Catharine E. Mennes, MSW CPDD 2004 Oral Session XVIII Presentation Date: 6162004 Presentation Time:

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Catharine E. Mennes, MSWCPDD 2004Oral Session
XVIIIPresentation Date 6/16/2004Presentation
Time 1130 AME-mail mennesce_at_epi.wustl.edu
Telephone [phone] or 314/286-2252
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Connectedness is Associated with Risk Behaviors
among Female Substance Abusers

• C. E. Mennes, MSW
• NIDA Predoctoral Trainee
• C. C. Meeks, MSW
• C. Ostella, MA
• A. Ben Abdallah, MS
• L. B. Cottler, Ph.D.

Washington University School of Medicine in St.
Louis, Missouri
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Disclosures

• Funded by
• NIAAA grant R01-AA12111, L. B. Cottler, PI
• NIDA grant R01-DA11622, L. B. Cottler, PI
• NIDA training grant 5T32-DA07313-04,
• L. B. Cottler, Training Director

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Background

• Social Connectedness developing and maintaining
  personal relationships that foster a sense of
  belonging to a community
• Relationships with friends, family, co-workers,
  and neighbors coupled with participation in group
  activities within the community
• Research has shown that those who are
  disconnected, or socially isolated, are at an
  increased risk for serious illness while those
  with social connectedness maintain a healthier
  status

Berkman, L.F. (1995). The Role of Social
Relations in Health Promotion. Psychosomatic
Medicine 57 245-254
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Background

• Social connectedness theoretically improves
  health, yet studies need to confirm this
  relationship
• Aspects of social connectedness need to be
  explored to understand how social factors
  influence health status
• These analyses aim to explore the characteristics
  of social connectedness in relation to risk
  behaviors among a population of female substance
  abusers

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Research Hypotheses

• The quantity of social connections is negatively
  associated with risk behaviors
• The type of social connections are related to
  risk behaviors
• Heterogeneity in type of social connections is
  protective against risk behaviors

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Sister to Sister Women Teaching Women Sample
Recruitment

• Eligible Women
• Over 18 years of age
• Sexually active 4 months prior to study
• Qualify as a Heavy Drinker by an AUDIT score of 4
  or greater (STS) or
• Test positive for cocaine, heroin or amphetamines
  (WTW)

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STS WTW Overview

• WU Risk Behavior Assessment for Women
• CIDI-SAM (Substance Abuse Module)
• WHODAS
• HIV, HCV, syphilis, gonorrhea, chlamydia
  screening

• Life Events Scale
• Partial Diagnostic Interview Schedule
• Violence Exposure Questionnaire
• Alcohol/Cocaine-Related Internal- External
  Locus of Control Scale
• Alcohol/Cocaine Expectancy Questionnaire

STS does not include Well-Woman Exam
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Methods

• Substance abusing women from STS/WTW who
  completed baseline, including the Washington
  University Locator form (N846), were used to
  explore the characteristics of connectedness
• Three aspects of connectedness were explored
  quantity of connectedness, type of connectedness,
  and heterogeneity of connectedness
• The sample was stratified for each aspect of
  connectedness
• The resulting groups were then compared across
  risk behaviors drinking alone, injection drug
  use, promiscuity, unprotected sex, sex trading,
  and STDs

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Washington University Locator Form

• The Locator Form elicits phone numbers and
  addresses to locate the respondents throughout
  the study and into the future.
• It elicits phone numbers and addresses for
• Best Place to Locate
• Parents
• Friends
• Relatives
• Church
• Employer
• Parole Officer
• Person contacted if Arrested
• Place would go if could not stay at current
  residence
• The items were examined for repeat entries and
  deduplicated to ensure that each item used
  represented one exclusive connection

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Statistical Analyses

• Bivariate analyses were run to determine the
  differences between the women in each group
• Chi-square tests and t-tests were used to
  determine the statistical significance of the
  differences
• The same process was used to examine quantity,
  type, and heterogeneity of social connectedness

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Quantity of Connectedness

• 13 items were used as a count to assess the
  quantity of social connectedness
• The sample was stratified into three groups

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Demographic Characteristics of Connectedness
Quantity
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Characteristics of Connectedness Quantity
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Characteristics of Connectedness Quantity
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Type of Connectedness

• The type of connection was assessed by coding the
  relationships of the items into six categories
  individual, family, friends, partners, community
  and mandated
• If the relationship was not specified (23),
  refused, or missing the type was coded as
  incomplete and not used in the analyses

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Grouping for Types of Connectedness
FAMILY ONLY
PERSONAL
Family
RESOURCES
Community or Mandated
Friends or Partners
ALL
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Characteristics of Connectedness Type
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Characteristics of Connectedness Type
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Characteristics of Connectedness Type
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Heterogeneity of Connectedness

• Heterogeneity of social connectedness was
  assessed by how many differing types of
  connections the respondents reported
• Heterogeneity ranged from 0 to 5 types
  (individual type was not included)

Distribution of Heterogeneity of Social
Connectedness
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Demographic Characteristics of Connectedness
Heterogeneity
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Characteristics of Connectedness Heterogeneity
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Characteristics of Connectedness Heterogeneity
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Conclusions

• These findings suggest that
• Quantity of connections is positively associated
  with HIV risk behaviors, namely injection drug
  use and sex trading, and have higher rates of
  Hepatitis C
• Personal type (family, partners, and friends) of
  connections are associated with reduced HIV risk
  behaviors, yet have higher rates of STDs
• Heterogeneity of connections is not protective
  and is associated with increased HIV risk
  behaviors

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Limitations

• The measurement of social connectedness may need
  to encompass more community attachment items and
  items to assess quality of connections to ensure
  the validity of the construct
• The Washington University Locator Form is a
  robust instrument to track respondents, having
  achieved a past record of 96.6 follow-up rate
  with IDU over 18 months, and the information
  provided by the respondents is for locating,
  which may not accurately capture the
  connectedness construct

Cottler et al. (1996). Achieving a 96.6 percent
follow-up rate in a longitudinal study of drug
abusers. Drug and Alcohol Dependence, 41
209-217
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Implications

• Given that women with high connectedness are more
  likely sex traders, perhaps this high risk
  population is more willing to engage than we
  previously believed
• The type of connections substance abusers are
  making is important more work needs to be done
  examining how type interacts with behaviors
• Overall, there needs to be more of a focus on how
  connectedness can serve to protect substance
  abusers against HIV risk behaviors

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Acknowledgements

• Linda Cottler, Ph.D.
• Arbi Ben Abdallah, MS
• Chris Ostella, MA
• Catina Meeks, MSW
• STS/WTW Project Staff