Off-premise alcohol sales policies, drinking, and sexual risk among people living with HIV

Drinking among HIV-positive individuals increases risks of disease progression and possibly sexual transmission. We examined whether state alcohol sales policies are associated with drinking and sexual risk among people living with HIV. In a multivariate analysis combining national survey and state policy data, we found that HIV-positive residents of states allowing liquor sales in drug and grocery stores had 70% to 88% greater odds of drinking, daily drinking, and binge drinking than did HIV-positive residents of other states. High-risk sexual activity was more prevalent in states permitting longer sales hours (7% greater odds for each additional hour). Restrictive alcohol sales policies may reduce drinking and transmission risk in HIV-positive individuals.

It's better on TV: does television set teenagers up for regret following sexual initiation?

CONTEXT

Two-thirds of sexually experienced teenagers in the United States say they wish they had waited longer to have intercourse for the first time. Little is known about why such a large proportion of teenagers express disappointment about the timing of their initial experience with sex.

METHODS

Data on television viewing, on regret about the timing of first intercourse and on potentially relevant covariates were obtained from a national, three-year (2001-2004) longitudinal survey of adolescents aged 12-17 at baseline. Logistic regression and path analysis were used to examine the association between exposure to sex on television and the likelihood of regret following sexual initiation, the extent to which shifts in expectations about the positive consequences of sex mediate this association and whether these relationships differ by gender.

RESULTS

Sixty-one percent of females and 39% of males who had sex for the first time during the study period reported that they wished they had waited to have sex. Exposure to sexual content on television was positively associated with the likelihood of regret following sexual initiation among males (coefficient, 0.34) but not females. The association among males was partly explained by a downward shift in males' sex-related outcome expectancies following sexual initiation.

CONCLUSIONS

Interventions that limit teenagers' exposure to televised sexual content, that provide a more accurate portrayal of sexuality than typically depicted on television or that help adolescents think critically about televised sexual content may help teenagers make more carefully considered decisions about sexual debut.

Does watching sex on television predict teen pregnancy? Findings from a national longitudinal survey of youth

OBJECTIVE

There is increasing evidence that youth exposure to sexual content on television shapes sexual attitudes and behavior in a manner that may influence reproductive health outcomes. To our knowledge, no previous work has empirically examined associations between exposure to television sexual content and adolescent pregnancy.

METHODS

Data from a national longitudinal survey of teens (12-17 years of age, monitored to 15-20 years of age) were used to assess whether exposure to televised sexual content predicted subsequent pregnancy for girls or responsibility for pregnancy for boys. Multivariate logistic regression models controlled for other known correlates of exposure to sexual content and pregnancy. We measured experience of a teen pregnancy during a 3-year period.

RESULTS

Exposure to sexual content on television predicted teen pregnancy, with adjustment for all covariates. Teens who were exposed to high levels of television sexual content (90th percentile) were twice as likely to experience a pregnancy in the subsequent 3 years, compared with those with lower levels of exposure (10th percentile).

CONCLUSIONS

This is the first study to demonstrate a prospective link between exposure to sexual content on television and the experience of a pregnancy before the age of 20. Limiting adolescent exposure to the sexual content on television and balancing portrayals of sex in the media with information about possible negative consequences might reduce the risk of teen pregnancy. Parents may be able to mitigate the influence of this sexual content by viewing with their children and discussing these depictions of sex.

Virginity pledges among the willing: delays in first intercourse and consistency of condom use

PURPOSE

We examine longitudinal relationships between virginity pledging in adolescence and both sexual initiation and condom use. Prior studies have had mixed results and may not adequately control for prepledge differences between pledgers and nonpledgers.

METHODS

Data came from a national sample of 12- to 17-year-olds surveyed in 2001 and reinterviewed 1 and 3 years later. Logistic regression models estimated the association between making a pledge and each outcome. Selection bias was reduced through propensity-score weighting and a rich set of demographic and psychosocial covariates.

RESULTS

Pledgers and nonpledgers differed substantially in preexisting characteristics. However, after propensity weighting and statistical controls, pledging was still associated with delayed intercourse. We estimate that in the absence of pledging 42.4% of virgins with characteristics indicating an inclination to pledge initiate intercourse within 3 years; in the presence of the pledge, 33.6% of such youth initiate intercourse. Among those who had sex during this period, pledging was unassociated with condom use. Among those who did not have sex during this period, pledging was unassociated with engagement in noncoital sexual behavior.

CONCLUSIONS

Making a virginity pledge appears to be an effective means of delaying sexual intercourse initiation among those inclined to pledge without influencing other sexual behavior; pledging does not appear to affect sexual safety among pledgers who fail to remain abstinent.

Media multitasking: Issues posed in measuring the effects of television sexual content exposure

Adolescents who see more sexual content on television are more likely to initiate intercourse over the subsequent year. The present study hypothesized that use of the internet while watching television would moderate this relationship. Internet use might either strengthen or weaken the association between television-viewing and sex; various theories conflict in their predictions. A national sample of 1,762 12-17 year olds completed a telephone survey at baseline and one year later. Using multivariate logistic regression analysis, baseline exposure to sexual content on television was used to predict intercourse initiation by follow-up among baseline virgins. The equation controlled for potentially confounding characteristics and tested for an interaction between sexual content exposure and self-reported multitasking. Half of youth reported using the internet while watching television. The interaction between multitasking and sexual content exposure was significant; exposure to sexual content on television was more strongly related to sexual initiation among multitaskers. Divided attention may allow television messages to "slip past the radar" of viewers who would reject these messages if they devoted cognitive resources to critically examining them. Media multitasking is likely to become more prevalent as new media continue to be introduced. Future studies of television-viewing effects may need to assess multitasking to avoid missing effects in this important subgroup of viewers.

Ultrasound guided location and resection of a suburothelial cavernous haemangioma of the bladder

Complete endoscopic resection of bladder tumours can be difficult. This is particularly true when there is normal overlying mucosa, as in a cavernous haemangioma. We describe a case where intraoperative ultrasound was used to guide successful endoscopic resection.

Association of sexual abstinence in adolescence with mental health in adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.

Early adolescent exposure to alcohol advertising and its relationship to underage drinking

PURPOSE

To determine whether early adolescents who are exposed to alcohol marketing are subsequently more likely to drink. Recent studies suggest that exposure to alcohol ads has a limited influence on drinking in mid-adolescence. Early adolescents may be more vulnerable to alcohol advertising effects.

METHODS

Two in-school surveys of 1786 South Dakota youth measured exposure to television beer advertisements, alcohol ads in magazines, in-store beer displays and beer concessions, radio-listening time, and ownership of beer promotional items during 6th grade, and drinking intentions and behavior at 7th grade. Multivariate regression equations predicted the two drinking outcomes using the advertising exposure variables and controlling for psychosocial factors and prior drinking.

RESULTS

After adjusting for covariates, the joint effect of exposure to advertising from all six sources at grade 6 was strongly predictive of grade 7 drinking and grade 7 intentions to drink. Youth in the 75th percentile of alcohol marketing exposure had a predicted probability of drinking that was 50% greater than that of youth in the 25th percentile.

CONCLUSIONS

Although causal effects are uncertain, policy makers should consider limiting a variety of marketing practices that could contribute to drinking in early adolescence.

Differential diffusion of HIV technologies by gender: the case of highly active antiretroviral therapy

We sought to examine whether diffusion of new HIV technologies differed by gender in the United States, the source of any such disparities, and whether disparities narrow over time as technologies become more established. In particular, we assess how rates of use of highly active antiretroviral therapy (HAART) varied between males and females during the late 1990s, when HAART was rapidly diffusing. We examined data from a prospective cohort study of a national probability sample of 1421 HIV-infected adults in medical care who were enrolled in the HIV Cost and Services Utilization Study (HCSUS) from January 1996 to December 1998. We found that HAART use substantially increased between 1996 and early 1998 for all groups. Women were less likely to receive HAART at all time points, although the diffusion of HAART between 1996 and 1998 reduced gender disparities. Gender disparities in 1998 were only partially explained by women's lower income and educational levels. We conclude that HAART therapy diffused more slowly to HIV-positive females than other groups. Policies that reduce the impact of income and education inequalities on health care may help to narrow gender disparities for new HIV technologies, but other factors may also disadvantage women.

The role of substance use in young adult divorce

AIM

To test the relationships between various forms of substance use during marriage and subsequent divorce among US young adults.

DESIGN

Three waves of survey data collected at approximately ages 18, 23 and 29 years were used. Using multivariate logistic regression and controlling for factors present at the two early waves, we tested for prospective relationships between substance use at the second assessment and divorce by the third.

PARTICIPANTS

A longitudinal panel following adolescents on the west coast of the United States into young adulthood. The analytic subsample consisted of the 454 individuals currently married at the age 23 survey.

MEASUREMENTS

Predictors were past-year frequency of alcohol intoxication, marijuana use and cigarette use, as well as any hard drug use in the past year. Covariates included substance use prior to marriage, demographic and socio-economic factors, marital discord and religiosity.

FINDINGS

Controlling for other factors, more frequent alcohol intoxication during marriage was an independent predictor of later divorce. Frequency of marijuana use had a significant bivariate relationship with divorce that was not significant in the multivariate model.

CONCLUSION

These data are consistent with the notion that alcohol intoxication is related causally to divorce among young adults.

The role of substance use in young adult divorce

AIM

To test the relationships between various forms of substance use during marriage and subsequent divorce among US young adults.

DESIGN

Three waves of survey data collected at approximately ages 18, 23 and 29 years were used. Using multivariate logistic regression and controlling for factors present at the two early waves, we tested for prospective relationships between substance use at the second assessment and divorce by the third.

PARTICIPANTS

A longitudinal panel following adolescents on the west coast of the United States into young adulthood. The analytic subsample consisted of the 454 individuals currently married at the age 23 survey.

MEASUREMENTS

Predictors were past-year frequency of alcohol intoxication, marijuana use and cigarette use, as well as any hard drug use in the past year. Covariates included substance use prior to marriage, demographic and socio-economic factors, marital discord and religiosity.

FINDINGS

Controlling for other factors, more frequent alcohol intoxication during marriage was an independent predictor of later divorce. Frequency of marijuana use had a significant bivariate relationship with divorce that was not significant in the multivariate model.

CONCLUSION

These data are consistent with the notion that alcohol intoxication is related causally to divorce among young adults.

The associations of gender, sexual identity and competing needs with healthcare utilization among people with HIV/AIDS

Studies report gender differences in medical service utilization among persons with HIV, although most compare women to heterogeneous groups of men. Competing needs for medical care of women may contribute to those differences. We examined prospectively the role that competing social, economic and health needs, such as caring for others, play in gender differences in hospital, ambulatory and emergency room (ER) visits. We considered sexual identity to study women, gay/bisexual men and heterosexual men in the most recent wave (n = 1,385) of the HCSUS, a nationally representative sample of persons with HIV/AIDS in care in the United States. We considered gay/bisexual men and heterosexual men separately because their different resources and social networks may lead to disparate service utilization. Multivariate regression showed that women were more likely than gay/bisexual men to be hospitalized, while women and gay/bisexual men were more likely than heterosexual men to use the ER without subsequent hospitalization. Controlling for competing needs eliminated neither difference but predicted hospitalization and ER use. Findings suggest that addressing competing needs could reduce unnecessary hospitalization and ER use for both genders. Furthermore, examinations of gender differences in service use should include sexual identity.

High school drug use predicts job-related outcomes at age 29

The present study examines the relationship between hard drug use in high school and occupational and job quality outcomes measured at approximately age 29. We use two different methods aimed at ruling out the possibility of spurious correlations between high school drug use and occupational outcomes: (1) directly controlling for pre-high school characteristics that may affect both high school drug use and later occupational characteristics (e.g., educational orientation, early drug use and deviant behavior); and (2) matching high school users with a subset of nonusers that have very similar characteristics and then estimating the difference in labor market outcomes for these two groups (i.e., propensity score matching). Overall, the results suggest that adolescent drug use is linked with poorer occupational and job quality outcomes as much as 10 years after high school. Interestingly, which job-related outcomes are affected by early hard drug use varies by gender. Females who use hard drugs as adolescents end up in lower skill, lower status jobs while males who use hard drugs as adolescents are more likely to end up in jobs with fewer benefits (e.g., health, retirement).

Does solitary substance use increase adolescents' risk for poor psychosocial and behavioral outcomes? A 9-year longitudinal study comparing solitary and social users

This longitudinal study compared Grade 8 solitary cigarette smokers (n = 541), drinkers (n = 577), and marijuana users (n = 148) with adolescents who restricted their use of these substances to social settings (ns = 562, 1,426, and 388, respectively) on adolescent functioning and young adult outcomes. In Grade 8, solitary users held more positive beliefs about the consequences of substance use, earned poorer grades, engaged in more deviant behavior, and devoted less time to school and more time to social activities. By age 23, these solitary users had lower educational attainment, poorer self-rated health, and greater substance use problems. Results indicate the importance of better understanding and addressing the needs of this understudied group of high-risk youth.

Religiosity, denominational affiliation and sexual behaviors among people with HIV in the United States

This study sought to describe religiosity and denominational affiliation among the U.S. population living with HIV and to test whether either is associated with HIV-related sexual risk behaviors. A nationally representative sample of 1,421 people in care for HIV, 932 of whom reported recent sexual activity, was utilized. Religiosity was associated with fewer sexual partners and a lower likelihood of engaging in unprotected sex and in high-risk sex. Catholics were less likely to report unprotected sex than were other Christians, adherents of non-Christian religions, and those reporting no religious affiliation. Catholics were also less likely than other Christians to report high-risk sex and reported fewer sexual partners compared to those of non-Christian religions. We did not observe a difference between Catholics and Evangelicals in the three sexual behaviors investigated. Results suggest that religiosity and some religious teachings may promote safer sex among people with HIV.

Impact of a school-based dating violence prevention program among Latino teens: randomized controlled effectiveness trial

PURPOSE

Given the high rate of dating violence between teens and associated deleterious outcomes, the need for effective prevention and early intervention programs is clear. Break the Cycle's Ending Violence curriculum, a three-class-session prevention program focused on legal issues, is evaluated here for its impact on Latino/a youth.

METHODS

Tracks within large urban high schools that had at least 80% Latino/a students were randomized to immediate or delayed curriculum. Classrooms were randomly selected within tracks and individual student outcomes were assessed pre- and postintervention and six months later.

RESULTS

Students in intervention classrooms showed improved knowledge, less acceptance of female-on-male aggression, and enhanced perception of the helpfulness and likelihood of seeking assistance from a number of sources immediately after the program. Improved knowledge and perceived helpfulness of an attorney were maintained six months later. There were no differences in recent abusive/fearful dating experiences or violence victimization or perpetration.

CONCLUSIONS

The Ending Violence curriculum has an impact on teen norms, knowledge, and help-seeking proclivities that may aid in early intervention for dating violence among Latino/a students.

Time trends and demographic differences in youth exposure to alcohol advertising on television

OBJECTIVE

To examine trends in youth exposure to alcohol advertising on television across different demographic groups.

METHODS

We used television ratings data on alcohol advertisements to examine trends in exposure between September 1998 and February 2002. Further, we explored the differences in exposure across demographic groups by examining group-level alcohol ad exposure across specific networks, program types, and times of day.

RESULTS

We found that boys were more exposed than girls and African-Americans are more exposed than whites. Moreover, the race differential appeared to be increasing over time, whereas the gender differential appeared to increase with age. Differences in viewing patterns across race and gender contributed to the observed differences in exposure to alcohol advertising on television.

CONCLUSIONS

These results provide guidance in identifying comparative vulnerabilities in exposure to alcohol advertising on television, and can aid in the development of strategies to inoculate youth against those vulnerabilities.

Are drug experimenters better adjusted than abstainers and users?: a longitudinal study of adolescent marijuana use

PURPOSE

Experimentation with substance use is normative during adolescence and prior research suggests that adolescents who refrain from experimentation may be psychologically maladjusted. This longitudinal study compared lifetime marijuana abstainers (n = 1177), experimenters (n = 873), and frequent users (n = 205) at grade 12 on psychosocial functioning during late adolescence and young adulthood.

METHODS

Participants were recruited from middle schools in 1985 (grade 7) and assessed repeatedly, including in 1990 (grade 12) and 1995 (age 23). Self-report surveys assessed lifetime substance use at grade 12, and psychosocial functioning at grade 12 and age 23. Group differences after controlling for key demographics were estimated using multivariate logistic regression and analysis of covariance.

RESULTS

Adolescent abstainers from marijuana often fared better (and in no case worse) than experimenters and frequent users both concurrently and later in life on school engagement, family and peer relations, mental health, and deviant behavior. Similar results were found in ancillary analyses using a definition of adolescent "abstainer" that also accounted for cigarette and alcohol use.

CONCLUSIONS

Results refute the idea that adolescents who abstain from substance use are maladjusted, and suggest instead that they function better than experimenters later in life, during the transition to young adulthood.

Correlates of sex without serostatus disclosure among a national probability sample of HIV patients

We examined potential correlates of sex without HIV disclosure within a sample of 875 participants from the HIV Cost and Services Utilization Study. Interviews with each participant assessed sexual activities with up to six recent partners, and this study included both respondent and partnership characteristics. Compared with marriage and/or primary same-sex relationships, occasional partnerships and one-time encounters were associated with sex with disclosure, and shorter relationships were more likely to involve sex without disclosure. Knowledge of partner serostatus was also associated with sex without disclosure. Women were less likely to have sex without disclosure than men having sex with men. We found an association between the perceived duty to disclosure to all partners and sex without disclosure, while we found no association in multivariate analyses between outcome expectancies and sex without disclosure.

Exposure to degrading versus nondegrading music lyrics and sexual behavior among youth

BACKGROUND

Early sexual activity is a significant problem in the United States. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancy and sexually transmitted diseases are more common among those who begin sexual activity earlier. Popular music may contribute to early sex. Music is an integral part of teens' lives. The average youth listens to music 1.5 to 2.5 hours per day. Sexual themes are common in much of this music and range from romantic and playful to degrading and hostile. Although a previous longitudinal study has linked music video consumption and sexual risk behavior, no previous study has tested longitudinal associations between the content of music lyrics and subsequent changes in sexual experience, such as intercourse initiation, nor has any study explored whether exposure to different kinds of portrayals of sex has different effects.

DESIGN AND PARTICIPANTS

We conducted a national longitudinal telephone survey of 1461 adolescents. Participants were interviewed at baseline (T1), when they were 12 to 17 years old, and again 1 and 3 years later (T2 and T3). At all of the interviews, participants reported their sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. A total of 1242 participants reported on their sexual behavior at all 3 time points; a subsample of 938 were identified as virgins before music exposure for certain analyses. Participants also indicated how frequently they listened to each of more than a dozen musical artists representing a variety of musical genres. Data on listening habits were combined with results of an analysis of the sexual content of each artist's songs to create measures of exposure to 2 kinds of sexual content: degrading and nondegrading.

OUTCOME MEASURES

We measured initiation of intercourse and advancement in noncoital sexual activity level over a 2-year period.

RESULTS

Multivariate regression analyses indicated that youth who listened to more degrading sexual content at T2 were more likely to subsequently initiate intercourse and to progress to more advanced levels of noncoital sexual activity, even after controlling for 18 respondent characteristics that might otherwise explain these relationships. In contrast, exposure to nondegrading sexual content was unrelated to changes in participants' sexual behavior.

CONCLUSION

Listening to music with degrading sexual lyrics is related to advances in a range of sexual activities among adolescents, whereas this does not seem to be true of other sexual lyrics. This result is consistent with sexual-script theory and suggests that cultural messages about expected sexual behavior among males and females may underlie the effect. Reducing the amount of degrading sexual content in popular music or reducing young people's exposure to music with this type of content could help delay the onset of sexual behavior.

Socio-environmental influences on adolescents' alcohol outcome expectancies: a prospective analysis

AIMS

To investigate the prospective influence of social influence and social bonding variables on the development of alcohol outcome expectancies among adolescents with and without drinking experience.

DESIGN

Longitudinal data from students in the control schools of a field trial designed to evaluate a school-based drug prevention program.

SETTING

A total of 19 middle schools in South Dakota, USA.

MEASUREMENTS

An alcohol outcome expectancy scale administered to 1410 students in grades 8 and 9. After using confirmatory factor analysis (CFA) to develop an expectancies measure, multiple-group (grade 8 drinkers versus grade 8 non-drinkers) path analysis was used to model 9th grade alcohol expectancies. Grade 8 social influence and bonding variables were used as predictors, controlling for grade 8 expectancies.

FINDINGS

At the bivariate level, peer and adult influences and social bonding variables were related consistently to alcohol outcome expectancies among drinkers and non-drinkers. A bivariate relationship between alcohol advertising and alcohol expectancies was found among drinkers only. In the multivariate model, greater alcohol use by important adults predicted independently increased alcohol positivity among drinkers; greater perceived approval of alcohol use by parents and peers predicted diminished perceived potency of alcohol among non-drinkers. Advertisement exposure and social bonding variables were not independent predictors of alcohol expectancies in the multivariate model.

CONCLUSIONS

These findings suggest that attempts to alter adolescents' alcohol expectancies are likely to fail unless they address the influence of immediate social models on these beliefs.

Exploring the link between substance abuse and abortion: the roles of unconventionality and unplanned pregnancy

CONTEXT

Several studies have found a relationship between abortion and prior substance use, suggesting that a reduction in substance use might help decrease abortion rates. However, such a conclusion requires a greater understanding of the processes linking abortion and prior substance use.

METHOD

Path analysis of longitudinal data from 1,224 women was used to simultaneously test two pathways from adolescent substance use to abortion by age 29, one mediated by higher rates of unplanned pregnancy and the other independent of unplanned pregnancy rates. The model was then expanded to examine how these pathways change when unconventional attitudes and behaviors (such as rebelliousness and low religiosity) are taken into consideration.

RESULTS

In the analysis that did not control for unconventionality, women who reported smoking cigarettes or using marijuana or hard drugs at age 18 had an increased likelihood of subsequent unplanned pregnancy and, as a result, higher rates of abortion. In addition, women who had used marijuana had an increased likelihood of abortion independent of unplanned pregnancy rates. In the final model, unconventionality strongly predicted both abortion and unplanned pregnancy. Moreover, it explained the associations between the use of hard drugs or marijuana and abortion that were due to higher unplanned pregnancy rates.

CONCLUSIONS

Unconventionality mediates certain associations between substance use and abortion, perhaps because unconventional women are more likely both to use substances and to engage in behaviors that increase their risk of unplanned pregnancy. Hence, it seems unlikely that reducing substance use will result in substantially fewer abortions.

Patterns and correlates of deliberate abstinence among men and women with HIV/AIDS

OBJECTIVES

We examined correlates of deliberate sexual abstinence among gay/bisexual men, heterosexual men, and women in a national probability sample of adults with HIV.

METHODS

Participants in the HIV Cost and Services Utilization Study (HCSUS; n=1339) answered questions about oral, anal, or vaginal sexual intercourse in the past 6 months; those who reported none of these behaviors (n=415) were asked about their reasons for abstinence. Of these, 201 participants (11% of gay/bisexual men, 18% of women, 18% of heterosexual men) indicated that their abstinence was deliberate. Multivariate models were used to predict deliberate abstinence.

RESULTS

In multivariate analyses, not having a primary relationship partner/spouse was a significant correlate of deliberate abstinence for all 3 groups. Higher perceived responsibility for limiting disease transmission and nondrinking status were related to deliberate abstinence only among gay/bisexual men. Worse health was associated with deliberate abstinence only among heterosexual men.

CONCLUSIONS

Perhaps because HIV is more common in gay communities, abstinence choices may be more closely linked to a higher sense of responsibility for reducing transmission among gay/bisexual men, and their illness may be less of an impediment to sexual activity.

Effects of early and later marriage on women's alcohol use in young adulthood: a prospective analysis

OBJECTIVE

Previous research shows that marriage leads to reductions in alcohol use, especially for women. Because marriage prior to age 20 (early marriage) is a marker for deviance, the protective effects of marriage may not extend to those who marry in adolescence. We compared the effects of marriage in adolescence versus young adulthood on alcohol consumption, negative alcohol-related consequences and heavy episodic drinking at age 29.

METHOD

We analyzed data from 1,138 women in a longitudinal cohort followed from ages 18 to 29. The original sample was recruited from 30 California and Oregon middle schools and first surveyed at age 13.

RESULTS

Women who had not married, had married early or had married between ages 20 and 29 did not differ on alcohol use at age 18. Women who married as young adults were less likely than singles to engage in any alcohol use, heavy episodic drinking or experience negative consequences and reported less alcohol use at age 29. Women who married in adolescence reported fewer negative consequences at age 29 than did singles and (if they had not divorced) were less likely to engage in heavy episodic drinking or experience any negative consequences, reported fewer consequences and consumed less alcohol. The protective effects of marriage in young adulthood were observed whether or not women divorced. Parenthood and college attendance before age 23 did not explain the marriage effect.

CONCLUSIONS

Results support role theory, which posits that individuals who marry are socialized into conventional adult roles that discourage deviant behavior.

Training pediatric residents to provide smoking cessation counseling to parents

The objective was to assess the effectiveness of a smoking cessation educational program on pediatric residents' counseling. Residents were randomly selected to receive the intervention. Residents who were trained were compared to untrained residents. Self-reported surveys and patient chart reviews were used. Measures included changes in self-reported knowledge, attitudes and behaviors of residents, and differences in chart documentation and caretaker-reported physician counseling behaviors. The intervention was multidimensional including a didactic presentation, a problem-solving session, clinic reminders, and provision of patient education materials. Results showed that residents who were trained were more likely to ask about tobacco use in their patients' households. They were also more likely to advise caretakers to cut down on or to quit smoking, to help set a quit date, and to follow up on the advice given at a subsequent visit. Trained residents were more likely to record a history of passive tobacco exposure in the medical record. These residents also reported improved confidence in their counseling skills and documented that they had done such counseling more often than did untrained residents. Caretakers of pediatric patients who smoke seen by intervention residents were more likely to report that they had received tobacco counseling. Following this intervention, pediatric residents significantly improved their behaviors, attitudes, and confidence in providing smoking cessation counseling to parents of their pediatric patients.