Demographic Correlates of Drug and Alcohol Use Among NYC STD Patients: Who Benefits from Interventions, and How Many Are We Missing?

Background: The New York City Department of Health and Mental Hygiene’s Screening, Brief Intervention, and Referral to Treatment services (SBIRT) program provides counseling by on-site interventionists (‘Brief Interventions’ or ‘BI’s) to STD clinic patients reporting drug or alcohol use (DOAU). DOAU is determined by either of two prescreening instruments scored on linear scales: DAST-10 (from 1-10) and AUDIT-c (from 1-40). Our goal was to identify demographic correlates of risk in order to prioritize patients for counselor services.

Methods: Using clinic medical record data (1/1/2012-3/1/2016), we assessed associations of DOAU with patient age, gender, sexual orientation, and race/ethnicity among 29,643 unique patients who received a BI. Further, we described demographics of 40,450 patients who were eligible for, but did not receive, >1 BI.

Results: Older age was positively correlated with both AUDIT (r=0.27, p<.001) and DAST-10 scores (r=0.67, p<.001); mean AUDIT and DAST scores were higher for males than for females (t=24.0, p<.0001 and t=6.5, p<.0001); the mean AUDIT score was higher for lesbian, gay, or bisexual (LGB) than for straight-identified patients (t=4.8, p<.0001); and mean DAST scores were higher for patients of minority race/ethnicity (non-Hispanic (NH)-black vs NH-white: t=6.4, p<.0001; Hispanic vs NH-white: t=9.6; p<.0001). Of the 40,450 patients who did not receive >1 BI, 60.7% (n = 23,915) were due to interventionist unavailability. Of those who did not receive >1 BI because of interventionist unavailability (n = 23,915): 66% (n = 15,889) were male, 30% (n = 7,209) were LGB, 30% (n = 7,159) were NH-white, 37% (n = 8,906) were NH-black, and 23% (n = 5,432) were Hispanic.

Conclusions: Our data may provide information to suggest which groups could be prioritized for counseling. The degree of interventionist unavailability may suggest missed opportunities among subpopulations at especially high risk of problematic DOAU, and improving staffing levels may help to boost patient outcomes.