drinking behaviors and sexual health among women with adhd across ethnicity

45 Pages·2017·0.58 MB·English

DRINKING BEHAVIORS AND SEXUAL HEALTH AMONG WOMEN WITH ADHD
ACROSS ETHNICITY: A PILOT STUDY OF FEMALE COLLEGE STUDENTS

__________________

A University Thesis Presented to the Faculty
of
California State University, East Bay

__________________

In Partial Fulfillment of the Requirements
for the Degree of Master of Social Work

__________________

By
Holly Pothier
December, 2017
Copyright © 2017 by Holly Pothier

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ABSTRACT
Although Attention Deficit Hyperactivity Disorder (ADHD) predicts higher likelihood of
adverse life experiences, there is very little research exploring the impact of ADHD in
girls and women of color. Due to their unique experiences/environments in conjunction
with ADHD symptomatology, outcomes in the areas of substance use and sexual
behavior are likely to differ from those of White women. Method: Using existing NCHA-
II data from the CSUEB student body, three layers of analyses on drinking and sexual
behaviors were conducted: differences between the ADHD group and the general
population; in-group differences between women of color (WOC) with and without
ADHD; differences between WOC with ADHD and White women with ADHD. Results:
Statistically significant differences in amount of alcohol consumed, number of drinking
incidents, number of heavy drinking incidents, and rates of HPV and Chlamydia were
found in the first two analyses, but not the third. Implications: Results suggest that
ADHD symptomatology may predict different outcomes in drinking behaviors across
race and ethnicity, necessitating more intersectional review of symptom manifestation,
outcomes, and culturally sensitive treatment.

Keywords: ADHD, Alcohol, Sexual Behavior, Women, Intersectional

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DRINKING BEHAVIORS AND SEXUAL HEALTH AMONG WOMEN WITH ADHD
ACROSS ETHNICITY: A PILOT STUDY OF FEMALE COLLEGE STUDENTS
By
Holly Pothier
Approved: Date:
,
;
Dma Redman, MPH, PhD, LCSW
/2 _,_} 7
Toni Naccarato, PhD
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Acknowledgements
First, I would like to thank all the people in my life who supported me when the
future extended so far beyond where I could see that I wondered if it was all worth it.
Matt, thank you for seeing me all the way through this process and for cheering me on.
I’m grateful to my family for their pride and confidence in me and my close friends who
kept my diet rich in stress-relieving laughter.
Thank you to all the researchers and respondents of the CSUEB 2016 NCHA-II
who made this study possible.
Finally, thank you to my research committee members, Dr. Dina Redman, and Dr.
Toni Naccarato. I would like to extend my highest gratitude to my committee chair, Dr.
Taylor, whose patience, guidance, and encouragement enabled this project.

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Tables of Contents
Introduction 1
Race, Gender, and ADHD Diagnosis 2
Women of Color with ADHD 4
ADHD Comorbidities in Women 5
Risk Behavior in Women of Color with ADHD 8
Discussion and Research Questions 12
Methodology 13
NCHA-II 14
Data Sample 15
Analysis 16
Results 17
Discussion 20
Limitations 21
Conclusions 22
References 26

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List of Figures
Figure 1: Concept Map 12
Figure 2: Drinking behaviors across race, ethnicity, and ADHD status 18

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1

Introduction
While often characterized as a childhood disorder, Attention Deficit Hyperactivity
Disorder (ADHD) is estimated to impact between 2-8% of college students (DuPaul,
Weyandt, O’Dell, & Varejao, 2009; Pryor, Hurtado, DeAngelo, Blake, & Tran, 2010).
Attention Deficit Hyperactivity Disorder is a neuropsychological disorder characterized
by problems with attention, hyperactivity, impulsivity, and executive function (American
Psychiatric Association, 2013). Persons with diagnoses of ADHD may struggle in a
variety of areas including education, employment, health, finances, and personal
relationships. While the body of research has expanded to better include girls and women
with ADHD, there is very little focusing on girls and women of color experiencing it.
Because ADHD is associated with a number of adverse health outcomes, including
problematic substance use and sexual behaviors that may present risks to sexual health,
lack of intersectional investigation should represent a concern for public health.
Sexual behaviors in college students are highly variable. A study of 13 California
community colleges found that 52.5% and 47% of college students aged 18-24 report
having engaged in vaginal and oral sex, respectively, with more than one half of the
7,898 respondents reporting only 1 or 2 sexual partners (Trieu, Bratton, & Hopp
Marshak, 2011). Slightly less than half of the sample endorsed condom use during last
vaginal sex (48.5%); however, many report even less consistent use during oral sex, with
only 6.3% claiming to have used condoms during their last encounter. Rates of STIs in
college-age young people are higher than rates in older adults, with individuals ages 15-
24 accounting for half of all new STIs each year (Satterwhite et al., 2013). However, it
has been noted that while colleges do collect data on student health, STIs are not always
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reported, resulting in a lack of comprehensive knowledge about prevalence among
college student populations (Allen, 2017; Smith & Roberts, 2009).
According to the 2015 National Survey on Drug Use and Health (NSDUH), 58%
of full-time college students reported consuming alcohol during the preceding month
while 37.9% reported binge drinking at least once in the same time frame (Substance
Abuse and Mental Health Services Administration, 2015). Furthermore, it is estimated
that about 20% of college students meet criteria for Alcohol Use Disorder (Blanco, et al.,
2008). Due to the prevalence of drinking behaviors and availability of alcohol on college
campuses, further research on groups vulnerable to problematic drinking is necessary.
In this study, we will utilize data from the 2015-2016 National College Health
Assessment- II to examine drinking and sexual behaviors from a small subset of the
population: women attending California State University, East Bay with ADHD. Details
regarding alcohol consumption, amount, frequency, consequences, sexual activity, sexual
partners, contraceptives/condom use, and STIs will be compared against those of survey
respondents who did not report an ADHD status. The focus of this paper will be on
differences in behaviors across race/ethnicity in women with ADHD; while it can
reasonably be assumed that aspects of the ADHD experience are mediated by culture and
socioeconomics, there is a dearth of research on the experiences of women of color
(WOC).
Race, Gender, and ADHD Diagnosis
While the existing body of knowledge on Attention Deficit Hyperactivity
Disorder (ADHD) encompasses race and gender issues, there is very little information
available on ADHD at the intersection of race and gender or in regards to women of
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color. Between 1998 and 2009, gaps in White and African American rates of ADHD
prevalence narrowed, with 10.6% of White children (from 8.2%) and 9.6 of African
American children (from 5.1%) impacted, and Mexican-American children having the
lowest rates according to National Health Institute Survey data compiled by Centers for
Disease Control and Prevention and analyzed by Akinbami, Liu, Pastor, and Reuben
(2011). Additionally, the data indicated that although ADHD prevalence in both male and
female students increased between 1998 and 2009, rates were consistently higher in boys
(9.9% to 12.3%) than in girls (3.6% to 5.5%).
Barriers to proper diagnosis and treatment in students of color and in girls or
women may be attributed to a variety of factors. While ADHD symptoms may be just as
impactful to women over their lifespans as they are to men (Hinshaw, Owen, Sami,
Fargeon, 2006), girls tend not to exhibit as many “externalizing,” or hyperactivity
symptoms as boys in classrooms (Biederman et al., 2005; Gaub & Carlson, 1997;
Gershon, 2002), making them less likely to be targeted for assessment. Proper diagnosis
and treatment of African American students may be confounded by the tendency of
teachers to rate their symptomatology and disruptive behaviors as more severe than those
of White students (DuPaul, Reid, Anastopoulos, Lambert, Watkins, & Power, 2016) and
differing parental attitudes regarding ADHD and medication treatment (Bussing,
Schoenberg, & Perwien, 1998; Mychailyszyn, Dosreis, & Myers, 2008). Additionally,
ADHD is often comorbid with other disorders (Murrell, Steinberg, Connally, Hulsey, &
Hogan, 2015), with mood and anxiety disorders present in roughly one third of cases
(Jensen et al., 2001).