Individual trajectories of substance use in lesbian, gay and bisexual youth and heterosexual youth

Aims Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders, and a recent meta‐analysis shows that these disparities most probably begin in adolescence; however, no studies to date have examined longitudinal growth in substance use in LGB youth and heterosexual youth to determine if they follow different trajectories into young adulthood. The primary aims of this paper were to estimate individual trajectories of substance use in youth and examine differences between self‐identified LGB and heterosexual subsamples. Method A school‐based, longitudinal study of health‐related behaviors of adolescents and their outcomes in young adulthood was used to test our hypotheses (The National Longitudinal Study of Adolescent Health). Participants were included if they were interviewed at all three waves and were not missing information regarding self‐identified sexual orientation (n = 10 670). Results Latent curve models (LCMs) showed that LGB identity was associated significantly with individual variability in substance use intercepts and slopes, above and beyond age, race and gender. Self‐identified LGB youth reported higher initial rates of substance use and on average their substance use increased over time more rapidly than did substance use by heterosexual youth. Two other indicators of sexual orientation (same‐sex romantic attraction and same‐sex sexual behavior) were also associated with substance use trajectories, and differential results were found for youth who identified as ‘mostly heterosexual’ and bisexual compared with youth who identified as completely heterosexual or homosexual. Conclusions Sexual orientation is an important risk marker for growth in adolescent substance use, and the disparity between LGB and heterosexual adolescents increases as they transition into young adulthood. More research is needed in order to examine: causal mechanisms, protective factors, important age‐related trends (using a cohort‐sequential design), the influence of gay‐related developmental milestones, curvilinear effects over time and long‐term health outcomes.     

Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis

AIM: To examine the associations between the frequency of cannabis use and the use of other illicit drugs. DESIGN: A 25-year longitudinal study of the health, development and adjustment of a birth cohort of 1,265 New Zealand children. MEASUREMENTS: Annual assessments of the frequency of cannabis use were obtained for the period 14-25 years, together with measures of the use of other illicit drugs from the same time period. FINDINGS: The frequency of cannabis use was associated significantly with the use of other illicit drugs, other illicit drug abuse/dependence and the use of a diversity of other drugs. This association was found to be particularly strong during adolescence but declined rapidly as age increased. Statistical control for confounding by both fixed and time dynamic factors using random- and fixed-effects regression models reduced the strength of association between frequency of cannabis use and other illicit drug use, but a strong association between frequency of cannabis use and other illicit drug use remained even after control for non-observed and time-dynamic sources of confounding. CONCLUSIONS: Regular or heavy cannabis use was associated with an increased risk of using other illicit drugs, abusing or becoming dependent upon other illicit drugs, and using a wider variety of other illicit drugs. The risks of use, abuse/dependence, and use of a diversity of other drugs declined with increasing age. The findings may support a general causal model such as the cannabis gateway hypothesis, but the actual causal mechanisms underlying such a gateway, and the extent to which these causal mechanisms are direct or indirect, remain unclear.     

Substance use among bi/multiracial youth in the United States: Profiles of psychosocial risk and protection

Background: Bi/multiracial youth face higher risk of engaging in substance use than most monoracial youth. Objectives: This study contrasts the prevalence of substance use among bi/multiracial youth with that of youth from other racial/ethnic groups, and identifies distinct profiles of bi/multiracial youth by examining their substance use risk. Methods: Using data from the National Survey on Drug Use and Health (collected between 2002 and 2014), we analyze data for 9,339 bi/multiracial youth ages 12–17 living in the United States. Analyses use multinomial regression and latent class analysis. Results: With few exceptions, bi/multiracial youth in general report higher levels of tobacco, alcohol, marijuana, and other illicit drug use compared to other youth of color. Bi/multiracial youth also report higher levels of marijuana use compared to non-Hispanic white adolescents. However, latent class modeling also revealed that a majority (54%) of bi/multiracial youth experience high levels of psychosocial protection (i.e., strong antidrug views and elevated parental engagement) and low levels of psychosocial risk (i.e., low peer substance use, school-related problems, and social-environmental risk), and report very low levels of substance use. Substance use was found to be particularly elevated among a minority of bi/multiracial youth (28%) reporting elevated psychosocial risk and low levels of protection. Bi/multiracial youth characterized by both elevated psychosocial risk and elevated psychosocial protection (22%) reported significantly elevated substance use as well. Conclusions: While bi/multiracial youth in general exhibit elevated levels of substance use, substantial heterogeneity exists among this rapidly-growing demographic.     

Long-term consequences of adolescent cannabis use: Examining intermediary processes

Background: In the United States, perceptions of marijuana’s acceptability are at an all-time high, risk perceptions among youth are low, and rates are rising among Black youth. Thus, it is imperative to increase the understanding of long-term effects of adolescent marijuana use and ways to mitigate adverse consequences. Objectives: To identify the midlife consequences of heavy adolescent marijuana use and the mechanisms driving effects among a Black, urban population. Methods: This study analyzed the propensity score-matched prospective data from the Woodlawn Study, a community cohort study of urban Black youth followed from ages 6–42. After matching the 165 adolescents who used marijuana heavily to 165 non-heavy/nonusers on background confounders to reduce selection effects (64.5% male), we tested the association of heavy marijuana use by age 16 with social, economic, and physical and psychological health outcomes in midlife and the ability of adult drug trajectories (marijuana, cocaine, and heroin use from ages 17–42) and school dropout to mediate effects. Results: Heavy adolescent marijuana use was associated with an increased risk of being poor and of being unmarried in midlife. Marijuana use also predicted lower income and greater anxious mood in midlife. Both adult drug use trajectories and school dropout significantly mediated socioeconomic effects but not marital or anxious mood outcomes. Conclusion: Heavy adolescent marijuana use seems to set Black, urban youth on a long-term trajectory of disadvantage that persists into midlife. It is critical to interrupt this long-term disadvantage through the prevention of heavy adolescent marijuana use, long-term marijuana and other drug use, and school dropout.     

A comparison of the latent class structure of cannabis problems among adult men and women who have used cannabis repeatedly

BACKGROUND: Little empirical evidence exists to determine if there are alternative classification schemes for cannabis abuse and dependence beyond the definitions provided by Diagnostic and Statistical Manual (DSM) criteria. Current evidence is not conclusive regarding gender differences for cannabis use, abuse and dependence. It is not known if symptom profiles differ by gender. METHODS: Latent class analysis (LCA) was used to assess whether cannabis abuse and dependence symptom patterns suggest a severity spectrum or distinct subtypes and to test whether symptom patterns differ by gender. Data from 3312 men and 2509 women in the National Longitudinal Alcohol Epidemiologic Survey (NLAES) who had used cannabis 12 + times life-time were included in the present analyses. The comparability of the solutions for men and women was examined through likelihood ratio chi(2) tests. RESULTS: Based on the Bayesian information criterion and interpretability, a four-class solution was selected, and the classes were labeled as 'unaffected/mild hazardous use', 'hazardous use/abuse', 'abuse/moderate dependence' and 'severe abuse/dependence'. The solutions were generally suggestive of a severity spectrum. Compared to men, women were more likely to be in the 'unaffected/mild hazardous use' class and less likely to be in the 'abuse/moderate dependence' or 'severe abuse/dependence' classes. The results were generally similar for men and women. However, men had consistently and substantially higher endorsements of hazardous use than women, women in the 'abuse/moderate dependence' class had moderately higher rates for four dependence symptoms, and women in two of the classes were more likely to endorse withdrawal. CONCLUSION: Our findings generally support the severity dimension for DSM-IV cannabis abuse and dependence symptomatology for both men and women. While our results indicate that public health messages may have generic and not gender-specific content, treatment providers should focus more effort on reducing hazardous use in men and alleviating withdrawal in women.     

Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy

Aims To evaluate computer‐ versus therapist‐delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems. Design Randomized controlled trial. Setting Community‐based participants in the Hunter Region of New South Wales, Australia. Participants Ninety‐seven people with comorbid major depression and alcohol/cannabis misuse. Intervention All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment ‘live’ (i.e. delivered by a psychologist) or via a computer‐based program (with brief weekly input from a psychologist). Measurements Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post‐baseline assessment. Findings (i) Depression responded better to intensive MI/CBT compared to BI alone, with ‘live’ treatment demonstrating a strong short‐term beneficial effect which was matched by computer‐based treatment at 12‐month follow‐up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer‐based therapy showing the largest treatment effect. Conclusions Computer‐based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12‐month outcomes relative to a ‘live’ intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer‐based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress.     

Uptake and adherence to highly active antiretroviral therapy among HIV-infected people with alcohol and other substance use problems: the impact of substance abuse treatment

Aim We examined the association of substance abuse treatment with uptake, adherence and virological response to highly active antiretroviral therapy (HAART) among HIV‐infected people with a history of alcohol problems. Design Prospective cohort study. Methods A standardized questionnaire was administered to 349 HIV‐infected participants with a history of alcohol problems regarding demographics, substance use, use of substance abuse treatment and uptake of and adherence to HAART. These subjects were followed every 6 months for up to seven occasions. We defined substance abuse treatment services as any of the following in the past 6 months: 12 weeks in a half‐way house or residential facility; 12 visits to a substance abuse counselor or mental health professional; or participation in any methadone maintenance program. Our outcome variables were uptake of antiretroviral therapy, 30‐day self‐reported adherence and HIV viral load suppression. Findings At baseline, 59% (205/349) of subjects were receiving HAART. Engagement in substance abuse treatment was independently associated with receiving antiretroviral therapy (adjusted OR; 95% CI: 1.70; 1.03–2.83). Substance abuse treatment was not associated with 30‐day adherence or HIV viral load suppression. More depressive symptoms (0.48; 0.32–0.78) and use of drugs or alcohol in the previous 30 days (0.17; 0.11–0.28) were associated with worse 30‐day adherence. HIV viral load suppression was positively associated with higher doses of antiretroviral medication (1.29; 1.15–1.45) and older age (1.04; 1.00–1.07) and negatively associated with use of drugs or alcohol in the previous 30 days (0.51; 0.33–0.78). Conclusion Substance abuse treatment was associated with receipt of HAART; however, it was not associated with adherence or HIV viral load suppression. Substance abuse treatment programs may provide an opportunity for HIV‐infected people with alcohol or drug problems to openly address issues of HIV care including enhancing adherence to HAART.     

Adolescent premarital sex and health outcomes among Taiwanese youth: perception of best friends' sexual behavior and the contextual effect

This study explores premarital sex among adolescents and its health outcomes in a typical East Asian society, Taiwan. As a collective society in terms of cultural heritage, a particular target of this study was perceived peer pressure and its contextual influence. The data were taken from the Taiwan Youth Project, 2004 and 2007, and never married youth aged 20 years constituted our sample (N=3530). Best friends' sexual behavior and other context-related factors, such as school attendance and community participation, are presumed to influence adolescent premarital sex as well as their health status. Logistic regression models show a positive and significant association between the perception of friends' sexual behavior and the likelihood of adolescent premarital sex engagement, after adjusting for the youth's own sex-related experience and attitudes, individual characteristics, and family background. The analysis also confirms that school attendance and community participation are significantly associated with a lower likelihood of having premarital sex. Furthermore, adolescent premarital sex was found to be linked to the perceived health status of the youth (self-rated health, smoking, and drinking), as expected. These findings demonstrate the importance of peers and social context, which suggests that HIV prevention and health promotion programs for youth need to take friendship networks and social context into consideration.     

Youth,violence and non-injection drug use: nexus of vulnerabilities among lesbian and bisexual sex workers

Despite increasing evidence of enhanced HIV risk among sexual minority populations, and sex workers (SWs) in particular, there remains a paucity of epidemiological data on the risk environments of SWs who identify as lesbian or bisexual. Therefore, this short report describes a study that examined the individual, interpersonal and structural associations with lesbian or bisexual identity among SWs in Vancouver, Canada. Analysis drew on data from an open prospective cohort of street and hidden off-street SWs in Vancouver. Bivariate and multivariable logistic regressions were used to examine the independent relationships between individual, interpersonal, work environment and structural factors and lesbian or bisexual identity. Of the 510 individuals in our sample, 95 (18.6%) identified as lesbian or bisexual. In multivariable analysis, reporting non-injection drug use in the last six months (adjusted odds ratio [AOR] = 2.89; 95% confidence intervals [CI] = 1.42, 5.75), youth ≤24 years of age (AOR = 2.43; 95% CI = 1.24, 4.73) and experiencing client-perpetrated verbal, physical and/or sexual violence in the last six months (AOR = 1.85; 95% CI = 1.15, 2.98) remained independently associated with lesbian/bisexual identity, after adjusting for potential confounders. The findings demonstrate an urgent need for evidence-based social and structural HIV prevention interventions. In particular, policies and programmes tailored to lesbian and bisexual youth and women working in sex work, including those that prevent violence and address issues of non-injection stimulant use are required.