy PhD , Stacey E. a
Rittmueller MPH & Sheryl L. Catz PhD
c
a
Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA b
Department of Health Services, University of Washington, Seattle, Washington, USA
c
Group Health Research Institute, Seattle, Washington, USA
d
Department of Medicine, University of Washington, Seattle, Washington, USA
e
Division of Nursing, Winston Salem State University, Winston-Salem, North Carolina, USA Accepted author version posted online: 13 Mar 2014.Published online: 08 Aug 2014.
To cite this article: Emily C. Williams PhD, MPH, Katharine A. Bradley MD, MPH, Benjamin H. Balderson PhD, Jennifer B. McClure PhD, Lou Grothaus MA, Katryna McCoy PhD, Stacey E. Rittmueller MPH & Sheryl L. Catz PhD (2014) Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy, Substance Abuse, 35:3, 245-253, DOI: 10.1080/08897077.2014.890997 To link to this article: http://dx.doi.org/10.1080/08897077.2014.890997
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
SUBSTANCE ABUSE, 35: 245–253, 2014 Copyright Ó Taylor & Francis Group, LLC ISSN: 0889-7077 print / 1547-0164 online DOI: 10.1080/08897077.2014.890997
Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy
Downloaded by [University of York] at 07:36 13 November 2014
Emily C. Williams, PhD, MPH,1,2,3 Katharine A. Bradley, MD, MPH,1,2,3,4 Benjamin H. Balderson, PhD,3 Jennifer B. McClure, PhD,3 Lou Grothaus, MA,3 Katryna McCoy, PhD,3,5 Stacey E. Rittmueller, MPH,1 and Sheryl L. Catz, PhD3 ABSTRACT. Background: Alcohol use, and particularly unhealthy alcohol use, is associated with poor human immunodeficiency virus (HIV)-related outcomes among persons living with HIV (PLWH). Despite a rapidly growing proportion of PLWH 50 years, alcohol use and its associated characteristics are underdescribed in this population. The authors describe alcohol use, severity, and associated characteristics using data from a sample of PLWH 50 years who participated in a trial of a telephone-based intervention to improve adherence to antiretroviral therapy (ART). Methods: Participants were recruited from acquired immunodeficiency syndrome (AIDS) service organizations in 9 states and included PLWH 50 years who were prescribed ART, reported suboptimal adherence at screening (missing >1.5 days of medication or taking medications 2 hours early or late on >3 days in the 30 days prior to screening), and consented to participate. The AUDIT-C (Alcohol Use Disorders Identification Test—Consumption) alcohol screen, sociodemographic characteristics, substance use, and mental health comorbidity were assessed at baseline. AUDIT-C scores were categorized into nondrinking, low-level drinking, and mild-moderate unhealthy, and severe unhealthy drinking (0, 1–3, 4–6, and 7–12, respectively). Analyses described and compared characteristics across drinking status (any/none) and across AUDITC categories among drinkers. Results: Among 447 participants, 57% reported drinking in the past year (35%, 15%, and 7% reported low-level drinking, mild-moderate unhealthy drinking, and severe unhealthy drinking, respectively). Any drinking was most common among men and those who were lesbian, gay, bisexual, or transgender (LGBT), married/partnered, had received past-year alcohol treatment, and never used injection drugs (P values all 3 days in the 30 days prior to screening), were able to hear on the telephone, were not cognitively impaired based on a brief screen,23 were willing to participate in the trial, and provided oral consent for the study (n D 468 among 1101 callers screened) were eligible. The majority of these (n D 452) completed a
baseline telephone survey and provided written informed consent to enroll in the PRIME study. Participants were compensated $30 for participating in the 30-minute baseline telephone assessment. The risks and benefits (including compensation for participation) of the study were described to participants during the informed consent process, and those who consented attested to understanding the risks and benefits. The analytic sample for the present study is composed of the 447 PRIME participants for whom data on alcohol use were complete. All research activities were approved by the Institutional Review Board of the Group Health Research Institute.
Measures Alcohol use and severity The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) questionnaire, which has been validated in persons with HIV,13 was administered to assess alcohol use. The AUDITC consists of 3 items that assess the quantity and frequency of average consumption and the frequency of heavy episodic drinking. Each item is scored 0–4 points (total score range from 0 to 12). Scores of 0 indicate no drinking in the past year, and higher scores are associated with increasing severity of unhealthy alcohol use.20,24,25 Based on AUDIT-C scores, participants were categorized as no past-year drinking (score D 0) versus any past-year drinking (score D 1–12) and then categorized into groups reflecting alcohol use severity based on their scores: no drinking in past year (0), low-level drinking (1–3), mild-moderate unhealthy drinking (4–6), and severe unhealthy drinking (7) based on validation studies.26–29
Sociodemographic characteristics Demographic information was assessed at baseline and included participant age, gender, race and ethnicity, educational level, sexual orientation, relationship status, and employment and disability status. Age in years at baseline was categorized as 50– 54, 55–59, and 60 or more years. Relationship status was categorized as married/partnered versus other. Sexual orientation was categorized as heterosexual versus lesbian, gay, bisexual, or transgender (LGBT). Race was categorized as African American, white or other due to small numbers of participants reporting other races; and ethnicity was categorized as Hispanic or non-Hispanic. Education as the highest grade or year of school completed was ascertained and categorized as high school or less versus greater than or equal to 1 year of college or technical school. Two measures were derived from the available employment data: employment status categorized as full-time, part-time, or other; and disability status indicating any report of currently being on Social Security Disability.
Substance use Two dichotomous measures were constructed to represent yes (versus no) responses to questions asking about ever and past-3month use of injection drugs.
WILLIAMS ET AL.
Depression Depression was assessed with the 8-item Patient Health Questionnaire (PHQ-8), a modified version of the 9-item PRIME-MD PHQ (PHQ-9) depression scale, which omits 1 item assessing suicidal ideation30 and performs well compared with the 9-item PHQ.22,31 For this study, the PHQ scores were categorized into a dichotomous measure indicating positive (10) versus negative (1, or none vs any) and categories of alcohol use severity (AUDIT-C D 0, 1–3, 4–6, and 7–12). Characteristics were then compared using 2 sets of chi-square tests. The first set compared characteristics across drinking status (1 degree of freedom), and the second set compared characteristics across the 3 groups of drinkers stratified by alcohol use severity (AUDIT-C D 1–3, 4–6, and 7–12; 2 degrees of freedom). All analyses were conducted in SAS version 9.2 (SAS Institute, Cary, NC).
247
TABLE 1 Characteristics of 447 HIVC Older Adults on Antiretroviral Therapy (ART) Who Enrolled in a Randomized Controlled Trial Characteristic Sociodemographic characteristics Female Age 50–54 55-59 60 Race Black White Other* Hispanic ethnicity Educational level high school Sexual orientation Heterosexual LGBT Married/partnered Employment status Full time Part time Other Social Security Disability Substance use and mental health comorbidity Injection drug use Ever Past 3 months Past-year mental health treatment Past-year alcohol treatment Past-year drug treatment Positive depression screen General comorbidity Number of chronic conditions 0 1—2 3 ART adherence 30-Day adherence to ART Very poor Poor Fair Good Very good Excellent High self-efficacy for adherence
n
(%)
125
(28)
263 126 58
(59) (28) (13)
244 166 37 29 222
(55) (37) (8) (6) (50)
248 196 107
(56) (44) (24)
35 64 348 325
(8) (14) (78) (73)
157 17 151 23 29 138
(35) (4) (34) (5) (7) (31)
27 141 279
(6) (32) (62)
13 15 58 100 138 122 221
(3) (3) (13) (22) (31) (27) (50)
*Other race category included 2 self-identified Asians, 11 self-identified Native Americans, and 24 participants who opted to self-identify as “Race—Other” in response to the survey.
RESULTS Participant Characteristics and Alcohol Use A majority of participants were between the ages of 50 and 54 years, black, and heterosexual. Half reported a high school education or less, and about a quarter reported being married or partnered (Table 1). Most participants (n D 256; 57%) reported drinking alcohol in the past year, with 35% having AUDIT-C scores consistent with low-level drinking, 15% with mild-moderate unhealthy drinking, and 7% with severe unhealthy drinking.
248
SUBSTANCE ABUSE TABLE 2 Characteristics of 447 HIVC Older Adults Compared Across Drinking Status
Downloaded by [University of York] at 07:36 13 November 2014
Characteristic Sociodemographic characteristics Female Age 50–54 55–59 60 Race Black White Other Hispanic ethnicity Educational level High school 1C years college Sexual orientation Heterosexual LGBT Married/partnered Employment status Full time Part time Other Social Security Disability Substance use and mental health comorbidity Injection drug use Ever Past 3 months Past-year mental health treatment Past-year alcohol treatment Past-year drug treatment Positive depression screen General comorbidity Number of chronic conditions 0 1–2 3 ART adherence 30-Day adherence to ART Very poor Poor Fair Good Very good Excellent High self-efficacy for adherence
No past-year drinking
Any past-year drinking
(n D 191)
(n D 256)
n
(%)
n
(%)
x2
P value
74
(38)
51
(20)
19.24 5.41
Substance Abuse Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wsub20
Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy Emily C. Williams PhD, MPH c
abc
, Katharine A. Bradley MD, MPH c
c
abcd
, Benjamin H. Balderson ce
PhD , Jennifer B. McClure PhD , Lou Grothaus MA , Katryna McCoy PhD , Stacey E. a
Rittmueller MPH & Sheryl L. Catz PhD
c
a
Health Services Research & Development, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, USA b
Department of Health Services, University of Washington, Seattle, Washington, USA
c
Group Health Research Institute, Seattle, Washington, USA
d
Department of Medicine, University of Washington, Seattle, Washington, USA
e
Division of Nursing, Winston Salem State University, Winston-Salem, North Carolina, USA Accepted author version posted online: 13 Mar 2014.Published online: 08 Aug 2014.
To cite this article: Emily C. Williams PhD, MPH, Katharine A. Bradley MD, MPH, Benjamin H. Balderson PhD, Jennifer B. McClure PhD, Lou Grothaus MA, Katryna McCoy PhD, Stacey E. Rittmueller MPH & Sheryl L. Catz PhD (2014) Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy, Substance Abuse, 35:3, 245-253, DOI: 10.1080/08897077.2014.890997 To link to this article: http://dx.doi.org/10.1080/08897077.2014.890997
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
SUBSTANCE ABUSE, 35: 245–253, 2014 Copyright Ó Taylor & Francis Group, LLC ISSN: 0889-7077 print / 1547-0164 online DOI: 10.1080/08897077.2014.890997
Alcohol and Associated Characteristics Among Older Persons Living With Human Immunodeficiency Virus on Antiretroviral Therapy
Downloaded by [University of York] at 07:36 13 November 2014
Emily C. Williams, PhD, MPH,1,2,3 Katharine A. Bradley, MD, MPH,1,2,3,4 Benjamin H. Balderson, PhD,3 Jennifer B. McClure, PhD,3 Lou Grothaus, MA,3 Katryna McCoy, PhD,3,5 Stacey E. Rittmueller, MPH,1 and Sheryl L. Catz, PhD3 ABSTRACT. Background: Alcohol use, and particularly unhealthy alcohol use, is associated with poor human immunodeficiency virus (HIV)-related outcomes among persons living with HIV (PLWH). Despite a rapidly growing proportion of PLWH 50 years, alcohol use and its associated characteristics are underdescribed in this population. The authors describe alcohol use, severity, and associated characteristics using data from a sample of PLWH 50 years who participated in a trial of a telephone-based intervention to improve adherence to antiretroviral therapy (ART). Methods: Participants were recruited from acquired immunodeficiency syndrome (AIDS) service organizations in 9 states and included PLWH 50 years who were prescribed ART, reported suboptimal adherence at screening (missing >1.5 days of medication or taking medications 2 hours early or late on >3 days in the 30 days prior to screening), and consented to participate. The AUDIT-C (Alcohol Use Disorders Identification Test—Consumption) alcohol screen, sociodemographic characteristics, substance use, and mental health comorbidity were assessed at baseline. AUDIT-C scores were categorized into nondrinking, low-level drinking, and mild-moderate unhealthy, and severe unhealthy drinking (0, 1–3, 4–6, and 7–12, respectively). Analyses described and compared characteristics across drinking status (any/none) and across AUDITC categories among drinkers. Results: Among 447 participants, 57% reported drinking in the past year (35%, 15%, and 7% reported low-level drinking, mild-moderate unhealthy drinking, and severe unhealthy drinking, respectively). Any drinking was most common among men and those who were lesbian, gay, bisexual, or transgender (LGBT), married/partnered, had received past-year alcohol treatment, and never used injection drugs (P values all 3 days in the 30 days prior to screening), were able to hear on the telephone, were not cognitively impaired based on a brief screen,23 were willing to participate in the trial, and provided oral consent for the study (n D 468 among 1101 callers screened) were eligible. The majority of these (n D 452) completed a
baseline telephone survey and provided written informed consent to enroll in the PRIME study. Participants were compensated $30 for participating in the 30-minute baseline telephone assessment. The risks and benefits (including compensation for participation) of the study were described to participants during the informed consent process, and those who consented attested to understanding the risks and benefits. The analytic sample for the present study is composed of the 447 PRIME participants for whom data on alcohol use were complete. All research activities were approved by the Institutional Review Board of the Group Health Research Institute.
Measures Alcohol use and severity The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) questionnaire, which has been validated in persons with HIV,13 was administered to assess alcohol use. The AUDITC consists of 3 items that assess the quantity and frequency of average consumption and the frequency of heavy episodic drinking. Each item is scored 0–4 points (total score range from 0 to 12). Scores of 0 indicate no drinking in the past year, and higher scores are associated with increasing severity of unhealthy alcohol use.20,24,25 Based on AUDIT-C scores, participants were categorized as no past-year drinking (score D 0) versus any past-year drinking (score D 1–12) and then categorized into groups reflecting alcohol use severity based on their scores: no drinking in past year (0), low-level drinking (1–3), mild-moderate unhealthy drinking (4–6), and severe unhealthy drinking (7) based on validation studies.26–29
Sociodemographic characteristics Demographic information was assessed at baseline and included participant age, gender, race and ethnicity, educational level, sexual orientation, relationship status, and employment and disability status. Age in years at baseline was categorized as 50– 54, 55–59, and 60 or more years. Relationship status was categorized as married/partnered versus other. Sexual orientation was categorized as heterosexual versus lesbian, gay, bisexual, or transgender (LGBT). Race was categorized as African American, white or other due to small numbers of participants reporting other races; and ethnicity was categorized as Hispanic or non-Hispanic. Education as the highest grade or year of school completed was ascertained and categorized as high school or less versus greater than or equal to 1 year of college or technical school. Two measures were derived from the available employment data: employment status categorized as full-time, part-time, or other; and disability status indicating any report of currently being on Social Security Disability.
Substance use Two dichotomous measures were constructed to represent yes (versus no) responses to questions asking about ever and past-3month use of injection drugs.
WILLIAMS ET AL.
Depression Depression was assessed with the 8-item Patient Health Questionnaire (PHQ-8), a modified version of the 9-item PRIME-MD PHQ (PHQ-9) depression scale, which omits 1 item assessing suicidal ideation30 and performs well compared with the 9-item PHQ.22,31 For this study, the PHQ scores were categorized into a dichotomous measure indicating positive (10) versus negative (1, or none vs any) and categories of alcohol use severity (AUDIT-C D 0, 1–3, 4–6, and 7–12). Characteristics were then compared using 2 sets of chi-square tests. The first set compared characteristics across drinking status (1 degree of freedom), and the second set compared characteristics across the 3 groups of drinkers stratified by alcohol use severity (AUDIT-C D 1–3, 4–6, and 7–12; 2 degrees of freedom). All analyses were conducted in SAS version 9.2 (SAS Institute, Cary, NC).
247
TABLE 1 Characteristics of 447 HIVC Older Adults on Antiretroviral Therapy (ART) Who Enrolled in a Randomized Controlled Trial Characteristic Sociodemographic characteristics Female Age 50–54 55-59 60 Race Black White Other* Hispanic ethnicity Educational level high school Sexual orientation Heterosexual LGBT Married/partnered Employment status Full time Part time Other Social Security Disability Substance use and mental health comorbidity Injection drug use Ever Past 3 months Past-year mental health treatment Past-year alcohol treatment Past-year drug treatment Positive depression screen General comorbidity Number of chronic conditions 0 1—2 3 ART adherence 30-Day adherence to ART Very poor Poor Fair Good Very good Excellent High self-efficacy for adherence
n
(%)
125
(28)
263 126 58
(59) (28) (13)
244 166 37 29 222
(55) (37) (8) (6) (50)
248 196 107
(56) (44) (24)
35 64 348 325
(8) (14) (78) (73)
157 17 151 23 29 138
(35) (4) (34) (5) (7) (31)
27 141 279
(6) (32) (62)
13 15 58 100 138 122 221
(3) (3) (13) (22) (31) (27) (50)
*Other race category included 2 self-identified Asians, 11 self-identified Native Americans, and 24 participants who opted to self-identify as “Race—Other” in response to the survey.
RESULTS Participant Characteristics and Alcohol Use A majority of participants were between the ages of 50 and 54 years, black, and heterosexual. Half reported a high school education or less, and about a quarter reported being married or partnered (Table 1). Most participants (n D 256; 57%) reported drinking alcohol in the past year, with 35% having AUDIT-C scores consistent with low-level drinking, 15% with mild-moderate unhealthy drinking, and 7% with severe unhealthy drinking.
248
SUBSTANCE ABUSE TABLE 2 Characteristics of 447 HIVC Older Adults Compared Across Drinking Status
Downloaded by [University of York] at 07:36 13 November 2014
Characteristic Sociodemographic characteristics Female Age 50–54 55–59 60 Race Black White Other Hispanic ethnicity Educational level High school 1C years college Sexual orientation Heterosexual LGBT Married/partnered Employment status Full time Part time Other Social Security Disability Substance use and mental health comorbidity Injection drug use Ever Past 3 months Past-year mental health treatment Past-year alcohol treatment Past-year drug treatment Positive depression screen General comorbidity Number of chronic conditions 0 1–2 3 ART adherence 30-Day adherence to ART Very poor Poor Fair Good Very good Excellent High self-efficacy for adherence
No past-year drinking
Any past-year drinking
(n D 191)
(n D 256)
n
(%)
n
(%)
x2
P value
74
(38)
51
(20)
19.24 5.41
