Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care

This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.     

Poly-Victimization and Risk of Posttraumatic,Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents

PurposeAdolescents exposed to multiple forms of psychological trauma (“poly-victimization,” Finkelhor et al. Child Abuse Negl 2007;31:7–26) may be at high risk for psychiatric and behavioral problems. This study empirically identifies trauma profiles in a national sample of adolescents to ascertain correlates of poly-victimization.MethodsLatent Class analyses and logistic regression analyses were used with data from the National Survey of Adolescents to identify trauma profiles and each profile's risk of posttraumatic stress disorder, major depressive disorder, substance use disorders, and delinquency involvement and deviant peer group relationships. Poly-victimization classes were also compared to classes with trauma exposure of lesser complexity.ResultsSix mutually exclusive trauma profiles (latent classes) were identified. Four classes were characterized by high likelihood of poly-victimization, including abuse victims (8%), physical assault victims (9%), and community violence victims (15.5%). Poly-victimization class members, especially abuse and assault victims, were more likely than do youth traumatized by witnessing violence or exposure to disaster/accident trauma to have psychiatric diagnosis and (independent of psychiatric diagnoses or demographics) to be involved in delinquency with delinquent peers.ConclusionsPoly-victimization is prevalent among adolescents and places youth at high risk for psychiatric impairment and for delinquency. Moreover, poly-victimized youths' risk of delinquency cannot be fully accounted for by posttraumatic stress disorder, depression, or substance use problems, suggesting that adolescent healthcare providers should consider poly-victimization as a risk for behavioral and legal problems even when PTSD, depression, or addiction symptoms are not clinically significant.     

Assessing the Sensitivity and Specificity of the MAYSI-2 for Detecting Trauma among Youth in Juvenile Detention

This study investigated the sensitivity and specificity of the most widely used mental health screening instrument in juvenile detention, the Massachusetts Youth Screening Instrument (MAYSI-2), for detecting trauma and symptoms of posttraumatic stress disorder (PTSD) among detained youth. The MAYSI-2 scales measuring Substance Use, Anger/Irritability, Depression/Anxiety, and Traumatic Experiences contributed to the prediction of PTSD symptoms; however, only Depression/Anxiety contributed to the prediction of associated symptoms for girls. The ROC curves technique indicated that the Traumatic Experiences scale was a moderately accurate predictor of likely Full or Partial PTSD but not superior to the other MAYSI-2 scales. These results suggest further work is needed to develop measures that are sensitive to the experiences of delinquent youth with histories of complex trauma.     

Marijuana use and sexually transmitted infections in young women who were teenage mothers.

PURPOSE: Teenage pregnancy and marijuana use are associated with higher risk of contracting sexually transmitted infections (STIs). In this study, we examined the role of early and current marijuana use as it related to STI risk in a sample of young women who were pregnant teenagers, using a variety of statistical models. METHODS: We recruited 279 pregnant adolescents, ages 12-18, from an urban prenatal clinic as part of a study that was developed to evaluate the long-term effects of prenatal substance exposure. Six years later, they were asked about their substance use and sexual history. The association of early and late marijuana use to lifetime sexual partners and STIs was examined, and then structural equation modeling (SEM) was used to illustrate the associations among marijuana use, number of sexual partners, and STIs. RESULTS: Bivariate analyses revealed a dose-response effect of early and current marijuana use on STIs in young adulthood. Early and current marijuana use also predicted a higher number of lifetime sexual partners. However, the effect of early marijuana use on STIs was mediated by lifetime number of sexual partners in the SEM, whereas African-American race, more externalizing problems, and a greater number of sexual partners were directly related to more STIs. CONCLUSIONS: Adolescent pregnancy, early marijuana use, mental health problems, and African-American race were significant risk factors for STIs in young adult women who had become mothers during adolescence. Pregnant teenage girls should be screened for early drug use and mental health problems, because they may benefit the most from the implementation of STI screening and skill-based prevention programs.     

Comparison of Substance Use Typologies as Predictors of Sexual Risk Outcomes in African American Adolescent Females

African American female adolescents have a disproportionate risk of sexually transmitted infections (STIs) and other adverse sexual health outcomes. Both alcohol and marijuana use have been shown to predict sexual risk among young African American women. However, no studies have attempted to differentiate alcohol and marijuana typologies use as predictors of sexual risk outcomes exclusively among adolescents who use these substances. This study compared recent alcohol and/or marijuana use as predictors of sexual risk outcomes over 18 months among 182 African American female adolescents. African American females (14–20 years) completed interviews at baseline, 6-, 12-, and 18-months. At each assessment, pregnancy testing was conducted and self-collected vaginal swab specimens were assayed for Trichomonas vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae using DNA amplification. Logistic subject-specific random-intercept models compared sexual risk outcomes during follow-up among adolescents who reported recent use of alcohol only (AO), marijuana only (MO) or both substances (A + M) at the baseline assessment. Relative to baseline AO use, baseline MO use predicted condom non-use at last sex. Relative to AO use, A + M use predicted pregnancy. Relative to MO use, A + M use predicted pregnancy and acquisition of T. vaginalis and any STI. The results suggest that African American female adolescents who use A + M may represent a priority population for STI, HIV, and pregnancy prevention efforts.     

Sexual Health Communication Within Religious African-American Families

While research suggests youth prefer parents and family members to serve as the primary sources of sexual health information, fear and discomfort around discussing sex with their parents may leave youth misinformed and underinformed. This study explored sexual heath communication within religious African-American families. Thirty adolescents participated in four focus groups, and 19 adults and 30 adolescents participated in six focus groups, at two predominantly African-American Christian churches in Flint, MI. All data were analyzed inductively using a constant comparison approach. Nearly all participants reported attending church weekly. Three themes emerged and are described: initiating sex talks, using mistakes as teaching tools, and clarifying prevention messages. Participants highlighted the need for religious parents to offer both religious and practical guidance to adolescents about sexual health. Findings from this study may be used to inform future sexual health promotion interventions for religious African-American families.     

Posttraumatic stress disorder among female Vietnam veterans: a causal model of etiology.

OBJECTIVES: The Vietnam and Persian Gulf wars have awakened people to the realization that military service can be traumatizing for women as well as men. This study investigated the etiological roles of both war and sexual trauma in the development of chronic posttraumatic stress disorder among female Vietnam veterans. METHODS: Data from the National Vietnam Veterans Readjustment Study for 396 Vietnam theater women and 250 Vietnam era women were analyzed with structural equation modeling. RESULTS: An etiological model with highly satisfactory fit and parsimony was developed. Exposure to war trauma contributed to the probability of posttraumatic stress disorder in theater women, as did sexual trauma in both theater and era women. Lack of social support at the time of homecoming acted as a powerful mediator of trauma for both groups of women. CONCLUSIONS: Within the constraints and assumptions of causal modeling, there is evidence that both war trauma and sexual trauma are powerful contributors to the development of posttraumatic stress disorder among female Vietnam veterans.     

The Relationship Between Substance Use and Sexual Health Among African-American Female Adolescents with a History of Seeking Mental Health Services

BackgroundThis study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services.MethodsParticipants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14–22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs.FindingsSubstance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior.ConclusionsResults suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.     

Associations of sociodemographic, psychosocial, and behavioral factors with sexual risk and sexually transmitted diseases in teen clinic patients.

PURPOSE: To examine the influence of sociodemographic characteristics, sexually transmitted disease (STD)/human immunodeficiency virus knowledge, and psychosocial and behavioral risk factors on sexual risk and STDs in adolescents using constructs from the Information, Motivation, and Behavioral Skills model (IMB). METHODS: A convenience sample of 303 sexually experienced, racially diverse adolescents (mean age 16.7 years, 57.9% female) who were seeking health care at a general health maintenance organization teen clinic were recruited for the study and completed a self-reported questionnaire which assessed sociodemographic, knowledge, and psychosocial factors, risk behaviors, and history of STDs. Multiple regression analyses were used to assess factors associated with sexual risk behavior and STD history. RESULTS: Many of the study participants were at risk for STDs; 43.8% had four or more lifetime sexual partners, 62.8% did not consistently use condoms, 21.1% had a history of pregnancy or impregnation, and 28.2% had a history of STDs. A multiple linear regression model to assess factors associated with sexual risk behavior (a nine-item index) indicate that perceptions of higher STD risk, perceptions that friends engage in risk behaviors, perceptions that friends will not support their STD risk-reduction efforts, knowing someone of a similar age who has had an STD, and having no intention of using condoms in the future are significantly associated with sexual behavioral risk (R(2) =.22, p <.000). A logistic regression model to examine history of STDs reveals that teens who are female, African-American, frequently use marijuana, have an older steady sexual partner, have a history of pregnancy or impregnation, have a greater number of lifetime sexual partners, and perceive that monogamy will not decrease STD risk are significantly more likely to report a history of STDs. CONCLUSIONS: Sociodemographic factors and constructs of the IMB model are associated with adolescents' risk and acquisition of STDs. Teens with such risk profiles should be targeted for risk-reduction intervention.     

Exploring unstructured parent–child communication about sex among African-American adolescents with HIV-positive mothers

Few studies have focused on the sexual health of HIV-affected adolescents despite their exposure to the same community-level factors that contributed to their parent’s status. Guided by an interpretative phenomenological analysis (IPA) approach, this study explored HIV-affected adolescents’ perceptions on the unstructured sexual health education received from their HIV-positive mothers and its influence on their decision-making and sexual health via six in-depth individual interviews with HIV-affected adolescents ages 15–17 years and a contextual focus group with eight HIV peer educators ages 13–18 years. Findings from this study (1) describe non-positive, HIV-affected adolescents’ perceptions of sexual health influenced by parent–child communication about sex and (2) identify deficiencies in sexual health education models available for the unique needs of HIV-affected families.     

HIV-relevant sexual behavior among a healthy inner-city heterosexual adolescent population in an endemic area of HIV

The AIDS crisis has devastated segments of the population including the gay community and those who use intravenous drugs. HIV has spread to other groups including prostitutes and those with other sexually transmitted diseases. We have been studying adolescents in a major Northeast city where there is a major HIV/AIDS epidemic. Despite high levels of AIDS related knowledge, these adolescents reported high levels of sex risk behaviors. In addition, our data suggests that even moderate alcohol or marijuana use predicts high risk sexual behaviors. These data indicate the urgent need to develop prevention strategies for the spread of HIV among inner-city youth based upon relevant predictors of risk behaviors. The coupling of HIV in inner-city populations with a high frequency of risk behaviors in adolescents demands an immediate public health response.     

The Association of Sexual Dysfunction and Substance Use Among a Community Epidemiological Sample

This study examines the prevalence of DSM-III sexual dysfunctions and their association with comorbid drug and alcohol use in a community epidemiologic sample. The data for these analyses are based on the Epidemiological Catchment Area Project, a multistage probability study of the incidence and prevalence of psychiatric disorders in the general population conducted in 1981-83. Only the sample of 3,004 adult community residents in the St. Louis area was queried on DSM-III sexual dysfunctions of inhibited orgasm, functional dyspareunia (painful sex), inhibited sexual excitement (i.e., lack of erection/arousal), and inhibited sexual desire. There was a prevalence rate of 11% for inhibited orgasm, 13% for painful sex, 5% for inhibited sexual excitement, 7% for inhibited sexual desire, and 26% for any of these sexual dysfunctions (14% for men and 33% for women). The prevalence of qualifying lifetime substance use among the population was 37%, with males meeting more drug and alcohol use criteria than females. After controlling for demographics, health status variables, and psychiatric comorbidity (depression disorder, generalized anxiety disorder, antisocial personality disorder, and residual disorders), inhibited orgasm was associated with marijuana and alcohol use. Painful sex was associated with illicit drug use and marijuana use. Inhibited sexual excitement was more likely among illicit drug users. Inhibited sexual desire was not associated with drug or alcohol use.     

Parental monitoring, negotiated unsupervised time, and parental trust: the role of perceived parenting practices in adolescent health risk behaviors.

PURPOSE: To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents. METHODS: Data were derived from 692 adolescents in 9th and 10th grades (x = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a self-administered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana). RESULTS: For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males. CONCLUSIONS: Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.     

Condom use and consistency among male adolescents in the United States

PURPOSE: To incorporate a behavioral model of health services utilization to examine whether male adolescents' family, individual, sex education, and partner factors are associated with several measures of condom use and consistency in heterosexual relationships. METHODS: We examine a sample of sexually experienced male adolescents 15-19 years of age in the 2002 National Survey of Family Growth (NSFG) to identify factors associated with condom use at first sex and last sex, condom consistency with their most recent sexual partner, and condom consistency in the past 4 weeks. RESULTS: Male adolescents who were Hispanic and those who did not receive formal sex education had lower odds of condom use and/or consistency, whereas African-American male adolescents and those with more positive attitudes about condoms had greater odds. Males who were older at most recent sex, who had an older sexual partner or a casual first sexual partner, who had a partner who used a method of contraception, who were in longer relationships, or who engaged in more frequent sex had reduced odds of contraceptive use. CONCLUSIONS: Findings highlight multiple domains of influence on condom use behaviors among male adolescents. Programs that provide targeted services, address condom use attitudes, and help teens to negotiate condom use decision making with sexual partners may help to reduce high rates of sexually transmitted infections among male adolescents in the United States.     

Can Self-Reported Drug Use Data Be Used to Assess Sex Risk Behavior in Adolescents?

To better understand and control the spread of sexually transmitted diseases among high-risk youth, we must first acquire reliable reports of sexual risk behavior. This study evaluates one potential method for validating such reports. We examined the association between marijuana and cocaine use reporting patterns and the number of reported recent sexual partners in a sample of juvenile arrestees/detainees. Using urinalysis to validate self-reported drug use, we categorized drug use reporting patterns into four groups: overreporters, underreporters, honest users, and honest nonusers. Analyses showed, in general, that overreporters reported more sexual partners than either underreporters or accurate reporters, suggesting that overreporters of drug use may also exaggerate sex partner reports. Findings suggest a new method for validating self-reported sexual behavior and provide a challenge to theories of juvenile delinquency.     

Demographic factors,mental health problems,and psychosocial resources influence women's AIDS risk

The aim of this study was to examine how depressive mood, posttraumatic stress disorder (PTSD) symptoms, self-efficacy, and social support are associated with HIV risk behaviors. Participants were sexually active women (N = 1488) recruited when attending gynecological consultations in primary care settings. Standardized questionnaires were administered to assess for depressive mood, abuse/assault-related PTSD, social support, self-efficacy, stress, and sexual risk behavior. The resulting association models showed that demographic factors, mental health problems, and resources are associated with sexual risk behavior. Detecting and treating mental health problems and interventions that bolster women's psychosocial resources are warranted.     

Methamphetamine Use and High-Risk Sexual Behaviors among Incarcerated Female Adolescents with a Diagnosed STD

Juvenile detention settings provide an important venue for addressing the health-related needs of adolescent populations, who often have high rates of sexually transmitted diseases (STDs) and concomitant drug use. This study examines factors associated with methamphetamine use and risky sexual behaviors among 539 incarcerated female adolescents between ages 12–18 years with an STD diagnosis. Data were obtained from interviews with detainees receiving STD case management services within a California juvenile detention facility in January 2006–June 2007. High-risk behaviors characterized the sample, such as low use of condoms consistently (43.3%), prior STD infection (25%), pregnancy history (26%), arrest charge for prostitution or drug use (23%), and a history of prostitution (18%). Half of the sample reported weekly alcohol or drug use; most commonly used drugs were marijuana (37%), alcohol (21%), and methamphetamine (16%). In multivariate analysis, African Americans had a lower odds of methamphetamine use (odds ratio [OR] = .163) compared with whites. Detainees who reported inconsistent condom use had over twice the odds of methamphetamine use (OR = 2.7) compared with consistent condom users. In addition, those who reported alcohol use had twice the odds of methamphetamine use (2.0). There was a significant interaction between Latina ethnicity and having an arrest charge for drugs or prostitution; Latinas who had this charge had over 11 times the odds of using methamphetamine compared with those with other arrest charges (OR = 11.28). A better understanding of the relationship between drug use and sexual risk behaviors of STD-positive incarcerated female adolescents can inform the development of appropriate corrections and community-based interventions serving this segment of high-risk adolescents.     

Violence involvement, substance use, and sexual activity among Mexican-American and European-American adolescents

PURPOSE: This study examined longitudinal associations between violence involvement, substance use, and sexual activity. METHODS: A total of 302 urban Mexican-American and European-American adolescents were randomly selected and recruited from the membership lists of a large health maintenance organization. Data were obtained from interviews conducted when the mean ages of adolescents were 15, 18, and 19 years. RESULTS: Independent of age, gender, ethnicity, family socioeconomic status, and previous levels of health risk behavior, adolescents who had been victimized by violence at age 15 were more likely to use tobacco at age 19. Adolescents who had been victimized by or perpetrated violence at age 18 had a greater number of sexual partners and were more likely to use marijuana at age 19. In addition, adolescents who had perpetrated violence at age 18 engaged in greater alcohol use at age 19. A second set of analyses showed that independent of demographics and previous violence involvement, adolescents who had used marijuana at age 15 were more likely to report violence involvement at age 19. Adolescents who had used tobacco or who had a greater number of sexual partners at ages 15 or 18 were more likely to report violent victimization at age 19. CONCLUSIONS: Associations between violence involvement and other forms of health risk behavior are bidirectional. Adolescents involved with violence are at risk for increases in substance use and sexual behavior over time. Adolescents who engage in substance use and sexual behavior with multiple partners are also at risk for later violence involvement.     

Unprotected sex as a function of alcohol and marijuana use among adolescent detainees.

PURPOSE: To examine the relationship between the use of two substances (alcohol and marijuana) and the occurrence of unprotected sexual intercourse among adolescent detainees. METHODS: Participants were asked about their use of alcohol, marijuana, and condoms. In addition to comparing levels of alcohol and marijuana use, the study examined relationships among the following variables: (a) the number of days that each substance was used and the number of unprotected episodes of sexual intercourse in the 30 days preceding admission to a youth detention center; (b) the number of times that each substance was used before or during sexual intercourse and the number of unprotected episodes in the same time period; (c) the use of each substance and unprotected intercourse at the last sexual episode; and (d) intentions to use each substance in the context of sex and to have unprotected intercourse in the future. Relationships among these variables were assessed in four regression models, each of which included participants' demographic characteristics, AIDS knowledge, attitudes toward condoms, and future orientation as covariates. RESULTS: Results of all four regression models indicated that marijuana use was associated with unprotected sexual intercourse. Adolescents who used more marijuana in general as well as specifically in sexual episodes in the 30 days preceding detention reported higher levels of unprotected sex. In addition, marijuana use in the last episode was related to the occurrence of unprotected sex during that episode. Moreover, intentions to use marijuana in future sexual episodes was associated with intentions to have unprotected intercourse in the future. CONCLUSIONS: Future studies should use more rigorous research designs to clarify the nature of the relationship between marijuana use and risky sex.     

Re-emergence of Posttraumatic Stress Disorder Nightmares With Nursing Home Admission: Treatment With Prazosin

Seniors with a history of emotional trauma decades earlier can experience a recurrence of posttraumatic stress disorder symptoms when transitioning to a nursing home. We present the case of an 86-year-old male Holocaust survivor admitted to a nursing home for physical therapy and rehabilitation 6 weeks after the death of his wife; the patient was expressing a persistent death wish. Despite the multiple risk factors for depression, his distress was specifically related to the reemergence of nightly posttraumatic nightmares. Over the course of 1 week of treatment with 1 mg prazosin at bedtime, his nightmares and his death wish completely resolved. He achieved his rehabilitation goals and was discharged to a community setting. This report highlights the importance of considering posttraumatic stress disorder in nursing home residents with a history of emotional trauma, and understanding how to address these symptoms pharmacologically and nonpharmacologically.