Patterns of initiation of sex and drug-related activities among urban low-income African-American adolescents

Evaluating Teach One Reach One-An STI/HIV Risk-Reduction Intervention to Enhance Adult-Youth Communication About Sex and Reduce the Burden of HIV/STI

PURPOSE

Parents and caregivers play an important role in sexual socialization of youth, often serving as the primary source of information about sex. For African American rural youth who experience disparate rates of HIV/sexually transmitted infection, improving caregiver-youth communication about sexual topics may help to reduce risky behaviors. This study assessed the impact of an intervention to improve sexual topic communication.

DESIGN

A Preintervention-postintervention, quasi-experimental, controlled, and community-based trial.

SETTING

Intervention was in 2 rural North Carolina counties with comparison group in 3 adjacent counties.

SUBJECTS

Participants (n = 249) were parents, caregivers, or parental figures for African American youth aged 10 to 14.

INTERVENTION

Twelve-session curriculum for participating dyads.

MEASURES

Audio computer-assisted self-interview to assess changes at 9 months from baseline in communication about general and sensitive sex topics and overall communication about sex.

ANALYSIS

Multivariable models were used to examine the differences between the changes in mean of scores for intervention and comparison groups.

RESULTS

Statistically significant differences in changes in mean scores for communication about general sex topics ( P < .0001), communication about sensitive sex topics ( P < .0001), and overall communication about sex ( P < .0001) existed. Differences in change in mean scores remained significant after adjusting baseline scores and other variables in the multivariate models.

CONCLUSIONS

In Teach One Reach One intervention, adult participants reported improved communication about sex, an important element to support risk reduction among youth in high-prevalence areas.

Early Adolescent Trajectories of Impulsiveness and Sensation Seeking in Children of Fathers with Histories of Alcohol and Other Substance Use Disorders

BACKGROUND

Problem substance use often begins in adolescence. This vulnerability likely stems, at least partially, from relatively rapid increases in sensation seeking occurring in early to mid-adolescence and more gradual improvements in impulse control occurring through later adolescence. Better understanding how these processes develop in high-risk youth may lead to enhanced substance use disorder treatment and prevention strategies.

METHODS

We characterized trajectories of self-reported impulsivity and sensation seeking in 305 FH+ youths who at minimum had a father with a history of alcohol or other drug use disorders and 81 youths with no family histories of substance use disorders (FH-). Assessments started at ages 10 to 12 and continued at 6-month intervals for up to 42 months. In addition, a subset of 58 FH+ youths who began alcohol or other drug use before age 15 (FH+ Users) were compared to 58 FH+ propensity-matched adolescents who did not initiate substance use before age 15 (FH+ Non-Users).

RESULTS

Compared to FH- youths at preadolescence, FH+ youths reported higher general impulsivity and higher impulsivity related to poor planning and attention. Over time, there were no differential effects of FH status on changes in impulsivity or sensation seeking across adolescence. FH+ Users had smaller decreases in general impulsivity and impulsivity related to restlessness and fidgeting across adolescence than FH+ Non-Users. FH+ Users also had greater increases in sensation seeking across adolescence than FH+ Non-Users.

CONCLUSIONS

Increased impulsivity in FH+ youths may make them less able to regulate sensation seeking drives that peak in adolescence, which may contribute to their high risk for developing substance use disorders. Additionally, FH+ adolescents who initiate early use may be at increased risk in part due to increased impulsivity coupled with greater increases in sensation seeking.

Adolescent Predictors of Generalized Health Risk in Young Adulthood: A 10-Year Longitudinal Assessment

We conducted a prospective examination of multiple adolescent predictors of generalized health risk in early adulthood. Data were used from 3,392 members of a longitudinal cohort surveyed at ages 13 and 23. A measure of generalized risk was constructed using confirmatory factor analysis to represent shared variance among substance use, sexual risk, and victimization. Multiple regression analysis indicated several robust sociodemographic, behavioral, and environmental early predictors of generalized adult risk, including gender, age, race, not coming from a nuclear family, engaging in smoking and deviant behavior as an adolescent, having poor grades in high school, alcohol and cigarette use by an adult important to the adolescent, and being offered substances as an adolescent. Results support the existence of an underlying risk construct in early adulthood, the importance of early adolescent deviance and substance use exposure in predicting risk, and the use of early comprehensive interventions that prevent several risks simultaneously.

Relationships Between Future Orientation, Impulsive Sensation Seeking, and Risk Behavior Among Adjudicated Adolescents

Because of high levels of risk behavior, adjudicated adolescents are at high risk for negative health outcomes such as nicotine and drug addiction and sexually transmitted diseases. The goal of this article is to examine relationships between future orientation and impulsive-sensation-seeking personality constructs to risk behaviors among 300 adjudicated adolescents. Significant relationships between impulsive sensation seeking and future orientation were found for several risk behaviors. Individuals with more positive future orientation were less likely to use marijuana, hard drugs, alcohol during sex, had fewer alcohol problems, had lower levels of alcohol frequency and quantity of use, and perceived greater risks associated with such behaviors. Higher impulsivity reliably predicted alcohol problems, alcohol use, condom use, and cigarette smoking.

Parent and youth dopamine D4 receptor genotypes moderate multilevel contextual effects on rural African American youth's risk behavior

The present investigation extends research on Gene × Environment interactions and youth risk behavior by linking multilevel contextual factors, such as community disadvantage and protective parenting practices, to both parental and youth dopamine D4 receptor (DRD4) genotypes. We expected community disadvantage to influence youth risk behavior via a series of indirect effects involving protective parenting and youth's planful future orientation when both parents' and youth's DRD4 status was considered. Genetic moderation processes also were tested to determine whether they conformed to a diathesis-stress or a differential susceptibility model. Hypotheses were investigated with data from 361 rural African American youth and their parents assessed 3 times when youth were ages 16 to 19. Community disadvantage interacted with parental DRD4 status to predict low levels of protective parenting. Protective parenting, in turn, interacted with youth DRD4 status to forecast increases in youth's planful future orientations, a proximal influence on changes in risk behavior. The Parental DRD4 × Community Disadvantage interaction, but not youth DRD4 × Protective Parenting, conformed to a differential susceptibility model. Indirect effect analyses revealed a significant indirect path linking community disadvantage to youth risk behavior through a series of multilevel Gene × Environment interaction processes.

On the relationships between commercial sexual exploitation/prostitution, substance dependency, and delinquency in youthful offenders

Researchers have consistently linked commercial sexual exploitation (CSE) of youth and involvement in prostitution with substance dependency and delinquency. Yet, important questions remain regarding the directionality and mechanisms driving this association. Utilizing a sample of 114 CSE/prostituted youth participating in the Pathways to Desistance study-a longitudinal investigation of the transition from adolescence to adulthood among serious adolescent offenders-the current study examined key criminal career parameters of CSE/prostitution including age of onset and rate of recurrence. Additionally, structural equation modeling (SEM) was used to explore concurrent associations and causal links between CSE/prostitution and drug involvement. Findings show a general sequential pattern of the ages of onset with substance use and selling drugs occurring prior to CSE/prostitution, evidence that a small group with chronic CSE/prostitution account for the majority of CSE/prostitution occurrences, and high rates of repeated CSE/prostitution. SEM results suggest CSE/prostituted youth persist in drug involvement from year to year but infrequently experience perpetuation of CSE/prostitution from year to year. Concurrent associations between CSE/prostitution and drug involvement were found across the length of the study. Additionally, drug involvement at one year was linked to CSE/prostitution during the subsequent year during early years of the study.

Culturally sensitive risk behavior prevention programs for African American adolescents: a systematic analysis

The current review conducted a systematic assessment of culturally sensitive risk prevention programs for African American adolescents. Prevention programs meeting the inclusion and exclusion criteria were evaluated across several domains: (1) theoretical orientation and foundation; (2) methodological rigor; (3) level of cultural integration; (4) program target or domain (e.g., schools, communities, families); (5) outcome change level assessed (e.g., addressing change in beliefs/values or behaviors); and (6) program effects on risk behaviors. Thirteen studies (N = 13) with adolescent participants ranging from 10 to 18 years were identified and evaluated. Analyses suggested that more effective culturally sensitive risk prevention programs included the following: (1) a clearly articulated theoretical orientation, which utilized both universal (e.g., behavioral theories) and culturally specific (e.g., Africultural theories) frameworks; (2) a rigorous methodological design (e.g., inclusion of control group, utilization of program manuals, valid and reliable study measures); (3) an integration of culture at multiple levels (e.g., accessibility, delivery, and content) of programming; (4) consideration of the influence of multiple contexts and domains (e.g., family, community, school); (5) multiple behavior change outcomes (e.g., behaviors, relationships, values); and (6) sustained program effects over time. Recommendations for increasing the effectiveness and efficacy of culturally sensitive prevention programs are discussed.

Processes linking parents' and adolescents' religiousness and adolescent substance use: monitoring and self-control

Empirical evidence suggests that religiousness is related negatively to adolescent substance use; yet, we know little about how such protective effects might occur. The current study examined whether parents' and adolescents' religiousness are associated positively with parental, religious, and self-monitoring, which in turn are related to higher self-control, thereby related to lower adolescent substance use. Participants were 220 adolescents (45 % female) who were interviewed at ages 10-16 and again 2.4 years later. Structural equation modeling analyses suggested that higher adolescents' religiousness at Time 1 was related to lower substance use at Time 2 indirectly through religious monitoring, self-monitoring, and self-control. Higher parents' religiousness at Time 1 was associated with higher parental monitoring at Time 2, which in turn was related to lower adolescent substance use at Time 2 directly and indirectly through higher adolescent self-control. The results illustrate that adolescents with high awareness of being monitored by God are likely to show high self-control abilities and, consequently, low substance use. The findings further suggest that adolescents' religiousness as well as their religious environments (e.g., familial context) can facilitate desirable developmental outcomes.

The relationship between substance use and sexual health among African-American female adolescents with a history of seeking mental health services

BACKGROUND

This study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services.

METHODS

Participants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14-22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs.

FINDINGS

Substance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior.

CONCLUSIONS

Results suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.

Forced intercourse, individual and family context, and risky sexual behavior among adolescent girls

PURPOSE

This study tested the hypothesis that individual and family factors associated with adolescent risky sexual behavior (RSB) operate differently in their relationship to RSB among girls who have experienced forced sexual intercourse (FSI), as compared to those girls who have not.

METHODS

Data were collected from 3,863 eighth-grade girls from a larger statewide sample. Different subgroups of participants received different sets of questions, so 655-2,548 students were included in each analysis. Multilevel modeling was used to examine relationships of individual (social negotiation skills, personal safety, depression, and sensation-seeking personality) and family factors (sibling deviance, parental monitoring, and quality of family relationships) to RSB. FSI was examined as a predictor of RSB and as a moderator of the relationship between individual and family variables and sexual risk.

RESULTS

In the case of individual predictors, social negotiation skills were associated with lower RSB for all girls, but these skills had a stronger relationship to RSB among girls who had experienced FSI. Depression and sensation-seeking tendencies had small positive relationships to RSB for all girls. In the case of family predictors, for girls without a history of FSI, parental monitoring was associated with lower RSB. However, among girls who had experienced FSI, parental monitoring was not significantly related to RSB, but sibling deviance was associated with lower RSB.

CONCLUSIONS

Results suggest that social negotiation skills and parental monitoring may warrant further attention in research and intervention.

Predictors of substance use among black urban adolescents with asthma: a longitudinal assessment

The physical and psychological consequences of asthma, a chronic respiratory disease disproportionately affecting black urban adolescents, may be amplified by substance use, yet studies have not assessed rates or predictors of substance use in this at-risk population. Therefore, this study examined rates of substance use and mental health/ asthma-related predictors of use among 110 black urban adolescents with asthma. Participants completed study questionnaires at baseline and 11 to 14 months post baseline. The mean age of the sample was 15.8 (SD +/- 1.85), 66 (60%) were female, and 82 (74%) of the participants had intermittent/mild persistent asthma. At follow-up, 37 (34%) participants endorsed using at least 1 substance in the past 30 days, including cannabis (n = 18 [16%]), cigarettes (n = 13 [12%]), and/or alcohol (n = 23 [21%]). The substance use variables were dichotomized for analyses (1 = use, 0 = nonuse). Logistic regression results indicated that older age (odds ratio [OR], 1.83; p < .05) was significantly associated with cigarette use and had a marginally significant (p = .06) association with cannabis use at follow-up. Increased anxiety symptoms were significantly associated with alcohol use (OR, 1.12; p < .05) and cannabis use (OR, 0.90; p < .05) at follow-up. Targeting adolescents earlier, those with anxiety difficulties, and those who report early substance initiation may improve prevention/intervention efforts for substance use reduction in this population. Asthma-related factors were not significantly associated with substance use. Future studies should assess the relationship between other asthma-related variables, as well as social and community factors, and substance use among black adolescents with asthma.

Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis

Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.

A longitudinal examination of risky sexual behaviors among Canadian and Italian adolescents: Considering individual, parental, and friend characteristics

In this study, two longitudinal models of early adolescent risky sexual behaviors (RSB) were compared using a pooled sample of 267 Canadian and Italian adolescents (55% females; 53% Canadians) assessed yearly from grade 8 to 10. We focused on parenting practices (monitoring, control, limit setting), adolescent problem behaviors (antisocial behaviors, substance use) and their friends' deviance (antisocial behaviors, substance use) as predictors of condom use frequency and lifetime number of sexual partners. The socialization model postulates that youths' problem behaviors and RSB are behaviors learned within the friendship network where deviancy training can occur. The selection model posits that delinquent youth tend to affiliate with each other, and that RSB is one of many behaviors that can form the basis of selection. Using structural equation modeling, this study showed that the socialization model was the most accurate to explain the emergence of RSB. A full mediation of parenting practices, passing through deviant friends and youths' problem behavior, was observed for condom use. The same process applied to number of sexual partners, but a direct effect for parenting practices was also found.

Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum

CONTEXT

Although a number of interventions are effective at reducing risky adolescent sexual behavior, it may be possible to make them even more effective by addressing adolescents' approaches to risk-taking.

METHODS

Schools were assigned to teach one of three curricula in a quasi-experimental intervention study: the school's standard pregnancy and HIV prevention curriculum; the Reducing the Risk curriculum; or a modified Reducing the Risk curriculum, adapted for high sensation seekers and impulsive decision makers. A sample of 1,944 students from 17 schools was surveyed at three time points between 1995 and 1997. Mixed models regression and logistic regression were used to examine the difference in impact among curricula.

RESULTS

Differences in the impact of the original and modified Reducing the Risk interventions were not significant for the total sample or for high sensation seekers and impulsive decision makers separately. Students from both intervention groups demonstrated short-term improvements in knowledge; students who received their schools' standard curriculum were significantly more likely than those assigned to either intervention to have initiated sexual intercourse by the third time point (odds ratio, 2.4).

CONCLUSION

More work is necessary to understand the best ways to design classroom messages that will be effective in reducing the risk behaviors of high sensation seekers and impulsive decision makers.

Living without a strong father figure: a context for teen mothers' experience of having become sexually active

Family dynamics have often been considered central to understanding high risk behavior among adolescents. During a phenomenological study of their experiences of having become sexually active, ten teen mothers shared their personal stories. Some of the information shared represented features of the teens' life-world, or the context of their experiences. One feature of the life-world the participants described, living without a strong father figure, was seen as an important general context for these teens' experiences of having become sexually active. While there is evidence in the literature that growing up with an absent father is related to early onset of sexual activity, the experience of a father who might be present but not emotionally connected to his daughter has not been well explored. Therefore, this research offers a richer and deeper perspective on teen sexual behavior.

The reliability and validity of the Brief Sensation Seeking Scale (BSSS-8) with young adult Latino workers: implications for tobacco and alcohol disparity research

AIM

This study investigated the reliability and validity of the Brief Sensation Seeking Scale (BSSS-8) in both English and Spanish with Latinos, the fastest-growing minority group in the United States, and the correlation between sensation seeking and tobacco and alcohol use.

DESIGN

Cross-sectional survey, computer-assisted telephone interviews (CATI).

SETTING

Dallas and Houston, Texas.

PARTICIPANTS

A total of 789 Latinos participated in this study. Participants were currently in the work-force, not enrolled in college, and between the ages of 18 and 30 years.

MEASUREMENTS

Participants completed a self-report questionnaire (in either English or Spanish) consisting of items measuring tobacco and alcohol use as well as the eight-item Brief Sensation Seeking Scale.

FINDINGS AND CONCLUSIONS

For English-speaking Latino participants, the BSSS factor structure was second-order unidimensional and correlated positively with life-time cigarette use, intention to smoke in the future and amount and frequency of alcohol consumption. For Spanish-speaking Latino participants, a four-subfactor solution for the BSSS provided the best fit to the data although correlations between the four subscales and cigarette use were small.

Reliability and validity of the youth version of the Balloon Analogue Risk Task (BART-Y) in the assessment of risk-taking behavior among inner-city adolescents

This study examined the reliability and validity of the youth version of the Balloon Analogue Risk Task (BART-Y) for assessing adolescent risk behaviors among a sample of 98 inner-city African American adolescents (M age = 14.8, SD = 1.5). In addition to a relation with sensation seeking, BART-Y responding evidenced a significant relation with a composite of risk behaviors across substance use, sexual behavior, delinquency, and health domains. BART-Y responding also explained unique variance in a composite of these risk behaviors above and beyond demographic variables and risk-related personality constructs, including sensation seeking and impulsivity.

Explaining associations between adolescent substance use and condom use

PURPOSE

This study examined different explanations for associations between adolescent substance use and lower condom use, in terms of the event-specific effects of alcohol or drugs, psychosocial factors, and sexual behaviors (intercourse frequency, greater number of partners and pill use).

METHODS

Pupils from 25 schools in Scotland, UK provided data on use of alcohol, tobacco, cannabis and psychosocial factors at ages 14 and 16 years; and sexual behaviors at age 16 years. Logistic regression was used to examine associations between substance use and condom use in those reporting intercourse more than once (n = 1322), adjusting for explanatory variables.

RESULTS

Regular use of any of the three substances at age 14 or 16 was associated with lower condom use at age 16, adjusting for gender and social background. The greatest attenuation of the substance use odds ratios was achieved by adjusting for all behaviors and psychosocial factors. This finding applied to different substance use groups, although cigarette-only and alcohol-only groups at age 16 differed in the relative importance of being "drunk or stoned" to other factors explaining condom use.

CONCLUSIONS

Among adolescent substance users, being "drunk or stoned" at intercourse was only one factor related to not using condoms. Psychosocial factors (including attitudes to sexual risks and peer sexual norms) and having more sexual partners also explained substance users' condom use, with lesser effects due to greater intercourse frequency and pill use. Multiple explanations for substance use/condom use associations may guide counseling and education services.

Associations between substance use and sexual risk among very young men who have sex with men

OBJECTIVE

To determine if an association exists in young men who have sex with men (MSM) between being under the influence of alcohol or drugs during sex and participation in sexual behaviors which increase the risk of human immunodeficiency virus (HIV).

STUDY DESIGN

A total of 3492 young MSM were interviewed through the Young Men's Survey, an anonymous, cross-sectional, multisite, venue-based survey conducted from 1994 through 1998 at 194 public venues frequented by MSM aged 15 to 22 years in 7 US cities.

RESULTS

The majority of young MSM reported both receptive and insertive anal intercourse, and of these, approximately half reported not using condoms. Report of unprotected receptive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (adjusted odds ratio [AOR]=1.5; 95% confidence interval [CI]=1.2-1.8), cocaine (AOR=1.6; 95% CI=1.1-2.2), amphetamines (AOR=1.5; 95% CI=1.1-2.0) or marijuana during sex (AOR=1.3; 95% CI=1.1-1.6). Report of unprotected insertive anal intercourse at least once in the prior 6 months was associated with being under the influence of alcohol (AOR=1.2; 95% CI=1.0-1.5), cocaine (AOR=1.5; 95% CI=1.1-2.0) or amphetamines (AOR=1.9; 95% CI=1.4-2.6).

CONCLUSIONS

HIV prevention strategies for young MSM need to incorporate substance use risk reduction.

Adolescence, schizophrenia and drug abuse: a window of vulnerability

OBJECTIVE

To discuss the neurobiological and psychosocial developmental factors in adolescence contributing to simultaneous onset and co-occurrence of psychosis and substance use disorders.

METHOD

A review of the literature.

RESULTS

Adolescence is a period with specific psychosocial challenges and specific changes in the brain that increase the probability of the onset of both psychosis and substance abuse, in predisposed people. In vulnerable adolescents it is proposed that an excessive pruning of dopaminergic neurones leads to mesocortical hypofrontality causing anhedonia and dysphoria. At the same time, anhedonia and dysphoria are important risk factors for the development of substance abuse. In turn, hypofrontality leads to a reduction in mesocortical feedback inhibition of the mesolimbic system resulting in aberrant salience and positive symptoms. Finally, the development of aberrant salience plays a role in both psychoses and craving.

CONCLUSION

Attention should be paid to the interaction of drug abuse and schizophrenia and an integrated treatment is needed. Dysphoria and anhedonia in schizophrenic adolescents are important factors in treatment with antipsychotic medication, both in terms of patient satisfaction and in the prevention of substance abuse.