Mental Health Status, Violence, and Sexual Risk Behaviors Among Native American Binge Substance Using Adults

Introduction: Sexually transmitted infections (STI), substance use and poor mental health have unique determinants and contribute to marked sexual health disparities in Native American communities. No interventions targeting these intertwining risks have been proven for this population. We have developed and are evaluating a culturally adapted, paraprofessional-delivered program called EMPWR (Educate, Motivate, Protect, Wellness and Respect) for binge substance-using Native American adults. This analysis explores predictors of unprotected sex and number of partners among our sample.

Methods: EMPWR is a 2-session, risk reduction intervention that counsels participants in how their binge substance use increases personal sexual health risk, and motivates STI screening behavior. EMPWR is being evaluated through a randomized controlled trial with N=286 participants. Data are collected at baseline through 6-months post-intervention and include sociodemographics, risk/protective factors, mental health status, and sexual risk behaviors. Negative binomial and multiple regression models examined factors predicting two high-risk sexual behaviors at baseline: a) number of unprotected sex acts in the last 3 months, and b) number of sexual partners in the last 3 months. Analyses explored differences by sex and clinical cut-off scores for depression.

Results: Among males and females, greater frequency of binge substance use significantly predicted the number of unprotected sex acts in the three months prior to baseline. Additionally, greater frequency of binge substance use significantly predicted number of sex acts among both participants who were and were not depressed. Older participants with depression had lower relative risk for unprotected sex acts. For females only, ever experiencing physical violence predicted number of unprotected sex acts. Being married or co-habitating significantly reduced the relative risk for number of partners among males and females. Cohabitation, regardless of depression status, also reduced risk for multiple partners. However, depressed participants with children had significantly higher risk for multiple partners. For females, ever experiencing sexual violence and ever experiencing physical violence significantly predicted having multiple partners. The latter factor was protective against multiple partners for males.

Conclusion: Binge substance use has a powerful association with sexual risk behaviors, as expected among this sample of Native American adults. Results suggest study aims are appropriate for this population for whom binge substance use significantly predicts the frequency of unprotected sex. The association between sexual and physical violence and sexual health risk behaviors warrants additional consideration and will receive careful attention in future impact analyses of the EMPWR intervention.