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.     

Clustering of Sex and Substance Use Behaviors in Adolescence

Background: Adolescents often experiment with substance use and sexual activity, which can impact upon their health and well-being, and establish harmful patterns of behavior which continue into adulthood. While substance use and participation in sexual behaviors often co-occur, few studies have examined whether these behaviors cluster in adolescence. Objective: To investigate clustering of sexual activity and substance use among youth in Northern Ireland. Method: Data from 875 young people (aged 16) who participated in the 2008 Northern Ireland Life and Times Survey were used to investigate clustering using the Odds/Expected ratio method. Gender differences in clustering were explored. Results: Alcohol consumption was the most prevalent risk behavior (75%), followed by cigarette smoking, sexual intercourse, illicit substance use, and solvent use the least prevalent. Over 40% of young people participated in multiple risk behaviors (2 or more). Several behavior combinations were statistically clustered, for most the reported prevalence was lower than expected, however, participation in all five risk behaviors occurred at a much higher rate than expected, particularly for male youth. Conclusions: While experimentation with risky behaviors is often considered developmentally appropriate in adolescence it is important to understand how young people experience these behaviors, and the potential for multiple risk exposures as a result of participation in substance use and sexual behaviors. These findings highlight the clustering of substance use and sexual behaviors, and indicate variations in vulnerability to participation in multiple risk behaviors by gender.     

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.     

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.     

Anxiety and Substance Use During Adolescence

ABSTRACT. Background: The primary goal of this study was to examine the relationship between anxiety symptomatology and substance use (alcohol use and drug use) during adolescence, systematically by gender and race/ethnicity. Methods: Self-report surveys were administered to 905 15–17-year-old adolescents (54% girls) in the spring of 2007. Results: Results from multiple group analyses indicated that the relationship between anxiety and substance use differs by gender and race/ethnicity. For Caucasian and African American boys, higher levels of social anxiety and separation anxiety were related to less substance use. In contrast, higher levels of generalized anxiety disorder and panic disorder were associated with more substance use for African American boys. The pattern was much less striking for girls. For Caucasian girls, higher levels of significant school avoidance were linked to more substance use, and consistent with the results for boys, higher levels of separation anxiety were associated with less substance use. None of the anxiety disorders were related to substance use for African American girls or Hispanic girls or boys. Conclusions: Findings from this study highlight the need to distinguish between different anxiety disorders. In addition, they underscore the importance of considering both gender and race/ethnicity when examining the relationship between anxiety and substance use during adolescence.     

Association between adolescent substance use and obesity in young adulthood: A group-based dual trajectory analysis

Purpose

This study investigated whether and how trajectories of substance use in adolescence were associated with obesity trajectories in young adulthood. We hypothesized that: (1) exposure to persistent substance use throughout adolescence may heighten obesity risk in young adulthood; and (2) such associations may differ once gender, ethnicity, socioeconomic status, and obesity status in adolescence, are considered.

Methods

The study included 5141 adolescents from the child sample of the 1979 National Longitudinal Survey of Youth and utilized biennial data across the 12 assessments (1986–2008) to examine trajectories of substance use behaviors (i.e., cigarette smoking, alcohol use, and marijuana use) from ages 12 to 18 and obesity trajectories from ages 20 to 24. Group-based dual trajectory modeling was applied to examine sequential associations of trajectories of each type of substance use behavior with obesity trajectories.

Results

Three distinctive trajectory patterns were respectively identified for cigarette smoking, alcohol use, and marijuana use from ages 12 to 18, as well as for obesity status (BMI ≥ 30) from ages 20 to 24. Taking into account gender, ethnicity, socioeconomic status, and obesity status in adolescence, adolescents with the most problematic smoking trajectory (High-decreasing) were more likely to exhibit a High-obesity trajectory from ages 20 to 24. Also, adolescents with an Increasing marijuana use trajectory were more likely to exhibit an Increased obesity trajectory in young adulthood.

Conclusions

The current study demonstrates that adolescent substance use is associated with subsequent obesity in young adulthood. The associations appear to differ based on the type of substance use and patterns of use.     

Physical Activity Interventions to Decrease Substance Use in Youth: A Review of the Literature

Background: Adolescent substance use, a major problem in the United States, has a significant negative effect on both short- and long-term mental and physical health. Physical activity (PA) may offer potentially effective strategies to combat substance use in youth. Like substance use, PA behaviors developed during adolescence persist into adulthood, so adolescence may be an ideal period in which to implement PA interventions to prevent substance abuse. However, there are no known systematic literature reviews of PA-based interventions that target substance use in adolescence. Objectives: To review PA interventions for adolescents, including research designs, intervention characteristics, and measures of substance use. Methods: Five databases were searched for articles published in English peer-reviewed journals. Search terms were related to the adolescent population, substance use, and PA interventions. Results: 17 articles fit inclusion criteria. The results suggest that PA interventions may decrease substance use in teens. A majority of the interventions were delivered in high schools. Substance use measures/outcomes included intention or willingness to use, cessation, and actual use. Alcohol use was measured most, followed by marijuana and tobacco use. Although most of the studies utilized group sessions to deliver interventions, decreased substance use was also associated with one-time, multi-health consultations. Conclusions/Importance: School-based interventions targeting multiple health behaviors may offer a particularly effective and efficient way to decrease substance use in adolescents.     

Do Classes of Polysubstance Use in Adolescence Differentiate Growth in Substances Used in the Transition to Young Adulthood?

Background: Past studies have differentiated classes of polysubstance use in adolescence, however, the associations of adolescent polysubstance use classes with longitudinal substance use trajectories from adolescence to young adulthood have not been studied. Objective: The current study examined substance use classes during adolescence and longitudinal trajectories of each substance used across the transition to young adulthood. Method: Data were collected biennially from 662 youth and followed 10 years across six measurement assessments. Using baseline data (T1), latent class analysis was used to identify classes of polysubstance use (cigarette, alcohol, marijuana, and illicit drug use) during adolescence. Using T2 through T6 data, we fit latent growth models for cigarette, alcohol, marijuana, and illicit drug use to examine longitudinal trajectories of each substance used by class. Results: A three-class model fit the data best and included a poly-use class, that had high probabilities of use among all substances, a co-use class, that had high probabilities of use among alcohol and marijuana, and a low-use class that had low probabilities of use among all substances. We then examined trajectories of each substance used by class. Strong continuity of substance use was found by class across 14 years. Additionally, for some substances, higher average levels of use of at age 14 were associated with change in growth of other substances used over time. Conclusions/Importance: Efforts that only target a single drug type may be missing an important opportunity to reduce the use and subsequent consequences related to the use of multiple substances.     

Alcohol and marijuana use in pathways of risk for sexually transmitted infection in white and black adolescent females

Background: Some types of sexually transmitted infection (STI) have higher prevalence in females than males, and among black, relative to white, females. Identifying mechanisms of STI risk is critical to effective intervention. The authors tested a model in which alcohol and marijuana use serve as mediating factors in the associations between depression and conduct problems with sexual risk behavior (SRB) and STI in adolescent females. Methods: The Pittsburgh Girls Study is a longitudinal observational study of females who have been followed annually to track the course of mental and physical health conditions. The 3 oldest cohorts (N = 1750; 56.8% black, 43.2% white) provided self-reports of substance use, depression and conduct problems, SRB, and STI at ages 16–18. A path model tested alcohol and marijuana use at age 17 as mechanisms that mediate the associations of depression and conduct problems at age 16 with SRB and STI at age 18. Results: Race was involved in 2 risk pathways. In one pathway, white females reported greater alcohol use, which was associated with greater SRB. In another pathway, black females reported earlier sexual onset, which was associated with subsequent SRB. Public assistance use was independently associated with early sexual onset and STI. SRB, but not substance use, mediated the association of depression and conduct problems with STI. Conclusions: Differences by race in pathways of risk for SRB and STI, involving, for example, alcohol use and early sexual onset, were identified for young white and black females, respectively. Depression and conduct problems may signal risk for SRB and STI in young females, and warrant attention to improve health outcomes.     

Types and Characteristics of Childhood Sexual Abuse: How Do They Matter in HIV Sexual Risk Behaviors Among Women in Methadone Treatment in New York City?

Background: Childhood sexual abuse (CSA) is often considered an important distal factor in HIV sexual risk behaviors; however, there are limited and mixed findings regarding this relationship among women experiencing substance use problems. In addition, research with this population of women has yet to examine differences in observed CSA-HIV sexual risk behaviors relationships by CSA type and characteristics. Objectives: This study examines relationships between CSA coding, type, and characteristics and HIV sexual risk behaviors with main intimate partners among a random sample of 390 women in methadone treatment in New York City who completed individual interviews with trained female interviewers. Results: Findings from logistic regression analyses indicate that CSA predicts substance use with sexual activity, with variations by CSA coding, type, and characteristics; however, the role of CSA is more limited than expected. Having a main partner with HIV risk mediates some relationships between CSA and drinking four or more drinks prior to sex. Intimate partner violence is the most consistent predictor of sexual risk behaviors. Other salient factors include polysubstance use, depression, social support, recent incarceration, relationship characteristics, and HIV status. Conclusions/Importance: This study contributes to understanding of relationships between CSA and HIV sexual risk behaviors and key correlates associated with HIV sexual risk behaviors among women in methadone treatment. It also highlights the complexity of measuring CSA and its association with sexual risk behaviors and the importance of comprehensive approaches to HIV prevention that address psychological, relational, situational, and substance use experiences associated with sexual risk behaviors among this population.     

Measuring alcohol use across the transition to adulthood: Racial/ethnic,sexual identity,and educational differences

BackgroundPatterns of alcohol use change from adolescence to adulthood and may differ based on race/ethnicity, sexual identity, and education. If alcohol use measures do not operate consistently across groups and developmental periods, parameter estimates and conclusions may be biased.ObjectivesTo test the measurement invariance of a multi-item alcohol use measure across groups defined by race/ethnicity, sexual identity, and college education during the transition to adulthood.MethodsUsing three waves from the National Longitudinal Study of Adolescent to Adult Health, we tested configural, metric, and scalar invariance of a 3-item alcohol use measure for groups defined by race/ethnicity, sexual identity, and college education at three points during the transition to adulthood. We then assessed longitudinal measurement invariance to test the feasibility of modeling developmental changes in alcohol use within groups defined by these characteristics.ResultsOverall, findings confirm notable variability in the construct reliability of a multi-item alcohol use measure during the transition to adulthood. The alcohol use measure failed tests of metric and scalar invariance, increasingly across ages, both between- and within-groups defined by race/ethnicity, sexual identity, and college education, particularly among females.ConclusionsMeasurement testing is a critical step when utilizing multi-item measures of alcohol use. Studies that do not account for the effects of group or longitudinal measurement non-invariance may be statistically biased, such that recommendations for risk and prevention efforts could be misguided.     

Music, substance use, and aggression

OBJECTIVE: This study investigated whether young people's substance use and aggressive behaviors are related to their listening to music containing messages of substance use and violence. METHOD: Using self-administered questionnaires, data were collected from a sample of community-college students, ages 15-25 years (N=1056; 57% female). A structural equation model (maximum likelihood method) was used to simultaneously assess the associations between listening to various genres of music and students' alcohol use, illicit-drug use, and aggressive behaviors. Respondents' age, gender, race/ethnicity, and level of sensation seeking were included in the analyses as control variables. RESULTS: Listening to rap music was significantly and positively associated with alcohol use, problematic alcohol use, illicit-drug use, and aggressive behaviors when all other variables were controlled. In addition, alcohol and illicit-drug use were positively associated with listening to musical genres of techno and reggae. Control variables (e.g., sensation seeking, age, gender and race/ethnicity) were significantly related to substance use and aggressive behaviors. CONCLUSIONS: The findings suggest that young people's substance use and aggressive behaviors may be related to their frequent exposure to music containing references to substance use and violence. Music listening preference, conversely, may reflect some personal predispositions or lifestyle preferences. There is also the possibility that substance use, aggression, and music preference are independent constructs that share common "third factors".     

Transition to Independent Living and Substance Involvement of Treated and High Risk Youth

ABSTRACT

National studies indicate that alcohol and drug involvement increases during transition from adolescence to young adulthood. The present study evaluated change in alcohol and drug use as youth move from living with their family of origin to independent living environments. Two samples of youth, those who had previously been treated for alcohol and drug problems (n = 102), and a sample of non-abusing youth (n = 70) with comparable socioeconomic backgrounds and family history of alcohol dependence, were compared as they transitioned into their first independent living environment. There was a 35% increase in the number of monthly drinking episodes across this transition to independent living, and a 46% increase in number of drinks per week. Drug involvement was less affected by this developmental transition, however a larger proportion of teens with a history of substance problems reported use of drugs (31% vs. 48%) following transition to independent living. Both level of exposure to substances in the new environment and peer substance use were significant predictors of post-transition substance involvement. Findings highlight significant changes in alcohol involvement in relation to this critical developmental transition of late adolescence and young adulthood.     

Sexual Behaviors Linked to Drug and Alcohol Use Among Men Who Have Sex With Men in China

Background: High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. Methods: As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. Results: A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). Conclusion: The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.     

Substance Use among Sexual Minorities: Has it Actually Gotten Better?

Background: Despite efforts to decrease substance use, rates among sexual minority youth (SMY) remain higher than among heterosexuals. Substance use is a leading contributor to morbidity and mortality in adulthood, and SMY's use of substances is related to poorer mental and emotional health. Objectives: We sought to document the trends in substance use for a large sample of youth over 14 years with special attention to SMY. In addition, we tested whether there were disparities in substance use behaviors between SMY and heterosexual youth. Last, we examined changes in disparities over time in substance use among SMY. Methods: We analyzed data from 8 waves of the Massachusetts YRBS (N = 26,002, M_age = 16), from 1999 to 2013, to investigate trends and disparities in current tobacco, alcohol, and cannabis use for heterosexual youth and SMY. We used logistic regression interaction models to test whether these disparities have widened or narrowed for SMY, as compared to heterosexuals, over the span of 14 years. Results: In absolute terms, substance use rates decreased for nearly all youth between 1999 and 2013. There were striking disparities in substance use between heterosexual youth and all sexual minority subgroups. These disparities in substance use narrowed among males but remained unchanged or worsened among females. Conclusions/Importance: Trends in substance use are changing over time, but not in the same ways for all sexual minority subgroups. Patterns are worsening for females. These findings suggest that we need to address the needs of LGB populations in novel ways.     

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.     

The Availability of Substances in Adolescence: Influences in Emerging Adulthood

ABSTRACT

This study examines the availability of substances in the home during adolescence and its influence on substance use in young adulthood. Data are drawn from the National Longitudinal Study of Adolescent Health (Add Health). The final sample consisted of approximately 15,000 cases from Waves 1, 3, and 4. Multivariate analyses indicate that the availability of substances in the home affects young adult substance use and substance use in later young adulthood. We also find that the availability of substances in the home during adolescence is associated with an earlier age at first substance use. This study offers further evidence for understanding how the home environment affects substance use behavior among young adults. In this case, exposure to substances in adolescence, and their easy availability, increase the likelihood of substance use in adolescence and increases use in young adulthood.     

Using the Primary Socialization Theory to Predict Substance Use and Sexual Risk Behaviors Between Black and White Adolescents

Using the Primary Socialization Theory (PST), we examined substance use and sexual risk-taking behaviors between Black (N = 1,464) and White (N = 3,946) adolescents in the National Longitudinal Study of Adolescent Health, Wave 1, public use (Add Health). Self-reported substance use and sexual risk-taking behaviors, PST constructs, and covariates were assessed using regression modeling techniques. Black youth were more likely to initiate sex, while White youth were more likely to report lifetime alcohol use. The PST predicted risk for White but not Black youth. The study's limitations are noted, and implications for future research are discussed.     

Associations between Sociodemographic Characteristics and Sexual Risk Behaviors among Methamphetamine-using Men who Have Sex with Men

Background: Methamphetamine-using men who have sex with men (MSM) exhibit elevated rates of HIV and STI prevalence, indicating increased engagement in sexual risk behaviors. Objectives: This analysis elucidates associations between participant sociodemographics (i.e., age, racial/ethnic identity, sexual identity, educational attainment, and HIV status) and sexual risk behaviors, particularly substance use before/during sex, and engagement in condomless anal intercourse (CAI) with casual, anonymous, and/or exchange male partners. Methods: From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a technology-based study to reduce methamphetamine use and HIV sexual risk behaviors. A robustly estimated generalized structural equation model employing the negative binomial family and log link function (n = 282) tested the simultaneous associations between participant sociodemographics and engagement in HIV sexual risk behaviors. Results: Participants' racial/ethnic identity (χ²₍₆₎ = 43.5; p < 0.0001), HIV status (χ²₍₆₎ = 22.0; p = 0.0012), educational attainment level (χ²₍₆₎ = 13.8; p = 0.0322), and years of age (χ²₍₆₎ = 32.4; p < 0.0001) all influenced participants' engagement in substance use before/during sex and engagement in CAI. Methamphetamine (χ²₍₂₎ = 7.0; p = 0.0309) and marijuana (χ²₍₂₎ = 9.7; p = 0.0079) use before/during sex influenced participants' engagement in CAI with casual, anonymous, and exchange male partners. Conclusion: Results indicate the importance of intervention efforts focused on younger racial/ethnic minority MSM with fewer years of educational attainment, and provides evidence of the specific subpopulations of MSM at greatest risk of detrimental effects of illicit substance use.