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Trenz RC. The effect of expressive writing on sexual risk behavior among college women. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1673-1679. [PMID: 34028342 DOI: 10.1080/07448481.2020.1818754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 06/22/2020] [Accepted: 08/28/2020] [Indexed: 06/12/2023]
Abstract
Objective: The current study tested an expressive writing intervention aimed at reducing alcohol use and sexual risk behavior among college women that consume alcohol. Methods: A 2 X 2 mixed between- within-subjects experimental design was utilized to test the effect of expressive writing on alcohol use and sexual risk behavior over time among college women that drink. Study participants completed baseline assessments of alcohol use and sexual risk behavior and were randomly assigned to either a control writing condition (first day of college) or an expressive writing condition (negative alcohol-related event). Participants completed baseline assessments 30 days later. Data for this study were collected in the Fall 2017 semester. Results: A significant interaction effect was found for writing condition over time on sexual risk behavior. Conclusion: Findings provide preliminary support for the use of expressive writing as mechanism to reduce sexual risk behavior among college women that consume alcohol.
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Yeater EA, Witkiewitz K, Votaw VR, Ross R, Vitek K, Blackwell M, Sheffield A. Occasions of Alcohol and Cannabis Use and Associated Risk for Sexual Assault Among College Women With Higher Sexual Risk Alcohol Expectancies. J Stud Alcohol Drugs 2022; 83:556-564. [PMID: 35838433 PMCID: PMC9318703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE College women report high rates of sexual assault. Research focused on women's risk factors for sexual assault remains necessary to assist women in reducing their risk. Previous work has shown alcohol use and cannabis use to be associated with sexual assault. The current study examined whether individual difference variables moderated women's risk for sexual assault during occasions of alcohol use and cannabis use using ecological momentary assessment (EMA). METHOD Participants were 18- to 24-year-old first-year undergraduate women (N = 101) who were unmarried and interested in dating men, consumed three or more alcoholic drinks on one occasion in the month before baseline, and engaged in sexual intercourse at least once. Baseline individual difference variables included sex-related alcohol expectancies, alcohol problems, decision skills, and sexual attitudes. EMA reports, collected three times per day over 42 days, included items regarding alcohol and cannabis use and sexual assault experiences. RESULTS Among women who experienced sexual assault during the EMA period (n = 40), those with higher sexual risk expectancies had a higher probability of sexual assault during occasions when they were using alcohol or cannabis. CONCLUSIONS Several modifiable risk factors for sexual assault and individual differences factors may exacerbate risk. Ecological momentary interventions may be useful to reduce sexual assault risk for women with high sexual risk expectancies who use alcohol or cannabis.
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Affiliation(s)
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Victoria R. Votaw
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Ryan Ross
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Kristen Vitek
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Meredith Blackwell
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Alexis Sheffield
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
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Eastwick PW, Joel S, Carswell KL, Molden DC, Finkel EJ, Blozis SA. Predicting romantic interest during early relationship development: A preregistered investigation using machine learning. EUROPEAN JOURNAL OF PERSONALITY 2022. [DOI: 10.1177/08902070221085877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are massive literatures on initial attraction and established relationships. But few studies capture early relationship development: the interstitial period in which people experience rising and falling romantic interest for partners who could—but often do not—become sexual or dating partners. In this study, 208 single participants reported on 1,065 potential romantic partners across 7,179 data points over 7 months. In stage 1, we used random forests (a type of machine learning) to estimate how well different classes of variables (e.g., individual differences vs. target-specific constructs) predicted participants’ romantic interest in these potential partners. We also tested (and found only modest support for) the perceiver × target moderation account of compatibility: the meta-theoretical perspective that some types of perceivers experience greater romantic interest for some types of targets. In stage 2, we used multilevel modeling to depict predictors retained by the random-forests models; robust (positive) main effects emerged for many variables, including sociosexuality, sex drive, perceptions of the partner’s positive attributes (e.g., attractive and exciting), attachment features (e.g., proximity seeking), and perceived interest. Finally, we found no support for ideal partner preference-matching effects on romantic interest. The discussion highlights the need for new models to explain the origin of romantic compatibility.
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Yeater EA, Witkiewitz K, Testa M, Bryan AD. Substance Use, Risky Sex, and Peer Interactions Predict Sexual Assault Among College Women: An Ecological Momentary Assessment (EMA) Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5094-NP5115. [PMID: 32969282 DOI: 10.1177/0886260520958720] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual assault is an unfortunately common experience among women in college campuses. This study used ecological momentary assessment (EMA) to gain a better understanding of the contextual determinants of sexual assault among college women. EMA reports inquired about sexual assault experiences, risky sex (sex without a condom and regretted hookups), and substance use (alcohol and cannabis use), as well as what activities participants were engaged in (e.g., pregaming, drinking with peers, and drinking with a casual sexual partner), and whether they experienced peer pressure to engage in casual sex. Participants were 103 freshman undergraduate women (18-24 years old) at a Southwestern university in the United States, who were unmarried, interested in dating opposite-sex partners, engaged in binge drinking (defined as having 3 or more drinks on one occasion) in the past month, and reported at least one experience of sexual intercourse in their lifetime. Participants completed reports (one random and two time-contingent) via EMA three times a day over a 42-day period. Compliance in completing EMA reports was good (84.2% of prompted reports were completed), and time-to-completion of reports once signaled was acceptable (mean = 26 minutes, median = 5.75 minutes). During the 42 days, 40 women (38.8%) reported 75 occasions of sexual assault. The odds of experiencing sexual assault were significantly greater during occasions of regretted hookups and unprotected sex. Additionally, drinking with peers and peer pressure to engage in casual sex were each associated significantly with occasions of sexual assault. Reducing risk for sexual assault among undergraduate women may be possible by targeting these behaviors and contextual features in near real-time via momentary intervention.
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Affiliation(s)
| | | | - Maria Testa
- The State University of New York, Buffalo, NY, United States
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Willoughby JF, Hust SJT, Li J, Couto L. Social Media, Marijuana and Sex: An Exploratory Study of Adolescents' Intentions to Use and College Students' Use of Marijuana. JOURNAL OF SEX RESEARCH 2022; 59:85-97. [PMID: 33034543 DOI: 10.1080/00224499.2020.1827217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Recreational marijuana continues to be legalized in U.S. states, with popular media discussing connections between cannabis and the facilitation of sexual activity. We conducted two surveys with adolescents and college students in Washington state to examine the role of viewing social media and pro-marijuana content on sex-related marijuana expectancies and intentions to use. In Study 1, among adolescents (N = 350), we found connections between social media use, exposure to pro-marijuana content, and sex-related marijuana expectancies, with boys' sex-related marijuana expectancies predicting intentions to use marijuana. In Study 2, we expanded this research to college students (N = 966), with the addition of frequency of marijuana use as an outcome. For men, sex-related marijuana expectancies were negatively associated with marijuana use. Sex-related marijuana expectancies were not associated with intentions to use or use of marijuana among adolescent girls and college women. Our findings highlight how social media use is associated with increased exposure to pro-marijuana content for adolescents and college students, and how such content is associated with sex-related marijuana expectancies. The mixed relationships in our data between sex-related marijuana expectancies and intentions and use highlight potential gender and developmental differences.
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Affiliation(s)
| | - Stacey J T Hust
- The Edward R. Murrow College of Communication, Washington State University
| | - Jiayu Li
- The Edward R. Murrow College of Communication, Washington State University
| | - Leticia Couto
- The Edward R. Murrow College of Communication, Washington State University
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Algren MH, Deen L, Tolstrup JS, Thygesen LC. Associations between health-risk behaviours and non-condom use among 28,620 Danish students: a cross-sectional study. EUR J CONTRACEP REPR 2021; 27:45-52. [PMID: 34907840 DOI: 10.1080/13625187.2021.2005018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Investigations into the associations between health-risk behaviours and non-condom use are important for planning effective preventive interventions targeted sexually transmitted infections. To date, there are no such studies on the Danish general population. The aim of this study was to examine associations between health-risk behaviours (including daily smoking, frequent binge-drinking, cannabis use within the last month and illicit drug use) and non-condom use among Danish students. MATERIAL AND METHOD Cross-sectional data from 28,620 sexually active students aged 15-25 years from the Danish National Youth Study 2014 were analysed using multilevel logistic regression. RESULTS Health-risk behaviours (daily smoking, frequent binge-drinking, cannabis use within the last month and illicit drug use) were significantly associated with higher odds for non-condom use among Danish students, even after adjustment for age, gender, education, religion, and geographical region. The associations remained significant after adjusting for the remaining health-risk behaviours. CONCLUSION Overall, the study showed a clear association between health-risk behaviours and non-condom use among Danish students. The findings of this study have important implications for future planning of more targeted health promotion intervention programmes aimed to increase condom use among young people as a means to reduce sexually transmitted infections.
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Affiliation(s)
- Maria Holst Algren
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Laura Deen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Fredericksen RJ, Whitney BM, Trejo E, Nance RM, Fitzsimmons E, Altice FL, Carrico AW, Cleland CM, Del Rio C, Duerr A, El-Sadr WM, Kahana S, Kuo I, Mayer K, Mehta S, Ouellet LJ, Quan VM, Rich J, Seal DW, Springer S, Taxman F, Wechsberg W, Crane HM, Delaney JAC. Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort. BMC Public Health 2021; 21:2002. [PMID: 34736425 PMCID: PMC8567631 DOI: 10.1186/s12889-021-12026-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS. METHODS We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years). RESULTS For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03). CONCLUSION Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.
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Affiliation(s)
- R. J. Fredericksen
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - B. M. Whitney
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Trejo
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - R. M. Nance
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - E. Fitzsimmons
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - F. L. Altice
- Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA
| | - A. W. Carrico
- Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL 33136 USA
| | - C. M. Cleland
- Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY 10012 USA
| | - C. Del Rio
- Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA 30322 USA
| | - A. Duerr
- Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA 98109 USA
| | - W. M. El-Sadr
- Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY 10032 USA
| | - S. Kahana
- National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland 20852 USA
| | - I. Kuo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052 USA
| | - K. Mayer
- The Fenway Institute, 1340 Boylston Street, Boston, MA 02215 USA
| | - S. Mehta
- Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - L. J. Ouellet
- School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL USA
| | - V. M. Quan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - J. Rich
- Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI 02904 USA
| | - D. W. Seal
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA 70112 USA
| | - S. Springer
- Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT 06510 USA
| | - F. Taxman
- Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA 22030 USA
| | - W. Wechsberg
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599 USA
| | - H. M. Crane
- UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA 98104-2499 USA
| | - J. A. C. Delaney
- College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba R3E 0T5 Canada
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Maisto SA, Simons JS, Palfai TP, Moskal D, Luehring-Jones P. Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2843-2860. [PMID: 33594529 DOI: 10.1007/s10508-020-01852-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21-50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant's own or study-provided mobile phone. Individual differences variables were measured by participants' completing questionnaires measuring effortful control and urgency, and the participant's self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol's effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol's effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.
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Affiliation(s)
- Stephen A Maisto
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA.
| | - Jeffrey S Simons
- Department of Psychology, University of South Dakota, Vermillion, SD, USA
| | - Tibor P Palfai
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Dezarie Moskal
- Department of Psychology, Syracuse University, 430 Huntington Hall, Syracuse, NY, 13244, USA
| | - Peter Luehring-Jones
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Pérez-Jiménez D, Acosta-Pérez E, Ortega-Guzmán JM, Maldonado-Martínez JA. Internet Study about Risk Factors Associated with HIV among Heterosexuals in Puerto Rico. PUERTO RICO HEALTH SCIENCES JOURNAL 2021; 40:26-32. [PMID: 33876915 PMCID: PMC8087157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Heterosexual intercourse is the main mode of HIV transmission among heterosexual women in Puerto Rico and the third for men. We conducted an Internetbased study of heterosexual young adults in Puerto Rico to explore their sexual practices, beliefs and decision-making skills for HIV prevention. Data presented in this study will help to understand the factors that contribute to the sexual transmission of HIV among heterosexuals within the Puerto Rican context. METHODS We administered an online-based survey to a sample of 618 young adult heterosexual men and women. Data were collected using Perseus Survey Solutions software. RESULTS Overall, most participants expressed they had the same sexual partner in the previous six months, never or almost never used male condoms with their main partner and did not perceive themselves at-risk of contracting HIV (have a low HIV risk perception). Men reported using male condoms more frequently than women (e.g. male condom on their male partner) during vaginal sex, in particular single and younger men. Women expressed more positive attitudes toward male condoms than men. CONCLUSION Results confirm the need to implement interventions that increases the sense of vulnerability among heterosexuals, as well as skills and use of male condoms. This study contributes additional data on sexual practices and attitudes to encourage the identification of new or current changes in HIV protective or risk factors, specifically for an understudied population of Heterosexuals in Puerto Rico.
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Affiliation(s)
| | - Edna Acosta-Pérez
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Huibregtse BM, Hatoum AS, Corley RP, Rhea SA, Hewitt JK, Stallings MC. Etiological Overlap Between Sex Under the Influence and Number of Lifetime Sexual Partners. Behav Genet 2021; 51:12-29. [PMID: 33118127 PMCID: PMC8092413 DOI: 10.1007/s10519-020-10019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Abstract
Drug and alcohol use is associated with risky sexual behavior (RSB). It is unclear whether this association is due to correlated liabilities (e.g., third variables influencing both traits), or whether use of drugs and alcohol during sexual decision making increases RSB. This study addresses this question by fitting a series of biometrical models using over 800 twin pairs assessed in early adulthood (m = 25.21 years). Measures included an index of sex under the influence (e.g., frequency that drugs or alcohol affect sexual decision making), number of lifetime sexual partners, and a general measure of substance use. Analyses suggest the covariance among these measures is explained by both genetic and environmental correlated liabilities. The overlap was not specific to sex under the influence, but was shared with a measure of general substance use. Models testing necessary but not sufficient parameters for direction of causation suggest that sex under the influence is unlikely to cause an increase in RSB; more evidence for reverse causation was found.
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Affiliation(s)
- Brooke M Huibregtse
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA.
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.
| | - Alexander S Hatoum
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Sally Ann Rhea
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Michael C Stallings
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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Carey MP, Rich C, Norris AL, Krieger N, Gavarkovs AG, Kaplan C, Guthrie KM, Carey KB. A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1231-1250. [PMID: 32189096 PMCID: PMC7150639 DOI: 10.1007/s10508-020-01635-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/17/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.
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Affiliation(s)
- Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA.
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Alyssa L Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Naomi Krieger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Adam G Gavarkovs
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | - Clair Kaplan
- Department of Clinical Research, Planned Parenthood of Southern New England, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Kate M Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
| | - Kate B Carey
- Department of Behavioral and Social Science, School of Public Health, Brown University, Providence, RI, USA
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Fairfortune TS, Stern JE, Richardson BA, Koutsky LA, Winer RL. Sexual Behavior Patterns and Condom Use in Newly Sexually Active Female University Students. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1053-1065. [PMID: 31407192 DOI: 10.1007/s10508-019-1411-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 06/10/2023]
Abstract
Our objective was to describe sexual behavior patterns and condom use in newly sexually active female university students. We conducted a 4-year retrospective cohort study (2000-2007) of university women enrolled close to sexual debut (N = 250). Participants reported daily information on intercourse, condom use, and partner/partnership characteristics into Web-based biweekly sexual behavior diaries. We calculated intercourse frequency, proportion of condom-protected events, and incidence of new partner acquisition. We used logistic regression to examine factors associated with condom use at sexual debut; Kaplan-Meier methods to describe cumulative incidence of condom non-use after use at debut; and Cox proportional hazards ratios to examine factors associated with condom non-use. A total of 188 women had at least one male sex partner prior to enrollment or during follow-up. One-third (34.1%) of 27,736 intercourse events were condom-protected. Older age (20+ vs. < 20 years) and use of hormonal birth control were associated with lower likelihood of condom use at sexual debut (adjusted odds ratio [aOR] 0.41, 95% CI 0.17-0.97 and aOR 0.32, 95% CI 0.10-1.03, respectively). Women who reported partners with previous sex partners were less likely to discontinue using condoms after debut (hazard ratio = 0.35, 0.16-0.77) than those reporting partners without previous partners. In college-aged women, older age and hormonal contraceptive use were each inversely associated with condom use at first intercourse. Women with sexually experienced partners were more likely to continue using condoms. Continued efforts are necessary to promote condom use among college-aged women.
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Affiliation(s)
- Tessa S Fairfortune
- HPV Research Group, Department of Epidemiology, University of Washington School of Public Health, 325 9th Ave., Box 359933, Seattle, WA, 98104, USA
| | - Joshua E Stern
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA
| | - Laura A Koutsky
- HPV Research Group, Department of Epidemiology, University of Washington School of Public Health, 325 9th Ave., Box 359933, Seattle, WA, 98104, USA
| | - Rachel L Winer
- HPV Research Group, Department of Epidemiology, University of Washington School of Public Health, 325 9th Ave., Box 359933, Seattle, WA, 98104, USA.
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Potard C. Relationships between women's emotional reaction to first coital experience and subsequent sexual risk-taking behaviour. EUR J CONTRACEP REPR 2020; 25:126-132. [PMID: 32069142 DOI: 10.1080/13625187.2020.1722993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The study aimed to consider the affective reactions of young French women to their experience of first sexual intercourse and examine the relationship with subsequent risky sexual behaviours, using cluster profiles.Methods: A descriptive cross-sectional study was conducted among women in France (n = 391) (mean age 22.36 years, standard deviation 3.08). Participants completed a questionnaire with self-reported measures of emotional responses to first sexual intercourse and risky sexual behaviours.Results: Cluster analyses revealed four emotional reaction profiles: Pleasure, Guilty-pleasure, Negative-emotional and Anxiety-unpleasant. The Pleasure group reported overall and higher satisfaction and positive emotions towards first sexual intercourse; this group reported lower condom use. The Guilty-pleasure group felt pleasure tinged with guilt and reported fewer same-sex partners. The Negative-emotional profile group tended to feel major negative emotions related to initial coital experience, reporting lower or no pleasure. The Anxiety-unpleasant group reported little pleasure and major anxiety associated with first sexual intercourse. The latter two groups, respectively, reported a higher number of male sexual partners and higher alcohol consumption prior to sexual intercourse compared with the two pleasure groups.Conclusion: These results suggest that women's emotional reactions to first sexual intercourse may be associated with subsequent healthy versus risky sexual behaviours in young adulthood.
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Affiliation(s)
- Catherine Potard
- Psychology Laboratory of the Pays de la Loire, Department of Psychology, University of Angers, Angers, France
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14
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Leeman RF, Rowland BHP, Gebru NM, Potenza MN. Relationships among impulsive, addictive and sexual tendencies and behaviours: a systematic review of experimental and prospective studies in humans. Philos Trans R Soc Lond B Biol Sci 2020; 374:20180129. [PMID: 30966924 DOI: 10.1098/rstb.2018.0129] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Impulsivity's relationships to addictive and sexual behaviours raise questions regarding the extent impulsivity may constitute a vulnerability factor for subsequent addictive and sexual behaviours and/or results from each of these. Here, we systematically reviewed empirical support for impulsivity as a precipitating factor or a consequence of addictive or sexual behaviours. We restricted ourselves to recent, human studies with assessments over time, including at least one measure of impulsivity, addictive and sexual behaviours, yielding a review including 29 published reports from 28 studies. Findings point to generalized, self-reported impulsivity as a predictor of addictive and sexual behaviours at a wide range of severity, with elements of both impulsivity and compulsivity to these acts. Alcohol consumption often increases impulsive behaviour, including inclinations towards impulsive and potentially compulsive sexual acts. Research using the Sexual Delay Discounting Task has yielded findings linking impulsivity, addictive and sexual behaviour and as such is a valuable research tool that should be used more extensively. The present review identified gaps to be addressed in further research that concurrently examines facets of impulsivity, addictive and sexual behaviours, especially because criteria for compulsive sexual behaviour disorder have been included in the eleventh edition of the International Classification of Diseases. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.
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Affiliation(s)
- Robert F Leeman
- 1 Department of Health Education and Behavior, College of Health and Human Performance and the Center for Addiction Research and Education, University of Florida , Gainesville, FL 32611 , USA.,2 Department of Psychiatry, Yale School of Medicine , New Haven, CT 06510 , USA
| | - Bonnie H P Rowland
- 1 Department of Health Education and Behavior, College of Health and Human Performance and the Center for Addiction Research and Education, University of Florida , Gainesville, FL 32611 , USA
| | - Nioud Mulugeta Gebru
- 1 Department of Health Education and Behavior, College of Health and Human Performance and the Center for Addiction Research and Education, University of Florida , Gainesville, FL 32611 , USA
| | - Marc N Potenza
- 2 Department of Psychiatry, Yale School of Medicine , New Haven, CT 06510 , USA.,3 Child Study Center and the Department of Neuroscience, Yale School of Medicine , New Haven, CT 06510 , USA.,4 Connecticut Council on Problem Gambling , Wethersfield, CT 06109 , USA.,5 Connecticut Mental Health Center , New Haven, CT 06519 , USA
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15
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Tucker JS, Shih RA, Pedersen ER, Seelam R, D'Amico EJ. Associations of Alcohol and Marijuana Use With Condom Use Among Young Adults: The Moderating Role of Partner Type. JOURNAL OF SEX RESEARCH 2019; 56:957-964. [PMID: 30028212 PMCID: PMC6339847 DOI: 10.1080/00224499.2018.1493571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study used multiple levels of analysis to examine associations of alcohol and marijuana (AM) use with condom use, including the moderating role of partner type, in a general sample of 754 sexually active young adults (mean age = 18.6, SD = 0.63; 77% non-White). Multivariable models examined associations over the past 30 days (global) and at the most recent sexual event (event specific). Over the past 30 days, participants who had a recent casual partner and used both substances reported a higher proportion of condom-protected sexual events during this period compared to AM nonusers, whereas those who had a recent steady partner and used alcohol, marijuana, or both substances reported a lower proportion of condom-protected sexual events compared to AM nonusers. At the most recent sexual event, participants who used both substances were four times more likely than AM nonusers to have condom-protected sex if the event involved a casual partner; however, there were no significant associations if the event involved a steady partner. Marijuana use, particularly combined with alcohol use, deserves greater attention in the context of condom use. Future research should consider different levels of analysis and partner types to fully understand these complex associations.
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16
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Schumacher A, Marzell M, Toepp AJ, Schweizer ML. Association Between Marijuana Use and Condom Use: A Meta-Analysis of Between-Subject Event-Based Studies. J Stud Alcohol Drugs 2019; 79:361-369. [PMID: 29885143 DOI: 10.15288/jsad.2018.79.361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Amy Schumacher
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Miesha Marzell
- Department of Social Work, College of Community and Public Affairs, Binghamton University, Binghamton, New York
| | - Angela J Toepp
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Marin L Schweizer
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
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17
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Age-related associations between substance use and sexual risk behavior among high-risk young African American women in the South. Addict Behav 2019; 96:110-118. [PMID: 31075728 DOI: 10.1016/j.addbeh.2019.04.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/27/2019] [Accepted: 04/28/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND We assessed age-related associations between substance use and sexual risk behavior using data from three HIV prevention trials that enrolled young African American women. METHODS We used integrative data analysis to pool data from 1862 individuals aged 16-25 years. We used time-varying effect models to examine associations between substance use (alcoholic drinks per month, recent marijuana use, cigarettes smoked per day) and sexual risk behaviors (monthly frequency of vaginal sex, multiple sex partners, condomless sex), adjusting for the fixed effect of trial. RESULTS In models that included all three substances, cigarette smoking was not associated with any outcome. Alcohol quantity was associated with greater frequency of sex at all ages, an increased likelihood of having multiple sex partners from about age 17-24 years, and an increased likelihood of condomless sex after about age 18.5 years. Associations between alcohol quantity and sex frequency were relatively stable; associations with having multiple sex partners and condomless sex increased beginning at about age 22 years. Marijuana use was associated with greater sex frequency at approximate ages 16.5-24 years and an increased likelihood of having multiple sex partners at ages 18-24 years. Associations with sex frequency were relatively stable; associations with having multiple sex partners increased from about age 18 and peaked at about age 23 years. CONCLUSIONS We observed developmentally-dependent relationships between both alcohol and marijuana and sexual risk behavior. The findings underscore the need to address substance-related sexual risk among young African American women and may inform optimal timing of intervention.
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18
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Eastwick PW, Finkel EJ, Simpson JA. Relationship Trajectories: A Meta-Theoretical Framework and Theoretical Applications. PSYCHOLOGICAL INQUIRY 2019. [DOI: 10.1080/1047840x.2019.1577072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paul W. Eastwick
- Department of Psychology, University of California, Davis, California
| | - Eli J. Finkel
- Department of Psychology and Kellogg School of Management, Northwestern University, Evanston, Illinois
| | - Jeffry A. Simpson
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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19
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Norris AL, Rich C, Krieger N, Guthrie KM, Kaplan C, Carey KB, Carey MP. Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic. BMC Womens Health 2019; 19:15. [PMID: 30665343 PMCID: PMC6341714 DOI: 10.1186/s12905-019-0709-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 01/02/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity. METHODS Women 18-29 years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%). RESULTS One-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms. CONCLUSIONS Reproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.
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Affiliation(s)
- Alyssa L. Norris
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02906 USA
| | - Carla Rich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
| | - Naomi Krieger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
| | - Kate M. Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02906 USA
| | - Clair Kaplan
- Department of Clinical Research, Planned Parenthood of Southern New England, 345 Whitney Avenue, New Haven, CT 06511 USA
- Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, Suite 200, New Haven, CT 06510 USA
| | - Kate B. Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903 USA
- Center for Alcohol and Addiction Studies, Brown University, 121 S. Main Street, Box G-S121-5, Providence, RI 02912 USA
| | - Michael P. Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave, Providence, RI 02906 USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI 02906 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Providence, RI 02903 USA
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20
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Subbaraman MS, Metrik J, Patterson D, Stout RL. Cannabis use during alcohol treatment is associated with alcohol-related problems one-year post-treatment. Drug Alcohol Depend 2018; 193:29-34. [PMID: 30336390 PMCID: PMC6239961 DOI: 10.1016/j.drugalcdep.2018.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prior research shows that cannabis use during treatment for Alcohol Use Disorders (AUD) is related to fewer abstinent days from alcohol, although only among those who use cannabis 1-2x/month. Here we extend prior research by assessing the relationship between the frequency of cannabis use during AUD treatment and post-treatment alcohol-related consequences. METHODS Data come from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, a large US randomized control trial of treatments for AUD. The current analyses include 206 cannabis users and 999 cannabis abstainers and compare longitudinal drinking data between those who used cannabis versus those who abstained during COMBINE treatment. The primary exposure was quartiles of cannabis use (Q1: less than 1x/month during treatment, Q2: 1-2x/month, Q3: 4-8x/month, Q4: 12x/month or more), with cannabis abstainers as the reference group. Outcomes were alcohol-related problems at the end of treatment and one-year post-treatment as measured by the Drinker Inventory Consequences. RESULTS Compared to cannabis abstinence, the most frequent use during treatment was related to 1.44 times as many physical consequences one-year post-treatment. Cannabis use was not related to physical consequences immediately after treatment, or to intrapersonal, interpersonal, social responsibility or impulse control problems at either post-treatment time point. CONCLUSIONS In a sample of individuals in treatment for AUD, using cannabis 12x/month or more during treatment is associated with increased rates of physical consequences attributed to alcohol use. Individuals in treatment for AUD who also use cannabis might benefit from reducing or stopping cannabis use to avoid alcohol-related physical problems.
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Affiliation(s)
- Meenakshi S Subbaraman
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Emeryville, CA, 94608, USA.
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, G-S121-4, Providence, RI, 02903, USA; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA.
| | - Deidre Patterson
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Emeryville, CA, 94608, USA.
| | - Robert L Stout
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, 1005 Main Street, Pawtucket, RI, 02860, USA.
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21
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Dolphin L, Fitzgerald A, Dooley B. Risky sex behaviours among college students: The psychosocial profile. Early Interv Psychiatry 2018; 12:1203-1212. [PMID: 29235241 DOI: 10.1111/eip.12526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/19/2017] [Accepted: 11/08/2017] [Indexed: 01/07/2023]
Abstract
AIMS Risky sex behaviours among college students are a growing public health concern. However, few studies have profiled these behaviours using a large range of psychosocial correlates. METHODS Participants were 6874 undergraduate and postgraduate students (64.7% female, age range 17-25 years, M = 20.43 years, SD = 1.86 years) drawn from 13 higher-level institutions in Ireland. RESULTS Regarding prevalence, 75% of the sample report that they have been, or are currently sexually active. Of this sexually active cohort (n = 5111), 27.2% report early sexual initiation, 29.5% report 5 or more lifetime sexual partners and 12.1% report 2 or more sexual partners in the past 3 months. In addition, 47.7% of students report inconsistent condom use and 39.5% report inconsistent use of other contraceptive methods in the past 3 months. Using multivariate logistic regression analyses, significant correlates of risky sex behaviour are identified across 5 groups of psychosocial predictors (demographic, sexuality and relationships, substance use, mental well-being and personal resources). Differences between males and females and between different sexual orientations are highlighted. CONCLUSIONS Suggestions are made for sexual education and intervention programs to specifically target subgroups of the student population.
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Affiliation(s)
- Louise Dolphin
- School of Psychology, University College Dublin, Belfield, Ireland
| | | | - Barbara Dooley
- School of Psychology, University College Dublin, Belfield, Ireland
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22
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Fairlie AM, Garcia TA, Lee CM, Lewis MA. Alcohol use and alcohol/marijuana use during the most recent sexual experience differentially predict characteristics of the sexual experience among sexually active young adult drinkers. Addict Behav 2018; 82:105-108. [PMID: 29510295 DOI: 10.1016/j.addbeh.2018.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Few studies have examined associations between using alcohol only and using both alcohol and marijuana with sexual behavior on specific occasions. The current study examined alcohol and marijuana use during the most recent sexual experience in association with relationship characteristics, psychological issues, and condom use. METHODS Young adult drinkers aged 18-25 who reported not using a condom during sex in the past month were recruited nationally. An analytic subsample (N = 378) was identified based on substance use during the most recent sexual experience [53% female, 70% Caucasian; mean age = 22.42 years (SD = 1.90)]. Using logistic regression, two dummy codes compared the alcohol use only group (n = 197) and the both alcohol and marijuana group (n = 95) to the group who used neither substance (n = 86). Participant sex, drinking frequency, and number of sexual partners were included as covariates. RESULTS The alcohol only group and the both alcohol and marijuana group had greater odds of being with a casual acquaintance and loss of respect compared to the group who used neither substance. The alcohol only group had greater odds of being with someone they just met and embarrassment compared to the group who used neither substance. No associations were found for condom use or emotional difficulties. CONCLUSIONS Preventative interventions may need to address both alcohol and marijuana to more effectively reduce risky behaviors.
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23
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Hayaki J, Anderson BJ, Stein MD. Dual use of alcohol and marijuana and condomless sex in young adult men and women: A within-subject day-level analysis. Am J Addict 2018; 27:413-418. [PMID: 29923270 DOI: 10.1111/ajad.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/20/2018] [Accepted: 05/03/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Unprotected sex has been linked independently to alcohol and marijuana use, but few studies have examined associations with dual use or gender differences in these associations. METHODS This study examined day-level associations between unprotected sex, defined as condomless vaginal sex with an opposite-sex partner, and use of alcohol, marijuana, neither, or both substances among 290 young adults (18-25 years, 52.3% female) who reported either alcohol or marijuana use. Participants reported demographics, alcohol use, marijuana use, and at least one episode of condomless sex as defined above in the past 90 days (Timeline Follow-Back). The likelihood of condomless sex was examined for days when alcohol, marijuana, neither, or both were used. Gender differences were also explored. RESULTS For females, compared to days with no substance use, the estimated risk of condomless sex increased by a factor of 2.12 on alcohol use days, 1.89 on marijuana use days, and 3.39 on dual use days. Among males, the odds of condomless sex increased only slightly on alcohol use (odds ratio [OR] = 1.03) or marijuana use (OR = 1.08) days, but increased by a factor of 1.71 on dual use days. DISCUSSION AND CONCLUSIONS Young persons who use alcohol and/or marijuana experience heightened likelihood of condomless sex. This increased likelihood is greater for women than for men on days with alcohol or marijuana use, each alone but especially when combined. SCIENTIFIC SIGNIFICANCE Young women may be especially susceptible to the influence of alcohol and/or marijuana use on sexual behavior. (Am J Addict 2018;XX:1-6).
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Affiliation(s)
- Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester, Massachusetts
| | | | - Michael D Stein
- Butler Hospital, 345 Blackstone Boulevard, Providence, Rhode Island
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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24
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Lemley SM, Jarmolowicz DP, Parkhurst D, Celio MA. The Effects of Condom Availability on College Women's Sexual Discounting. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:551-563. [PMID: 28913688 DOI: 10.1007/s10508-017-1040-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 06/28/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
College students commonly engage in risky sexual behaviors, such as casual sexual encounters and inconsistent condom use. Discounting paradigms that examine how individuals devalue rewards due to their delay or uncertainty have been used to improve our understanding of behavioral problems, including sexual risk. The current study assessed relations between college women's sexual partners discounting and risky sexual behavior. In this study, college women (N = 42) completed two sexual partners delay discounting tasks that assessed how choices among hypothetical sexual partners changed across a parametric range of delays in two conditions: condom availability and condom unavailability. Participants also completed two sexual partners probability discounting tasks that assessed partner choices across a parametric range of probabilities in condom availability and unavailability conditions. Additionally, participants reported risky sexual behavior on the Sexual Risk Survey (SRS). Participants discounted delayed partners more steeply in the condom availability condition, but those differences were significant only for those women with three or fewer lifetime sexual partners. There were no consistent differences in discounting rate across condom availability conditions for probability discounting. Sexual partners discounting measures correlated with risky sexual behaviors as measured by the SRS, but a greater number of significant relations were observed with the condoms-unavailable delay discounting task. These findings suggest the importance of examining the interaction of inconsistent condom use and multiple partners in examinations of sexual decision-making.
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Affiliation(s)
- Shea M Lemley
- Department of Applied Behavioral Science, University of Kansas, 4041 Dole Developmental Center, 1000 Sunnyside Ave., Lawrence, KS, 66045, USA.
| | - David P Jarmolowicz
- Department of Applied Behavioral Science and Problem Gambling Research and Education Support System, University of Kansas, 1000 Sunnyside Ave., Lawrence, KS, 66045, USA
| | - Daniel Parkhurst
- Department of Applied Behavioral Science, University of Kansas, 4050 Dole Developmental Center, 1000 Sunnyside Ave., Lawrence, KS, 66045, USA
| | - Mark A Celio
- Department of Behavioral and Social Sciences, Brown University, Box G-121-5, 121 S. Main Street, Providence, RI, 02915, USA
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25
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Palamar JJ, Acosta P, Ompad DC, Friedman SR. A Qualitative Investigation Comparing Psychosocial and Physical Sexual Experiences Related to Alcohol and Marijuana Use among Adults. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:757-770. [PMID: 27439599 PMCID: PMC5250581 DOI: 10.1007/s10508-016-0782-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 05/09/2016] [Accepted: 05/26/2016] [Indexed: 05/25/2023]
Abstract
Alcohol and marijuana are two of the most prevalent psychoactive substances and each may result in distinct psychosocial and physical sexual experiences and different sexual risk behaviors. With marijuana becoming more accepted in the US along with more liberal state-level policies, it is important to examine and compare users' psychosocial and physical sexual experiences and sexual risk behavior associated with these drugs. In this study, we interviewed 24 adults who recently used marijuana before sex. Participants were 50 % female and all self-identified as heterosexual and HIV-negative. Using thematic analysis, we compared self-reported psychosocial and physical sexual experiences of alcohol and marijuana. Participants described differences between drugs with regard to psychosocial (e.g., partner interactions and contexts before sex, partner choice, perceived attractiveness of self and others, disinhibition, and feelings of regret after sex) and physical sexual experiences (e.g., sexual dysfunction, dose effects, sensations of body/sex organs, length and intensity of sex, and orgasm). Alcohol use was commonly associated with social outgoingness and use facilitated connections with potential sexual partners; however, alcohol was more likely than marijuana to lead to atypical partner choice or post-sex regret. Both alcohol and marijuana had a variety of negative sexual effects, and the illegality of marijuana reportedly facilitated intimate encounters. While sexual experiences tended to be similar across males and females, we did find some variation by gender. Results can inform prevention and harm reduction programming that will allow us to design more realistic programs and to craft interventions, which guide potential users to make safer choices.
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Affiliation(s)
- Joseph J Palamar
- Department of Population Health, New York University Langone Medical Center, 227 East 30th Street, 7th Floor, New York, NY, 10016, USA.
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA.
- Center for Health, Identity, Behavior & Prevention Studies, New York University Steinhardt School of Culture, Education and Human Development, New York, NY, USA.
| | - Patricia Acosta
- Department of Population Health, New York University Langone Medical Center, 227 East 30th Street, 7th Floor, New York, NY, 10016, USA
| | - Danielle C Ompad
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA
- Center for Health, Identity, Behavior & Prevention Studies, New York University Steinhardt School of Culture, Education and Human Development, New York, NY, USA
- College of Global Public Health, New York University, New York, NY, USA
| | - Samuel R Friedman
- Center for Drug Use and HIV Research, New York University College of Nursing, New York, NY, USA
- National Development and Research Institutes, New York, NY, USA
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26
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Simons JS, Simons RM, Maisto SA, Hahn AM, Walters KJ. Daily associations between alcohol and sexual behavior in young adults. Exp Clin Psychopharmacol 2018; 26:36-48. [PMID: 29389169 PMCID: PMC5798003 DOI: 10.1037/pha0000163] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We tested within-person effects of alcohol on sexual behavior among young adults in a longitudinal burst design (N = 213, 6,487 days) using data collected from a previously published parent study. We differentiated effects of alcohol on likelihood of sexual activity versus use of protection against sexually transmitted diseases (STDs) or pregnancy on intercourse occasions by testing a multilevel multinomial model with 4 outcomes (no sex, oral sex without intercourse, protected intercourse, and unprotected intercourse). At the within-person level, effects of alcohol were hypothesized to be conditional upon level of intoxication (i.e., curvilinear effect). We also tested effects of four between-person moderators: gender, typical length of relationship with sexual partners, and two facets of self-control (effortful control and reactivity). Consistent with our hypothesis, low-level intoxication was associated with increased likelihood of engaging in oral sex or protected intercourse (relative to no sex) but was not related to likelihood of unprotected intercourse. The effect of intoxication on unprotected versus protected intercourse was an accelerating curve, significantly increasing likelihood of unprotected intercourse at high levels of intoxication. Between-person factors moderated associations between intoxication and sexual behavior. Effects of intoxication on both protected and unprotected intercourse were diminished for individuals with more familiar sexual partners. Effortful control exhibited a protective effect, reducing the effects of intoxication on likelihood of unprotected intercourse. Hypothesized effects of reactivity were not supported. Intoxication was a stronger predictor of oral sex and protected intercourse (but not unprotected intercourse) for women relative to men. Results highlight the inherent complexities of the alcohol-sexual behavior nexus. (PsycINFO Database Record
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Affiliation(s)
- Jeffrey S. Simons
- University of South Dakota, 414 East Clark St., Department of Psychology, Vermillion, SD 57069 USA
| | - Raluca M. Simons
- University of South Dakota, 414 East Clark St., Department of Psychology, Vermillion, SD 57069 USA
| | - Stephen A. Maisto
- Syracuse University, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244 USA
| | - Austin M. Hahn
- University of South Dakota, 414 East Clark St., Department of Psychology, Vermillion, SD 57069 USA
| | - Kyle J. Walters
- University of South Dakota, 414 East Clark St., Department of Psychology, Vermillion, SD 57069 USA
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27
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Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients. Ann Behav Med 2018; 51:39-56. [PMID: 27550626 DOI: 10.1007/s12160-016-9826-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior. PURPOSE We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients. METHODS Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern USA (N = 3761, 59 % male, 72 % Black) completed measures at 3-month intervals over 9-12 months. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in the number of partners and unprotected sex. RESULTS Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs = 0.17-0.40, ps < 0.001) and changes in (rs = 0.21-0.80, ps < 0.05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = 0.25-0.43, ps < 0.001) and changes in (rs = 0.24-0.57, ps < 0.01) alcohol use and unprotected sex in one study recruiting hazardous drinkers. CONCLUSIONS Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use.
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28
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Gomes AICDS, Nunes MCS. Predicting Condom Use: A Comparison of the Theory of Reasoned Action, the Theory of Planned Behavior and an Extended Model of TPB. PSICOLOGIA: TEORIA E PESQUISA 2018. [DOI: 10.1590/0102.3772e33422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT It was our goal to give a contribution to the prediction of condom use using socio-cognitive models, comparing classic theories to an extended model. A cross-sectional study was conducted using a questionnaire of self-reported measures. From the students who agreed to participate in the study, 140 were eligible for the full study. A confirmatory analysis was used to assess the predictive value of the researched model. The model tested had slightly better fit indexes and predictive value than classic Theories of Reasoned Action and Planned Behaviour. Although the results found, discussion continues to understand the gap between intention and behaviour, as further investigation is necessary to fully understand the reasons for condom use inconsistency.
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29
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Joel S, Eastwick PW. Intervening Earlier: An Upstream Approach to Improving Relationship Quality. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2372732217745099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Relationship quality has far-reaching consequences for health and well-being. To date, large-scale efforts to improve relationship quality have targeted established relationships. However, a novel approach would be to target relationships much earlier. Investment-based programs would intervene (on a voluntary basis) before partners become strongly tied to one another (i.e., within the first few months of “official” dating) and help people to avoid investing in relationships that they might later decide are wrong for them. Selection-based programs would intervene before an official dating relationship has formed, perhaps by helping people to identify especially compatible partners from within their network of friends and acquaintances. To develop such interventions, researchers must (a) identify when important relationship experiences (e.g., perceived responsiveness, capitalization, and sexual satisfaction) become reliably predictive of long-term outcomes and (b) identify how this information could be better incorporated into early relationship decisions. Overall, efforts to facilitate the initial formation and development of high-quality relationships may hold promising, untested potential.
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30
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Slavin MN, Kraus SW, Ecker A, Sartor C, Blycker GR, Potenza MN, Dukes K, Foster DW. Marijuana Use, Marijuana Expectancies, and Hypersexuality among College Students. SEXUAL ADDICTION & COMPULSIVITY 2017; 24:248-256. [PMID: 30174385 PMCID: PMC6115197 DOI: 10.1080/10720162.2017.1388203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research supports links between marijuana effect expectancies and risky sexual behaviors among marijuana users, but associations between marijuana expectancies and hypersexuality have yet to be investigated. The current study examined links between marijuana lifetime use and hypersexuality among university students. A hierarchical regression adjusting for gender and alcohol use was used to determine the degree to which marijuana use and expectancies accounted for variance in hypersexuality. Marijuana lifetime use and hypersexuality were significantly and positive related. After adjusting for covariates, perceptual and cognitive enhancement expectancies positively correlated with hypersexuality, while tension reduction and relaxation expectancies negatively correlated with hypersexuality.
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Affiliation(s)
| | - Shane W. Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
| | - Anthony Ecker
- VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX
- Baylor College of Medicine, Houston, TX
| | - Carolyn Sartor
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
| | | | - Marc N. Potenza
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
- Yale School of Medicine, Department of Neuroscience, New Haven, CT
- Yale School of Medicine, Child Study Center, New Haven, CT
- Yale School of Medicine, National Center on Addiction and Substance Abuse, New Haven, CT
- Connecticut Mental Health Center, New Haven, CT
| | - Kristin Dukes
- Simmons College, Department of Psychology, Boston, MA
| | - Dawn W. Foster
- Yale School of Medicine, Department of Psychiatry, New Haven, CT
- Connecticut Mental Health Center, New Haven, CT
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31
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Skalski LM, Gunn RL, Caswell A, Maisto S, Metrik J. Sex-related marijuana expectancies as predictors of sexual risk behavior following smoked marijuana challenge. Exp Clin Psychopharmacol 2017; 25:402-411. [PMID: 29048189 PMCID: PMC5657572 DOI: 10.1037/pha0000138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Marijuana use has been associated with sexual risk behavior, but the mechanisms that underlie this relationship are not well understood. The present study examined whether marijuana acutely increased sexual risk on a behavioral decision-making task and whether sex-related marijuana outcome expectancies influenced sexual risk decisions after marijuana administration. Participants were heterosexual marijuana users (n = 126) who were randomly assigned to 1 of 4 study conditions using a 2 × 2 factorial design crossing drug administration (received 2.8% delta-9-tetrahydrocannabinol [THC] or 0% THC) with instructional set (told THC or told placebo). Participants completed a self-report measure of sex-related marijuana outcome expectancies at baseline and estimated likelihood of using condoms with a new and a steady partner in an interactive sexual role-play task (SRT) after smoking. In gender-specific analyses, there was a significant interaction of drug administration by sex-related outcome expectancies, such that for men in the received-placebo conditions, more salient sex-related marijuana outcome expectancies were associated with increased likelihood for sex without a condom with a new partner. Among women, there was no interaction or main effect of drug administration but more salient sex-related marijuana outcome expectancies were associated with increased likelihood of sex without a condom with a steady but not new partner. Findings suggest marijuana does not acutely increase risk for engaging in sexual risk behaviors. By contrast, sex-related marijuana outcome expectancies may play a more significant role in sexual decision-making process among marijuana users. (PsycINFO Database Record
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Affiliation(s)
- Linda M. Skalski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912
- Providence VA Medical Center, Providence, RI, 02908
| | - Rachel L. Gunn
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912
| | - Amy Caswell
- Department of Psychology, University of Bath, UK BA2 7AY
| | - Stephen Maisto
- Department of Psychology, Syracuse University, Syracuse, NY 13244
| | - Jane Metrik
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02912
- Providence VA Medical Center, Providence, RI, 02908
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903
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32
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Griffith G, Kumaraswami T, Chrysanthopoulou SA, Mattocks KM, Clark RE. Prescription contraception use and adherence by women with substance use disorders. Addiction 2017; 112:1638-1646. [PMID: 28387979 DOI: 10.1111/add.13840] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 12/12/2016] [Accepted: 04/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Unintended pregnancy rates are high among women with substance use disorders (SUDs), which could be explained partly by lower use of and adherence to contraception. We aimed to test: (1) the association of SUD with prescription contraceptive use, contraceptive method selection and adherence; (2) whether practices participating in the Patient-Centered Medical Home Initiative (PCMHI) had better contraceptive use and adherence for patients with SUD; and (3) for differences in the association of SUD with adherence by type of contraceptive used. DESIGN Retrospective cohort analysis of claims and encounter data. SETTING Massachusetts, USA. PARTICIPANTS A total of 47 902 women aged 16-45 years enrolled in Medicaid or Commonwealth Care in Massachusetts between 2010 and 2014. MEASUREMENTS We examined three dependent variables: (1) use of a reversible prescription contraceptive during 2012; (2) the contraceptive methods used; and (3) the proportion of days covered by a prescription contraceptive in the year following the first prescription contraceptive claim. The primary predictor was diagnosed SUD, defined as at least one claim for an alcohol or drug use disorder. FINDINGS SUD was associated with lower rates of prescription contraceptive use during 2012 [19.2 versus 23.9%; adjusted odds ratio (aOR) = 0.79, P < 0.001]. SUD was associated with decreased selection of long-acting reversible contraception (LARC) compared with short-acting contraception (SARC) (42.8 versus 44.5%; aOR = 0.83, P = 0.011). There was no significant association between SUD and adherence (aOR = 0.84, P = 0.068). PCMHI enrollment did not alter the relationship between SUD and contraceptive use or adherence. Contraceptive method did not impact the relationship between SUD and adherence. CONCLUSION Women with substance use disorders are less likely to use prescription contraceptives, especially long-acting methods, but are not significantly less likely to adhere to them once prescribed than women without substance use disorders.
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Affiliation(s)
- Gillian Griffith
- Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, MA, USA.,Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, MA, USA
| | - Tara Kumaraswami
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Kristin M Mattocks
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,VA Central Western Massachusetts, Leeds, MA, USA
| | - Robin E Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA
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33
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Subbaraman MS, Metrik J, Patterson D, Swift R. Cannabis use during treatment for alcohol use disorders predicts alcohol treatment outcomes. Addiction 2017; 112:685-694. [PMID: 27865015 PMCID: PMC5339049 DOI: 10.1111/add.13693] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/15/2016] [Accepted: 11/15/2016] [Indexed: 02/04/2023]
Abstract
AIMS To compare post-treatment alcohol use between those who use cannabis and those who abstain during treatment for alcohol use disorders (AUD); and to examine potential cannabis use thresholds by comparing post-treatment alcohol use between four frequency groups of cannabis users relative to abstainers. DESIGN Secondary analyses of the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study, a randomized control trial of AUD treatments. The current study compares longitudinal drinking data between those who used cannabis versus those who abstained during COMBINE treatment. SETTING The COMBINE Study treatments were delivered on an out-patient basis for 16 weeks. The current analyses include 206 cannabis users and 999 cannabis abstainers. PARTICIPANTS All participants met diagnosis of primary alcohol dependence (n = 1383). MEASUREMENTS Primary exposures were any cannabis use and quartiles of cannabis use (Q1: 1-4 use days during treatment, Q2: 5-9 days, Q3: 10-44 days, Q4: 45-112 days). Outcomes were percentage of days abstinent from alcohol (PDA), drinks per drinking day (DPDD) and percentage of heavy drinking days (PHD), all measured at treatment end and 1 year post-treatment. FINDINGS Compared with no cannabis use, any cannabis use during treatment was associated with 4.35% [95% confidence interval (CI) = -8.68, -0.02], or approximately 4 fewer alcohol abstinent days at the end of treatment. This association weakened by 1 year post-treatment (95% CI = -9.78, 0.54). Compared with no cannabis use, only those in the second quartile of cannabis use (those who used once or twice per month during treatment) had 8.81% (95% CI = -17.00, -0.63), or approximately 10 fewer days alcohol abstinent at end of treatment, and 11.82% (95% CI = -21.56, -2.07), or approximately 13 fewer alcohol abstinent days 1 year post-treatment. Neither any cannabis use nor quartiles were associated with DPDD or PHD at either time-point. CONCLUSIONS Among individuals in alcohol treatment, any cannabis use (compared with none) is related to a significantly lower percentage of days abstinent from alcohol post-treatment, although only among those who used cannabis once or twice per month.
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Affiliation(s)
- Meenakshi Sabina Subbaraman
- Alcohol Research Group, Public Health Institute, Emeryville, CA 94608,Corresponding author: Address: Alcohol Research Group, 6001 Shellmound Ave, Emeryville, CA 94608, USA, Phone: (510) 898-5854, Fax: (510) 985-6459,
| | - Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
| | - Deidre Patterson
- Alcohol Research Group, Public Health Institute, Emeryville, CA 94608
| | - Robert Swift
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, 02903,Providence Veterans Affairs Medical Center, Providence, RI, 02908
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34
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Green KM, Musci RJ, Matson PA, Johnson RM, Reboussin BA, Ialongo NS. Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood. J Urban Health 2017; 94:115-124. [PMID: 28083726 PMCID: PMC5359168 DOI: 10.1007/s11524-016-0108-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Urban populations disproportionately experience poor sexual outcomes, including high rates of teenage pregnancy and sexually transmitted infections. However, the contribution of substance use across adolescence to poor sexual outcomes in young adulthood has not been investigated in depth, despite offering opportunities for more targeted prevention. This study aimed to estimate joint trajectories of adolescent alcohol and marijuana use to determine if they relate differently to four sexual outcomes: multiple sexual partners, sex without a condom, teenage pregnancy, and contraction of a sexually transmitted infection in young adulthood (by age 25). Data came from a longitudinal study of urban youth followed from age 6 to age 25, with annual assessments during adolescence and young adulthood (n = 608). The sample showed high levels of sexual risk, with young adults on average having sex without a condom once in the past month, 28.5% having multiple sexual partners in the past month, one quarter having contracted a sexually transmitted infection, and over 60% of the women being pregnant as a teenager and 36% of the men having gotten a partner pregnant. Applying longitudinal latent profile analysis to estimate joint trajectories of alcohol and marijuana use from grades 8-12, we identified four classes representing high dual use, moderate alcohol use, moderate alcohol use with increasing marijuana use, and non-use. Class membership differently predicted all four outcomes investigated with high dual users having the highest level of teenage pregnancy and the increasing marijuana trajectory having the highest risk of engaging with multiple sexual partners in the past month. Results suggest implications for both sexual risk and substance use prevention for urban youth.
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Affiliation(s)
- Kerry M Green
- Department of Behavioral and Community Health, University of Maryland School of Public Health, SPH Building, Valley Drive, College Park, MD, 20742, USA.
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, 8th Floor, Baltimore, MD, 21205, USA
| | - Pamela A Matson
- Department of Pediatrics, Johns Hopkins School of Medicine, 200 N. Wolfe St, Rm 2025, Baltimore, MD, 21287, USA
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, 8th Floor, Baltimore, MD, 21205, USA
| | - Beth A Reboussin
- Department of Biostatistical Sciences and Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Nicholas S Ialongo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, 8th Floor, Baltimore, MD, 21205, USA
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35
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The Association between Alcohol and Sexual Risk Behaviors among College Students: A Review. CURRENT ADDICTION REPORTS 2016; 3:349-355. [PMID: 27896039 DOI: 10.1007/s40429-016-0125-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Alcohol use is prevalent among college students and may contribute to sexual risk behavior engagement. A narrative review of the recent empirical literature examining the association between alcohol use and sexual risk behaviors among college student samples was conducted. The purpose of this review was to: (a) review studies examining the association between alcohol use and risky sexual behaviors; and (b) overview research investigating alcohol expectancies and partner characteristics as factors that may influence the alcohol-risky sex relation among college students. RECENT FINDINGS Findings regarding the direct link between alcohol use and sexual risk behaviors were mixed. Results suggest a more nuanced association between alcohol and risky sexual behaviors that is influenced by alcohol expectancies and partner characteristics. SUMMARY Results highlight the importance of considering additional factors that may influence the alcohol-risky sex relation. Future interventions targeting alcohol-related sexual risk behavior engagement among college students are needed.
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36
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Does it really matter which drug you choose? An examination of the influence of type of drug on type of risky sexual behavior. Addict Behav 2016; 60:97-102. [PMID: 27104799 DOI: 10.1016/j.addbeh.2016.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/05/2016] [Accepted: 03/29/2016] [Indexed: 01/22/2023]
Abstract
This study investigates whether certain types of substances are differentially related to certain risky sexual behaviors (RSBs) within the same population and determines whether combination substance use (SU) has additive, redundant or antagonistic effects on RSBs. African-American youth aged 9-19 participated in a large, community-based survey assessing substance use and sexual behaviors. Multilevel modeling was used to predict the differential influence of alcohol, marijuana, and cocaine use on condom use measured in the past 90days and at last intercourse, sex while drunk/high, and number of sexual partners. Tests of the within-participant relations showed that participants increasing their SU over time concurrently increased their RSBs, establishing a strong link between the two behaviors (alcohol: condom β=-0.045, sex while drunk/high β=0.138, sex partners β=0.102; marijuana: condom β=-0.081, sex while drunk/high β=0.255, sex partners β=0.166; cocaine: condom β=-0.091, sex while drunk/high β=0.103, sex partners β=0.031; all p's<0.01). Tests of the between-participant relations showed that, generally, youth reporting less SU across their teenage years were also more likely to report fewer RSBs over this period (alcohol: condom β=-0.128, sex while drunk/high β=0.120, sex partners β=0.169; marijuana: condom β=-0.170, sex while drunk/high β=0.638, sex partners β=0.357; cocaine: condom β=-0.353; all p's<0.05). Moreover, the combination of some substances has unique redundant or antagonistic effects on RSB. Such findings support the consideration of type of SU, and particular combinations of substances, on RSBs in intervention development.
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37
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Metrik J, Caswell AJ, Magill M, Monti PM, Kahler CW. Sexual Risk Behavior and Heavy Drinking Among Weekly Marijuana Users. J Stud Alcohol Drugs 2016; 77:104-12. [PMID: 26751360 DOI: 10.15288/jsad.2016.77.104] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Sexual behavior that incurs increased risk for sexually transmitted infections and HIV incidence is associated with both heavy alcohol and marijuana use. Whereas detrimental effects of alcohol on increased sexual risk have been documented in event-level and laboratory studies, less is known about the combined use of alcohol and marijuana and their relative impact on sexual risk behavior. We examined the degree to which both heavy drinking and marijuana use were associated with condomless sexual intercourse with casual versus main partners in a sample of weekly marijuana smokers. METHOD Participants reported substance use and sexual activity using a 60-day Timeline Followback interview method (n = 112). RESULTS Results of generalized estimating equations indicated that both alcohol and marijuana use were independently associated with greater odds of having sexual intercourse but were not associated with greater odds of unprotected sex with a casual partner. Heavy drinking on a given day was associated with increased odds of having casual protected sex. Using both substances synergistically increased the likelihood of unprotected sex with a main partner. CONCLUSIONS Findings suggest that behaviors posing higher sexual risk (condomless intercourse or sex with casual partners) occur on days when alcohol use exceeds moderate drinking guidelines. Interventions designed to reduce sexual risk behaviors may need to specifically target heavy drinking alone or when used with marijuana.
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Affiliation(s)
- Jane Metrik
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island.,Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Amy J Caswell
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
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38
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Brown JL, Talley AE, Littlefield AK, Gause NK. Young women's alcohol expectancies for sexual risk-taking mediate the link between sexual enhancement motives and condomless sex when drinking. J Behav Med 2016; 39:925-30. [PMID: 27342615 DOI: 10.1007/s10865-016-9760-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/17/2016] [Indexed: 11/25/2022]
Abstract
Alcohol use is prevalent among young women. Alcohol expectancies for sexual risk-taking and sexual enhancement motives have been associated with decreased condom use. This study investigated whether alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condom use. Young women (N = 287, M age = 20.1) completed a survey assessing alcohol expectancies for sexual risk-taking, sexual enhancement motives, and characteristics of their most recent sexual encounter involving alcohol. Most participants (66.9 %) reported unprotected sex during their last sexual encounter involving alcohol. Higher sexual enhancement motives (OR = 1.35, p = .019) and alcohol expectancies for sexual risk-taking (OR = 1.89, p < .001) were associated with increased likelihood of condomless sex. Alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condomless vaginal sex. Within the context of sexual encounters involving alcohol, expectancies that drinking may result in sexual risk-taking may account for why sexual enhancement motives relate to decreased condom use.
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Affiliation(s)
- Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, 3131 Harvey Avenue, Suite 104, Cincinnati, OH, 45229, USA.
| | - Amelia E Talley
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Nicole K Gause
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
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Schmiege SJ, Bryan AD. Heterogeneity in the Relationship of Substance Use to Risky Sexual Behavior Among Justice-Involved Youth: A Regression Mixture Modeling Approach. AIDS Behav 2016; 20:821-32. [PMID: 26456405 DOI: 10.1007/s10461-015-1219-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13120 E. 19th Ave, Mail Stop C288-04, Aurora, CO, 80045, USA.
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
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Palamar JJ, Fenstermaker M, Kamboukos D, Ompad DC, Cleland CM, Weitzman M. Adverse psychosocial outcomes associated with drug use among US high school seniors: a comparison of alcohol and marijuana. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 40:438-46. [PMID: 25169838 DOI: 10.3109/00952990.2014.943371] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES There is debate about whether marijuana (cannabis) use is more dangerous than alcohol use. Although difficult to make objective comparisons, research is needed to compare relative dangers in order to help inform preventive efforts and policy. METHODS Data were analyzed from a nationally representative sample of high school seniors in the Monitoring the Future study (2007-2011; Weighted n = 7437; modal age: 18) who reported lifetime use of alcohol or marijuana. Students were asked to indicate whether they experienced various adverse psychosocial outcomes resulting from use of each substance. We examined which outcomes were more prevalent for each substance. RESULTS Compared to alcohol use, marijuana use was more commonly reported to compromise relationships with teachers or supervisors, result in less energy or interest, and result in lower school or job performance. Compared to marijuana use, alcohol was more commonly reported to compromise relationships with friends and significant others; it was also reported to lead to more regret (particularly among females), and driving unsafely. Marijuana users were more likely to report no adverse outcomes. Females and white students were more likely to report various adverse outcomes and higher frequency use of each substance also increased occurrences of reported adverse outcomes. CONCLUSIONS Marijuana and alcohol are associated with unique adverse psychosocial outcomes. Outcomes differ by sex and race/ethnicity, and perception or experience of outcomes may also be related to legal status and associated stigma. Public health interventions may be more effective by focusing on harm reduction strategies for these drug-specific outcomes.
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Affiliation(s)
- Joseph J Palamar
- New York University Langone Medical Center, Department of Population Health , New York
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Vrangalova Z. Hooking up and psychological well-being in college students: short-term prospective links across different hookup definitions. JOURNAL OF SEX RESEARCH 2014; 52:485-98. [PMID: 25073476 DOI: 10.1080/00224499.2014.910745] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Hooking up (sex outside committed, romantic relationships) is feared to result from or lead to compromised psychological well-being among undergraduates, yet longitudinal evidence is scarce and inconclusive, and different hookup definitions complicate cross-study comparisons. This study examined short-term longitudinal associations with four well-being indicators (depression, anxiety, life satisfaction, and self-esteem) across several definitions of hookups based on relationship length (one time, longer casual, and any) and physical intimacy level (kissing, genital touching, oral sex, and intercourse). A university-wide sample of 666 Northeastern U.S. freshmen and juniors (63% female, 68% White) completed online surveys at the beginning and end of one academic semester. Linear and logistic regressions explored whether hookups over the semester were linked to later well-being, and whether initial well-being was linked to later hookups. Across all 96 regressions, statistically significant associations between well-being and hookups were infrequent (23%), predominantly confined to anxiety and life satisfaction, equally likely in the direction of higher (13%) as lower (10%) well-being, and affected by both casual relationship length and intimacy level. When gender differences emerged (11%), hookups were associated with higher well-being for women and lower well-being for men. This complex set of results points to the importance of researchers' choices in hookup definitions.
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Connor J, Cousins K, Samaranayaka A, Kypri K. Situational and contextual factors that increase the risk of harm when students drink: Case-control and case-crossover investigation. Drug Alcohol Rev 2014; 33:401-11. [DOI: 10.1111/dar.12172] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/07/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Jennie Connor
- Department of Preventive and Social Medicine; University of Otago; Dunedin New Zealand
| | - Kimberly Cousins
- Department of Preventive and Social Medicine; University of Otago; Dunedin New Zealand
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine; University of Otago; Dunedin New Zealand
| | - Kypros Kypri
- School of Medicine and Public Health; University of Newcastle; Newcastle Australia
- Injury Prevention Research Unit; Department of Preventive and Social Medicine; University of Otago; Dunedin New Zealand
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