Stimulant Use Associated with Psychosocial Factors, HIV risk and Concurrent Hazardous Alcohol Use among US Adults recruited via an online crowdsourcing platform (Preprint)

BACKGROUND Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States (US). To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to utilize large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the U.S. OBJECTIVE We identified the correlates of stimulant use among people who use alcohol and/or stimulants in the U.S recruited using MTurk. METHODS Participants who were aged ≥ 18 years in the U.S. and reported alcohol or stimulant (i.e., cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited online using MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (i.e., depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data was collected and analyzed with STATA (version 17). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine correlates of stimulant use. Multivariable models controlled for: age, race, health insurance, and relationship status. RESULTS Out of 272 participants, 73.8% identified as male, 49.2% were MSM, 18.9% were from racial/ethnic minoritized communities and 58% were in a relationship. The mean age was 36.10 (SD=10.3). Forty (14.7%) participants reported stimulant use in the past six months. Factors significantly associated with stimulant use were: being MSM (adjusted odds ratio [aOR] = 4.61; 95% CI = 1.97-10.81), a higher AUDIT-C score (aOR = 1.24; 95% CI = 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR = 1.03; 95% CI = 1.01-1.04), a higher depression score (aOR = 1.06; 95% CI = 1.01-1.12), a greater number of male partners in the last six months (aOR = 1.32; 95% CI = 1.08-1.61), a greater number of female partners in the last six months (aOR = 1.42; 95% CI = 1.04-1.92), and being diagnosed with a sexually transmitted infection (e.g. Syphilis, Gonorrhea, Chlamydia, HSV, HPV, and Other) in the last six months (aOR = 14.61; 95% CI = 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared to non-MSM (RERI = 0.085; CI = 0.037–0.13). CONCLUSIONS Interventions that address stimulant use should employ evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations.