Prospective Associations between Delinquency and Suicidal Behaviors in a Nationally Representative Sample

PurposeWe examined the prospective associations between delinquency and suicidal behaviors among adolescents using a nationally representative sample.MethodsThe National Longitudinal Study of Adolescent Health was used to assess the prospective associations between delinquency at ages 12–17 years and suicidal behaviors (ideation, attempts, treatment for attempts) 1 and 7 years later.ResultsControlling for demographic variables, delinquency was prospectively associated with an increased risk for all three suicidal behaviors 1 year later, and to ideations and attempts 7 years later. After controlling for other risk factors (i.e., depression, self-esteem, problem drinking, impulsivity, religiosity), delinquency was still significantly related to an increased likelihood for suicidal ideation 1 and 7 years later, and to suicide attempts 1 year later. Further, delinquency was significantly related to suicidal ideation for girls more than for boys.ConclusionsThese findings suggest that delinquent youth, particularly delinquent girls, should be targeted in interventions to reduce suicidal behaviors.     

Prevalence and Patterns of Polysubstance Use in a Nationally Representative Sample of 10th Graders in the United States

PurposeThe current study examines the prevalence and demographic correlates of self-reported substance use and identifies subgroups of polysubstance users among a cohort of United States 10th-grade students.MethodsA nationally representative school-based cohort of United States 10th-grade students completed the NEXT Generation Health Study baseline survey in spring 2010 (N = 2,524).ResultsPast-year use of marijuana was most common among illicit drugs (26%), followed by misuse of medication (9%) and use of other illicit drugs (8%). During the past month, alcohol use was reported by more than one third (35%), binge drinking by 27%, and cigarette smoking by 19%. Results further show that substance use varied somewhat by demographic characteristics. Results from the latent class analysis of polysubstance use indicated a four-class solution as the best-fitting model; class 1 (59%) included the nonuser group; class 2 (23%) comprised the predominant alcohol user group; class 3 (11%) formed the predominant marijuana user group; and class 4 (8%) was characterized as the predominant polysubstance user group. Somatic and depressive symptoms varied significantly by class membership, with predominant polysubstance users reporting elevated levels of somatic and depressive symptoms.ConclusionsThe findings from this national study of 10th-grade students indicate high rates of substance and polysubstance use. The high level of depressive and somatic symptoms among polysubstance users indicates the need for mental health screening and referral.     

Sexual Timetables for Oral-Genital,Vaginal, and Anal Intercourse: Sociodemographic Comparisons in a Nationally Representative Sample of Adolescents

Objectives. We documented the prevalence and relative timing of oral-genital, vaginal, and anal intercourse during adolescence and examined whether these timetables varied by sociodemographic factors.Methods. We used data from almost 14 000 Wave IV respondents to the National Longitudinal Study of Adolescent Health to generate prevalence estimates for adolescents who reached age 18 years by 2001 and logistic and ordinary least squares regression to examine sociodemographic correlates of sexual patterns.Results. One in 5 adolescents did not engage in any of these sexual behaviors by age 18 years. More than two thirds reported vaginal or oral-genital sexual activity, but only about half experienced both. One in 10 reported anal intercourse experience. A third initiated 2 or more behaviors within a 1-year period. In longer timetables, vaginal intercourse was more often initiated first. Most sociodemographic characteristics examined were uniquely associated with prevalence and sexual timing.Conclusions. Diversity in patterns of sexual initiation occurring in the 1990s underscores the ongoing need for comprehensive and nuanced examinations of adolescent sexual trajectories and their implications for sexual health in more recent cohorts.Sexual behavior patterns have evolved significantly since the “first sexual revolution” of the 1920s.1 Fewer than 10% of individuals born early in the 20th century had sex by age 18 years, compared with more than 50% of persons born between 1968 and 1973.2 Of individuals 15 to 44 years old in 2002, 75% had had premarital vaginal intercourse by age 20 years3; almost 90% of individuals 18 to 27 years old in 2001 had had premarital vaginal intercourse.4Most adolescent sexuality research focuses exclusively on vaginal intercourse. Two cross-sectional US national surveys routinely measure vaginal intercourse in adolescent samples. Estimates from the Centers for Disease Control and Prevention’s 2009 Youth Risk Behavior Survey indicate that approximately 60% of male and 65% of female high-school seniors have had vaginal intercourse.5 Similarly, in the 2006 to 2008 National Survey of Family Growth (NSFG), 66% of men and 62% of women aged 18 and 19 years had had vaginal intercourse.6By contrast, estimates of adolescent oral-genital and anal intercourse experience vary widely, probably because most, except NSFG figures, are based on smaller community samples.7–10 During the 1980s and 1990s, estimates of adolescent oral-genital sexual activity ranged from 35% to 66%. In the 2006 to 2008 NSFG, 70% of men and 63% of women aged 18 to 19 reported oral-genital sexual activity.6 Community sample prevalence estimates of adolescent anal intercourse range from 20% to 32%.10 Recent NSFG data indicate that almost 17% of men and 15% of women aged 18 to 19 years have ever had anal intercourse.6 The Youth Risk Behavior Survey does not ask about oral-genital or anal intercourse.The order of initiating oral-genital and vaginal intercourse is of interest because initiating oral-genital sexual activity first, which carries lower risk of sexually transmitted diseases (STDs) than does vaginal or anal intercourse, could substitute for vaginal and anal intercourse, postpone their onset, or hasten the transition to coital or anal experience. Community sample estimates of initiating oral-genital intercourse first range from 14% to 50%.7–9,11,12 Some analyses indicate that “vaginal virgins” are less likely to have had oral-genital intercourse than are “vaginal nonvirgins,” implying that vaginal intercourse typically occurs first.10,13,14 However, about half of male and female respondents aged 15 to 24 reported that they had oral-genital before vaginal intercourse in the 2006 to 2008 NSFG data.6 The NSFG does not measure the amount of time separating oral-genital and vaginal initiation. There has been less investigation of anal intercourse, but given its low prevalence (10% of respondents aged 15–19 years in the 2006–2008 NSFG),6 if anal intercourse is initiated during adolescence, it will typically occur last.Timing of first sexual experience may have implications for the sexual sequence and pace that follow.14 There has been extensive research on the timing of first vaginal intercourse in particular. In the United States, the average age at first vaginal intercourse is about 17 years.15 Mean ages at initiation of oral-genital and anal intercourse have not been reported for current national data.Documenting variation and typicality in the order and timing of life experiences—including sexual experience—across cohorts is important because they may differentially affect physical and emotional health within and across historical time.16 For example, initiating intimate behaviors (e.g., vaginal intercourse) before less intimate ones (e.g., kissing) has been linked to inconsistent use of contraception.17 Findings suggest differential psychosocial implications of oral-genital and vaginal intercourse,18,19 which may make order of initiation important. Compared with adolescents with vaginal intercourse experience (with or without oral-genital sexual experience), adolescents who have had only oral-genital intercourse are less likely to feel guilty or used or to get into trouble with parents because of sexual activity. However, they are also less likely to experience sexual pleasure or to report feeling good about themselves.18 Early coitus is also linked to higher likelihood of sexual risk taking, including inconsistent condom use, more sexual partners, and, at least during adolescence, a higher likelihood of STDs.20–23 Heterosexual anal intercourse is also a marker for sexual risk taking.24In summary, despite potential implications for sexual health and general well-being, few studies have documented the typicality of sexual timetables for multiple behaviors, and much of the available information is based on relatively small and geographically limited samples. To date, only NSFG data from 2002 forward allow estimates of adolescent oral-genital and anal intercourse for a nationally representative sample. Although a valuable resource, NSFG data do not include ages at initiation of noncoital behavior, limiting opportunities to evaluate implications of sexual timing.The current study provided unique information about the timing (age at initiation) of oral-genital, vaginal, and anal intercourse and order of initiation for adolescents in grades 7 through 12 in the 1994 to 1995 school year. Documenting sexual timetables during adolescence provides a foundation for examining developmental implications of patterns and offers a point of reference to examine historical changes. We used data from the National Longitudinal Study of Adolescent Health (Add Health) to examine the

• prevalence of vaginal, oral-genital, and anal sexual experience during adolescence and whether prevalence varies by age cohort, biological sex, pubertal timing, race/ethnicity, family structure, and parent education;
• typicality of the earliest behavior (i.e., which is initiated first) across groups defined earlier;
• average timing (age) at initiation of oral-genital, vaginal, and anal intercourse and whether timing varies by groups defined earlier; and
• overlap in experience of oral-genital, vaginal, and anal intercourse during adolescence and whether overlap varies by biological sex.

     

Relationship between Bullying,Substance Use,Psychiatric Disorders,and Social Problems in a Sample of Kenyan Secondary Schools

Prevention Science - We aimed to investigate how direct bullying and victimization relate with substance use, the presence of psychiatric disorders, poor school performance, disruptive behaviors,...     

Associations among School Characteristics and Foodservice Practices in a Nationally Representative Sample of United States Schools

ObjectiveDetermine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices.DesignSecondary analysis of cross-sectional data.SettingNationally representative sample of public and private elementary, middle, and high schools.ParticipantsData from the 2006 School Health Policies and Practices Study Food Service School Questionnaire, n = 526 for Healthy and Unhealthy Offerings analysis; n = 520 for Healthy Preparation analysis.Main Outcome MeasuresScores for healthy/unhealthy foodservice offerings and healthy food preparation practices.AnalysisMultivariable regression to determine significant associations among school characteristics and offerings/preparation practices.ResultsPublic schools and schools participating in the United States Department of Agriculture (USDA) Team Nutrition reported more healthy offerings and preparation than private or nonparticipating schools, respectively. Elementary schools reported fewer unhealthy offerings than middle or high schools; middle schools reported fewer unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation, whereas those requiring completion of a foodservice training program reported fewer unhealthy offerings and more healthy preparation than schools without these requirements.Conclusions and ImplicationsResults suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition.     

Age-Varying Associations Between Attempts to Lose Weight and Nicotine Vaping Across Adolescence: Results From a Nationally Representative Sample

PurposeThe prevalence of nicotine vaping is increasing among adolescents and emerging evidence suggests weight concerns may promote risk for vaping. The aims of this study were to investigate whether there is an association between attempting to lose weight and nicotine vaping during adolescence, when this association emerges and is strongest, and whether there are sex differences in this link.MethodsThis study used time-varying effect modeling, an analytic method that estimates regression coefficients as a continuous function of age, to model dynamic associations between weight loss behavior and nicotine vaping across adolescence and sex differences in these links. Data were from 13,677 adolescents (aged 14–18 years, 49.4% female) who participated in the 2019 National Youth Risk Behavior Survey, a nationally representative U.S. sample.ResultsResults revealed an age-varying association that differed by sex. Girls who were trying to lose weight were at a higher risk for past 30-day vaping from ages 14.2–15.9 years, with the strongest association at 14.8 years (odds ratio [OR] = 1.92, 95% confidence interval [CI] [1.25, 2.95]). For boys, this association was nonsignificant across age (OR = 1.76, 95% CI [0.91, 3.41] at age 14.0 years). Girls who were trying to lose weight were at a higher risk for frequent vaping (vaping on 20–30 of the past 30 days) from ages 15.2–17.1 years, with the strongest association at 16.1 years (OR = 2.59, 95% CI [1.45, 4.62]). This link was not meaningfully significant at any age for boys (OR = 3.26, 95% CI [0.86, 12.33] at age 14.0 years).DiscussionGirls, but not boys, who are trying to lose weight appear vulnerable to nicotine vaping during adolescence.     

Sexual Health and Language Dominance Among Hispanic/Latino Women and Men: Analysis of a Nationally Representative Sample

This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population.     

Sexual Assaulters in the United States: Prevalence and Psychiatric Correlates in a National Sample

This study presents sociodemographic characteristics and psychiatric correlates of a representative sample of sexual assaulters in the United States. Data were drawn from a nationally representative survey, the National Epidemiologic Survey on Alcohol and Related Conditions. Face-to-face interviews of more than 43,000 adults were conducted between the 2001–2002 period, based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. The prevalence of committing sexual assault in the U.S. was 0.15 %. Sexual assaulters had significantly lower education than their counterparts. Sexual assaulters were significantly more likely to report a wide range of antisocial behaviors. Multivariate logistic regression analyses indicated strong associations between sexual assault and lifetime psychiatric disorders often associated with impaired impulse control, such as antisocial personality disorder, conduct disorder, and cocaine use disorder. In addition, psychotic disorders were consistently associated with sexual assault. Our findings indicate that sexual assault could represent a behavioral manifestation of a broader spectrum, including impairment of impulse control and psychotic disorders.     

Onset of Alcohol Use Disorders and Comorbid Psychiatric Disorders in a Military Cohort: Are there Critical Periods for Prevention of Alcohol Use Disorders?

Alcohol use disorders (AUD) are commonly comorbid with anxiety and mood disorders; however, a strategy for AUD prevention remains unclear in the presence of three competing etiological models that each recommends different high-risk groups. Therefore, the investigation of the three hypotheses in a characteristically unique cohort is critical to identifying pervasive characteristics of AUD that can inform a universal prevention strategy. The current study evaluated the temporality and onset of comorbid AUD and psychiatric disorders in a representative sample of 528 Ohio Army National Guard soldiers using structured clinical interviews from 2009 to 2012. We examined temporality both statistically and graphically to identify patterns that could inform prevention. General estimating equations with dichotomous predictor variables were used to estimate odds ratios between comorbid psychiatric disorders and AUDs. An annualized rate of 13.5 % persons per year was diagnosed with any AUD between 2010 and 2012. About an equal proportion of participants with comorbid psychiatric disorders and AUD initiated the psychiatric disorder prior to the AUD and half initiated the psychiatric disorder after the AUD. Regardless of onset, however, the majority (80 %) AUD initiated during a short interval between the ages of 16 and 23. Focused primary prevention during this narrow age range (16–23 years) may have the greatest potential to reduce population mental health burden of AUD, irrespective of the sequencing of comorbid psychiatric disorder.     

The Sociodemographic Characteristics of Concurrent Sexual Partnerships and their Risky Sexual Behaviors: Results of a Nationally Representative Sample of South Korean Adults

This study assessed the risky sexual behavior of a group of adult men and women with sexual experience within the past 1 year who, while in a relationship with a stable partner, reported having sex with another person. The data were collected in 2003 using a nationally representative, multi-stage stratified probability sample (n = 1,271) of women and men in South Korea. Via hierarchical regression models, we assessed the gendered effects of socioeconomic characteristics, health behavior, sex behavior, and safe sex attitude factors. According to the results, for groups with concurrent sexual partnership experience, if the subject was a single person with smoking and drinking who had engaged in sex resulting in unwanted pregnancy, and anal sex initiated before the age of 17, the likelihood of engaging in concurrent sexual partnerships was statistically significant. Furthermore, our gender-elaborated analysis demonstrated that the majority of sexual risk was borne by women. When the partners of concurrent sexual partnerships are categorized by type, the key characteristic of a casual relationship or relationship with female sex workers is one-night-stand sex, accompanied by drinking. This study found that, for groups with concurrent sexual partnerships experience, there is a statistical association between health risky variables and risky sexual behavior. We should attempt to intervene in these concurrent sexual partnerships groups for the effective management of sexually transmitted infections.     

Impaired-Driving Prevalence Among US High School Students: Associations With Substance Use and Risky Driving Behaviors

Objectives. We examined the prevalence of impaired driving among US high school students and associations with substance use and risky driving behavior.Methods. We assessed driving while alcohol or drug impaired (DWI) and riding with alcohol- or drug-impaired drivers (RWI) in a nationally representative sample of 11th-grade US high school students (n = 2431). We examined associations with drinking and binge drinking, illicit drug use, risky driving, and demographic factors using multivariate sequential logistic regression analysis.Results. Thirteen percent of 11th-grade students reported DWI at least 1 of the past 30 days, and 24% reported RWI at least once in the past year. Risky driving was positively associated with DWI (odds ratio [OR] = 1.25; P < .001) and RWI (OR = 1.09; P < .05), controlling for binge drinking (DWI: OR = 3.17; P < .01; RWI: OR = 6.12; P < .001) and illicit drug use (DWI: OR = 5.91; P < .001; RWI: OR = 2.29; P = .05). DWI was higher for adolescents who drove after midnight (OR = 15.7), drove while sleepy or drowsy (OR = 8.6), read text messages (OR = 11.8), sent text messages (OR = 5.0), and made cell phone calls (OR = 3.2) while driving.Conclusions. Our findings suggest the need for comprehensive approaches to the prevention of DWI, RWI, and other risky driving behavior.Motor vehicle crashes are the leading cause of mortality for US adolescents.1 In general, alcohol and drug use impairs driving performance in proportion to the amount consumed and contributes significantly to motor vehicle crashes,2,3 particularly among younger drivers.4 In 2008, 31% of young drivers who were killed in motor vehicle crashes had been drinking5; in 2009, half of the child passengers who died in crashes involving alcohol were riding with an alcohol-impaired driver.6 Illicit drug use also contributes to a large portion of fatal motor vehicle crashes involving adolescents and adults.7–10 Despite downward trends among adolescents in rates of drinking and driving (from 17% in 1991 to 10% in 2009) and riding with drinking drivers (from 40% in 1991 to 28% in 2009), rates remain alarmingly high.11 Therefore, better understanding of the current prevalence, variability, and determinants of adolescent driving while intoxicated (DWI) and riding with alcohol- or drug-impaired drivers (RWI) is needed to guide the development of prevention strategies.Adolescence, the transition period from childhood to emerging adulthood, is a time of increased sensation seeking and risk behavior.12,13 During this transition, learning to drive and obtaining a license are major rites of passage for entering adulthood. However, adolescent drivers have high crash rates and tend to drive in a deliberately risky manner, typified by speeding, close following, sharp cornering, and hard stops.14–18 At the same time, drinking and drug use increase during adolescence, and vehicles become a primary means of transportation and provide a somewhat private place for adolescents to drink and use illicit drugs.19,20Previous research indicates that the prevalence of DWI and RWI among adolescents is higher for male than female adolescents and for Latinos than Whites.21–24 Concurrent and longitudinal research has shown that drinking, binge drinking, cigarette use, and marijuana use are associated with adolescent DWI and RWI.20,25–28 Similarly, drinking, drug use, and traffic violations are associated with adolescent risky driving.17,26 It has been shown in a few regional studies that risky driving covaries with other problem behaviors,17,26,29 but no national studies have reported associations between risky driving and DWI and RWI among adolescents.Using a national probability sample, we examined the following: (1) the variability in the prevalence of DWI and RWI among adolescents by demographic factors; (2) the association between risky driving and DWI and RWI; and (3) the independent contribution of binge drinking, illicit drug use, and risky driving to DWI and RWI.     

Different Categorizations of Women's Sexual Orientation Reveal Unique Health Outcomes in a Nationally Representative U.S. Sample

BackgroundSexual minority women (i.e., women minoritized for their sexualities) are identified as high risk for mental health and substance use problems; however, there is no consensus on the criteria by which women are categorized as sexual minority. Though there is some evidence suggesting that certain subgroups of women are at higher risk than others based on sexual orientation, different categorization schemes for sexual orientation have yet to be compared within the same sample.MethodUsing data from the National Epidemiologic Survey of Alcohol and Related Conditions–III (N = 19,528), we examined how multiple categorization schemes (i.e., identity, behavior, recency of sexual behavior) for categorizing women who have sex with women (WSW) yield different estimates of prevalence of mental health and substance use issues. We used chi-square and logistic regression to analyze the link between sexual orientation categorization schemes and health, categorizing by 1) self-identification only, 2) behavior only, and 3) the combination of self-identification and behavior (recent vs. past).ResultsWe discovered high prevalence rates of health problems among heterosexual-identified WSW who reported no recent sexual activity with women (i.e., previously had sex with women but not within the past 12 months); this category of women comprised 35% of all WSW.DiscussionStep by step, we found more detailed information about these women's experiences by moving to the complex categorization scheme (the combination of self-identification and behavior). Heterosexual-identified women who have had sex with women in their past (though not recently) presented as a large group with high prevalence rates of substance use and mental disorders. These women remain invisible to researchers who categorize sexual orientation only by sexual identity or by behavior and ignore the role of behavior change over time—imprecisely categorizing such women as heterosexual or as women who have sex with men. They thus are underserved by health research and represent a significant population for further study and intervention.     

Iron Status and Its Determinants in a Nationally Representative Sample of Pregnant Women

Iron-deficiency anemia is associated with adverse neonatal health outcomes. Iron status and its determinants were assessed in a representative sample of Belgian pregnant women. Blood samples were collected and a questionnaire was completed face-to-face. Hemoglobin (Hb) and mean cell volume were measured using a Beckman Coulter Hematology Analyzer and serum ferritin (SF) and transferrin receptor (sTfr) concentrations by immunoassay. In total, 55 obstetric clinics and 1,311 pregnant women were included. Approximately 40% of third-trimester and 6% of first-trimester women had SF levels less than 15 μg/L. Approximately 21% of third-trimester and 4% of first-trimester women had anemia (Hb <110 g/L). Of the third-trimester women, 23% were iron-deficient nonanemic (SF <15 μg/L and Hb ≥110 g/L), 16% had iron-deficiency anemia (SF <15 μg/L and Hb <110 g/L), and approximately 7% had tissue iron deficiency (sTfr >8.5 mg/L). The median body iron stores were 8.1 mg/kg among first-trimester women, but only 3.6 mg/kg among third-trimester women. SF levels were significantly positively associated with age and education level, and were higher among nulliparous women and lower among North-African women. sTfr concentrations were significantly negatively associated with age and were lower among smokers, nulliparous women, and women who planned their pregnancy. Despite the fact that two thirds of Belgian pregnant women took iron-containing supplements, iron deficiency and iron-deficiency anemia were frequent in third-trimester women. The World Health Organization regards this as a moderate public health problem. National iron supplementation guidelines are needed in Belgium to optimize iron status during pregnancy.