Chronic disease multimorbidity and substance use among African American men: veteran-non-veteran differences

ObjectivesThe 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.DesignData 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.ResultsFrom 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.DiscussionChronic 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.

Automated summary

The study aimed to explore the relationship between chronic disease multimorbidity and substance use among African American men in the United States, and whether prior military service moderates this relationship. The data analysis from the National Survey on Drug Use and Health revealed that the relationship between chronic disease multimorbidity and substance use is indeed moderated by prior military service. Non-veterans with chronic diseases are more likely to use tobacco and opioids, while veterans with chronic diseases are more likely to use illicit drugs.