Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

Risk-stratified analysis of sex risk behaviors and correlates among school-going adolescents in Argentina: insights from a national survey

OBJECTIVES

This study was conducted to address a critical gap in understanding adolescent sexual health risks in Argentina, a country that has undergone substantial socio-economic changes that made significant strides in education and healthcare.

METHODS

A secondary data analysis of the 2018 Argentina Global School-based Student Health Survey was performed. In this study, 23,262 sexually active adolescents were categorized into four risk groups based on the predicted granular risk: number of sexual partners and condom use in their last sexual encounter.

RESULTS

Males and older adolescents were more prone to high-risk sexual behaviors. Additionally, key psychosocial factors such as loneliness, anxiety, experiences of violence, and school absenteeism were significantly associated with high-risk sexual behaviors. Early alcohol use and recent experiences of hunger were also identified as strong predictors of heightened sexual risk behaviors. Conversely, positive parental engagement and awareness exhibited protective factors.

CONCLUSIONS

These findings highlight the necessity for policy interventions that focus on mental health support, parental involvement, and awareness of adolescent issues and activities.

Cannabis use disorder is associated with shorter length of stay and increased home discharge after primary total joint arthroplasty: a propensity-weighted analysis

INTRODUCTION

Increased legalization of cannabis use across the United States has been correlated with increased cannabis use in the clinical setting. However, little is known regarding the characteristics and postoperative outcomes after primary joint arthroplasty (TJA) for patients with cannabis use disorder (CUD).

METHODS

This retrospective cohort study used data from the National Inpatient Sample of patients undergoing primary TJA between 2006 to 2015. Patients were grouped based on presence of concomitant CUD. Patient demographic characteristics and outcome data between groups were analyzed. Propensity score methodology was used to compare immediate in-hospital complications and economic outcomes.

RESULTS

A total of 8,740,798 TJAs were included. The prevalence of CUD increased nearly five-fold from 0.05% to 0.26% during this time (P < 0.0001). CUD patients were significantly younger, more likely to be male, most frequently of non-Hispanic Black race, and had higher rates of Medicaid insurance. Patients with CUD had a significantly shorter length of hospital stay (3.04 vs. 3.24 days, P = 0.0297), while incurring significantly higher daily ($22,614 vs. $17,955, P < 0.0001) and total charges during admission ($58,507 vs. $50,924, P < 0.0001), compared to patients without CUD. When compared with the control group, CUD was associated with significantly greater odds of home discharge (odds ratio (OR): 1.45, P = 0.0007), and significantly lower odds of rehab discharge (OR: 0.70, P = 0.0013). There were no differences in overall complication profile or in the vast majority of individual in-hospital complications between groups.

CONCLUSION

While CUD is correlated to shorter length of stay and increased home discharge after TJA, it does not show a strong effect on complications in an inpatient postoperative setting. It is important for clinicians to appreciate the demographic profile and expected clinical and economic outcomes for patients with CUD undergoing TJA, particularly in the context of evolving laws surrounding cannabis use.

Condom use self-efficacy centered on sexual experience, cannabis, and CBD use among college students

OBJECTIVES

The goal of this study was to understand how condom use self-efficacy varies based on sexual experience, cannabis and CBD use.

METHODS

A cross-sectional survey was implemented through Qualtrics. A total of 455 undergraduate students were surveyed at a large U.S. northeastern university.

RESULTS

Findings suggested that sexual experience itself and sexual experience with cannabis and CBD are associated with a person's condom use self-efficacy. Precisely, non-sexually active and cannabis or CBD nonusers perceived themselves as less efficacious in their future use of condoms compared with sexually active adolescents.

CONCLUSIONS

Implications for health interventions are discussed, such as the importance of giving attention to non-sexually active adolescents and strengthening their condom use self- efficacy. It is critical to promote healthy sexual behaviors among future sexually active college students and reinforce healthy sexual behaviors among sexually active adolescents.

Cannabis Use Disorder in the Setting of Primary Total Hip Arthroplasty: Understanding the Epidemiology, Demographic Characteristics, and Inpatient Postoperative Outcomes

INTRODUCTION

Cannabis use is expected to increase in the context of its decriminalization and legalization in several states. The purpose of this study was to report on the epidemiologic and demographic characteristics and inpatient postoperative outcomes of patients with cannabis use disorder (CUD) undergoing primary total hip arthroplasty (THA).

METHODS

The National Inpatient Sample registry was used to identify patients undergoing THA between 2006 and 2015. Patients were stratified into groups with and without CUD. Epidemiology, comorbidity, and outcomes data were comparatively analyzed between these two groups.

RESULTS

A total of 2,838,742 THAs were performed during the study period. The prevalence of CUD significantly increased from 0.10% in 2006 to 0.39% in 2015 (P < 0.0001). Patients with CUD were significantly younger, more likely to be male, had higher rates of Medicaid insurance and were more likely to be non-Hispanic Black and less likely to be non-Hispanic White when compared with the control group. When comparing patients with and without CUD, there was no significant difference in the composite any complication variable and no significant difference in seven of eight individual in-hospital complications assessed, with the exception being higher genitourinary complications in the CUD group. There were no significant differences in discharge disposition or length of stay.

DISCUSSION

Although CUD is significantly associated with various demographic, comorbidity, and hospital characteristics, it is not significantly associated with in-hospital complications, discharge disposition, and length of stay outcomes in the immediate in-hospital, postoperative period. It is critical for clinicians and public health professionals to understand the characteristics and expected inpatient outcomes of this evolving population of patients with CUD undergoing THA, particularly in the context of widespread legalization.

LEVEL OF EVIDENCE

Level III.

Medical marijuana for inflammatory bowel disease: the highs and lows

Increased interest in cannabis as a potential treatment and/or adjuvant therapy for inflammatory bowel disease (IBD) has been driven by patients with refractory disease seeking relief as well those who desire alternatives to conventional therapies. Available data have shown a potential role of cannabis as a supportive medication, particularly in pain reduction; however, it remains unknown whether cannabis has any impact on the underlying inflammatory process of IBD. The purpose of this review article is to summarize the available literature concerning the use of cannabis for the treatment of IBD and highlight potential areas for future study.

Ethnic Identity, Empowerment, Social Support and Sexual Risk Behaviors Among Black Adolescent Girls: Examining Drug Use as a Mediator

Substance abuse and sexual health research tends to overlook the resiliency skills that Black adolescent girls possess. Using a strengths-based lens, this study examines the role of protective factors: (e.g. ethnic identity, social support, and psychological empowerment) on sexual risk behaviors testing drug use as a mediator among a sample of Black adolescent girls. The study uses a sample (N = 340) female adolescents (13-17 years old) who identified as being Black only and reside in a northeastern urban community in New Jersey. Structural equation modeling was employed to test the hypothesized model of the mediating role of drug use on sexual risk behaviors among this sample. Findings revealed that drug use significantly mediated the relationship between social support, ethnic identity, and psychological empowerment on sexual risk behaviors, with high ethnic identity scores having the strongest relationship on low sexual risk behaviors and low levels of drug use. Given the rise of sexually transmitted infections (STIs) in the United States among Black adolescent girls, findings from this study can contribute to development of culturally appropriate and innovative strategies to reduce risky behaviors by promoting social and cultural strengths among Black girls living in urban communities.

Incarceration and Subsequent Pregnancy Loss: Exploration of Sexually Transmitted Infections as Mediating Pathways

Background: Incarceration is linked to risk of sexually transmitted infection (STI) postrelease among women. There has been little examination of incarceration's association with related sexual and reproductive outcomes such as pelvic inflammatory disease (PID) and pregnancy loss, or the role of STI in this relationship and whether these relationships differ between Black and White women. Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined cross-sectional associations between incarceration (Wave IV; 2007-2008; ages 24-34) and history of STI and PID (n = 5,968), and longitudinal associations between incarceration and later pregnancy loss in mid-adulthood (Wave V; 2016-2018; ages 34-43) among women who had ever been pregnant (n = 2,353); we estimated racial differences. Using causal mediation, we explored whether STI mediated associations with pregnancy loss. Results: Incarceration was associated with a history of STI (White adjusted prevalence ratio [APR]: 1.54, 95% confidence interval [CI] 1.14-2.06; Black APR: 1.26, 95% CI 1.02-1.56); the association between incarceration and PID was null among White women (APR: 0.99, 95% CI 0.47-2.09) and elevated among Black women (APR: 2.82, 95% CI 1.36-5.83). Prior incarceration did not appear associated with pregnancy loss among White women (APR: 1.01, 95% CI 0.70-1.45), but was associated among Black women (APR: 1.38, 95% CI: 0.97-1.97), with STI appearing to partially mediate. Conclusions: Pregnancy loss may be elevated among Black women who have been incarcerated, and incarceration-related increases in STI may account for some of this association.

Daily Marijuana Use Predicts HIV Seroconversion Among Black Men Who Have Sex with Men and Transgender Women in Atlanta, GA

We evaluated whether different types of substance use predicted HIV seroconversion among a cohort of 449 Black men who have sex with men (MSM) and transgender women (TGW). A community-based sample was recruited in Atlanta, GA between December 2012 and November 2014. Participants completed a survey and were tested for STIs (Chlamydia and gonorrhoeae using urine samples and rectal swabs) at baseline. HIV testing was conducted at 12-months post enrollment. Multivariable binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CI) for associations between substance use and HIV seroconversion. By 12-month follow-up, 5.3% (n = 24) of participants seroconverted. In multivariable analyses, daily marijuana use was positively associated with HIV seroconversion (aOR 3.07, 95% CI 1.11-8.48, P = 0.030). HIV incidence was high and daily marijuana use was associated with a more than threefold increased odds of HIV seroconversion among a community-based cohort of Black MSM and TGW.

Associations of alcohol, marijuana, and polysubstance use with non-adherence to COVID-19 public health guidelines in a US sample

Background: We sought to understand the association between heavy alcohol and frequent drug use and non-adherence to recommended social distancing and personal hygiene guidelines for preventing the spread of COVID-19 early in the US pandemic. Methods: A survey was offered on the crowdsourcing platform, Amazon Mechanical Turk (MTurk) during April 2020 (the early days of strict, social distancing restrictions). The study included 1,521 adults ages 18 years and older who resided in the US and were enrolled as MTurk workers, i.e., workers who are qualified by Amazon to complete a range of human interaction tasks, including surveys through the MTurk worker platform. Main predictors included measures of heavy drinking, marijuana, and polysubstance use. The dependent measures were measures of social distancing and personal hygiene, based on guidelines recommended at the time of the survey by the US Centers for Disease Control to prevent the spread of COVID-19. Results: We found consistent negative associations between heavy drinking and drug use and adherence to social distancing and personal hygiene. Additionally, three control variables, age, gender, and race/ethnicity, were significant correlates of adherence to these measures. Conclusions: The findings here are consistent with previous research exploring links between substance use and other adverse health behaviors. Further, the negative association between heavy drinking (five or more drinks in one sitting) and adherence underscore the public health risks entailed with the unrestricted reopening of public drinking establishments.

Concurrent and Concordant Oral and Genital High-Risk Human Papillomavirus in the United States: Results from the National Health and Nutrition Examination Survey

BACKGROUND

Oropharyngeal cancers associated with high-risk human papillomavirus (HR-HPV) infection are increasing in the United States, especially among men. We evaluated the prevalence and predictors of concurrent (genital and oral) and concordant (same-type) HR-HPV infections in the United States.

METHODS

We used the National Health and Nutrition Examination Survey from 2009 to 2016. Predictors were assessed via multivariable logistic regression.

RESULTS

Among 10 334 respondents, 172 (2.1%) had concurrent infections (109 [3.5%] men and 63 [0.76%] women]. Ninety-three (1.0%) had concordant infections (54 [1.6%] men and 39 [0.5%] women). Predictors of concurrence in men included the following: no longer married versus married (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3-4.9), living with a partner versus married (3.0; 1.2-7.5), and having 2-5 lifetime oral sex partners (3.0; 1.2-7.5). In women they included the following: no longer married versus married (3.6; 1.3-10.3), ≥2 recent sex partners (4.6; 1.4-15.6 for 2-5 partners and 3.9; 1.1-14.3 for ≥6 partners), and marijuana use (2.2; 1.0-4.5). The predictor of concordance in men and women was no longer married versus married (3.5; 1.2-9.9 in men and 3.2; 1.1-9.4 in women).

CONCLUSIONS

Concurrent and concordant HR-HPV infections occur at a high rate, especially among men, and are associated with behavioral factors. This underscores the importance of HPV vaccination, screening, and education in men.

Associations between Cannabis Use and Sexual Risk Behavior among Women under Community Supervision: A Brief Report

OBJECTIVES

Cannabis use and sexual risk behavior have been found to co-occur, but more research on these associations is needed among criminal justice-involved women (i.e., courts, jails, or prisons).

METHODS

Regression models examined past 90-day cannabis use on unprotected sex, multiple sexual partners, and STIs/HIV among 306 women under NYC community supervision, adjusting for alcohol, other illicit substances, and socio-demographics.

RESULTS

Cannabis use, but not alcohol or other illicit substance use, was positively associated with having unprotected sex and multiple sexual partners, but not STIs or HIV.

CONCLUSIONS

Criminal justice-involved women may benefit from sexual risk reduction interventions incorporating cannabis content.

Marijuana Use and Sexual Risk Behavior Among Young Black Men Who Have Sex with Men in California

Young black men who have sex with men (YBMSM) are disproportionately affected by HIV and continue to experience higher rates of new HIV infections when compared to other population groups. As part of the Peer Promotion of Wellness and Enhanced Linkage to Resources Project, we examined problem marijuana use and the overall sexual risk profile of 250 YBMSM. Eighty percent reported prior use of marijuana in their lifetime (n = 200). Among those, problem marijuana use was correlated with problem use of alcohol (r = 0.51, p < 0.001) and other drugs (r = 0.29, p < 0.001); lower household income (r = - .22, p < .01); homelessness (r = 0.15, p < 0.05); incarceration (r = 0.16, p < 0.05); exchanging sex for money, drugs, or shelter (r = 0.18, p < 0.05); having sex with someone known or suspected of having HIV and/or an STI (r = 0.20, p < 0.01); having sex with someone known or suspected of being an injector (r = 0.24, p < 0.01); and having unprotected sex while under the influence of alcohol or drugs (r = 0.32, p < 0.001). The complex relationship between marijuana and sexual risk behavior was examined while accounting for the possible moderating effects of alcohol or other drugs. Problem marijuana, alcohol, and other drug use each made unique contributions to predicting risky sex behavior. A significant marijuana and other drug interaction was found to predict sexual risk behaviors. Future efforts should include holistic intervention approaches for YBMSM that consider factors facilitating high-risk sexual behaviors.

Evaluating the impact of COVID-19: A cohort comparison study of drug use and risky sexual behavior among sexual minority men in the U.S.A

BACKGROUND

Sexual minority men who use drugs have high sexual HIV transmission risk. Sexual interactions may also increase COVID-19 risk.This study compared marijuana use, other illegal drugs use (i.e. cocaine/crack, methamphetamine, MDMA/ecstasy, GHB, and ketamine) and sexual behavior with casual partners among sexual minority cismen active on social networking and dating applications before and during the COVID-19 epidemic.

METHODS

This cohort-control study compared 455 adult respondents (surveyed May 6th to 17th, 2020) and a matched sample selected from 65,707 respondents surveyed pre-COVID. Participants were recruited on social networking and dating applications and completed surveys online.

RESULTS

The proportion reporting marijuana use declined significantly in the COVID cohort (34.5 % versus 45.7 % pre-COVID,p < .001) as did their illegal drug use (11.0 % versus 22.9 % pre-COVID, p < .001). While the number of casual partners per month was stable, the proportion reporting condomless anal sex with casual partners declined significantly during COVID (26.4 % versus 71.6 % pre-COVID, p < .001). The effect of illegal drug use (excluding marijuana) on number of casual partners per month (aRR = 1.45 pre-COVID versus 2.84, p < .01) and odds of condomless anal sex (aOR = 2.00 pre-COVID versus 5.22, p = .04) were significantly greater in the COVID cohort.

CONCLUSIONS

While the proportion of participants reporting drug use and condomless anal sex with casual partners declined in the COVID cohort, the association between drug use and sexual behavior was magnified. Sexual minority men who use drugs are significantly more likely to engage in sexual behaviors that place them at risk for HIV and COVID-19 transmission.

Longitudinal predictors of male sexual partner risk among Black and Latina women in their late thirties: ethnic/racial identity commitment as a protective factor

This study aimed to investigate predictors of male sexual partner risk among Latinas and Black women in their late thirties. We used multiple regression analysis to examine factors associated with male sexual partner risk among 296 women who participated in two waves of the Harlem Longitudinal Development Study (New York, 2011-2013 and 2014-2016). Women who experienced childhood sexual abuse had higher risk partners than those who did not [b = 0.16, 95% confidence interval (CI) = 0.06, 0.28]. Earlier marijuana use was a risk factor for partner risk in the late thirties (b = 0.12, 95% CI = 0.04, 0.27). Higher levels of ethnic/racial identity commitment mitigated this risk (b = - 0.15, 95% CI = - 0.26, - 0.04). Ethnic/racial identity commitment can be protective against male sexual partner risk among Latina and Black women who use marijuana. Further research should explore the protective role of different dimensions of ethnic/racial identity against sexually transmitted infections, including HIV.

Polysubstance use among frequent marijuana users: an examination of John Henryism Active Coping, psychiatric symptoms, and family social support among African American incarcerated men

Incarcerated African American men who use marijuana are vulnerable to polysubstance use, which is associated with greater risk for negative health and psychosocial outcomes than marijuana use alone. It is imperative to understand risk and protective factors for polysubstance use among this vulnerable population to inform the development of culturally tailored substance use interventions. The current study examined the association between John Henryism Active Coping (JHAC), family social support, psychiatric symptoms, and polysubstance use among African American incarcerated men who frequently use marijuana. Results indicated that higher John Henryism Active Coping (JHAC) is associated with decreased likelihood of engaging in polysubstance use, while psychiatric symptoms are associated with increased likelihood of polysubstance use. Incorporating elements of JHAC into concurrent mental health and substance use treatment may reduce risk for overdose and reincarceration among African American incarcerated men upon release into the community.

Association between cannabis use and sexual behavior among adolescents aged 12-15 years in 21 low- and middle-income countries

AIMS

To investigate the relationship between cannabis use and two sexual behaviors (ever had sex, multiple partners) in a large representative sample of adolescents aged 12-15 years from 21 low- and-middle income countries.

METHODS

Data from 84,867 adolescents aged 12-15 years participating in the Global School-based Student Health Survey were analyzed. Participants reported lifetime frequency of cannabis use (analyzed as 0, 1-2, 3-19 or ≥ 20 times), whether they had ever had sexual intercourse (yes/no) and, if yes, their lifetime number of sexual partners. We used multivariable logistic regression to analyze associations, adjusting for a range of relevant covariates.

RESULTS

12.7% of the sample reported having had sexual intercourse, and of these adolescents, 53.1% had had multiple sexual partners. The prevalence of lifetime cannabis use of 1-2 times, 3-19 times, and ≥ 20 times were 1.1%, 1.2%, and 0.4%, respectively. Those who reported using cannabis 1-2 times, 3-9 times, and ≥ 20 times had 2.32 (95%CI = 1.47-3.65), 2.34 (95%CI = 1.34-4.07), and 5.45 (95%CI = 2.22-13.40) times higher odds of having had sexual intercourse than those who had never used cannabis. Among those who had ever had sexual intercourse, the respective odds ratios (95%CIs) for having multiple sexual partners were 1.56 (0.93-2.62), 1.70 (0.92-3.14), and 5.66 (2.97-10.82). There were no significant interactions by sex for these associations.

CONCLUSIONS

Adolescents from LMIC who use cannabis are more likely to have ever had sexual intercourse than those who do not. Among those who have had sexual intercourse, those who use cannabis are more likely to have had multiple sexual partners.

Trends of poly-substance use among Canadian youth

INTRODUCTION

Poly-substance use, increasingly understood as a behaviour with uniquely adverse consequences, is on the rise among Canadian youth. High levels of e-cigarette vaping and the recent legalization of recreational cannabis use may result in an acceleration of this trend. The aim of this work was to characterise changes in youth poly-substance use over time, generate baseline data for future investigations, and highlight areas of interest for policy action.

METHODS

Descriptive statistics and regression models explored patterns and trends in concurrent use of multiple substances (alcohol, cigarettes, cannabis, and e-cigarettes) among Canadian high school students taking part in the COMPASS prospective cohort study during Y2 (2013/2014; n = 45,298), Y3 (2014/2015, n = 42,355), Y4 (2015/2016; n = 40,436), Y5 (2016/2017; n = 37,060), and Y6 (2017/2018; n = 34,879).

RESULTS

Poly-substance use increased significantly over time, with over 50% of students who used substance reporting past-year use of multiple substances by 2017/2018. Male and Indigenous students were significantly more likely to report poly-substance use than female and white students respectively. E-cigarette vaping doubled from Y5 to Y6 and was included in all increasingly prevalent substance use combinations.

CONCLUSIONS

Youth poly-substance use, rising since 2012/2013, saw a particularly steep increase after 2016/2017. Differential effects were observed for distinct demographic subpopulations, indicating tailored interventions may be required. E-cigarette vaping surged in parallel with the observed increase, suggesting a key role for this behaviour in shaping youth poly-substance use.

Associations of Alcohol and Marijuana Use With Condom Use Among Young Adults: The Moderating Role of Partner Type

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.

Alcohol and Cannabis Use and Sexual Risk Behaviors in the Malawi Defence Force

Substance abuse is a public health priority in the context of the HIV epidemic, especially in military communities. This cross-sectional study quantified alcohol and cannabis use in the Malawi Defence Force and investigated its associations with condom use, transactional sex, multiple sexual partners, and sexual violence. Participants were 944 male and female service members ≥ 18 years old. Data were collected in 2013 using a computer-assisted self-interview. Twenty-four percent of men and women screened positive for hazardous and harmful drinking [Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8]. About 6% reported using cannabis in the past year and 10% reported using cannabis prior to 1 year ago. Multivariable models found elevated adjusted odds of transactional sex and multiple sexual partners for men with an AUDIT score ≥ 8, and men who reported ever using cannabis. The adjusted odds of experiencing sexual violence were also elevated for men who reported ever using cannabis. These findings add to the growing concern that substance use may perpetuate the HIV epidemic in Sub-Saharan Africa by increasing risky sexual behaviors. A comprehensive military HIV prevention response should include substance use education and appropriate care and treatment for individuals screening positive for hazardous and harmful drinking.

Dual use of alcohol and marijuana and condomless sex in young adult men and women: A within-subject day-level analysis

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).

Associations of Drug Use, Violence, and Depressive Symptoms with Sexual Risk Behaviors Among Women with Alcohol Misuse

BACKGROUND

Alcohol misuse is associated with increased human immunodeficiency virus sexual risk behaviors by women. Drug use, intimate partner violence (IPV), and depressive symptoms frequently co-occur, are well-recognized alcohol misuse comorbidities, and may interact to increase risk behaviors. Using a syndemic framework we examined associations between drug use, IPV, and depressive symptoms and sexual risk behaviors by 400 women with alcohol misuse attending an urban sexually transmitted infections clinic.

METHODS

Participants completed computer-assisted interviews querying drug use, IPV, and depressive symptoms and sexual risk behavior outcomes-unprotected sex under the influence of alcohol, sex for drugs/money, and number of lifetime sexual partners. We used multivariable analysis to estimate prevalence ratios (PR) for independent and joint associations between drug use, IPV, and depressive symptoms and our outcomes. To investigate synergy between risk factors we calculated the relative excess prevalence owing to interaction for all variable combinations.

RESULTS

In multivariable analysis, drug use, IPV, and depressive symptoms alone and in combination were associated with higher prevalence/count of risk behaviors compared with women with alcohol misuse alone. The greatest prevalence/count occurred when all three were present (unprotected sex under the influence of alcohol [PR, 2.6; 95% confidence interval, 1.3-4.9]), sex for money or drugs [PR, 2.6; 95% confidence interval, 1.7-4.2], and number of lifetime partners [PR, 3.2; 95% confidence interval, 1.9-5.2]). Drug use, IPV, and depressive symptoms did not interact synergistically to increase sexual risk behavior prevalence.

CONCLUSIONS

A higher prevalence of sexual risk behaviors by women with alcohol misuse combined with drug use, IPV, and depressive symptoms supports the need for alcohol interventions addressing these additional comorbidities.

One-year abstinence improves ADHD symptoms among patients with polysubstance use disorder

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a common comorbid disorder in patients suffering from substance use disorder (SUD). Individuals with co-occurring SUD and ADHD are more likely than SUD patients without ADHD to have developed SUD at a younger age, be polysubstance users, and need inpatient treatment more often. The present study investigates whether individuals with polysubstance use disorder who remain abstinent for a year after entering treatment have a more substantial reduction in ADHD symptoms than those who relapsed and controls.

MATERIAL AND METHODS

Subjects were SUD patients (N = 115) and healthy controls (N = 34). ADHD symptoms were assessed using the adult ADHD Self-Report Scale (ASRS). Substance use was assessed by self-reports on the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Use Disorders Identification Test (DUDIT). Participants were defined as having relapsed if they had an AUDIT score ≥ 8 or a DUDIT score ≥ 2 for women and ≥ 6 for men.

RESULTS

Patients who remained abstinent for one year reported a substantial reduction of ADHD symptoms compared to patients who relapsed and controls.

CONCLUSIONS

Abstinence alleviates ADHD symptoms among patients with polysubstance use disorder. We suggest that confirmation of an ADHD diagnosis should follow a period of abstinence to avoid identification of false-positive cases.

Longitudinal pathways from unconventional personal attributes in the late 20s to cannabis use prior to sexual intercourse in the late 30s

A quarter of people living with human immunodeficiency virus (HIV) infection in the United States are women. Furthermore, African American and Hispanic/Latina women continue to be disproportionately affected by HIV, compared with women of other races/ethnicities. Cannabis use prior to intercourse may be associated with increased risky sexual behaviors which are highly related to HIV. The ultimate goal of this research is to better understand the relationships between unconventional personal attributes (e.g., risk-taking behaviors) in the late 20s, substance use (e.g., alcohol) in the mid 30s, and cannabis use prior to intercourse in the late 30s using a community sample; such an understanding may inform interventions. This study employing data from the Harlem Longitudinal Development Study includes 343 female participants (50% African Americans, 50% Puerto Ricans). Structural equation modeling indicated that unconventional personal attributes in the late 20s were associated with substance use in the mid 30s (β=0.32, p<0.001), which in turn, was associated with cannabis use prior to sexual intercourse in the late 30s (β=0.64, p<0.001). Unconventional personal attributes in the late 20s were also directly related to cannabis use prior to sexual intercourse in the late 30s (β=0.39, p<0.01). The findings of this study suggest that interventions focused on decreasing unconventional personal attributes as well as substance use may reduce sexual risk behaviors among urban African American and Puerto Rican women. Also, the implications of this study for health care providers and researchers working in HIV prevention are that these precursors may be useful as patient screening tools.

Developmental Patterns of Adolescent Marijuana and Alcohol Use and Their Joint Association with Sexual Risk Behavior and Outcomes in Young Adulthood

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.

Altered subjective reward valuation among female heavy marijuana users

Maladaptive decision-making is a cardinal feature of drug use, contributing to ongoing use, and reflecting alterations in how drug users assess uncertain reward value. Accumulating evidence indicates the consequences of heavy marijuana use are worse for female versus male animals and humans, but research assessing sex differences in reward-related decision-making among marijuana users remains scarce. We examined sex differences in the subjective valuation of certain and uncertain rewards among heavy marijuana users (52; 26 male and 26 female) and controls (52; 26 male and 26 female). We offered male and female heavy marijuana users and controls monetary rewards of certain and uncertain (probabilistic) values. We measured how preferences for uncertain rewards varied by the objective value of those rewards, moderators of reward uncertainty, Marijuana Group and Sex. Men were more sensitive to changes in the objective value of uncertain rewards than women. However, this effect of Sex differed by Marijuana Group. Female heavy marijuana users were more sensitive to changes in uncertain reward value, particularly when the "stakes" were high (i.e., greater difference between potential uncertain rewards), than female controls. Female heavy marijuana users' sensitivity to changes in the value of high stakes uncertain rewards was comparable to male marijuana users and controls. In contrast, male marijuana users' sensitivity to changes in the value of high stakes uncertain rewards did not differ from male controls. These results suggest sex differences in sensitivity to high risk rewards may be one pathway contributing to severer consequences of heavy marijuana use among women. (PsycINFO Database Record

Network dynamics of HIV risk and prevention in a population-based cohort of young Black men who have sex with men

Critical to the development of improved HIV elimination efforts is a greater understanding of how social networks and their dynamics are related to HIV risk and prevention. In this paper, we examine network stability of confidant and sexual networks among young black men who have sex with men (YBMSM). We use data from uConnect (2013–2016), a population-based, longitudinal cohort study. We use an innovative approach to measure both sexual and confidant network stability at three time points, and examine the relationship between each type of stability and HIV risk and prevention behaviors. This approach is consistent with a co-evolutionary perspective in which behavior is not only affected by static properties of an individual's network, but may also be associated with changes in the topology of his or her egocentric network. Our results indicate that although confidant and sexual network stability are moderately correlated, their dynamics are distinct with different predictors and differing associations with behavior. Both types of stability are associated with lower rates of risk behaviors, and both are reduced among those who have spent time in jail. Public health awareness and engagement with both types of networks may provide new opportunities for HIV prevention interventions.

Change in Risk Perceptions and Marijuana and Cigarette Use Among African American Young Adult Females in an HIV Prevention Intervention

Cigarette smoking and marijuana use have been tied to increased risky sexual behaviors, which may exacerbate risk of HIV transmission and other STIs (sexually transmitted infections). Research suggests that change in general perceptions of risk is associated with change in non-domain-targeted behaviors. The goal of the current study was to determine whether change in general risk perceptions among African American college females enrolled in a culturally-tailored HIV prevention intervention would be associated with decreased cigarette and marijuana use over time. Data were collected from 108 women enrolled in the SISTA Project intervention at a large university at baseline, post-test, and 3-month follow-up. Results from moderation analyses indicated that change in risk perceptions moderated the relationship between past 30-day cigarette use at baseline and past 30-day cigarette use at both post-test and at 3-month follow-up. Change in risk-perceptions also moderated the relationship between past 30-day marijuana use at baseline and past 30-day marijuana use at 3-month follow-up. Implications of the study indicate that heightening risk perceptions in any one area may impact behavior via specific and general increases in self-efficacy and motivation to reduce health risks more generally.

Marijuana Use Among Young Black Men Who Have Sex With Men and the HIV Care Continuum: Findings From the uConnect Cohort

BACKGROUND

Young Black men who have sex with men (YBMSM) are at highest risk for HIV seroconversion in the United States. Successful movement through the HIV care continuum is an important intervention for limiting onwards HIV transmission.

OBJECTIVE

Little data exists on how substances most commonly used by YBMSM, such as marijuana, are related to the HIV continuum, which represents the primary aim of this study.

METHODS

A cohort of YBMSM (n = 618) was generated through respondent-driven sampling. Frequency of marijuana use and marijuana use as a sex-drug were assessed across the HIV care continuum using weighted logistic regression models.

RESULTS

Study participants reported more intermittent marijuana use (n = 254, 56.2%) compared to heavy use (n = 198, 43.8%). Our sample contained 212 (34.3%) HIV seropositive participants of which 52 (24.5%) were unaware of their HIV positive status. Study participants who were heavy marijuana users were more likely to be unaware of their HIV seropositive status (AOR: 4.18; 95% CI 1.26, 13.89). All other stages in the care continuum demonstrated no significant differences between those who use marijuana intermittently or heavily or as a sex-drug and nonusers.

CONCLUSIONS

YBMSM who used marijuana heavily were more likely to be HIV-positive unaware than those who never used marijuana. Findings were inconclusive regarding the relationships between marijuana use and other HIV care continuum metrics. However, knowledge of ones' HIV status is a critical requirement for engaging in care and may have implications for onwards HIV transmission.

[Drug use and treatment misuse: Key points on polydrug use]

Problematic use of psychoactive drugs, be it legal, on prescription, or not, remains a broad phenomenon when taken as a whole, with an increasingly large spectrum of used products. The polysubstance drug use is an expanding new trend. Although its epidemiological analysis is complex, needing further research, certain patterns of drug combinations can be found, allowing to identify clusters of users associated to more specific medical and social risks. Managing polysubstance users involves assessing each drug use, but also the connections between drugs and the patient's expectations for each of them. Complications, as well as psychiatric and somatic comorbidities are to be taken into account. The therapeutic tools for polysubstance drug use, mainly pharmacological, are still often limited to the sum of specific tools for each product. Prevention is crucial but has to adapt to the identified use clusters, and the gender. Notably, a good knowledge of chronic pain management and prescribed drug dependency risks is required to prevent polysubstance drug use involving opioids.

Adolescent cannabis use and repeated voluntary unprotected sex in women

BACKGROUND AND AIMS

Substance use has been implicated in the onset and maintenance of risky sexual behaviors, which have particularly devastating consequences in young women. This study examined whether (i) adolescent onset of cannabis use is associated with repeated voluntary unprotected sex in women and (ii) whether this association persists after accounting for correlated familial influences.

DESIGN

General population sample of female twins.

SETTING

Midwestern United States.

PARTICIPANTS

A total of 2784 sexually active twin women (15.5% African American) aged 18-27 years (assessed 2002-05), including 119 dizygotic (DZ) and 115 monozygotic (MZ) discordant pairs.

MEASUREMENTS

Self-report interview data on cannabis use that first occurred prior to age 17 (27.1%) and repeated voluntary unprotected sex (27.2%). Key covariates included early onset of regular drinking, regular smoking, sexual debut and menstruation as well as conduct disorder symptoms and childhood sexual abuse.

FINDINGS

Compared with never users and those who started using cannabis at a later age, adolescent cannabis users were more likely to report repeated voluntary unprotected sex [odds ratio (OR) = 2.69; 95% confidence interval (CI) = 2.24-3.22]. Genetic (r_g  = 0.57, 95% CI = 0.38-0.87) and non-shared environmental (r_e  = 0.21, 95% CI = 0.02-0.38) factors contributed to the association. After accounting for correlated familial factors, there was a consistent elevation in the likelihood of repeated voluntary unprotected sex in the exposed twin relative to her genetically identical never/late-onset user co-twin (unadjusted OR = 2.25, 95% CI = 1.14-4.44), even after adjustment for covariates (adjusted OR = 2.27, 95% CI = 1.08-4.80).

CONCLUSIONS

Women who start using cannabis during adolescence appear to be more likely to report voluntary engagement in repeated unprotected sex than women who never use cannabis or who initiate cannabis use after adolescence. The results appear to be independent of shared genetic influences.

Mostly Smokers: Identifying Subtypes of Emerging Adult Substance Users

BACKGROUND

The concurrent use of marijuana and other substances among emerging adults (ages 18-25) is a major public health problem. This study examined if there are distinct subtypes of emerging adult marijuana users and if these are associated with demographic and substance use variables.

METHODS

The design was a cross-sectional interview with a community sample of 1,503 emerging adults in the northeastern U.S. who reported last month marijuana use. We used latent class analysis (LCA) to identify distinct subtypes of emerging adults who used additional substances and examined predictors of the latent classes.

RESULTS

We identified three distinct classes of emerging adults who use substances: "mostly smokers" (those who primarily use marijuana and nicotine), "moderate users" (those who primarily use marijuana and/or heavy episodic alcohol), and "polysubstance users." Polysubstance users had higher probabilities of use of all assessed substances (e.g. cocaine, opiates, sleep medications, stimulants, synthetic marijuana, and inhalants) than the other two groups. Not being currently enrolled in school and male gender were associated with mostly smokers and polysubstance users group status.

CONCLUSIONS

We identified a distinct group of emerging adult marijuana users who primarily smoke marijuana and cigarettes, suggesting that there could be a shared vulnerability for risk of co-occurrence.

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

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

Substance use patterns and unprotected sex among street-involved youth in a Canadian setting: a prospective cohort study

Background

Rates of sexually transmitted infections (STI) and unplanned pregnancy are high among youth. While the intersection between drug and alcohol use and unprotected sex is well recognized, few studies have examined the relationship between substance use patterns and unprotected sex among high risk-populations such as street-involved youth.

Methods

Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth from Vancouver, Canada. Generalized estimating equations (GEE) were used to examine substance use patterns that were independently associated with unprotected sex, defined as (vaginal or anal) sexual intercourse without consistent condom use.

Results

Between September 2005 and May 2013, 1,026 youth were recruited into the ARYS cohort and 75 % (n = 766) reported engaging in recent unprotected sex at some point during the study period. In a multivariable analysis, female gender (adjusted odds ratio [AOR] = 1.46, 95 % confidence interval [CI]: 1.18-1.81), Caucasian ancestry (AOR = 1.38, 95 % CI: 1.13-1.68), being in a stable relationship (AOR = 4.64, 95 % CI: 3.82-5.65), having multiple sex partners (AOR = 2.60, 95 % CI: 2.18-3.10) and the following substance use patterns were all independently associated with recent unprotected sex: injection or non-injection crystal methamphetamine use (AOR = 1.21, 95 % CI: 1.03-1.43), injection or non-injection cocaine use (AOR = 1.20, 95 % CI: 1.02-1.41), marijuana use (AOR = 1.23, 95 % CI: 1.02-1.49), ecstasy use (AOR = 1.23, 95 % CI: 1.01-1.48) and alcohol use (AOR = 1.31, 95 % CI: 1.11-1.55) (all p < 0.05).

Conclusions

Unprotected sex was prevalent among street-involved youth in this setting, and independently associated with female gender and a wide range of substance use patterns. Evidence-based and gender-informed sexual health interventions are needed in addition to increased access to youth-centered addiction treatment services. STI testing and linkages to healthcare professionals remain important priorities for street-involved youth, and should be integrated across all health and social services.

Recruitment, Follow-Up and Characteristics of HIV Infected Adults who Use Illicit Drugs in Southern Africa

BACKGROUND

With one of the worst HIV prevalence rates in the world, Botswana has made great strides in addressing AIDS. Nevertheless, to fully contain the epidemic, outreach to marginalized groups, including illicit drug users, is critical.

OBJECTIVE

To conduct targeted outreach within an intervention trial to recruit HIV-infected drug users and assess HIV disease and nutritional status.

METHOD

Recruitment strategies included safeguarding confidentiality, involving ocal health-care professionals, advertising, and participation incentives. Urine toxicology, CD4 cell count, HIV viral load, blood chemistry, plasma micronutrients, dietary history, drug use and morbidity were assessed for two years.

RESULTS

Targeted outreach identified 138 HIV-infected persons who used marijuana; 18.1% had CD4 cell counts ≤ 350 cells/μL and 39.9% had low BMI. Eligible marijuana users (N=52) had significantly lower BMI (21.8 3.7 vs. 24.3 ± 5.3 kg/m², P=0.001), higher HIV viral load (4.36 ± 0.89 vs. 4.09 ± 0.89 log₁₀, P=0.018), and higher kilocalorie intake (1924 ± 1055 vs. 1620 ± 926 Kcalories, P=0.025) than those who did not use marijuana (N=748) with similar CD4 cell count. Marijuana users ≥ 40 years old had more opportunistic diseases (P=0.020) than non-users of the same age. Benzodiazepine use was detected among 57 participants and they had higher BMI than marijuana users (24.4 ± 6.8 vs. 21.8 ± 3.7 kg/m², P= 0.017).

CONCLUSION

A population stigmatized by illicit drug use and HIV-infection can be brought into a clinical research setting in Africa. HIV-infected marijuana users were at a risk for higher HIV viral load, lower BMI and more comorbidities than nonusers. Outreach to this marginalized group is important for containing the HIV epidemic.

The Impact of Marijuana Use on the Successful Aging of HIV-Infected Adults

OBJECTIVE

To determine the impact of self-reported marijuana use on the components of successful aging of HIV-infected persons.

METHODS

Cross-sectional study of 45- to 65-year-old HIV-infected subjects on antiretroviral therapy >6 months with undetectable HIV-1 viral load. Successful aging was defined as absence of disease, adequate physical function, high quality of life (QOL), and social engagement. Clinical characteristics, physical function assessments, and QOL from short form 36 were compared between groups defined by self-reported recent marijuana use (RMU), adjusted for tobacco use, CD4 T-cell count, and time since HIV diagnosis, using logistic or linear regression for binary or continuous measures.

RESULTS

93 of 359 total subjects (26%) reported RMU. Demographically, patients reporting RMU had been diagnosed with HIV less recently [14 (13-16) vs 11 (10-12) years], reported smoking (48% vs 25%) and lower income (92% vs 80%) with greater prevalence than non-RMU patients; other demographics and clinical characteristics (age, CD4 T-cell count) were similar. Gender, race/ethnicity, physical outcomes, physical function, and disease burden were not significantly different. Patients reporting RMU demonstrated lower mental QOL and increased odds of low social engagement and un- or under-employment compared with nonusers.

CONCLUSIONS

The negative association between RMU and mental or social QOL should be considered when assessing the success with which HIV patients reporting RMU are aging.

Polysubstance use: diagnostic challenges, patterns of use and health

PURPOSE OF REVIEW

Polysubstance use is common, particularly amongst some age groups and subcultures. It is also associated with elevated risk of psychiatric and physical health problems. We review the recent research findings, comment on changes to polysubstance diagnoses, report on contemporary clinical and epidemiological polysubstance trends, and examine the efficacy of preventive and treatment approaches.

RECENT FINDINGS

Approaches to describing polysubstance use profiles are becoming more sophisticated. Models over the last 18 months that employ latent class analysis typically report a no use or limited-range cluster (alcohol, tobacco and marijuana), a moderate-range cluster (limited range and amphetamine derivatives), and an extended-range cluster (moderate range, and nonmedical use of prescription drugs and other illicit drugs). Prevalence rates vary as a function of the population surveyed. Wide-ranging polysubstance users carry higher risk of comorbid psychopathology, health problems, and deficits in cognitive functioning.

SUMMARY

Wide-ranging polysubstance use is more prevalent in subcultures such as 'ravers' (dance club attendees) and those already dependent on substances. Health risks are elevated in these groups. Research into the prevention and treatment of polysubstance use is underdeveloped. There may be benefit in targeting specific polysubstance use and risk profiles in prevention and clinical research.

Pretreatment measures of brain structure and reward-processing brain function in cannabis dependence: an exploratory study of relationships with abstinence during behavioral treatment

BACKGROUND

Cannabis is widely abused, and efficacies of therapeutics for cannabis dependence remain suboptimal. Magnetic resonance imaging (MRI) may aid in the identification of biological markers for successful treatment outcomes (i.e., abstinence).

METHODS

Twenty men with cannabis dependence and twenty non-substance-using healthy comparison (HC) men underwent MRI scanning. Cannabis-dependent individuals then participated in a 12-week randomized clinical trial of behavioral treatments (contingency management (CM), cognitive behavioral therapy (CBT) or both). Pretreatment functional and structural data were compared between the cannabis-dependent and HC participants. In addition, individuals with cannabis dependence were subdivided based on the successful achievement of 21 days of consecutive abstinence during treatment to assess whether abstinent versus non-abstinent cannabis-dependent participants displayed different pretreatment functional and structural characteristics when compared to HC participants.

RESULTS

In comparison to HC participants, cannabis-dependent participants demonstrated greater ventral striatal activation during the receipt of losing outcomes and smaller putamenal volumes. Cannabis-dependent participants who did not subsequently achieve 21 days of consecutive abstinence had increased activity within the striatum during the receipt of losing outcomes, relative to HC participants. Cannabis-dependent participants who did not achieve 21 days of abstinence had decreased bilateral putamen volumes prior to treatment, relative to HC participants.

CONCLUSIONS

Individual differences in pretreatment striatal function and structure may relate to individual differences in treatment responses for cannabis dependence. While mechanisms underlying these associations require further exploration, the striatum might mediate treatment responses via its role in associative reward-learning (e.g., through skills training in CBT or reinforcement of abstinence in CM).