Elsevier

Addictive Behaviors

Volume 33, Issue 8, August 2008, Pages 1055-1060
Addictive Behaviors

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Prevalence of recent illicit substance use and reporting bias among MSM and other urban males

https://doi.org/10.1016/j.addbeh.2008.03.003Get rights and content

Abstract

This paper explores whether elevated rates of self-reported substance use among MSM compared to other males may be an artifact of reporting bias. Past month prevalence rates of marijuana, cocaine, heroin, methamphetamine, Ecstasy, and Ketamine use were compared between a sample of men who have sex with men (MSM), and a general household sample of men, all residing in Chicago. We compared rates of self-reported use, and corrected rates based on the results of drug testing (urine and oral fluid tests). While MSM over 30 years old were significantly more likely than other men in this age group to report past month use of cocaine, test-corrected rates of use were equivalent. On the other hand, test-corrected estimates confirmed elevated rates of Ketamine and Ecstasy use in the MSM sample. Differential disclosure of substance use between MSM and other males may in some cases lead to distorted conclusions about differences in substance use between these groups. The use of biological testing in epidemiological studies of substance use can reduce the uncertainty of such comparisons.

Introduction

While it is clear that many men who have sex with men (MSM) do not use illicit drugs, research shows that illicit substance use is prevalent in this population (Stall et al., 2001, Thiede et al., 2003), and prevalence rates for a variety of illicit substances have consistently been higher for MSM than for non-MSM in studies where direct comparisons are available (McCabe et al., 2005, Woody et al., 2001). Several recent studies indicate that “club drugs” (e.g., MDMA, amphetamines, and LSD) in particular may be used to a greater extent among MSM (Fendrich et al., 2003, McCabe et al., 2003, Stall et al., 2001). The tracking of emerging substance use trends within any particular population subgroup facilitates the targeting of community based prevention efforts and can also serve as a means of evaluating ongoing program activities. Within the context of MSM, research on substance use behavior has particular import because of purported associations with risky sexual behavior and practices which potentially increase the spread of HIV (Stall & Purcell, 2000).

An issue which has not been addressed is the extent to which differences in self-reported substance use may be an artifact of differential willingness to report the use of illicit substances. Some studies of MSM, including our own, systematically screen for gay identity or MSM behavior as a criteria for study inclusion. Subjects who are willing to disclose MSM behavior at screening may generally be more willing to share “private” information in research surveys. In addition, to the extent that substance use is relatively more prevalent among MSM, substance use may be more normative and this behavior may be relatively less “sensitive”. If the reports of elevated rates of substance use among MSM compared to men in general are artifactual, this has implications for studies relating substance use to risky sexual behavior. Greater willingness among MSM to disclose sensitive behaviors such as drug use and risky sex may lead to overestimation of the association between the two behaviors, as well as inflated differences between MSM and heterosexual men in both drug use and sexual behavior. The present study addresses this issue by examining self-reported rates of use of several substances, and corrected rates using the results of biological tests (urine and oral fluid) between MSM and community samples of adult respondents.

Section snippets

Sample and procedure

This study employed two multi-stage area household probability samples of men in Chicago. The first was a sample of more than 600 Chicago residents, ages 18–40, conducted from June 2001 to January 2002, and described in detail elsewhere (Fendrich, Johnson, Wislar, Hubbell, & Spiehler, 2004). Interviews were completed with 242 men; 92% of these men self-identified as being only heterosexual. The second sample was obtained as a supplement to the general population survey, and was concentrated in

Self-reported substance use prevalence

Prevalence estimates based on self-reported substance use are shown in Table 2, Table 3. Significance levels are adjusted for 10 comparisons. No estimates are shown for Rohypnol as there was no reported use of this substance in either sample within the past year.

Young MSM were significantly more likely than young general population males to report past year use of Ecstasy (F = 15.57, p < .01), inhalants (F = 12.92, p < .01), Ketamine, (F = 6.90, p < .05) methamphetamine (F = 9.67, p < .05), and

Discussion

Higher rates of self-reported use in the past year, and in the past month were found among MSM compared to men in the general population sample for several substances. Differences in past month use were evident only among men over 30 years old, for cocaine, Ecstasy, inhalants, and Ketamine. When corrected for underreporting, Ecstasy and Ketamine use, but not cocaine use, appeared as more prevalent among older MSM. In multivariate analyses, adjusting for age, White race/ethnicity, and education

Acknowledgment

This study was funded by a grant from the National Institute on Drug Abuse, U.S.A. (R01DA018625).

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