School of Social Work, University of Arkansas, Fayetteville, AR, USA.
School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA.
Ethn Health. 2023 Nov;28(8):1145-1160. doi: 10.1080/13557858.2023.2224949. Epub 2023 Jun 18.
The purpose of the study was to explore the extent to which prior military service may moderate the relationship between chronic disease multimorbidity and substance use among African American men in the United States.
Data for this cross-sectional study was downloaded from the 2016 -2019 United States (US) National Survey on Drug Use and Health. We estimated three survey-weighted multivariable logistic regression models, where use of each of the following substances served as the dependent variables: illicit drugs, opioids, and tobacco. Differences in these outcomes were examined along two primary independent variables: veteran status and multimorbidity (and an interaction term for these variables). We also controlled for the following covariates: age, education, income, rurality, criminal behavior, and religiosity.
From the 37,203,237 (weighted N) African American men in the sample, approximately 17% reported prior military service. Veterans with ≥ 2 chronic diseases had higher rates of illicit drug use (aOR = 1.37, 95% CI = 1.01, 1.87; 32% vs. 28%) than non-veterans with ≥ 2 chronic diseases. Non-veterans with one chronic disease had higher rates of tobacco use (aOR = 0.80, 95% CI = 0.69, 0.93; 29% vs. 26%) and opioid misuse (aOR = 0.49, 95% CI = 0.36, 0.67; 29% vs. 18%) than veterans with one chronic disease.
Chronic disease multi-morbidity appears to be a context in which African American veterans may be at greater risk for certain undesirable health behaviors than African American non-veterans and at lower risk for others. This may be due to exposure to trauma, difficulty accessing care, socio-environmental factors, and co-occurring mental health conditions. These complex interactions may contribute to higher rates of SUDs among African American veterans compared to African American non-veterans.
本研究旨在探讨美国非裔男性的既往兵役经历在多大程度上可以缓和慢性疾病多病共存与物质使用之间的关系。
本横断面研究的数据来自 2016-2019 年美国全国毒品使用与健康调查。我们估计了三个经过调查加权的多变量逻辑回归模型，其中每种物质的使用情况作为因变量：非法药物、阿片类药物和烟草。通过两个主要的独立变量来检查这些结果的差异：退伍军人身份和多病共存（以及这些变量的交互项）。我们还控制了以下协变量：年龄、教育、收入、农村地区、犯罪行为和宗教信仰。
在样本中的 37203237 名非裔美国男性中，约有 17%的人报告有既往兵役经历。患有≥2 种慢性疾病的退伍军人使用非法药物的比例更高（调整后比值比[aOR]=1.37，95%置信区间[CI]=1.01，1.87；32%比 28%），而非患有≥2 种慢性疾病的非退伍军人。患有一种慢性疾病的非退伍军人使用烟草的比例更高（调整后比值比[aOR]=0.80，95%CI=0.69，0.93；29%比 26%）和阿片类药物滥用的比例更高（调整后比值比[aOR]=0.49，95%CI=0.36，0.67；29%比 18%），而非患有一种慢性疾病的退伍军人。
慢性疾病多病共存似乎是一个背景，在这个背景下，非裔美国退伍军人可能比非裔美国非退伍军人更容易出现某些不良健康行为，而在其他方面则风险较低。这可能是由于接触创伤、难以获得医疗服务、社会环境因素和共病的心理健康状况。这些复杂的相互作用可能导致非裔美国退伍军人的物质使用障碍（SUDs）比非裔美国非退伍军人更高。
