Early age of first sexual intercourse and affiliation with deviant peers predict development of SUD: a prospective longitudinal study

Exogenous Correlates of Substance Use Among Youth Who Have Experienced Maltreatment and Child Welfare Involvement

BACKGROUND

Adolescents with a history of maltreatment and child welfare involvement are at elevated risk for substance use, but few studies have focused on exogenous correlates (e.g., neighborhood, family, and peer characteristics) of substance use in this population. The current cross-sectional study explored associations between exogenous risk and protective factors and past-year substance use.

METHODS

Self-reported data were collected from 249 youth (Mage = 13.95 years, SD = 0.67) who had experienced maltreatment and had an open child welfare case.

RESULTS

Almost one-third of the sample reported any substance use in the past year. In the full sample, community violence exposure and deviant peer affiliations were found to be risk factors for past-year substance use. For females, community violence exposure and deviant peer affiliations were risk factors for substance use, while affiliation with prosocial peers was a protective factor. For males, community violence exposure and living at home (vs. in out-of-home care) were risk factors for substance use. Parental monitoring and school connectedness were not related to substance use, suggesting that these protective factors are less salient in this sample.

CONCLUSIONS

Findings suggest that focusing on modifiable intervention targets (e.g., discouraging affiliations with deviant peers), providing mental health treatment for violence exposure, and addressing broader contextual risk factors are promising directions for substance use prevention efforts for this vulnerable population of youth.

Identifying causal associations between women's reproductive traits and risk of schizophrenia: a multivariate validated two-sample Mendelian randomization analysis

BACKGROUND

A significant association between women's reproductive traits and the risk of schizophrenia (SCZ) has been discovered, but the causalities remain unclear. We designed a two-sample univariate Mendelian randomization (MR) study using female-specific SNPs collected from a large-scale genome-wide association study as a genetic tool to explore the causal effect of female reproductive traits on the risk of SCZ, and conducted a multivariate MR study to re-validate the above findings.

METHODS

From extensive genome-wide association studies (GWAS) of people with European ancestry (n = 176,881 to 418,758 individuals), summary-level data on five female reproductive variables were extracted. Summary-level information on SCZ was taken from a GWAS meta-analysis involving 320,404 people with European ancestry. The inverse variance weighting estimations for both univariable MR (UVMR) and multivariable MR (MVMR) were presented as the primary results. MR-Egger, weighted median, simple mode, and weighted mode regression methods for UVMR, and MVMR-Egger, MVMR-Lasso, and MVMR-median methods for MVMR were used for sensitivity analyses.

RESULTS

The UVMR produced compelling proof for a connection between genetically predicted later age at first sexual intercourse (AFS) (OR, 0.632; 95% CI, 0.512-0.777; P < 0.01) and decreased SCZ risk. Pleiotropy analysis of the AFS-SCZ association confirmed the robustness of the MR results (P > 0.05). Consistent, substantial causal effects of AFS (OR, 0.592; 95%CI, 0.407-0.862; P < 0.01) on the risk of SCZ were demonstrated after adjusting for body mass index, years of schooling, and smoking initiation using MVMR.

CONCLUSIONS

Our findings provide convincing evidence that early AFS is a risk factor for SCZ. SCZ risk may be decreased by raising awareness of reproductive healthcare for women.

Genetic liability to age at first sex and birth in relation to cardiovascular diseases: a Mendelian randomization study

BACKGROUND

Growing evidence suggests that various reproductive factors, including early menarche, early menopause, and age at first birth, may increase the risk of developing cardiovascular disease (CVD) later in life. However, the associations between reproductive factors and CVDs are inconsistent and controversial. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis to explore the potential links between age at first sex (AFS) and age at first birth (AFB) and several CVDs.

METHODS

We obtained summary statistics for exposure from the largest genome-wide association studies of AFS and AFB. To serve as instrumental variables, we selected 259 SNPs associated with AFS and 81 SNPs associated with AFB at the genome-wide significance level. We employed a random-effects inverse-variance weighted method to pool estimates, and conducted multivariable MR analysis to determine the direct association between AFS and AFB with CVDs, while accounting for the effects of confounders.

RESULTS

The genetic liability to later AFS was associated with decreased risks of heart failure (odd ratio [OR] 0.700; 95% confidence interval [CI] 0.639-0.767; p = 2.23 × 10^-14), coronary artery disease (OR 0.728; 95% CI 0.657-0.808; p = 1.82 × 10^-9), myocardial infarction (OR 0.731; 95% CI 0.657-0.813; p = 8.33 × 10^-9), stroke (OR 0.747; 95% CI 0.684-0.816; p = 6.89 × 10^-11), and atrial fibrillation (OR 0.871; 95% CI 0.806-0.941; p = 4.48 × 10^-4). The genetic liability to later AFB was also associated with decreased risks of CVDs, including myocardial infarction (OR 0.895; 95% CI 0.852-0.940; p = 8.66 × 10^-6), coronary heart disease (OR 0.901; 95% CI 0.860-0.943; p = 9.02 × 10^-6), heart failure (OR 0.925; 95% CI 0.891-0.961; p = 5.32 × 10^-5), and atrial fibrillation (OR 0.944; 95% CI 0.911-0.978; p = 0.001). However, no association was found between AFB and stroke. The associations remained independent from the effects of AFS and AFB on potential confounders, including smoking, alcohol intake, body mass index, and depression. Mediation analysis suggested that education attainment partly mediates the link from AFS and AFB to CVD outcomes.

CONCLUSION

Our results observed a causal relationship between later AFS, AFB and lower CVDs risk; it emphasizes the importance of providing sex education since early sex and birth may have undesirable effects. Cardiovascular risk stratification that considers reproductive factors may help address CVD risk.

Age of Sexual Debut among Young Gay-identified Sexual Minority Men: The P18 Cohort Study

Age of sexual debut is a critical health indicator for young sexual minority men (YSMM), associated with an increased likelihood of HIV acquisition, use of alcohol, tobacco, and other substances, and psychological distress. This study examined the age of same-sex sexual debut for five sexual behaviors in a sample of racially/ethnically and socioeconomically diverse gay-identified YSMM in New York City. The mean age of sexual debut of any behavior was 14.5 years old and 19% of the sample reported sexual debut prior to age 13. Overall, mutual masturbation occurred at the youngest mean age, followed by performed oral, received oral, receptive anal, and insertive anal intercourse. There were significant differences by race/ethnicity and perceived familial socioeconomic status (SES), such that Black and Hispanic/Latino men had earlier ages of debut for performed oral and receptive and insertive anal sex, while upper SES men had later ages of debut for receptive and insertive anal intercourse. These findings are relevant to trends in HIV incidence in the U.S., which are highest among Black and Hispanic/Latino YSMM and may be associated with earlier age of sexual debut. These findings also underscore a need for comprehensive and inclusive sex education at younger ages.

Sex, drugs, and early emerging risk: Examining the association between sexual debut and substance use across adolescence

Sexual debut, or first intercourse, predicts problem behaviors such as substance use. This association could reflect a direct effect of debut itself, general developmental trends, or the fact that some youth are more predisposed to a wide array of problem behaviors (e.g., risky sex, substance use). Understanding the association between sexual debut and substance use thus requires methods that can distinguish between these various accounts. In this study the association between sexual debut and substance use was investigated in a longitudinal sample of Mexican-origin youth (N = 674) assessed annually from 5^th (M_age = 10.86 years, SD = 0.51) through 12^th grade (M_age = 17.69 years, SD = 0.48). The longitudinal aspect of the data allowed the direct effect of sexual debut on substance use to be tested while accounting for long-term trends in substance use, and stable individual differences in those trends based on early risk and debut timing. Substance use increased over time, and early risk and debut were consistently associated with more substance use. Sexual debut also modestly predicted an increase in substance use after accounting for these effects, however. Taken together, results provide some evidence consistent with each of the potential explanations for the association between sexual debut and substance use across adolescence.

Nonmedical use of prescription drugs during sexual activity as a predictor of condom use among a sample of college students

Objective: To examine the impact of nonmedical use of prescription drugs (NMUPD) during sexual activity on the frequency of condom use among a sample of college students. Participants: Students attending a large Midwestern University (N = 4284) during April 2015. Methods: Retrospective cross-sectional analysis of survey data using logistic regression. Results: Respondents and/or their sexual partners who engaged in NMUPD during sexual activity were significantly less likely to use condoms during 75% or more of past 12-month sexual encounters compared to respondents who had not engaged in lifetime and past 12-month NMUPD. Although not statistically significant, trends suggest that respondents who engaged in NMUPD during sexual activity may be less likely to use condoms than those who engaged in lifetime or past 12-month NMUPD but not during sexual activity. Conclusions: Findings suggest a need for specific strategies for reducing risk behaviors related to prescription drugs and sexual activity.

Outcomes of Early Adolescent Sexual Behavior in Australia: Longitudinal Findings in Young Adulthood

PURPOSE

Limited longitudinal research has examined the adult health and behavioral outcomes associated with early adolescent sexual behavior. This paper examined whether adolescent sexual behavior predicted young adult health and social outcomes within longitudinal cohorts in Victoria, Australia.

METHODS

Adolescents were recruited in 2002 to be state-representative of school students in Victoria, Australia, and resurveyed in 2003 and 2004. The sample responded to a web-based survey as young adults in 2010/2011. Multivariate negative binomial regression models examined the predictive effect of sex by age 15 on young adult outcomes (average age 21) of sexual risk taking, substance use, antisocial behavior, and psychological distress (N = 2,147).

RESULTS

After adjustment for other factors, sex at age 15 or younger (early sex) predicted higher rates of young adult sexual risk taking such as pregnancy, lifetime partners, and sex without using a condom. Early sex also predicted higher rates of young adult substance use (alcohol, tobacco, and/or illicit substance use) and antisocial behavior, but rates of adult psychological distress were not affected.

CONCLUSIONS

This study found that early adolescent sex had unique predictive effects on a range of adverse young adulthood outcomes. Public health policies should synthesize longitudinal data on the risks of early sexual behavior, while advocating evidence-based adolescent sexual health promotion interventions.

Psychopathology is associated with reproductive health risk in European adolescents

Background

Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.

Methods

A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.

Results

Of 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.

Conclusions

These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.

Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence

BACKGROUND AND AIMS

Little is known about transition pathways among heroin users prior to treatment. This study examined the demographic and clinical predictors of transition speed from heroin use, to dependence, to first treatment episode.

METHODS

1149 heroin-dependent participants recruited from opioid agonist treatment clinics in Sydney, Australia, underwent a structured interview. Age of onset (AOO) was collected for heroin use, dependence and treatment-seeking, childhood maltreatment, psychiatric history and other substance dependence. Discrete-time survival analyses modelled years from onset of use to dependence, and from dependence to treatment-seeking, including demographic and clinical covariates.

FINDINGS

Median AOO for first heroin use, dependence and treatment-seeking was 18 years (inter-quartile range, or IQR = 6), 21 years (IQR = 7), and 24 years (IQR = 10) respectively. In adjusted models, younger birth cohorts (vs. born <1960), greater childhood maltreatment and later AAO of first heroin use were associated with more rapid transitions from heroin use to dependence. Living independently, parental violence, and alcohol dependence were associated with slower transitions. Earlier treatment-seeking was associated with younger birth cohorts, having dependent children and later AOO of dependence. Delayed treatment-seeking was associated with <10 years school education, living independently, depression and alcohol dependence.

CONCLUSIONS

In this treatment sample, onset of heroin use occurred during late adolescence, suggesting the need for targeted interventions in mid-adolescence. Transitions to heroin dependence, then treatment-seeking, occurred during early adulthood. Rapid transitions from use to dependence were associated with younger birth cohorts, greater exposure to childhood maltreatment, and later onset of use.

Socio-Demographic, Health and Lifestyle Factors Influencing Age of Sexual Initiation among Adolescents

Behavioural and developmental factors mean that adolescents who initiate sexual intercourse early may be at an increased risk of adverse sexual health outcomes at the time of first sex and later in life. In an Irish context, there is insufficient knowledge about the specific correlates of early sexual initiation. This research explores relationships between contextual socio-demographic, health and lifestyle factors and the timing of first sexual intercourse among 15–17-year-olds in Ireland. Multiple regression analysis was carried out in conjunction with Multiple Imputation using data collected through the 2014 Health Behaviour in School-Aged Children Ireland study on a sample of 879 sexually active adolescents. The socio-demographic and lifestyle factors measured were a stronger predictor of age of sexual initiation among girls than boys. Risk behaviour initiation was significantly related to age of sexual initiation for adolescents, while alcohol use/drunkenness and unhealthy food consumption was significant among girls only. Family support and number of male friends were significant predictors for boys only. The study highlights the need for holistic approaches to sexual health promotion and provides a foundation for the development of alternative strategies and policies aimed at reducing negative health, well-being, educational and economic outcomes.

Early sexual experience and hypertension in US adults: results from the National Health and Nutrition Examination Survey 2001-2016

OBJECTIVES

We examined whether the early initiation of sexual activity is associated with hypertension in US adults, and whether the timing of first menstruation is meaningful in regard of this association. We also assessed the effect modification by ethnicity.

METHODS

Using data from 2001 to 2016 National Health and Nutrition Examination Survey, we included 39 788 women. The association of age at the first sexual intercourse (FSI) and hypertension (SBP ≥ 130 mmHg or DBP ≥ 80 mmHg) was examined using multivariate logistic regression. Effect modification by ethnicity was assessed through a cross-product interaction term between age at FSI and ethnicity.

RESULTS

Among women with FSI after their first menstruation, the odds of hypertension decrease by 20% [95% confidence interval (CI) -27 to -13%] in those who experienced FSI after 19 years of age, relative to those with FSI before 19 years of age. Ethnicity significantly modified the inverse association between age at FSI and hypertension (P value for interaction: 0.0003). Among non-Hispanic white, having FSI aged at least 19 years reduced the odds of hypertension by 34% (95% CI -41 to -27%). Turning to Latina women, the FSI before 19 years of age and before first menstruation resulted to a marked increase in the odds of hypertension [odds ratio = 1.38 (95% CI 1.15-1.65)]. In non-Hispanic black, the age at FSI was not linked to hypertension.

CONCLUSION

The FSI before 19 years of age is associated with hypertension during adulthood in US non-Hispanic white and Hispanic women, but not in non-Hispanic black.

Sociosexual Attitudes, Sociosexual Behaviors, and Alcohol Use

OBJECTIVE

Prior studies have demonstrated an association between high-risk sexual behavior and alcohol use, and there is emerging evidence that dating status and sexual behavior are related to risk for subsequent alcohol use. However, relatively little is known regarding the specific attitudinal or behavioral indicators of alcohol-related risk associated with sexual behavior. The present study distinguished between sociosexual attitudes and sociosexual behaviors, two aspects of sexual risk that may contribute to individual differences in drinking behavior. The primary hypothesis was that sociosexual attitudes would indirectly contribute to heavier drinking through greater engagement in sociosexual behaviors.

METHOD

Study hypotheses were tested using baseline data from an alcohol challenge study in a sample of young adult heavy drinkers (n = 211, 73.7% male). Participants completed surveys assessing typical drinking behavior and both sociosexual attitudes and sociosexual behaviors.

RESULTS

As hypothesized, sociosexual attitudes were indirectly related to heavier alcohol use through greater engagement in sociosexual behavior. However, the relation between sociosexual attitudes and sociosexual behaviors was stronger for men, as were the indirect effects of sociosexual attitudes on drinking behavior.

CONCLUSIONS

Engagement in sociosexual behavior appears to be a risk factor for heavy alcohol use. This highlights the potential utility of targeted alcohol interventions in settings associated with sexual risk, including sexually transmitted infection clinics and college campuses. Future research should explore the mechanisms through which sociosexual behaviors contribute to drinking outcomes to further inform targeted alcohol interventions and to bolster protective factors among those who engage in sociosexual behaviors.

Sexual behaviour in early adolescence: a cross-national comparison of Australian and United States youth

OBJECTIVE

This study used matched samples from schools in the states of Victoria, Australia and Washington, United States (US), to compare sexual behaviour in early adolescence. It was hypothesised that the contrasting dominant policy objectives of harm minimisation in Australia and abstinence in the US would result in state differences for markers of sexual risk, mirroring prior cross-national findings in substance use.

METHOD

A two-stage cluster sampling approach was used to recruit students from the two states. Self-reported sexual behaviour was examined for 1,596 students in annual surveys from Grade 7 in 2002 to Grade 9 in 2004. Prevalence estimates were derived for each measure of sexual behaviour, and comparisons were made between gender groups in each state.

RESULTS

State differences were found for girls' first sex, with significantly more girls in Washington than Victoria having had sex by Grade 7. By Grade 9, significantly more girls in Victoria reported sex in the last year and more sexual partners than girls in Washington. A large proportion of Grade 9 students across both states reported inconsistent contraception use.

CONCLUSIONS

Contradicting the abstinence policy objective, first sex by Grade 7 was more prevalent in Washington than Victoria. Whilst sexual behaviour was more prevalent in Grade 9 in Victoria, the sexually active showed no clear cross-national differences in markers of risk such as contraception use and pregnancy outcomes. Findings demonstrate few cross-national differences in adolescent sexual behaviour despite the different policy contexts of Victoria, Australia and Washington, US.

Differences in sexual behavior, health, and history of child abuse among school students who had and had not engaged in sexual activity by the age of 18 years: a cross-sectional study

Background

Empirical research about late sexual debut and its consequences is limited, and further research is needed.

Objective

To explore how students who had not had intercourse by the age of 18 years differed in terms of sociodemographic factors, physical and psychological health, sexual behavior, and history of sexual abuse from those who had.

Materials and methods

This is a cross-sectional survey involving 3,380 Swedish 18-year-olds. Descriptive analyses were used to investigate different types of sexual behavior. Ordinal data concerning alcohol consumption, self-esteem, sexual and physical abuse, parental relationships, sense of coherence, and health were analyzed, and multiple regression was carried out to identify the most important factors associated with no sexual debut.

Results

Just under a quarter of the adolescents had not had oral, anal, or vaginal sex by the age of 18 years, and they comprised the index group. They were characterized by being more likely to have caring fathers, parents born outside Europe, lower pornography consumption, lower alcohol and tobacco consumption, less antisocial behavior, and above all lower sexual desire (sometimes, adjusted odds ratio [aOR] 3.8; never/seldom, aOR 13.3) and fewer experiences of sexual abuse (aOR 25.5). Family structure and culture matters when it comes to the age of sexual debut.

Conclusion

Adolescents with no sexual debut at 18 years of age seemed to live a more stable and cautious life than more sexual experienced peers, exemplified by fewer antisocial acts, less smoking and alcohol/drug consumption, less sexual desire, and less experience of sexual abuse.

Bidirectional associations between alcohol use and sexual risk-taking behavior from adolescence into young adulthood

Overwhelming evidence indicates that sexual risk-taking behavior and alcohol use are linked, but the nature, strength, and timing of these relations may differ between gender and racial subgroups. These issues were addressed by examining the course and interrelations of both behaviors from adolescence into young adulthood, as well as how these patterns differed between both men and women and between Blacks and Whites. Data came from a representative, community-based sample of 1867 urban participants surveyed up to 5 times over a 15-year period. Although both prospective and trajectory analyses showed that adolescent involvement in one behavior predicted later involvement in the other, most patterns were moderated by gender, race, or both. In general, positive, bidirectional associations were discovered among men and Whites. Among women, adolescent sexual risk-taking behavior positively predicted later drinking, but not vice versa. For Blacks, adolescent alcohol use was inconsistently related to later sexual risk-taking behavior, and adolescent sexual risk-taking negatively predicted later alcohol use. Results suggest that associations between sexual risk-taking behavior and alcohol use are more complex than previously thought and that an adequate understanding of these links must account for both gender and racial differences.

Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life

AIM

This study investigated the relationship between sexual debut before 14 years of age and socio-demographics, sexual experience, health, experience of child abuse and behaviour at 18 years of age.

METHODS

A sample of 3432 Swedish high school seniors completed a survey about sexuality, health and abuse at the age of 18.

RESULTS

Early debut was positively correlated with risky behaviours, such as the number of partners, experience of oral and anal sex, health behaviours, such as smoking, drug and alcohol use, and antisocial behaviour, such as being violent, lying, stealing and running away from home. Girls with an early sexual debut had significantly more experience of sexual abuse. Boys with an early sexual debut were more likely to have a weak sense of coherence, low self-esteem and poor mental health, together with experience of sexual abuse, selling sex and physical abuse. A multiple logistic regression model showed that a number of antisocial acts and health behaviours remained significant, but early sexual debut did not increase the risk of psychiatric symptoms, low self-esteem or low sense of coherence at 18 years of age.

CONCLUSION

Early sexual debut was associated with problematic behaviours during later adolescence, and this vulnerability requires attention from parents and healthcare providers.

Young age at first intercourse and subsequent risk-taking behaviour: An epidemiological study of more than 20,000 Danish men from the general population

Aim: First intercourse at the age of 14 years or younger is usually considered high-risk behaviour for sexually transmitted infections (STIs). It has been linked to other types of risky behaviour in women, while conflicting results have been obtained for men. The aim of the study was to estimate the prevalence of first intercourse at a young age in various birth cohorts of men and to determine any association with later risky behaviour. Methods: We studied 22,979 randomly selected men aged 18–45 years from the Danish general male population who responded to a self-administered questionnaire. Multiple sexual partners over a lifetime, multiple new sexual partners within the past 6 months, intercourse with a commercial sex worker, having an STI, binge drinking and current smoking were considered risky behaviour. Results: First intercourse at the age of 14 years or younger was more prevalent in younger (14%) than in older (10%) birth cohorts and among men with shorter schooling. Young age at sexual debut was associated with a more than twofold increase in the risks for subsequent risky behaviour. Conclusions: More than 10% of Danish men first had sex at an early age, and this was closely related to subsequent risk-taking behaviour.

Correlates of high school freshman girls' reported reasons for engaging in sexual intercourse

BACKGROUND

Intrapersonal and external factors, including social pressures and the desire for acceptance from peers, influence sexual activity among adolescents. This study examined how personal characteristics, risky behaviors, normative beliefs, household factors, and engagement in extracurricular activities were related to high school freshman girls' reported reasons for having sexual intercourse.

METHODS

Baseline data were analyzed from 158 girls enrolled in high school-based abstinence-only-until-marriage education programs during their freshman year. Binary logistic regression was performed to identify factors associated with Pressures and Reasons for Engaging in Sex Scale (PRESS) scores.

RESULTS

Results indicate that girls with high PRESS scores were significantly more likely to have had sex (OR = 4.29), consumed alcohol within the previous year (OR = 6.13), reported strict household rules (OR = 1.49), and thought more girls their age had sex (OR = 1.67).

CONCLUSION

School- and family-based interventions should be developed to encourage and strengthen parent-teen communication within the household and reinforce self-worth and positive self-perceptions among adolescent girls.

Does stress mediate the development of substance use disorders among youth transitioning to young adulthood?

BACKGROUND

Stress is a well-documented factor in the development of addiction. However, no longitudinal studies to date have assessed the role of stress in mediating the development of substance use disorders (SUD). Our previous results have demonstrated that a measure called Transmissible Liability Index (TLI) assessed during pre-adolescent years serves as a significant predictor of risk for substance use disorder among young adults. However, it remains unclear whether life stress mediates the relationship between TLI and SUD, or whether stress predicts SUD.

METHODS

We conducted a longitudinal study involving 191 male subjects to assess whether life stress mediates the relationship between TLI as assessed at age 10-12 and subsequent development of SUD at age 22, after controlling for other relevant factors.

RESULTS

Logistic regression demonstrated that the development of SUD at age 22 was associated with stress at age 19. A path analysis demonstrated that stress at age 19 significantly predicted SUD at age 22. However, stress did not mediate the relationship between the TLI assessed at age 10-12 and SUD in young adulthood.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

These findings confirm that stress plays a role in the development of SUD, but also shows that stress does not mediate the development of SUD. Further studies are warranted to clarify the role of stress in the etiology of SUD.

Predicting high-risk versus higher-risk substance use during late adolescence from early adolescent risk factors using Latent Class Analysis

Much of the existing risk factor literature focuses on identifying predictors of low-levels of substance use versus higher-levels of substance use. In this paper, we explore more nuanced patterns of alcohol, tobacco, and other drug (ATOD) use during late adolescence. Our aims were to: 1) identify subgroups of youth with qualitatively different patterns of ATOD use; and 2) explore whether membership among qualitatively distinct, high-risk classes could be predicted based on early adolescent risk factors. Data came from a selected subsample of the National Longitudinal Survey of Youth (n = 1,689). Predictors were measured when youth were about 12 years old; ATOD use was assessed when youth were aged 17 years. Results showed that adolescent ATOD use is not a homogenous behavior. Four distinct classes of adolescent ATOD users were derived. Each class had a qualitatively distinct and discriminable pattern of ATOD use. Ecological predictors were shown to differentiate between latent classes, with peer factors playing a particularly important role in differentiating between high-risk and higher-risk users. Implications for prevention and limitations are discussed.

The Age of Initiation of Drug Use and Sexual Behavior May Influence Subsequent HIV Risk Behavior: A Systematic Review

Researchers examining injection drug users (IDUs) in drug treatment have been trying for decades to determine the optimal way to intervene to prevent the transmission and spread of human immunodeficiency virus (HIV) in this population. Although efficacious HIV risk reduction interventions are widely available, questions remain about what specific factors are most related to HIV risk behavior and defined as unprotected sexual activity and/or high risk drug use. This review involved an evaluation of the research literature in order to better understand the association between drug use and sexual behavior debut on HIV risk behavior. Findings suggest that drug use debut and sexual behavior debut may be related to subsequent HIV risk behavior. Evidence to date implies that intervening at an earlier age to assist youth to avoid or delay these high risk behaviors may be an additional means of reducing subsequent HIV risk.

Genetic and environmental influences on affiliation with deviant peers during adolescence and early adulthood

Adolescence and early adulthood is a time when peer groups become increasingly influential in the lives of young people. Youths exposed to deviant peers risk susceptibility to externalizing behaviors and related psychopathology. In addition to environmental correlates of deviant peer affiliation, a growing body of evidence has suggested that affiliation with deviant peers is heritable. This study examined the magnitude of genetic and environmental influences on affiliation with deviant peers, changes in the relative importance of these factors, and which of these factors contribute to the stability of affiliation across this critical developmental period using a longitudinal twin study design that assessed same-sex twins (485 monozygotic pairs, 271 dizygotic pairs) at 3 discrete ages: 15, 18, and 21 years of age. Biometric models revealed that genetic influences increased with age. New genetic influences appeared during late adolescence, and no new genetic influences emerged by age 21. Environmental influences shared by sibling pairs decreased with age, while the proportion of nonshared environmental effects unique to each individual remained relatively stable over the course of development. Shared environmental influences were largely age-overlapping, whereas nonshared environmental influences were largely age-specific. In summary, this study found variance in affiliation with deviant peers is explained by shared and nonshared environment effects as well as by genetic influences (46% by age 21), supporting the role of genetically influenced selection factors. The shared environment was almost exclusively responsible for the stability in late adolescence, while genetic influences were primarily responsible for stability in early adulthood.

Modeling the association between sexual maturation, transmissible risk, and peer relationships during childhood and adolescence on development of substance use disorder in young adulthood

BACKGROUND

This prospective study investigated pubertal timing and transmissible risk in relation to affiliation with deviant peers on the development of substance use disorder (SUD).

METHOD

Participants were boys (N = 500) ascertained through proband fathers with (N = 250), and without (N = 250) DSM-III-R lifetime diagnosis of SUD who were prospectively tracked from age 10-12 to 22. Transmissible liability index (TLI), Tanner stage, peer delinquency, and substance use were measured at ages 10-12 and 16. SUD diagnosis during early adulthood was determined.

RESULTS

Structural equation modeling revealed two pathways in which transmissible risk and sexual maturation influenced development of SUD. In the first pathway, transmissible risk was correlated with and prospectively predicted affiliation with deviant peers and substance use presaging SUD. In the second pathway, advanced sexual maturation positively predicted affiliation with deviant peers and substance use, which in turn predicted SUD. However, transmissible risk was not associated with pubertal development.

CONCLUSION

These findings indicate that advanced sexual maturation and transmissible risk constitute unrelated facets of SUD liability; however, both factors bias development toward SUD via affiliation with deviant peers.

SCIENTIFIC SIGNIFICANCE

Youth with advanced sexual maturation and/or transmissible risk for SUD are at higher risk for developing SUD. Additional research is needed to determine if addressing these risk factors will contribute to advancements in SUD prevention.

The relationship between multiple sex partners and anxiety, depression, and substance dependence disorders: a cohort study

Changes in sexual behavior have resulted in longer periods of multiple serial or concurrent relationships. This study investigated the effects of multiple heterosexual partners on mental health, specifically, whether higher numbers of partners were linked to later anxiety, depression, and substance dependency. Data from the Dunedin Multidisciplinary Health and Development Study, a prospective, longitudinal study of a birth cohort born in 1972-1973 in Dunedin, New Zealand were used. The relationship between numbers of sex partners over three age periods (18-20, 21-25, and 26-32 years) and diagnoses of anxiety, depression, and substance dependence disorder at 21, 26, and 32 years were examined, using logistic regression. Interaction by gender was examined. Adjustment was made for prior mental health status. There was no significant association between number of sex partners and later anxiety and depression. Increasing numbers of sex partners were associated with increasing risk of substance dependence disorder at all three ages. The association was stronger for women and remained after adjusting for prior disorder. For women reporting 2.5 or more partners per year, compared to 0-1 partners, the adjusted odd ratios (and 95 % CIs) were 9.6 (4.4-20.9), 7.3 (2.5-21.3), and 17.5 (3.5-88.1) at 21, 26, and 32 years, respectively. Analyses using new cases of these disorders showed similar patterns. This study established a strong association between number of sex partners and later substance disorder, especially for women, which persisted beyond prior substance use and mental health problems more generally. The reasons for this association deserve investigation.

Why does early sexual intercourse predict subsequent maladjustment? Exploring potential familial confounds

OBJECTIVE

Previous studies have found an association between early age at first sexual intercourse and subsequent psychosocial maladjustment. Using a quasi-experimental approach, we examined the extent to which this observed association may be due to familial confounds not explored in prior research.

METHODS

Using a population-based cohort of Swedish adult twins (ages 19-47; N = 12,126), we examined the nature of the association between early sexual intercourse (i.e., first intercourse occurring before age 16) and various outcomes reflecting psychosocial health, including substance use, depression, criminal convictions, and adolescent childbearing. We used two methods--discordant-twin analyses and bivariate twin modeling--to estimate the extent to which genetic and environmental confounds explained observed associations.

RESULTS

Individuals who engaged in early intercourse were at greater risk for most of the adverse psychosocial health outcomes measured in this study. However, twin pairs discordant for engaging in early intercourse did not differ significantly in their risk for psychosocial maladjustment. Our results indicated that early age at first sexual intercourse and subsequent psychosocial maladjustment may be associated because of familial factors shared by twins.

CONCLUSIONS

Early intercourse may be associated with poor psychosocial health largely due to shared familial influences rather than through a direct causal connection. Therefore, effective and efficient interventions should address other risk factors common to early intercourse and poor psychosocial health.

Developmental Precursors of Number of Sexual Partners from Age 16 to 22

This study examines family and child characteristics, parent and peer relationships, and early adolescent behavior as statistical predictors of trajectories of number of sexual partners from mid-adolescence through early adulthood using data from 527 participants in the Child Development Project. Early adolescent developmental antecedents accounted for modest variance in number of sexual partners. Latent growth models revealed that African American race, more advanced pubertal development, lower parental monitoring knowledge, association with more deviant peers, and lower GPA in early adolescence each predicted having more sexual partners at age 16. In addition, non-African American race, lower child IQ, higher parental monitoring knowledge, and lower early adolescent internalizing problems each was associated with a higher rate of growth in number of sexual partners over time at the ages following 16. Latent growth mixture modeling identified subgroups with distinct trajectories of involvement with sexual partners that were associated with family and child characteristics, parent and peer relationships, and behavior in early adolescence.

Sexual risk behavior among early initiators of sexual intercourse

The aim of this study was to examine sexual risk behavior among adolescents in the United States classified as early initiators of sexual intercourse. Secondary analyses were carried out with data from the 2007 Youth Risk Behavior Survey (n=14,041). Only adolescents 16-18 years old who reported being sexually experienced were selected for analyses (n=5315, 48% female). Of sexually experienced adolescents, 11% were classified as early initiators of sexual intercourse. Based on prior research it was expected that early initiators of sexual intercourse would demonstrate increased sexual risk behavior when compared to adolescents who initiated sexual intercourse at later ages and that there would be ethnic and gender differences in risk behavior. Early initiators were significantly more likely to report multiple sex partners in their lifetime and were more likely to drink or use drugs before the last time they had sex. Overall, the findings did not demonstrate differences in sexual risk based on gender and ethnicity.

PTSD contributes to teen and young adult cannabis use disorders

BACKGROUND

Previous studies involving adults suggest that Post Traumatic Stress Disorder (PTSD) increases the prevalence of cannabis use disorders (CUD) (cannabis dependence and cannabis abuse). However, little work with PTSD and CUD has been conducted involving adolescents, despite the fact that CUD typically have their onset during adolescence. This study addresses the effect of PTSD on CUD among teenagers transitioning to young adulthood.

METHOD

The subjects in this ongoing study were the offspring of adult men with a lifetime history of a substance use disorder (SUD) (SUD+probands, N=343) vs those with no lifetime history of a SUD (SUD-probands, N=350). The participants were initially recruited when the index sons of these fathers were 10-12 years of age, and subsequent assessments were conducted at age 12-14, 16, 19, 22, and 25. Other variables examined were an index of behavioral undercontrol associated with future risk for developing SUD, known as the Transmissible Liability Index, or TLI, and affiliation with deviant peers. Multivariate logistic regression and path analyses were conducted.

RESULTS

Of these 693 subjects, 31 subjects were diagnosed with PTSD, and 161 were diagnosed with a CUD. The CUD subjects included 136 male participants and 25 female participants, including 103 (64%) Caucasian participants and 58 (36%) participants of other races. Logistic regression demonstrated that the development of a CUD was associated with deviance of peers (Wald=63.4, p=0.000), the TLI (Wald=28.8, p=0.000), African American race (Wald=14.2, p=0.000), PTSD (Wald=12.7, p=0.000), male gender (Wald=12.0, p=0.001), household SES (Wald=9.2, p=0.002), and being an offspring of a SUD+proband (Wald=6.9, p=0.009). Path analyses demonstrated that PTSD is directly associated with the presence of a CUD and with peer deviance, that higher peer deviance is associated with the presence of a CUD, and that PTSD mediated the association between peer deviance and CUD.

CONCLUSIONS

These findings suggest that PTSD contributes to the etiology of CUD among teenagers making the transition to young adulthood beyond the effects of deviant peers, the TLI (Transmissible Liability Index, a measure of risk for SUD), and demographic factors.

Affect and sexual behavior in the transition to university

This research applied a lifespan developmental framework to the study of sexual behavior among late adolescents by examining monthly covariations of penetrative and oral sex with positive and negative affect across the first year of university. Participants were 177 Canadian students who completed baseline questionnaires, followed by six monthly, web-based questionnaires assessing sexual behaviors and affect. Multilevel analyses revealed an average positive relation between oral sex and positive affect. Of six variables, five predicted individual differences in covariation between sex and affect: psychosocial maturity (immature and semi-mature status), attitudes toward sex, prior sexual experience, and living situation. During months when participants reported sexual behavior, psychosocially mature students reported more positive affect than did less mature students; students with more permissive attitudes reported more positive affect than did students with less permissive attitudes; students with no penetrative sexual experience reported more positive affect than students who had penetrative sexual experience; and living away from parents was associated with less negative affect. Implications for further study of sexual behavior from a developmental perspective are discussed.

A tale of two systems: co-occurring mental health and substance abuse disorders treatment for adolescents

Co-occurring disorders present serious challenges to traditional mental health and substance abuse treatment systems. Among adolescents in need of behavioral health services, co-occurring disorders are highly prevalent and difficult to treat. Without effective intervention, youth with co-occurring disorders are at increased risk of serious medical and legal problems, incarceration, suicide, school difficulties and dropout, unemployment, and poor interpersonal relationships. In general, current service systems are inadequately prepared to meet this need due to a variety of clinical, administrative, financial, and policy barriers. This article presents an overview of co-occurring disorders among adolescents, highlights general considerations for co-occurring disorders treatment, reviews selected treatment models and outcomes, and discusses recommendations and best practice strategies.

Husbands' SUD is associated with higher levels of co-occurring but not non-co-occurring psychiatric disorders among their wives

OBJECTIVE

Substance use among husbands has been shown to be associated with higher rates of substance use and of psychiatric symptoms among their wives. However, substance use disorders (SUD) and psychiatric disorders (as opposed to substance use or psychiatric symptoms) are rarely rigorously assessed among large samples of couples, so it is unclear whether SUD among husbands are associated with SUD among their wives, and whether the wives also display a higher prevalence of co-occurring or non-co-occurring psychiatric disorders. We compared the level of SUD, of co-occurring (with SUD) psychiatric disorders, and of non-co-occurring psychiatric diagnoses among the wives of males with SUDs vs among the wives of males without SUDs. We hypothesized that the presence of SUDs among males would be associated with a higher level of SUDs, of co-occurring psychiatric disorders, and of non-co-occurring psychiatric disorders in their wives.

METHOD

The subjects in this study were the spouses of adult men with a lifetime history of an SUD (SUD+ husbands, N=342) vs those with no lifetime history of an SUD (SUD- husbands, N=350). These subjects were recruited for participation in a longitudinal project designed to elucidate the etiology of substance use disorders.

RESULTS

Co-occurring SUDs were five times more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands (10.2% vs 2.0%, chi-square=19.7, p=0.000). SUD/depressive disorder and SUD/anxiety disorder were both seven times more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands (19.4% vs 4.7%, chi-square=45.8, p=0.000; 14.3% vs 2.0%, chi-square=34.5, p=0.000). In contrast, non-co-occurring depressive disorders and non-co-occurring anxiety disorders were not more common among the wives of the SUD+ husbands than among the SUD- husbands.

CONCLUSIONS

These findings demonstrate that SUD and co-occurring psychiatric disorders (with SUD) are more common among the spouses of SUD+ husbands than among the spouses of SUD- husbands, but non-co-occurring ("pure") psychiatric disorders are not more common among the spouses of the SUD+ husbands.

Early and adverse experiences with sex and alcohol are associated with adolescent drinking before and during pregnancy

The goal of this study was to examine the effects of early and adverse experiences with sex and alcohol on adolescent drinking the year before and during pregnancy. Pregnant adolescents, recruited at an outpatient prenatal clinic, were interviewed about their substance use. A subsample was asked about their first sexual experiences. Associations among early experiences with alcohol and sex and drinking before and during pregnancy were examined. Early age at first alcoholic drink predicted problem alcohol use before pregnancy and drinking during pregnancy. Coercive first coitus was not associated with alcohol use, but drinking during first coitus predicted problem alcohol use before pregnancy as well as drinking during the first trimester of pregnancy. In sum, early use of alcohol and use of alcohol during first coitus may be risk factors for problematic alcohol use before pregnancy and during pregnancy among childbearing teenagers. Implications for the health of adolescent mothers and their offspring are discussed.