Substance Use and the Number of Male Sex Partners by African American and Puerto Rican Women

1. Department of Psychiatry, New York University School of Medicine, New York, USA

ARTICLE INFO		ABSTRACT
Short Communication Received: 18  May 2017 Accepted: 3 Sep 2017		Introduction: In the United States (US), there are 19 million new sexually transmitted disease (STD) infections each year. Untreated STDs can lead to serious long-term adverse health consequences, especially for young women. Centers for Disease Control and Prevention estimates that undiagnosed and untreated STDs cause at least 24,000 women in the US each year to become infertile. This clearly is a public health issue of great concern for young women. Methods: The current cross-sectional study included a community sample consisting of 343 female participants (50% African Americans, 50% Puerto Ricans) at their mean age of 39 years. Regression analyses were conducted to examine the associations of time-varying factors within-person (e.g., substance use) and fixed effects factors between-persons (e.g., race/ethnicity) with the number of male sexual partners. Results: Alcohol use (b = 0.14, p < 0.01), cannabis use (b = 1.10, p < 0.01), marital status – unmarried (b = -0.16, p < 0.05), and race/ethnicity – African American (b = -0.20, p < 0.01) were significantly related to having a higher number of male sex partners in the past year. Conclusion: From a public health perspective, treatment and prevention programs for sexual risk behavior focused on substance use as well as socio-cultural factors (i.e., marital status, race/ethnicity) may be more effective than programs focused only on substance use.     Keywords: Cross-sectional study, substance use, race/ethnicity, sexual risk behavior, regression analysis
Corresponding Author: Judith S. Brook Judith.brook@nyumc.org

The Centers for Disease Control and Prevention (CDC) estimates that there are approximately 19 million new sexually transmitted disease (STD) infections each year (1, 2). The cost of STDs to the United States (US) health care system is estimated to be as much as $17 billion annually (2, 3). Moreover, untreated STDs can lead to serious long-term adverse health consequences, especially for young women. CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in the US each year to become infertile (2).
Young women are particularly vulnerable to STDs for several reasons, including their tendency to have multiple sexual partners (concurrent or sequential) and because there are some difficulties in accessing effective STD prevention services (4). Indeed, less than half of people at risk who should be screened receive recommended STD screening services (2). This clearly is public health issue with regard to prevention and treatment. Given the adverse consequences of infection which could lead to a serious public health problem, the current study seeks to better understand possible correlates with STD-related risk behavior. More specifically, the current study examines time-varying factors within-person (e.g., substance use) and fixed effects factors between-persons (e.g., race/ethnicity) as related to STD-related risk behavior.
Substance use such as alcohol use and cannabis use have both been found to be positively associated with sexual risk behaviors (5, 6). Aicken et al. (5) documented that heavy drinking was more common among those reporting both a larger number of sexual partners and two or more partners in the past year. Similarly, Patrick et al. (6) showed that more frequent marijuana use was associated with both a larger number of sexual partners and lesser use of condoms. Married people, on the other hand, are less likely to engage in sexual risk behaviors than those not married (6). In 2014, STD rates were found to be 6-10 times higher among African American women (7) and two times higher among Hispanic women (8) than White women in the US. Higher educational level was negatively associated with sexual risk behaviors (6).
The present study focuses on the impact of substance use as well as demographic correlates with STD-related risk behavior. We hypothesize that more frequent substance use, unmarried
status, race/ethnicity (African American), and lower educational level (non college attendance) will be positively related to a higher number of male sexual partners during the past year among women of color in their late thirties.
Methods
This study included 343 female participants (50% African American, 50% Puerto Rican) who completed the 7th wave of data collection in the Harlem Longitudinal Development Study. The data were collected during 2014 – 2016. The mean age of the participants at this wave was 39.1 years (Standard deviation=1.5 years). We obtained informed assent or consent from all of the participants. The Institutional Review Board of the New York University School of Medicine approved the study.
For the independent variables, the participants were asked about their ethnicity (African American=1, Puerto Rican=2), marital status (Engaged or married=1, otherwise=0), and educational level (college attend or higher=1, otherwise=0). The participants were also asked about the frequency of alcohol use and cannabis use. Answer options for alcohol use ranged: none at all =0, less than once a week=1, once a week or several times a week=2, 1-2 drinks a day=3, 3-4 drinks a day=4, 5 or more drinks a day=5. Answer options for cannabis use ranged: none at all =0, 1-2 times a month=1, 3-5 times a month=2, 6-9 times a month =3, 10 or more times a month=5. For the dependent variable, the participants reported the number of male sex partners in the past year.
Regression analyses were conducted using the number of male sex partners as the dependent variable and using alcohol use, cannabis use, marital status, race/ethnicity, and college attendance as the independent variables.

Results
Among the 343 female participants, 0.55% (n = 19) had no male sex partners in the past
year. As shown in Table 1, alcohol use (b = 0.14, p < 0.01), cannabis use (b = 1.10, p < 0.01), marital status – unmarried (b = -0.16, p < 0.05), and race/ethnicity – African American (b = -0.20, p < 0.01) were significantly related to a higher number of male sex partners in the past year.

	The number of male sex partners in the past year
	Estimation		Standard Error	p-value
Time-varying within-person
Alcohol use		0.14	0.04	0.0013
Cannabis use		1.10	0.03	0.0021
Marital status – Married		-0.16	0.08	0.0414
Fixed effects between-persons
Ethnicity		-0.20	0.08	0.0095
College attendance		-0.06	0.08	0.3996

Discussion
As hypothesized, the findings indicated that women who use substances (i.e., alcohol and cannabis) had a higher number of male sexual partners. Also, unmarried women as compared to married women and African American women as compared to Puerto Rican women both had a higher number of sexual partners. These findings are consistent with the results from other research papers (5, 6, 9).
The current study showed strong associations between substance use and the number of male sexual partners. Intervention programs that wish to reduce sexual risk behaviors among women who use substances need to develop creative and effective ways to work with this population. Entering drug treatment programs may also help these women reduce or recover from their drug abuse or addiction. Entry into drug treatment has been shown by researchers to be associated with reduced rates of involvement in a variety of sexual risk behaviors (10, 11).
It is worth noting that race/ethnicity also makes it important that prevention and intervention programs targeting these women and their risk behaviors may be designed and implemented by utilizing an understanding socio-cultural factor. Since the present study included only African American and Puerto Rican women, interventions should be designed with input from African American and Puerto Rican women. Our findings indicating higher sexual risk behavior among African American women than among Puerto Rican women suggest that issues of high importance to African American women
should be taken into consideration in developing intervention programs. This type of approach has been shown to be effective in studies of other sexual risk behavior interventions (12).
In addition to race/ethnicity, unmarried status was found to be associated with elevated sexual risk behavior in this study. Since many studies have documented differences in sexual risk behavioral involvement and in the issues/circumstances underlying sexual risk behavioral involvement based on marital status (6, 13), intervention programs designed to work with such high-frequency drug-using unmarried women should consider this variable.
Conclusion
The sample consisted of an African American and Puerto Rican inner city female population. Further studies should include other ethnic groups for generalization to the US population. Our data are also based on self-reports, which can lead to biased results, since people may under-report their experiences with drug use. However, studies have shown that the use of this type of self-report data yields reliable results (14).
From a public health perspective, the present study suggests that treatments designed to reduce or quit drinking alcohol and smoking cannabis may reduce the sexual risk behavior among unmarried African American women. Therefore, treatment and prevention programs focused on substance use as well as socio-cultural factors (i.e., marital status, race/ethnicity) may be more effective than programs focused only on substance use.
Acknowledgments
This research was supported by the following grants from the National Institute of Health: 1K01 DA041609-01A1 awarded to Dr. Lee and 5R01 DA03540-04 awarded to Drs. J.S. Brook and Pahl both from the National Institute on Drug Abuse.
Conflict of Interest
None declared by authors.

 
 
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