Alcohol screening and brief intervention among military service members and veterans: rural–urban disparities

Abstract

BackgroundAccess to screening, brief intervention and referral to treatment programmes for alcohol use have been shown to be effective; however, little is known about access to these services among service members and veterans. We examined the association of service member or veteran rural-dwelling area and the following outcomes: recent general health check-up, alcohol screening and alcohol brief intervention.MethodsData on 5080 military service members and veterans were obtained from the 2017 Behavioural Risk Factor Surveillance System of the USA. We estimated rural–urban disparities in the receipt of a recent voluntary general health check-up, as well as the receipt of alcohol screening and brief intervention, using a mixed logit model.ResultsOf the 5080 participants in the study, a total of 4666 (90.49%, 95% CI 89.39% to 91.48%) reported a general health check-up in the last 2 years. Results showed 7.48% of the sample (95% CI 6.64% to 8.41%) exhibited heavy alcohol consumption patterns. Of the 414 participants who did not undergo a general health check-up, 13.80% (95% CI 9.63% to 19.41%) exhibited a pattern of heavy alcohol consumption. Rural individuals were less likely to report a recent health check-up (adjusted OR=0.82, 95% CI 0.79 to 0.87). Rurality was also independently associated with decreased likelihood of receiving an alcohol screening and brief intervention.ConclusionGreater access to telehealth or other geographically flexible screening and brief intervention programmes is needed in rural areas for service members and veterans.

Measuring the Impact of the COVID-19 Pandemic on Health Behaviors and Health Care Utilization in Rural and Urban Patients with Cancer and Cancer Survivors

“…The mean number of alcoholic drinks was higher among rural respondents. Rural residence is associated with higher rates of alcohol consumption in patients with head and neck cancer ( 19 ), yet rural residents are less likely to receive evidence-based alcohol screening and intervention in primary care ( 20 ). A total of 12.2% of respondents overall reported an increase in alcohol consumption since the start of the pandemic.…”

Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé

“…Elles sont également moins susceptibles d’avoir accès à des consultations en personne (RRI 0,84; n = 66 053) et aux médicaments de prévention des rechutes approuvés par la Food and Drug Administration des États-Unis (RRI 0,89; n = 66 053) que les hommes 165 . Les personnes vivant en milieu rural sont moins susceptibles que les citadins de subir un dépistage concernant la consommation d’alcool (RC 0,15, IC de 95 % 0,14–0,16), d’être renseignés à ce sujet (RC 0,15, IC de 95 % 0,14–0,17) ou de recevoir des conseils appropriés (RC 0,08, IC de 95 % 0,06–0,09) après un dépistage positif 166 . En milieu rural, on observe aussi moins de traitements instaurés (RC 0,88, IC de 95 % 0,83–0,93; n = 52 165), d’observance thérapeutique (RC 0,86, IC de 95 % 0,77–0,97; n = 14 114) et de médicaments prescrits (RC 0,83, IC de 95 % 0,73–0,94; n = 15 062) qu’en milieu urbain 167 .…”

Treatment of Alcohol Use Problems Among Rural Populations: a Review of Barriers and Considerations for Increasing Access to Quality Care

“… Maulik et al [ 81 •] 1417 residents of villages involved in an anti-stigma campaign Andhra Pradesh, India Stigma perceptions related to help seeking improved significantly over the course of the anti-stigma campaign ( p < 0.001). McDaniel et al [ 18 ] 5080 Veterans and service members USA Rural individuals had significantly lower odds of receiving an alcohol screening and of receiving advice on alcohol consumption compared to suburban/urban residents. Mushi et al [ 32 •] 1604 adults Northern Tanzania 0.3% of participants had documented AUD screening and management, and only 5% of those who screened positive for AUD had sought help.…”

“…Veterans in rural areas were 17% less likely than veterans in urban areas to receive evidence-based medications for alcohol use disorder (AUD) [ 17 ]. In another study, rural veterans were less likely than urban or suburban dwelling veterans to receive an alcohol screening at medical checkups [ 18 ]. Among those who did complete a screening and endorsed heavy alcohol consumption, rural veterans were 63% less likely to receive education on alcohol use and 92% less likely than suburban dwelling veterans to receive advice about cutting down or stopping their alcohol use [ 18 ].…”

“…In another study, rural veterans were less likely than urban or suburban dwelling veterans to receive an alcohol screening at medical checkups [ 18 ]. Among those who did complete a screening and endorsed heavy alcohol consumption, rural veterans were 63% less likely to receive education on alcohol use and 92% less likely than suburban dwelling veterans to receive advice about cutting down or stopping their alcohol use [ 18 ]. Finally, one study of veterans living with HIV found more modest differences in alcohol treatment following positive screens for problematic use [ 19 ].…”