Marijuana use and HIV risk among adolescent offenders: the moderating effect of age

Association Between Marijuana Use and Condom Use: A Meta-Analysis of Between-Subject Event-Based Studies

OBJECTIVE

With the current public health burden of sexually transmitted infections, it is important to identify factors affecting condom use. The association between marijuana use and condom use is especially important because of the increasing number of U.S. states legalizing marijuana; however, relevant research findings are mixed. The goal of this study was to perform a meta-analysis assessing the relationship between marijuana and condom use at instances of sexual intercourse.

METHOD

A systematic search of four databases was performed. Data were extracted and pooled estimates were calculated using random-effects models with inverse variance weighting. Heterogeneity was evaluated using the Cochran Q chi-square test.

RESULTS

Eleven studies were included. There was a statistically significant relationship between marijuana and condom use in the overall pooled analysis (odds ratio [OR] = 0.71, 95% CI [0.56, 0.89]), and studies were homogeneous, I² = 12%, χ²(10) = 11.37, p = .33. Stratified analyses showed that although the pooled OR was not significant for adults (OR = 0.92, 95% CI [0.64, 1.33]), there was a significant relationship between condom use and marijuana use for adolescents (OR = 0.62, 95% CI [0.47, 0.82]).

CONCLUSIONS

This meta-analysis found that the odds of condom use were lower for those who used marijuana around the time of intercourse than for those who did not, with this effect only significant for adolescents in a subgroup analysis. As the adolescent populations in this analysis were not representative of a general population of adolescents, future research should focus not only on those considered high risk.

Heterogeneity in the Relationship of Substance Use to Risky Sexual Behavior Among Justice-Involved Youth: A Regression Mixture Modeling Approach

Justice-involved adolescents engage in high levels of risky sexual behavior and substance use, and understanding potential relationships among these constructs is important for effective HIV/STI prevention. A regression mixture modeling approach was used to determine whether subgroups could be identified based on the regression of two indicators of sexual risk (condom use and frequency of intercourse) on three measures of substance use (alcohol, marijuana and hard drugs). Three classes were observed among n = 596 adolescents on probation: none of the substances predicted outcomes for approximately 18 % of the sample; alcohol and marijuana use were predictive for approximately 59 % of the sample, and marijuana use and hard drug use were predictive in approximately 23 % of the sample. Demographic, individual difference, and additional sexual and substance use risk variables were examined in relation to class membership. Findings are discussed in terms of understanding profiles of risk behavior among at-risk youth.

The relationship between child maltreatment and substance abuse treatment outcomes among emerging adults and adolescents

Emerging adulthood is the period of greatest risk for problematic substance use. The primary aim of the current study was to examine the relationship between a broad measure of child maltreatment and several key outcomes for a large clinical sample of emerging adults (n = 858) and adolescents (n = 2,697). The secondary aim was to examine the extent to which the relationship between child maltreatment and treatment outcomes differed between emerging adults and adolescents. Multilevel latent growth curve analyses revealed emerging adults and adolescents who experienced child maltreatment reported significantly greater reductions over time on several treatment outcomes (e.g., substance use, substance-related problems, and emotional problems). Overall, analyses did not support differential relationships between child maltreatment and changes over time in these substance use disorder treatment outcomes for emerging adults and adolescents. The one exception was that although emerging adults with child maltreatment did reduce their HIV risk over time, their improvements were not as great as were the improvements in HIV risk reported by adolescents who had experienced child maltreatment.

Is cannabis use associated with HIV drug and sex risk behaviors among Russian HIV-infected risky drinkers?

BACKGROUND

While cannabis use has been associated with increased HIV drug and sex risk behaviors, its impact on risk behaviors among HIV-infected individuals has not yet been established.

METHODS

This study examined data from Russian HIV-infected risky drinkers enrolled in a randomized controlled trial of a behavioral intervention. The primary independent variable was cannabis use (current [past 30 days use], recent past [use but not in past 30 days] vs. no past year use). Primary outcomes were needle sharing and number of unprotected sexual episodes. Secondary outcomes were drug injection, number of injections, and multiple sex partners. Longitudinal regression analyses controlled for age, gender, marital status, education, CD4 count, ART use, risky alcohol use, other drug use, depressive symptoms and randomization group.

RESULTS

Cannabis use was common with 20% current and 26% recent past use at baseline. In longitudinal analyses current, but not recent past, cannabis consumption was significantly associated with needle sharing (AOR 2.23 current vs. none, 95% CI: 1.46, 3.36), drug injection (AOR 3.05 current vs. none, 95% CI: 2.06, 4.53) and number of injections (adjusted IRR 1.50 current vs. none, 95% CI: 1.19, 1.89). Current and recent past cannabis use were significantly associated with multiple sex partners but not with number of unprotected sex episodes.

CONCLUSION

Cannabis use was associated with drug and sex risk behaviors among Russian HIV-infected risky drinkers. Inquiry about cannabis use among HIV-infected patients may reveal a patient group at higher risk for sex and drug use behaviors that lead to HIV transmission.

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.

Gender Differences in Drug Use, Sexually Transmitted Diseases, and Risky Sexual Behavior among Arrested Youths

Data were collected on arrested youths processed at a centralized intake facility, including youths released back to the community and those placed in secure detention. This paper reports the results of a test of a structural model involving newly arrested male and female youths' sexually transmitted diseases (STD) test results, urine analysis results for recent cocaine and marijuana use, and self-reported engaging in risky sexual behavior. The across gender, multiple group model involved: (1) a confirmatory factor analysis of these variables, reflecting a latent variable labeled Risk, (2) a regression of Risk on the youths' age, and (3) an examination of the covariance between Risk and the youths' race and seriousness of arrest charge. Results indicate the youths' STD status, drug use, and reported risky sexual behavior are interrelated phenomena, similarly experienced across gender. Age was the only correlate of Risk status that demonstrated a significant gender group difference. The youths' race and seriousness of arrest charges did not significantly affect Risk, regardless of gender. Research and policy implications of the findings are discussed.

Drug use and sexually transmitted diseases among female and male arrested youths

Knowledge of the rates and correlates of juvenile offenders' sexually transmitted diseases (STD) has been limited to samples of incarcerated youths comprised mostly of males. Data collected on 442 female and 506 male youths processed at a centralized intake facility enabled us to study this important public health problem among a sample of juvenile offenders at the front end of the justice system. Female-male, multi-group latent class analyses identified two subgroups, High Risk and Lower Risk, of youths described by a latent construct of risk based on drug test results, STD test results, and a classification for the seriousness of arrest charge. The results found: (1) a similar classification distinguished High Risk and Lower Risk male and female youths, and (2) important gender group differences in sexual risk related factors (e.g., substance use during sexual encounters). Among the youths in this sample who tested positive for an STD, 66% of the girls and 57% of the boys were released back into the community after arrest. Overall, our findings raise serious public health and social welfare concerns, for both the youths and the community. Prevention and intervention implications of these findings are also discussed.

Sexually-related expectancies for alcohol use and marijuana use among juvenile detainees

This study is focused on sexually-related expectancies for substance use among juvenile detainees. Over a 6 month period, 272 juveniles recruited from a short-term detention facility completed measures assessing sexually-related expectancies in relation to alcohol use and marijuana use as well as measures assessing their actual use of these substances. Repeated measures analyses of sexual risk expectancy measures indicated that the sample as a whole, and older respondents in particular, expected more sexual risk in relation to using alcohol than in relation to using marijuana. Repeated measures analyses of sexual enhancement expectancy measures indicated that African-American and younger respondents expected more sexual enhancement from using marijuana than from using alcohol. Logistic regression analyses indicated that expectancies for sexual enhancement from alcohol use, and expectancies for sexual enhancement from marijuana use, were respectively associated with the use of these substances in a recent sexual incident. Limitations of the study are discussed.

A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community

OBJECTIVES

Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections.

METHODS

At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10 to 18 years. Participants were reinterviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and 2 participants who self-identified their race as "other."

RESULTS

More than 60% of youth had engaged in > or = 10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in > or = 10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics.

CONCLUSIONS

Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth--primary care, education, mental health, and juvenile justice--can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.

A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community

OBJECTIVES

Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections.

METHODS

At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10 to 18 years. Participants were reinterviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and 2 participants who self-identified their race as "other."

RESULTS

More than 60% of youth had engaged in > or = 10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in > or = 10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics.

CONCLUSIONS

Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth--primary care, education, mental health, and juvenile justice--can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.

Risky sexual behavior in relation to marijuana and alcohol use among African-American, male adolescent detainees and their female partners

This study examined substance use and risky sexual behavior (RSB) in a specific incident among 210 African-American, male adolescents who were being held in juvenile detention facilities. The participants completed a questionnaire that included four measures of substance use (i.e. alcohol and marijuana use by the participants and their partners), two measures of RSB (i.e. no prior discussion of sexual risks, condom nonuse) and six measures of potential correlates of sexual risk. Within-subjects analyses indicated participants and their partners were more likely to have used marijuana than alcohol during the sexual incident. Bivariate analyses indicated the participants' marijuana use was associated with no prior discussion of sexual risks and condom nonuse, and the partners' marijuana use was associated with no prior discussion of sexual risks. The association between participant marijuana use and condom nonuse, and the association between partner marijuana use and no prior discussion of sexual risks, also emerged in multivariate analyses that included the substance use variables and potential covariates. These findings suggest that marijuana use should be addressed in interventions that aim to prevent sexually transmitted diseases and unwanted pregnancies among adolescent detainees.