Latent Growth Curve Modeling of Non-Injection Drug Use and Condomless Sexual Behavior from Ages 18 to 21 in Gay,Bisexual, and Other YMSM: The P18 Cohort Study

Background: HIV/AIDS continues to be a health disparity faced by sexual minority men, and is exacerbated by non-injection drug use. Objectives: We sought to delineate growth in non-injection drug use and condomless sex in a sample of racially and economically diverse of gay, bisexual, and other young men who have sex with men (YMSM) as they emerged into adulthood between the ages of 18 and 21 and who came of age in the post-HAART era. Methods: Behavioral data on drug use and condomless sex, collected via a calendar based technique over 7 waves of a cohort study of 600 YMSM, were analyzed using latent growth curve modeling to document patterns of growth in these behaviors, their associations, and the extent to which patterns and associations are moderated by race/ethnicity and socioeconomic status. Results: Significant growth was noted in the frequencies of condomless oral and anal intercourse, alcohol to intoxication, marijuana use, and inhalant nitrate use. High levels of association were noted between all behaviors across time but associations did not differ by either race/ethnicity or socioeconomic status. The link between drug use and risky sexual behavior continue to be evident in YMSM with significant increases in these behaviors demonstrated as YMSM transition between adolescence and young adulthood. Conclusions/Importance: Healthcare for a new generation of sexual minority males must address the synergy of these behaviors and also nest HIV prevention and care within a larger context of sexual minority health that acknowledges the advances made in the last three decades.     

Prevention of alcohol use in middle school students: psychometric assessment of the decisional balance inventory

A measurement model should be equivalent across the different subgroups of a target population. The Decisional Balance Inventory for the Prevention of Alcohol Use is a 2-factor correlated model with 3 items for Pros of alcohol use and 3 items for Cons. The measure is part of a tailored intervention for middle school students. This study evaluated the important psychometric assumptions of factorial invariance and scale reliability with a large sample of sixth grade students (N=3565) from 20 schools. A measure is factorially invariant when the model is the same across subgroups. Three levels of invariance were assessed, from least restrictive to most restrictive: 1) Configural Invariance (unconstrained nonzero factor loadings); 2) Pattern Identity Invariance (equal factor loadings); and 3) Strong Factorial Invariance (equal factor loadings and measurement errors). Structural equation modeling was used to assess invariance over two levels of gender (male and female), race (white and black), ethnicity (Hispanic and non-Hispanic), and school size (large, indicating >200 students per grade, or small). The strongest level of invariance, Strong Factorial Invariance, was a good fit for the model across all of the subgroups: gender (CFI: 0.94), race (CFI: 0.96), ethnicity (CFI: 0.93), and school size (CFI: 0.97). Coefficient alpha was 0.61 for the Pros and 0.67 for Cons. Together, invariance and reliability provide strong empirical support for the validity of the measure.     

Impulsivity-related traits,college alcohol beliefs,and alcohol outcomes: Examination of a prospective multiple mediation model among college students in Spain,Argentina, and USA

ObjectivesThe present study examined (both cross-sectionally and prospectively) the mediational role of college alcohol beliefs in the relationship between impulsivity-related traits and alcohol outcomes (i.e., alcohol use and negative consequences) among college student drinkers from the United States (U.S.), Spain, and Argentina.MethodA sample of 1429 (U.S. = 733, Spain = 292, Argentina = 404) drinkers (at least one drinking episode within the previous month) completed the baseline survey, and 242 drinkers completed the follow-up. To test study aims, a cross-sectional model was first employed to examine whether the proposed double-mediated paths (i.e., each dimension of impulsivity → college alcohol beliefs → alcohol use → negative alcohol-related consequences) extends across samples with different cultural backgrounds (i.e., structural invariance testing). A longitudinal model was then conducted to assess if college alcohol beliefs prospectively mediate the associations between trait impulsivity and alcohol outcomes.ResultsCollege alcohol beliefs were concurrently and prospectively associated with both greater alcohol use and increased number of negative alcohol-related consequences. These internalized beliefs about college student drinking culture significantly mediated the effects of several distinct impulsivity-related traits on alcohol-related outcomes including urgency (positive and negative), sensation seeking, and perseverance. These findings were invariant across gender and across three countries (Argentina, Spain, and the U.S.).ConclusionsOur findings highlight the modulatory role of cognitive factors on problematic alcohol use among college students with different cultural backgrounds. Our results suggest that, despite the cultural differences exhibited by these three countries, the unique and mediational effects of college alcohol beliefs appear relatively universal.     

Assessing the Invariance of Smoking-Related Self-Efficacy,Beliefs, and Intention Among High School Current Smokers

Measures of correlates of youth smoking should be invariant. We examined the measurement invariance of smoking-related self-efficacy, beliefs, and intention across gender, race (White vs. Black), ethnicity (non-Hispanic vs. Hispanic), and grade level (9th/10th vs. 11th/12th grade) for 2767 high school current smokers. Strong factorial invariance was found in the factors across gender (NNFI:0.959; CFI:0.959; RMSEA:0.085), grade (NNFI:0.962; CFI:0.962; RMSEA: 0.079), race (NNFI: 0.967; CFI: 0.967; RMSEA: 0.074), and ethnicity (NNFI: 0.965; CFI: 0.965; RMSEA: 0.078). Smoking-related self-efficacy, beliefs, and intention measures may be confidently used to understand attitudinal differences across gender, race, ethnicity, and grade level for youth smokers.     

Psychometric evaluation of the drinking refusal self-efficacy scale - revised with college students in the United States

Drinking refusal self-efficacy has recently emerged as a potential factor related to reduced alcohol consumption and alcohol-related negative consequences in college students. The Drinking Refusal Self-Efficacy Questionnaire-Revised (DRSEQ-R) has been commonly used to assess for drinking refusal self-efficacy. However, psychometric evaluation of the measure with college students from the United States is needed to enhance its research and clinical utility. The goal of the present study was to confirm the factor structure of the DRSEQ-R with a sample of traditional aged college students from the United States as well as assess the measurement invariance of the factor structure across sex and race and the measure's convergent validity with other common alcohol use measures. Traditional age college students (n = 1683, 73% women; 63% White, non-Hispanic) completed measures of drink refusal self-efficacy, protective behavioral strategies, weekly alcohol use, hazardous drinking, and alcohol-related negative consequences. Using exploratory factor analysis and multi-group confirmatory factor analyses, a three-factor structure was identified, but, unlike the DRSEQ-R, one item loaded onto the opportunistic relief factor instead of the social pressure factor. The proposed model registered more reliable internal consistencies across the subscales, was invariant across sex and race, and demonstrated acceptable convergent validity with other commonly used alcohol measures. The proposed model for the DRSE-R may be a more psychometrically sound way to assess for drinking refusal self-efficacy among college students in the United States. Implications, limitations, and future research directions are discussed.     

Patterns of high-intensity drinking among young adults in the United States: A repeated measures latent class analysis

ObjectiveUsing a national sample of young adults, this study identified latent classes of alcohol use including high-intensity drinking (10+ drinks) from ages 18 to 25/26, and explored associations between time-invariant covariates measured at age 18 and class membership.MethodLongitudinal data from the national Monitoring the Future study were available for 1078 individuals (51% female) first surveyed as 12th grade students in 2005–2008, and followed through modal age 25/26. Repeated measures latent class analysis was used to identify latent classes based on self-reported alcohol use: no past 30-day drinking, 1–9 drinks per occasion in the past 2 weeks, and 10+ drinks per occasion.ResultsFour latent classes of alcohol use from ages 18 to 25/26 were identified: (1) Non-Drinkers (21%); (2) Legal Non-High-Intensity Drinkers (23%); (3) Persistent Non-High-Intensity Drinkers (40%); and (4) High-Intensity Drinkers (16%). Membership in the High-Intensity Drinkers class was characterized by higher than average probabilities of high-intensity drinking at all ages, with the probability of high-intensity drinking increasing between ages 18 and 21/22. Both gender and race/ethnicity significantly differentiated class membership, whereas neither parental education (a proxy for socioeconomic status) nor college plans at 12th grade showed significant associations.ConclusionsMore than one in seven individuals who were seniors in high school experienced a long-term pattern of high-intensity drinking lasting into middle young adulthood. Young adult high-intensity drinking is often preceded by high-intensity drinking in high school, suggesting the importance of screening and prevention for high-intensity drinking during adolescence.     

Adolescent Substance Use and Sensation-Seeking on Sexual Behaviors Among Young Adults from Continuation High Schools

Background: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. Objective: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. Methods: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. Results: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. Conclusions/Importance: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.     

Factorial invariance and internal consistency for the decisional balance inventory--short form

A crucial assumption for a measure is that it is factorially invariant; that is, the measurement model is the same in different subgroups and across different occasions. The invariance of the short form of the decisional balance inventory was investigated using data from a representative sample of smokers (N=4144). Separate analyses evaluated the invariance across two levels of gender (male and female), four levels of education (grade school, high school, college, and graduate school), two levels of race (white and black), four levels of age (18-25, 26-35, 36-50, and 50+), and across four assessment occasions. The results indicated that the decisional balance inventory demonstrated strong factorial invariance across the four demographic variables and across assessments.     

Age of Sexual Debut and Cannabis Use in the United States

Background: Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health. Objectives: The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity. Methods: Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n = 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity. Results: Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37–0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68–1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42–0.78). Results were generally consistent across race/ethnicity and gender. Conclusions: Multifactorial intervention strategies targeting both sexual health and substance use may be warranted.     

Gender,Depressive Symptoms,and Daily Cigarette Use

Objective: It is widely known that cigarette use and depressive symptoms co-occur during adolescence and young adulthood and that there are gender differences in smoking initiation, progression, and co-occurrence with other drug use. Given that females have an earlier onset of depressive symptoms while males have an earlier onset of cigarette use, this study explored the possible bidirectional development of cigarette use and depressive symptoms by gender across the transition from adolescence to young adulthood. Gender differences in the stability and crossed effects of depressive symptoms and cigarette smoking during the transition to young adulthood, controlling for other known risk factors, were examined using a nationally representative longitudinal sample. Methods: A bivariate autoregressive multi-group structural equation model examined the longitudinal stability and crossed relationships between a latent construct of depressive symptoms and cigarette smoking over four waves of data. Data for this study came from four waves of participants (N = 6,501) from the National Longitudinal Survey of Adolescent Health. At each of four waves, participants completed a battery of measures including questions on depressive symptoms and an ordinal measure of number of cigarettes smoked per day. Results: The best-fitting bivariate autoregressive models were gender-specific, included both crossed and parallel associations between depressive symptoms and cigarette use during the transition to adulthood, and controlled for wave-specific parental smoking, alcohol use, and number of friends who smoke. For females, greater depressive symptoms at each wave, except the first one, were associated with greater subsequent cigarette use. There were bidirectional associations between depressive symptoms and cigarette use only for females during young adulthood, but not for males. Conclusions: The development of depressive symptoms and cigarette use from adolescence and into young adulthood follows similar patterns for males and females. Controlling for the correlation and stability between initial levels of depressive symptoms and cigarette use from adolescence into young adulthood, there remains a crossed association between cigarette use and depressive symptoms specific to females during young adulthood. The findings suggest that prevention interventions focused on mental health should include warnings that cigarette use may exacerbate depressive symptoms.     

Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network

Background: Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. Objectives: The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. Methods: Baseline assessments of male (N = 430) and female (N = 377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. Results: When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. Conclusions/Importance: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.     

Assessing the psychometric properties of smoking-related attitudes,self-efficacy,and intention among a diverse population of middle school students

Large-scale surveys frequently assess smoking-related attitudes, self-efficacy and intention to understand differences in smoking behavior. However, a critical assumption is that measures of these determinants should be equivalent across different subgroups of a target population. The current study examined the factorial invariance of measures of smoking-related attitudes, self-efficacy, and intention with a large sample (N = 13,733) of middle school students from 25 schools in Texas. We examined five levels of factorial invariance using a sequential process, in which increasingly constrained models assess the equivalence of a measure across subgroups. Strong factorial invariance provided a good fit for the model across all of the subgroups: race/ethnicity (CFI = .93), gender (CFI = .96), age (CFI = .95), and grade level (CFI = .95). Invariance results provide strong empirical support for the validity of smoking-related attitudes, self-efficacy, and intention measures across race/ethnicity, gender, age, and grade level for middle school students.     

Validation of the College Alcohol Problem Scale—revised (CAPS-r) for use with non-adjudicated first-year students

First-year students in transition to college are at increased risk for consuming greater amounts of alcohol and are subject to subsequent alcohol-related problems. The 8-item College Alcohol Problem Scale—revised (CAPS-r) has been used to measure alcohol-related problems in adjudicated undergraduates and psychology majors. However, structural validity of the CAPS-r has not been examined in a general first-year student population. Confirmatory factor analysis (CFA) was used to test the structural validity of this two-factor model using LISREL 8.5. The original two-factor measurement model for the 8-item CAPS-r represented acceptable fit to the data (χ² = 37.52, df = 19, p = .007, CFI = .968, SRMR = .0449), supporting its use with first-year college students. Future studies need to examine invariance across ethnic, gender, and geographical groups.     

Alcohol Use Among Young Men Who Have Sex With Men

This study reveals associations between alcohol use and demographic variables, as well as the relation between alcohol use and sexual activity, using episodic data. Data were obtained during summer and fall from a sample of 558 gay, bisexual, and other young men who have sex with men (YMSM), ages of 13–29 years in New York City. Recruitment strategies targeted potential participants at gay-related venues and public spaces often frequented by YMSM. Alcohol use varied by race/ethnicity, with White YMSM consuming significantly more alcohol than other races/ethnicities. Participants over the age of 21 drank significantly more alcohol than participants ages 13–20. Alcohol use was not found to be associated with sexual risk-taking activity. Our findings are enriched by a large, diverse sample of urban YMSM. Study limitations are noted.     

Predictors of alcohol use during the first year of college: implications for prevention

The first year of college is a unique transition period, in which the student establishes a college identity and social network. Alcohol use is often part of this process, and many first-year college students develop a pattern of heavy drinking that puts them at risk for adverse consequences during their college years and into young adulthood. To better understand the development of risky alcohol use during this transition, we reviewed the literature on influences on college drinking and identified moderators and mediators that were particularly relevant for first-year alcohol use. As the transition from high school to college presents a unique opportunity for intervention, we discuss how these moderators and mediators can inform alcohol abuse prevention programs. We also identify approaches aimed at changing the culture of alcohol use on campus. Limitations of the reviewed research are highlighted in the context of promising directions for future research.     

Outcomes associated with adolescent marijuana and alcohol use among urban young adults: A prospective study

ObjectiveThis study identifies and compares outcomes in young adulthood associated with longitudinal patterns of alcohol and marijuana use during adolescence among urban youth.MethodData come from a cohort of 678 urban, predominantly Black children followed from ages 6–25 (1993–2012). Analyses are based on the 608 children who participated over time (53.6% male). Longitudinal patterning of alcohol and marijuana use were based on annual frequency reports from grades 8–12 and estimated through latent profile analysis.ResultsWe identified four classes of alcohol and marijuana use including Non-Use (47%), Moderate Alcohol Use (28%), Moderate Alcohol/Increasing Marijuana Use (12%) and High Dual Use (13%). A marijuana only class was not identified. Analyses show negative outcomes in adulthood associated with all three adolescent substance use classes. Compared to the non-use class, all use classes had statistically significantly higher rates of substance dependence. Those in the ‘High Dual Use’ class had the lowest rate of high school graduation. Comparing classes with similar alcohol but different marijuana patterns, the ‘Moderate Alcohol/Increasing Marijuana Use’ class had a statistically significant increased risk of having a criminal justice record and developing substance use dependence in adulthood.ConclusionAmong urban youth, heterogeneous patterns of alcohol and marijuana use across adolescence are evident, and these patterns are associated with distinct outcomes in adulthood. These findings suggest a need for targeted education and intervention efforts to address the needs of youth using both marijuana and alcohol, as well as the importance of universal early preventive intervention efforts.     

Are Dimensions of Parenting Differentially Linked to Substance Use Across Caucasian and Asian American College Students?

Background: Parental warmth and autonomy granting are commonly thought of as protective factors against substance use among Caucasians. However, limited research has examined whether associations between parenting dimensions and substance use outcomes are the same or different among Asian Americans. Method: A final analytic sample of 839 college students was used to test whether race (Caucasian vs. Asian American) moderated the relations between parenting dimensions and substance use outcomes across Caucasians and Asian Americans. We utilized the Parental Bonding Instrument (Parker, Tupling, & Brown, 1979) to measure maternal and paternal warmth, encouragement of behavioral freedom, and denial of psychological autonomy. Results: Multivariate regression models controlling for covariates including age, gender, and paternal education indicated four significant parenting by race interactions on alcohol problems and/or marijuana use. Specifically, maternal warmth was inversely associated with both alcohol problems and marijuana use among Caucasians but not among Asian Americans. Both maternal and paternal denial of psychological autonomy were positively associated with alcohol problems among Caucasians but not among Asian Americans. Conclusions: Consistent with emerging cross-cultural research, the associations between parenting dimensions and substance use behaviors observed in Caucasian populations may not be readily generalized to Asian Americans. These findings highlight the importance of considering different parenting dimensions in understanding substance use etiology among Asian Americans. Future research should use longitudinal data to replicate these findings across development and seek to identify other parenting dimensions that may be more relevant for Asian American youth.